Introduction: Intensified efforts are needed to achieve the Immunization Agenda 2030 (IA2030) target to halve the number of children not reached by routine vaccination (‘zero-dose’ (ZD) children) by 2030. This scoping review maps and synthesises the scientific literature on ZD children in low-income and middle-income countries since the IA2030 launch. Methods: Our protocol, developed per the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines, was registered on the Open Science Framework prior to execution, and our search strategies were designed by a research librarian. We searched MEDLINE (Ovid), CINAHL Complete (EBSCOhost), EBM Reviews (Ovid), EMBASE (Ovid), LILACS and Google Scholar for peer-reviewed studies with quantitative evidence on ZD children published between January 2020 and January 2024. Using Covidence, we screened citations in a two-stage process by two independent reviewers and conducted data charting using a pretested form. Disagreements were resolved by consensus or consultation with a senior reviewer. Results: Of the 82 articles included, 73 provided evidence on prevalence, and/or distribution, 24 on barriers to vaccination services and 44 on deprivations faced by ZD children, their households and communities, with the risk of deprivations varying importantly across contexts. The barriers to vaccination most reported related to the intent to vaccinate (n=20), followed by community access (n=10). Deprivations mainly concerned access to health services, such as low utilisation of maternal health services (n=22), and other key development indicators, such as low socioeconomic status (n=29) and poor maternal education/literacy (n=28). We found no studies (n=0) on interventions focused on reaching ZD children with routine immunisation services. Conclusion: Our findings highlight the imperative to generate evidence on interventions delivering routine immunisation to ZD children and missed communities. Results also underscore the need for transformative approaches that address multiple deprivations using carefully selected, integrated services, tailored to context-specific needs.

Background: Since 1974, Essential Programme on Immunisation managers from ten Central African countries meet yearly with partners to review progress made and share experiences and lessons learned from the implementation of immunization programmes. The 2024 meeting occurred in Kinshasa, Democratic Republic of Congo, in September 2024. This conference report summarizes the key takeaways from discussions on using immunization data for decision-making, the implementation of the Big Catch-Up (BCU) initiative to reduce the burden of zero-dose children, and progress and challenges in introducing selected new vaccines. Conference Takeaways: Inaccurate administrative data on routine immunization observed in most countries, compared to WHO/UNICEF Estimates of National Immunization Coverage and national survey estimates, affect timely decisions to improve the Expanded Programme on Immunization (EPI) performance. Five countries in Central Africa are among the priority countries of the BCU initiative but, as of the end of August 2024, are yet to formally start its implementation. Cameroon and Central African Republic introduced the malaria vaccine in January 2024 and August 2024, respectively, while the Democratic Republic of Congo, Chad, and Burundi have planned to do so by 2025. Conclusions and Recommendations: Meeting participants put forward several recommendations for countries and immunization partners, including but not limited to (i) investing more in routine immunization data quality assurance to better use data to inform decisions, (ii) accelerating the implementation of the BCU initiative to close the immunity gap resulting from routine immunization disruptions due to the COVID-19 pandemic, (iii) updating malaria vaccine introduction plans to invest more in demand generation and community engagement, and (iv) learning from Cameroon’s experience in tackling hesitancy to human papilloma virus vaccine. It is critical to set up an appropriate mechanism for monitoring the implementation of these recommendations.

Background. In 2022, the WHO recommended the vaccination of breastfeeding women against COVID-19. In the same year, the Minister of Health sent a referral to the National Committee of Independent Experts for Vaccination and Vaccines of Côte d'Ivoire (CNEIV-CI) for its opinion on the vaccination of breastfeeding women against COVID-19 in the country. The CNEIV-CI recommended the vaccination of breastfeeding women against COVID-19. Objective. To identify factors associated with COVID-19 vaccination among breastfeeding women. Method. We conducted a cross-sectional survey. The study population consisted of breastfeeding women. Data were collected, using a questionnaire, in health centers during a direct interview with breastfeeding women who came for their child's vaccination. The dependent variables were COVID-19 vaccination status and vaccination intention after weaning, and the independent variables were age, education level, religion, living with a partner, and district of residence. A multivariate analysis, by logistic regression, was performed to search for factors associated with COVID-19 vaccination status, on the one hand, and with vaccination intention after weaning, on the other hand. The measure of association was the adjusted Odds Ratio (ajOR) with a 95% confidence interval (95% CI) and a degree of significance p < 0.05. The data were analyzed using SPSS. Results. A total of 1009 breastfeeding women were surveyed. The respondents median age was 29 years; the minimum age was 16 years and the maximum age was 44 years. 49 % of respondents were vaccinated. Factors associated with COVID-19 vaccination status among breastfeeding women were education level (ajOR = 8.57; 95 % CI: 4.92 – 14.94), living with a partner (ajOR = 4.75; 95 % CI: 3.34 – 6.76), and age group (ajOR = 1.63; 95 % CI: 1.02 – 2.6). Conclusion. Awareness-raising among women on the acceptance of COVID-19 vaccination must continue. Factors associated with COVID-19 vaccination status were living with a partner, education level, and age group. Qualitative studies could be carried out to understand the underlying reasons behind non-vaccination among breastfeeding women.

Background. Coronavirus 2019 or COVID-19 is an emerging respiratory disease caused by a new human coronavirus first detected in December 2019, in Wuhan, China. Beliefs and perceptions play an important role in the adoption of health behaviors. Objective. The objective of this study is to identify factors associated with belief in vaccine protection against COVID-19 in Côte d'Ivoire. Method. We carried out a cross-sectional survey for analytical purposes. We conducted a two-stage cluster survey. The first stage involved selecting 40 clusters in each district, by systematic random sampling. The second stage consisted in selecting the households. In each household, the person surveyed was the head of household. In his absence, the head of household's representative was interviewed. The dependent variable was the belief in COVID-19 vaccine protection. Factors associated with the dependent variable were identified using logistic regression. The measure of association was the Adjusted Odds Ratio (ajOR) with a 95% confidence interval (95% CI). Data were analyzed using PASW Statistics 18. Result. A total of 3,611 people were surveyed including 53% of females, 87 of individuals aged 18 to 59 years, 48% of Christian, 47% of Muslim, and 49% of vaccinated individuals. Factors associated with belief in COVID-19 vaccine protection were cohabitation (ajOR 1.71 [1.27 – 2.31]), religion (ajOR 0.58 [0.43 – 0.79]) and age (ajOR [ajOR 0.37 [0.16 – 0.86]). Conclusion. Socio-demographic factors associated with belief in vaccine protection against COVID-19 in our study were marital status, religion, and age. Health authorities should take into account these factors in developing strategies to increase COVID-19 vaccine acceptance. Qualitative studies could be carried out to understand the underlying reasons behind the belief in vaccine protection against COVID-19 or the reasons for COVID-19 vaccination hesitancy or refusal.

Context: The COVID-19 pandemic has highlighted critical weaknesses in global health systems, underscoring the need to strengthen emergency preparedness capacities. Abidjan, the rapidly growing capital of Côte d'Ivoire, faces unprecedented threats to health and livelihoods due to deadly annual floods and the resulting waterborne diseases such as cholera, dengue fever, and leptospirosis. It must be noted that, to date, the health districts of Abidjan, although basic units of the health system, do not have a regional PHEOC, which raises concerns about their level of preparedness. The National PHEOC, under the supervision of the National Institute of Public Health (NIPH), coordinates preparedness and response to health emergencies. It develops contingency plans and improves its capabilities through simulation exercises. The health districts (HDs) of Abidjan, grouped into two health regions: Abidjan 1 Grands Ponts and Abidjan 2 Lagunes, are not members of the national PHEOC. This observation raises concerns about the capacity of this operational unit to respond quickly to health emergencies in its area of intervention. Consequently, questions arise: how is the coordination and planning of interventions in the event of public health emergencies structured within this specific regional hub that is Abidjan? How prepared are Abidjan's health districts to respond to health risks in the city? Objective: To assess organizational capacities for health emergency preparedness in the two health regions of Abidjan (Côte d’Ivoire) in 2024. Methods: A descriptive cross-sectional study conducted from May 1 to June 8, 2024, among 31 key stakeholders in the ten health districts of Abidjan. A structured questionnaire, based on the 2021 WHO preparedness framework, was administered. Data were entered into SPSS and analyzed. Results: The median age of participants was 47 years, and the male-to-female ratio was 1.4. Sixty-eight percent were general practitioners or pharmacists, and 61% had a specialization in public health. Seventy-seven percent of districts had a Rapid Response Team (RRT), and 13% had conducted simulation exercises. However, 68% reported a lack of funds dedicated to emergencies, and 35% reported a lack of effective alert and awareness mechanisms. Conclusion: This study highlights the crucial importance of preparedness and management of health emergencies in Côte d'Ivoire, particularly in the city of Abidjan. In the health regions of Abidjan, organizational capacities for health emergency preparedness remain insufficient despite increasing vulnerability to epidemics. Consolidate surveillance and alert systems to improve the resilience of the health system.

Background: Timely and reliable remuneration of frontline health workers is critical for vaccination campaign performance, yet in many low- and middle-income countries cash-based disbursement remains vulnerable to delays, leakage, and inefficiencies. These weaknesses undermine accountability and create recurrent financial burdens, particularly in large-scale operations such as polio immunization campaigns. Objective: This study aimed to evaluate the cost implications of shifting from traditional cash payments to digital disbursement through mobile money during Cote d’Ivoire’s October 2023 national polio immunization campaign. Method: A partial economic evaluation was conducted using a top-down costing approach from the payer’s perspective. Data from all 113 districts and 33 regions were analyzed to compare cash-based and mobile money systems. The analysis focused on direct financial costs, including transaction fees (digital) and transport allowances or ghost worker disbursements (cash). A cost-minimization framework was applied under the assumption of equivalent immunization outputs, and deterministic sensitivity analysis was performed to test robustness. Result: Both systems disbursed the same total amount to vaccinators (397,582,460 FCFA). However, cash payments incurred additional costs of 7,820,967 FCFA in transport and 3,938,930 FCFA in ghost payments, while digital payments generated a 1% transaction fee (3,975,825 FCFA). The digital modality produced a net saving of 7,784,073 FCFA (12,435 USD), or 257 FCFA (0.41 USD) per vaccinator. Sensitivity analysis confirmed the stability of these savings across plausible parameter variations. Conclusion: Digital disbursement via mobile money offers a cost-saving and governance-enhancing alternative to cash payments in vaccination campaigns. Although the absolute savings represent less than 2% of total outlays, the benefits in efficiency, fraud reduction, and transparency are significant for health systems facing budget constraints. Cote d’Ivoire’s experience provides evidence for policymakers to consider institutionalizing digital payments to strengthen financial sustainability and support universal health coverage.