From policy to practice: Systemic solutions to strengthen maternal immunization in sub-Saharan Africa.

Maternal immunization confers dual protection on pregnant women and their newborns through transplacental antibody transfer, yet vaccination coverage across sub-Saharan Africa remains critically inadequate. Two intersecting crises drive this gap: vaccine hesitancy, rooted in historical distrust and pervasive misinformation, and vaccine scarcity, driven by supply chain fragility and infrastructural deficits. Sub-Saharan Africa bears approximately 70% of global maternal deaths and 57% of neonatal deaths worldwide, with an estimated 200 000 vaccine-preventable neonatal deaths annually. This narrative review examines the causes and impacts of both crises and reviews the evidence base for key maternal vaccines including tetanus toxoid, Anti-D immunoglobulin, influenza, Tdap (tetanus, diphtheria, and pertussis), and respiratory syncytial virus. Drawing on a conceptual pathway model, we present a six-pillar framework addressing structural determinants, prenatal care integration, workforce capacity, supply chain modernization, community engagement, and equity-focused monitoring. We conclude with a call to action for concerted, multi-stakeholder intervention to build a resilient and equitable maternal immunization ecosystem across the region.