African countries like Uganda and South Africa are rewriting the rules of emergency response. The rest of the world must follow – or fall behind.

Every April, World Immunisation Week is observed with predictable rhetoric: health leaders celebrate progress, governments make declarations, and global agencies issue reports highlighting gains and gaps in vaccination.

But as we enter a new phase of global health uncertainty with mounting climate shocks, geopolitical upheavals, and pandemic threats. We must go beyond ritual. It’s time to fundamentally reframe how we see vaccines: not just as tools to end disease, but as core infrastructure in the architecture of pandemic preparedness and response (PPR).

To do this, we must first understand how we got here.

From smallpox to COVID-19

Vaccines have always been about more than biology, they are about equity, power, and politics. The roots of modern immunisation trace back to the 18th century, when Edward Jenner introduced the smallpox vaccine in 1796.

But in truth, the practice of inoculation dates far earlier, with African, Asian, and Indigenous communities using forms of variolation centuries before Jenner’s discovery.

In the 20th century, vaccination scaled into a global public good. The World Health Organisation (WHO) launched the Expanded Programme on Immunisation (EPI) in 1974, with a mission to provide universal access to life-saving vaccines such as those for measles, polio, diphtheria, and tuberculosis.

This catalysed one of the greatest public health successes of all time: a 99% reduction in polio cases, millions of measles deaths averted, and a world finally free of smallpox by 1980.

Yet, in this century, immunisation programmes have struggled to maintain momentum. The COVID-19 pandemic disrupted routine services worldwide, and in many African countries, immunisation coverage dropped sharply due to supply chain failures, misinformation, and funding gaps. In 2021 alone, nearly 25 million children missed routine vaccinations — 6 million more than in 2019.

But the pandemic also proved something profound: that immunisation systems, if properly funded and embedded into broader health systems, can serve as vital early warning and rapid response mechanisms.

Mainstreaming immunisation in pandemic preparedness

Immunisation programmes are often treated as siloed verticals, disconnected from national health security strategies. This is a mistake. In reality, robust immunisation systems are the frontline infrastructure for epidemic intelligence, surveillance, risk communication, and rapid response.

They have three critical advantages that pandemic preparedness cannot afford to overlook:

First up: Trusted Community Networks. Immunisation programmes have built decades of trust with communities. These networks—often led by nurses, midwives, community health workers, and civil society—are essential for communicating risk and reaching marginalised populations quickly during outbreaks.

Cold chain infrastructure is a second bonus.  No other area of the health system has the logistical muscle that immunisation programmes do. From solar fridges in rural Mali to drone deliveries in Rwanda, the cold chain is a backbone for health commodities distribution.

Lastly, immunisation drives are data-driven systems.  Immunisation tracking systems such as DHIS2 and electronic immunisation registries are already collecting real-time, geo-tagged health data. These can be integrated into early warning systems for new outbreaks.

Mainstreaming immunisation into PPR is not just smart, it is urgently necessary. The WHO’s Immunisation Agenda 2030 (IA2030) is clear: immunisation must be part of a life-course approach to health, linked to emergency response and resilient systems.

Africa is already showing us the way.

Uganda: Integrating immunisation and emergency preparedness

In 2018, Uganda launched a National Action Plan for Health Security (NAPHS), aligning its immunisation efforts with the International Health Regulations (IHR) framework. When COVID-19 hit, the country was able to leverage its longstanding immunisation network, especially in rural districts like Lira and Gulu, to support pandemic response.

Immunisation personnel were re-trained to support contact tracing, community awareness campaigns, and vaccine rollout. Cold chain equipment originally purchased for EPI was used to store COVID-19 vaccines. And thanks to the country’s Electronic Immunisation Register, Uganda was able to rapidly track coverage rates and identify gaps.

The result? Despite global inequities in vaccine supply, routine immunisation coverage bounced back faster than expected, aided by strengthened surveillance and data systems.

Uganda’s model demonstrates what is possible when immunisation and preparedness are not in competition, but in collaboration.

South Africa’s ‘whole-of-government’ vaccine response

South Africa’s response to COVID-19 was complex, but one standout success was integrating its immunisation programme with broader disaster management systems. From the outset, the National Institute for Communicable Diseases (NICD) worked closely with the Expanded Programme on Immunisation to align data streams, forecasting, and workforce planning.

The government built an innovative digital platform—EVDS (Electronic Vaccine Data System)—that merged COVID-19 vaccination records with existing health databases, enabling real-time tracking and equitable rollout strategies [1]. Community-based organisations, many of which had deep roots in HIV vaccine research and advocacy, were mobilised to counter disinformation and support outreach.

Importantly, lessons from COVID-19 were fed back into South Africa’s revised National Pandemic Preparedness Plan, which now explicitly positions routine immunisation as a frontline defence and key surveillance tool.

This whole-of-government approach shows that mainstreaming immunisation isn’t about reinventing the wheel, it’s about unlocking the full potential of existing systems.

Risk of missing the moment

Despite these examples, many global frameworks still fail to treat immunisation as a core element of pandemic prevention. After three years of negotiations, the Pandemic Accord that will be presented at the World Health Assembly on 27 May makes only superficial mention of routine vaccination.

The text mentions strong primary health care and immunisation as important prevention, but for all intents and purposes these strategies are presented in siloes. Ideally, member states should have been mandated to integrate routine immunisation into primary health services, an approach which has “some of the greatest reach and demonstrable health outcomes,” according to Gavi, The Vaccine Alliance.  

Funding from initiatives such as the Pandemic Fund risks bypassing immunisation programmes altogether unless civil society and national governments push for integration.

This gap is not just technical—it’s political. Immunisation, especially in African contexts, has too often been treated as donor-driven charity rather than essential sovereignty. Reclaiming vaccines as part of national security and public infrastructure is part of a larger decolonial project: one that sees African states not as passive recipients of aid, but as active shapers of their own health futures.

Delivering on immunisation agenda 2030

As we mark Immunisation Week in 2025, we must move from commemoration to transformation. This means taking concrete steps to mainstream immunisation into national and global pandemic preparedness strategies:

Governments must include immunisation in national PPR Plans. Every country must revise its pandemic preparedness frameworks to explicitly include immunisation networks, data systems, and cold chain assets.

We must push for immunisation to be funded as core infrastructure. Donors and financing bodies, including the Pandemic Fund, must stop treating immunisation as a “vertical” programme and start investing in it as cross-cutting, systems-strengthening infrastructure.

Community leadership must be supported. Civil society, especially women-led and Indigenous organisations, must be funded and integrated into immunisation and emergency response planning.

Finally, the WHO’s Immunisation Agenda 2030 lays out a bold vision, but it will remain paper unless national governments are held accountable for delivering on its goals, including equity, coverage, and resilience.

This is not just about vaccines. It’s about dignity, sovereignty, and building systems that protect everyone, especially the most vulnerable, not just in times of crisis but every day.

Ultimately, the future of pandemic preparedness in Africa may lie not in high-tech labs or global summits, but in the quiet strength of a nurse with a cooler on her back, walking dusty roads to reach the last mile. That is where the next pandemic will be won—or lost.

Let us act before we forget.

Tian Johnson is the founder of the African Alliance and served on the South African Ministerial Advisory Council for COVID-19 at the height of the pandemic.

 

Image Credits: UNICEF.