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

Abstract 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.