Conference Report on the 2025 Annual Review of the Essential Programme on Immunization in DR Congo: Dealing with Complexity

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This paper presents a report of the review progress meeting of the Essential Immunization Programme (EPI) in the DR Congo. The results are impressive in vue of the difficulties of vaccinating in this big country exposed to many challenges. In particular, the authors mention in the limitations section that "The situation may have evolved since the meeting close-up." Unfortunately, as we know that the  the war in the eastern Democratic Republic of Congo (DRC) has entered a critical, escalated phase, an unfavorable evolution is very probable in this part of the country. But this is a meeting report and the recent evolution is out of subject here.

Minor comments:

Figure 1: the legend does not explicit clearly the figure.

• What are do the small numbers between brackets above the graphs?
• It seems that the 6 graphs are presenting 6 different areas (provinces?) with a variable number of subareas. I suggest to suppress these small numbers if they are not useful and replace them by the names of the areas. Out of the text, we can understand that the upper left graph concerns Kinshasa province, but it should be easier for the reader if it mentioned.

Lines 99-106: is there some explanation for the Kinshasa province to present an opposite discrepancy of administrative and adjusted target population coverage?

Lines 127 and 128: you mention twice “(ii)”. I suppose the first one should be “(i)”.

Lines 173-175: this sentence is not entirely clear for the reader.I suppose that you mean that people may not understand why the vaccines are available in some health zones but not in theirs?

Author Response

Comment 1: This paper presents a report of the review progress meeting of the Essential Immunization Programme (EPI) in the DR Congo. The results are impressive in vue of the difficulties of vaccinating in this big country exposed to many challenges. In particular, the authors mention in the limitations section that "The situation may have evolved since the meeting close-up." Unfortunately, as we know that the  war in the eastern Democratic Republic of Congo (DRC) has entered a critical, escalated phase, an unfavorable evolution is very probable in this part of the country. But this is a meeting report and the recent evolution is out of subject here.

Response:

The sentence referring to the possible evolution of the situation after the meeting’s close-up has been removed.

Minor comments:

Comment 2: Figure 1: the legend does not explicit clearly the figure.

• What are do the small numbers between brackets above the graphs?
• It seems that the 6 graphs are presenting 6 different areas (provinces?) with a variable number of subareas. I suggest to suppress these small numbers if they are not useful and replace them by the names of the areas. Out of the text, we can understand that the upper left graph concerns Kinshasa province, but it should be easier for the reader if it mentioned.

Response:

Thank you for this relevant comment. We have merged the 6 graphs into and therefore removed the small numbers between brackets.

 

Comment 3: Lines 99-106: is there some explanation for the Kinshasa province to present an opposite discrepancy of administrative and adjusted target population coverage?

Response:

Thank you for this relevant comment. We have added one sentence to better explained the opposite discrepancy in Kinshasa (see line 106-108).

 

Comment 4: Lines 127 and 128: you mention twice “(ii)”. I suppose the first one should be “(i)”.

Response: Thank you for this observation. This has been corrected.

 

Comment 5: Lines 173-175: this sentence is not entirely clear for the reader.I suppose that you mean that people may not understand why the vaccines are available in some health zones but not in theirs?

Response: Thank you for this observation. This has been clarified (see lines 188-191). The new sentence is the following: “The introduction in these provinces may have ethical and political implications as people in health zones with low transmission may not understand why the vaccines are available in some health zones but not in theirs”

Reviewer 2 Report

Comments and Suggestions for Authors

1. "Figure 1. DTP3 coverage by antenna using administrative and adjusted target population (data from 96 January to September 2025) - Figures on top each frame represent the range of the difference be- 97 tween administrative and adjusted coverage."
   1. Please translate the figure wording into English to accomodate broader audience.
   2. Please add a description/definition of the vaccine coverage in terms of the analysis performed in this figure. This would help clarify what the percentages exactly represent
2. Cite sources:
   1. Most of the sentences pertaining to the number of zones and their status lack sources. If these numbers are from news reports, internal reports, etc., then they should be cited as long as the sources are available. For instance, "As of mid-December 2025, 12 health zones out of 34 in North Kivu and 20 out of 34 108 in South Kivu were located in areas fully controlled by armed groups while 17 health 109 zones out of 36 were partially inaccessible due to security risks in Ituri." "About 40% 115 of vaccine cold chain equipment has been damaged by armed conflicts." "Figure 2. Distribution of health zones by accessibility status due."
   2. "Malaria remains the first cause of morbi-mortality in DR Congo among pregnant 151 women and children under five years old." Please cite.
3. Reword:
   1. Reword this sentence "The introduction in the 10 remaining provinces has been delayed and is scheduled for 2026, as the 78 health zones of low transmission, which are not eligible for Gavi support, are located in these provinces." to "The introduction in the 10 remaining provinces has been delayed and is scheduled for 2026. The 78 health zones with a low transmission rate of malaria are not Gavi support eligible and are located in these provinces."
4. Add details:
   1. "(US$ 3.99, i.e. 176 US$ 11.5 million to cover 70% of th..." Please clarify that the US$ 3.99 is the cost per vaccine/dose.

Author Response

Comment 1. "Figure 1. DTP3 coverage by antenna using administrative and adjusted target population (data from January to September 2025) - Figures on top each frame represent the range of the difference between administrative and adjusted coverage."

 1.1. Please translate the figure wording into English to accomodate broader audience.

 1.2. Please add a description/definition of the vaccine coverage in terms of the analysis performed in this figure. This would help clarify what the percentages exactly represent.

Response: Thank you for this relevant comment and suggestions. We have merged the 6 graphs into and therefore removed the small numbers between brackets.

 

Comment 2. Cite sources:

• Most of the sentences pertaining to the number of zones and their status lack sources. If these numbers are from news reports, internal reports, etc., then they should be cited as long as the sources are available. For instance, "As of mid-December 2025, 12 health zones out of 34 in North Kivu and 20 out of 34 108 in South Kivu were located in areas fully controlled by armed groups while 17 health 109 zones out of 36 were partially inaccessible due to security risks in Ituri." "About 40% of vaccine cold chain equipment has been damaged by armed conflicts." "Figure 2. Distribution of health zones by accessibility status due."

Response: Thank you for these suggestions. We have specified that the data on health zones affected and % of cold chain equipment damaged are from an unpublished assessment conducted by the DR Congo EPI.

• "Malaria remains the first cause of morbi-mortality in DR Congo among pregnant women and children under five years old." Please cite.

Response: Thank you for this suggestion. A reference has been added.

Reword:

• Reword this sentence "The introduction in the 10 remaining provinces has been delayed and is scheduled for 2026, as the 78 health zones of low transmission, which are not eligible for Gavi support, are located in these provinces." to "The introduction in the 10 remaining provinces has been delayed and is scheduled for 2026. The 78 health zones with a low transmission rate of malaria are not Gavi support eligible and are located in these provinces."

Response: Thank you for this suggestion. The sentence has been corrected as suggested.

Comment 3: Add details:

"(US$ 3.99, i.e. 176 US$ 11.5 million to cover 70% of th..." Please clarify that the US$ 3.99 is the cost per vaccine/dose.

Response: Thank you for this suggestion. This has been corrected.