From policy to practice: Systemic solutions to strengthen maternal immunization in sub-Saharan Africa

Area of Science:

• Public Health
• Immunology
• Global Health

Background:

• Maternal immunization provides dual protection for mothers and newborns via transplacental antibody transfer.
• Sub-Saharan Africa faces critically inadequate vaccination coverage, contributing to high maternal and neonatal mortality rates.
• An estimated 200,000 vaccine-preventable neonatal deaths occur annually in the region.

Purpose of the Study:

• To examine the causes and impacts of vaccine hesitancy and scarcity affecting maternal immunization in sub-Saharan Africa.
• To review the evidence for key maternal vaccines, including tetanus toxoid, Anti-D immunoglobulin, influenza, Tdap, and RSV vaccines.
• To propose a framework for improving maternal immunization coverage and outcomes.

Main Methods:

• This narrative review synthesizes existing literature on maternal immunization in sub-Saharan Africa.
• It analyzes the intersecting crises of vaccine hesitancy and scarcity.
• A conceptual pathway model informed the development of a six-pillar framework for intervention.

Main Results:

• Vaccine hesitancy is fueled by historical distrust and misinformation.
• Vaccine scarcity stems from fragile supply chains and infrastructural limitations.
• Key maternal vaccines reviewed include tetanus toxoid, Anti-D immunoglobulin, influenza, Tdap, and RSV vaccines.

Conclusions:

• A six-pillar framework is proposed to address structural determinants, integrate prenatal care, build workforce capacity, modernize supply chains, enhance community engagement, and ensure equity-focused monitoring.
• Concerted, multi-stakeholder action is essential to establish a resilient and equitable maternal immunization ecosystem.
• Improving maternal immunization coverage is critical to reducing preventable maternal and neonatal deaths in sub-Saharan Africa.