By Africa, for Africa: Towards vaccine sovereignty

The COVID-19 pandemic exposed stark disparities in vaccine access worldwide, leaving behind many low- and middle-income countries, especially in Africa. The lack of equitable access highlighted cracks in global solidarity and coordination during health emergencies. In response, a continental movement for vaccine sovereignty gained momentum. The IDRC-supported project Equitable access to COVID-19 vaccines in Africa (ECOVA) is part of this broader effort to build a fairer, more self-reliant vaccine future for Africa.

Ensuring equitable access for all vaccine needs

Africa produces only 1% of the vaccines it needs, a gap widened by the surge in demand during the COVID-19 pandemic. The African Union (AU) has set an ambitious goal of increasing domestic vaccine production to 60% of the continent's needs by 2040 to address Africa’s vaccine production gap.

The ECOVA project was timely in supporting the continent’s efforts to improve vaccine access for the population. Led by the African Health Economics and Policy Association (AfHEA) in partnership with Africa Centres for Disease Control and Prevention (Africa CDC) and the United Nations Economic Commission for Africa, ECOVA aimed to generate knowledge for evidence-informed policymaking and Africa’s vaccine leadership.

The ECOVA project selected nine countries that reflect Africa’s linguistic and regional diversity, representing both high and low vaccine coverage contexts. The project embarked on an in-depth study of policy, legal and governance frameworks affecting equitable vaccine access and uptake, with a special focus on gender minorities, displaced populations, people living with disabilities and other groups who are particularly vulnerable in health emergencies — and are too often neglected.

Overcoming obstacles to vaccine equity

Vaccine sovereignty is in part determined by manufacturing capacity, and vaccine access is determined by availability, access, affordability and acceptability by those who need them.

Regarding manufacturing and availability, capacity remains a major challenge to equitable vaccine access, constrained by funding gaps, corruption and poor storage capacities, among other barriers.

Regarding access and acceptability, vaccination rates in Africa vary by country, ranging from 19% to 68.5%, with vaccine hesitancy still impeding uptake in many countries. This is mainly the result of:

• widespread misinformation
• misconceptions and conspiracy theories
• limited access to accurate information
• low public trust in institutions

Other obstacles include gender-based disparities, difficulty reaching vulnerable populations, and population displacement caused by conflict or natural disasters. 

“Africa has the capacity to produce its own vaccines, vaccine raw materials, diagnostics and other medical supplies,” said Naomi Setshegetso, deputy executive director for business development at AfHEA. “However, to be successful, there is a need to realign Africa’s investment decisions and encourage public-private partnerships or product development partnerships to further expand capacity for research and development of vaccines in Africa.”

African-led solutions shaping global health

ECOVA has played an integral part in the pan-African aspiration to strengthen health systems, advance innovation and expand vaccine production in the post-pandemic era. The project team conducted research, shared knowledge with decision-makers and advocated for policy reform. 

From 2022 to 2025, ECOVA activities included:

• scoping reviews, qualitative studies, policy briefs and manuscripts
• country-level stakeholder engagement through webinars, workshops and events on vaccine manufacturing, access, uptake and hesitancy
• planning for equitable vaccination access and distribution

The question of how to plan for equitable vaccination access and distribution was central to all project activities. In addition to the research activities, researchers received training on developing effective policy briefs — key tools for translating evidence into action — and took part in workshops on gender and intersectionality.

Gender and equity were mainstreamed across all project activities, supported by a dedicated gender expert who ensured the rigour of the findings about disparities in vaccine uptake, particularly the lower rates among women and rural populations.

Success stories

Mozambique

Misinformation and disinformation were major barriers to vaccine uptake in Mozambique, especially in marginalized and rural populations. Prioritizing community engagement and inclusivity in a vaccine rollout program helps ensure success by:

• involving all groups of society in decision-making
• reaching all segments of the population
• using inclusive language during outreach
• decentralizing testing to reach communities more effectively

With a clear delivery plan, Mozambique’s phased vaccine allocation strategy prioritized health workers, older people, people with chronic diseases and other high-risk groups. Investments in logistics and testing capacity, combined with an evidence-based approach, helped the country achieve 97% vaccination coverage by December 2023.

Ethiopia

In Ethiopia, the project focused on understanding and improving equitable vaccine access in rural and underserved communities. Success required overcoming logistical challenges, misinformation, gender disparities and infrastructure gaps — all major barriers to uptake.

Key achievements included:

• engaging communities with clear messaging about vaccine safety to improve vaccine acceptance
• investing in vaccine infrastructure
• strengthening political will with evidence
• ensuring high-level leadership and stakeholder engagement

Vaccine uptake among women increased through inclusive strategies that incorporated gender-sensitive approaches prioritizing vulnerable populations. 

Ghana

The integration of gender dimensions into the research revealed disparities in vaccine uptake between men and women, as well as between urban and rural populations in Ghana. 

A national validation workshop with stakeholders from the Ministry of Health, civil society and development partners validated findings and generated actionable recommendations.

Other insights included:

• health committees and community leaders play a critical role in fostering vaccine acceptance
• community involvement is an important aspect of vaccine delivery
• clear commitment, transparency and communication are essential for success

A gender synthesis report from these findings now guides gender-responsive vaccine policies. from these findings now guides gender-responsive vaccine policies.

Towards African vaccine sovereignty

Africa’s experience demonstrates that vaccine sovereignty is critical to building health security and resilience. A robust and reliable vaccine capacity in Africa is “a global public good that deserves global support,” said Professor Aziza Mwisongo, an AfHEA member.

With the AU Partnerships for African Vaccine Manufacturing now established, this vision is closer to reality than ever before.

Through ECOVA, African researchers and institutions generated evidence to improve equitable vaccine access, inform policy decisions and address systemic barriers — while advancing gender equity and progress toward the AU’s vaccine manufacturing goal.