(1) Introduction: The Democratic Republic of the Congo (DRC) has one of the largest cohorts of un- and under-vaccinated children worldwide. This study aimed to identify and compare the main reasons for there being zero-dose (ZD) or under-vaccinated children in the DRC. (2) Methods: This is a secondary analysis derived from a province-level vaccination coverage survey conducted between November 2021 and February 2022; this survey included questions about the reasons for not receiving one or more vaccines. A zero-dose child (ZD) was a person aged 12–23 months not having received any pentavalent vaccine (diphtheria–tetanus–pertussis–Hemophilus influenzae type b (Hib)–Hepatitis B) as per card or caregiver recall and an under-vaccinated child was one who had not received the third dose of the pentavalent vaccine. The proportions of the reasons for non-vaccination were first presented using the WHO-endorsed behavioral and social drivers for vaccination (BeSD) conceptual framework and then compared across the groups of ZD and under-vaccinated children using the Rao–Scott chi-square test; analyses were conducted at province and national level, and accounting for the sample approach. (3) Results: Of the 51,054 children aged 12–23 m in the survey sample, 19,676 ZD and under-vaccinated children were included in the study. For the ZD children, reasons related to people’s thinking and feelings were cited as 64.03% and those related to social reasons as 31.13%; both proportions were higher than for under-vaccinated children (44.7% and 26.2%, respectively, p < 0.001). Regarding intentions to vaccinate their children, 82.15% of the parents/guardians of the ZD children said they wanted their children to receive “none” of the recommended vaccines, which was significantly higher than for the under-vaccinated children. In contrast, “practical issues” were cited for 35.60% of the ZD children, compared to 55.60% for the under-vaccinated children (p < 0.001). The distribution of reasons varied between provinces, e.g., 12 of the 26 provinces had a proportion of reasons for the ZD children relating to practical issues that was higher than the national level. (4) Conclusions: reasons provided for non-vaccination among the ZD children in the DRC were largely related to lack of parental/guardian motivation to have their children vaccinated, while reasons among under-vaccinated children were mostly related to practical issues. These results can help inform decision-makers to direct vaccination interventions.

(1) Background: The Democratic Republic of the Congo (DRC) is one of the countries with the highest number of never vaccinated or “zero-dose” (ZD) children in the world. This study was conducted to examine the proportion of ZD children and associated factors in the DRC. (2) Methods: Child and household data from a provincial-level vaccination coverage survey conducted between November 2021–February 2021 and 2022 were used. ZD was defined as a child aged 12 to 23 months who had not received any dose of pentavalent (diphtheria-tetanus-pertussis-Haemophilus influenzae type b (Hib)-Hepatitis B) vaccine (by card or recall). The proportion of ZD children was calculated and associated factors were explored using logistic regression, taking into account the complex sampling approach. (3) Results: The study included 51,054 children. The proportion of ZD children was 19.1% (95%CI: 19.0–19.2%); ZD ranged from 62.4% in Tshopo to 2.4% in Haut Lomami. After adjustment, being ZD was associated with low level of maternal education and having a young mother/guardian (aged ≤ 19 years); religious affiliation (willful failure to disclose religious affiliation as the highest associated factor compared to being Catholic, followed by Muslims, revival/independent church, Kimbanguist, Protestant); proxies for wealth such as not having a telephone or a radio; having to pay for a vaccination card or for another immunization-related service; not being able to name any vaccine-preventable disease. A child’s lack of civil registration was also associated with being ZD. (4) Conclusions: In 2021, one in five children aged 12–23 months in DRC had never been vaccinated. The factors associated with being a ZD child suggest inequalities in vaccination that must be further explored to better target appropriate interventions.

Transmission of wild polioviruses (WPVs) and vaccine-derived polioviruses (VDPVs) have been interrupted in Cameroon since July 2014. Subsequently, Cameroon withdrew Sabin type 2 from routine immunization in April 2016. This study aimed to investigate the detection rates and overtime distribution of the types of PVs recovered from urban sewage in Cameroon. From January 2016 to December 2017, 517 sewage specimens originating from Yaounde (325 specimens) and Douala (192 specimens) were analyzed. No WPVs and VDPVs were isolated in this study. In contrast, vaccine strains of poliovirus were detected throughout the study period. Isolates Sabin types 1 and 3 were sporadically detected whereas Sabin 2 was found only from January to May 2016 both in Yaounde and Douala. The absence of Sabin 2 in sewage specimens since June 2016 indicates its rapid disappearance after withdrawal from routine immunization in April 2016. This study provides substantial support to the observation that WPV and VDPVs have been successfully eliminated in Cameroon. However, it remains essential to maintain and extend high quality environmental surveillance as long as WPV reservoirs and VDPV outbreaks are detected in Africa.

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: The prevalence of hepatitis B virus infection remains high in the Democratic Republic of Congo (DRC), constituting a public health problem in view of the fatal complications it causes, notably cirrhosis and hepatocellular carcinoma. The aim of this study was to provide an overview of the situation of viral hepatitis B in the DRC and in particular its implications for public health. Methods: A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) group guidelines. Google Scholar, PubMed, and ResearchGate were used as databases. The review essentially analyzed the viral hepatitis B (HBV) vaccination status of study subjects, diagnostic means, HBV genotypes in DR Congo, seroprevalence of HBV infection, subjects’ level of knowledge and perceptions of HBV, co-infection/comorbidity with HBV infection, factors associated with HBV infection and public health issues raised by HBV infection. Results: The vast majority of studies (69%) were carried out to determine the seroprevalence of HBV infection. The Determine rapid test was the most widely used test (10 studies), sometimes combined with ELISA (3 studies) and polymerase chain reaction (PCR) (1 study, for genotyping). Some of the public health issues raised by hepatitis B virus infection were identified in the course of the included studies, in relation to co-infection, comorbidity, associated factors, and individuals’ level of knowledge and perceptions of HBV. Certain factors were identified as being closely associated with HBV, notably healthcare professions (e.g., doctor, laboratory technician) and having several sexual partners. In terms of perception of HBV, the hepatitis B virus is recognized as dangerous, and the majority of people questioned in the various studies were aware that vaccination remains the most effective means of prevention. Conclusions: Hepatitis B is a highly contagious infectious disease present in the DRC, with a higher prevalence among healthcare professionals, sex workers, patients with certain diseases including HIV, and people with a history of blood transfusion. The surveillance system within the national blood transfusion program needs to be strengthened. Raising public awareness of the seriousness of viral hepatitis B, offering vaccination to at-risk populations, and systematically screening pregnant women and blood donors for HBV infection could help reduce the prevalence of viral hepatitis B.

Immunisation is a high priority for improving health outcomes. Yet, in many low-income and middle-income countries, achieving coverage targets independently is hindered by lack of domestic resources and reliance on partners’ support. Both the 2001 Abuja Declaration and 2016 Addis Declaration were key political commitments to improving immunisation coverage; however, many signatories have yet to meet international targets. Despite signing the Global Vaccine Action Plan and Addis Declaration, the Democratic Republic of the Congo (DRC) was unable to fully disburse its portion of allocated funds to cover vaccines without support from Gavi, the Vaccine Alliance and the World Bank between 2017 and 2019. Additionally, during the same time, vaccine coverage outcomes indicated negative trends, with over 750 000 children considered ‘zero-dose’ in 2018. In 2019, a primary focus of the then newly elected President’s agenda was universal healthcare. In collaboration with development partners and stakeholders, the first Presidential Forum was held as a public commitment to increasing childhood immunisation and ensuring the country remains polio-free. This article seeks to highlight the key outcomes of the Forum such as the signing of the Kinshasa Declaration, which formally set targets and specified national, provincial and community-level commitments to vaccination and polio eradication. As of 2023, three Forums have been conducted to reiterate political commitment to routine immunisation in the DRC. This type of high-level commitment could serve as a template for other countries struggling to have high engagement as targets for polio eradication and strengthened routine immunisation are set for 2025–2030.