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Universal access to childhood vaccination is important to child health and sustainable development. Here we identify, at a fine spatial scale, under-immunized children and zero-dose children. Using Chad, as an example, the most recent nationally representative household survey that included recommended vaccine antigens was assembled. Age-disaggregated population (12-23 months) and vaccination coverage were modelled at a fine spatial resolution scale (1km × 1 km) using a Bayesian geostatistical framework adjusting for a set of parsimonious covariates. There was a variation at fine spatial scale in the population 12-23 months a national mean of 18.6% (CrI 15.8%-22.6%) with the highest proportion in the South-East district of Laremanaye 20.0% (14.8-25.0). Modelled coverage at birth was 49.0% (31.2%-75.3%) for BCG, 44.8% (27.1-74.3) for DTP1, 24.7% (12.5-46.3) for DTP3 and 47.0% (30.6-71.0) for measles (MCV1). Combining coverage estimates with the modelled population at a fine spatial scale yielded 312,723 (Lower estimate 156055-409266) zero-dose children based on DTP1. Improving routine immunization will require investment in the health system as part of enhancing primary health care. The uncertainties in our estimates highlight areas that require further investigation and higher quality data to gain a better understanding of vaccination coverage., (© 2024. The Author(s).)

Somatic gene therapy will be one of the most exciting practices of genetic medicine in Africa and is primed to offer a "new life" for persons living with sickle cell disease (SCD). Recently, successful gene therapy trials for SCD in the USA have sparked a ray of hope within the SCD community in Africa. However, the high cost, estimated to exceed 1.5 million USD, continues to be a major concern for many stakeholders. While affordability is a key global health equity consideration, it is equally important to reflect on other ethical, legal and social issues (ELSIs) that may impact the responsible implementation of gene therapy for SCD in Africa. These include informed consent comprehension, risk of therapeutic misestimation and optimistic bias; priorities for SCD therapy trials; dearth of ethical and regulatory oversight for gene therapy in many African countries; identifying a favourable risk-benefit ratio; criteria for the selection of trial participants; decisional conflict in consent; standards of care; bounded justice; and genetic tourism. Given these ELSIs, we suggest that researchers, pharma, funders, global health agencies, ethics committees, science councils and SCD patient support/advocacy groups should work together to co-develop: (1) patient-centric governance for gene therapy in Africa, (2) public engagement and education materials, and (3) decision making toolkits for trial participants. It is also critical to establish harmonised ethical and regulatory frameworks for gene therapy in Africa, and for global health agencies to accelerate access to basic care for SCD in Africa, while simultaneously strengthening capacity for gene therapy., (© 2023. The Author(s).)