Mapping the role of vaccines in combating AMR in the WHO African region: a scoping review and implications for research and policy.

Abstract

Introduction: There is substantive evidence that vaccines play a crucial role in curbing antimicrobial resistance (AMR). This has a potentially high impact in the WHO African Region. However, there is a need for a viable strategy to leverage vaccines in addressing AMR in the region. We conducted a scoping review to map existing evidence on the role of vaccines in combating AMR in the WHO African Region, identify critical knowledge gaps, and propose priority areas for research and policy interventions.

Methods: We systematically reviewed the literature to identify studies that have been published in this area, with no date or study design restriction. The search results were screened for eligibility, and data from eligible studies were extracted and synthesised following the PRISMA Extension for Scoping Reviews.

Results: A total of 10 studies were included in this review. Seven studies either focused on Africa as a whole or were multi-regional studies that included Africa, with country-specific studies mostly from South Africa and Ethiopia. Four studies focused on pneumococcal conjugate vaccines (PCV), while others examined influenza, rotavirus, respiratory syncytial virus, tuberculosis, and Klebsiella pneumoniae vaccines. Five studies estimated the potential impact of vaccines on AMR, focusing on outcomes such as reductions in AMR burden, disease incidence, deaths due to resistant pathogens, and antibiotic consumption. The remaining studies examined economic value and potential role in antimicrobial stewardship programmes. Three studies addressed policy-related issues, including potential barriers and collaboration between AMR and vaccination programmes.

Conclusion: This review underscores the need for more country-level studies to build evidence on vaccine impact on AMR, including cost-effectiveness studies. Research priorities should include clinical trials with AMR-related endpoints and evaluation of vaccine impact during new vaccine introductions. Strengthening AMR surveillance systems and enhancing collaboration between AMR and vaccination programmes are crucial. The development and review of regulatory frameworks that explicitly address vaccines and AMR may be required.