Reflections from the Africa CDC webinar on success stories in immunization, ahead of African Vaccination Week 2026
At the Africa CDC webinar convened by Folake Olayinka, Director of Immunization, to open African Vaccination Week 2026, The Geneva Learning Foundation’s Charlotte Mbuh offered a proposition that unsettled the usual framing of zero-dose work.
Zero-dose children, she argued, are rarely beyond reach.
They are beyond routine visibility.
The evidence she brought to the panel came from two peer learning initiatives under the Movement for Immunization Agenda 2030, carried out in Nigeria in 2024 and the Democratic Republic of the Congo in 2025, in partnership with the respective Ministries of Health, UNICEF, and with support from Gavi.
In Nigeria, more than 4,000 health workers across all 36 states and the Federal Capital Territory connected through peer learning, and over 300 Local Government Areas produced 409 root cause analyses using the five whys technique.
In DRC, 2,779 health workers joined from 25 provinces, generated 385 root cause analyses of zero-dose situations, and reached more than 7,000 zero-dose and under-immunized children within a 30-day implementation cycle led by 130 participants.
The missing integration of local knowledge
Reviewing more than 400 root cause analyses from Nigeria, Charlotte and her colleagues found that many solutions were already known to frontline health workers and were being used in communities.
The barrier was implementation at scale, not a shortage of ideas.
In DRC, peer-generated narratives surfaced trust-building strategies that standard guidance often misses, including repeated engagement with hesitant families and partnerships with women’s groups and religious leaders to sustain trust over time.
The reframe matters.
Standard programme logic often treats frontline health workers as delivery channels.
Charlotte asked the panel to treat them instead as knowledge partners.
What actually builds trust
Charlotte offered three practices, grounded in what health workers themselves reported.
- Listen for the real barrier. In Nigeria, what appeared to be vaccine hesitancy was often a staffing gap, a poor service experience, or a planning failure rather than a demand problem, she noted.
- Work through trusted voices. In DRC, health workers pointed to religious and traditional leaders, women’s groups, and local communicators as critical partners, especially in fragile and conflict-affected settings.
- Adapt to people’s reality. In some cases, the only change required was adjusting immunization schedules to fit family routines, which unlocked targets that had previously been missed.
A community health worker from Bauchi State, Nigeria, summarised the shift in a single line. “I just discovered that over the years, I have been superficial in my approach,” said John Emmanuel.
Civil society finds, reaches, and stays
In the Nigeria Immunization Collaborative, 628 organizations joined, and 65% of participants worked at Local Government Area or facility level, close to where children are missed.
Civil society often provides the only bridge to families who are mobile, displaced, or socially excluded from routine systems, using faith networks and everyday spaces where families already gather.
And in DRC, 229 detailed narratives from 24 provinces, with 21% from conflict-affected areas, showed how repeated engagement sustains trust where single campaigns cannot.
During the question and answer session, Charlotte offered a concrete example from the south region of Cameroon, where participants used community gatekeepers to negotiate passage with different factions, allowing integrated vaccination services to continue in insecure areas.
She also pushed back on the framing of non-compliance.
What health workers had initially called refusal often turned out to be absent staff, long waits, unsafe travel, or bad prior experiences, and once those were fixed, many non-compliant families returned.
A citizen’s issue, not only a health sector issue
Charlotte closed with a frame that Folake Olayinka singled out in her synthesis.
Listen better, partner better, adapt better.
The search for zero-dose children, a health worker from the Zero-Dose Impact Accelerator in DRC reminded the webinar, must become a citizen’s issue, because when alarmist messages circulate and trust crumbles, uptake collapses quickly.
For African Vaccination Week 2026, under the theme vaccinated communities, healthier communities, the practical question is whether systems will continue to treat communities as the terrain on which immunization is delivered, or start treating them as partners whose knowledge shapes how the work is done.
The evidence from Nigeria and DRC suggests that the second path is already open.
It is waiting to be taken at scale.