Adaptation of vaccine delivery systems to climate change and its implications for immunisation equity in sub-Saharan Africa

Abstract Background Climate change increasingly threatens the resilience of vaccine delivery systems in sub-Saharan Africa (SSA), where fragile infrastructure and unreliable power supply already impede immunisation equity. This scoping review synthesises evidence on the effects of climate-related disruptions and the organisational, infrastructural, and policy adaptation strategies employed to sustain immunisation services across SSA. Methods This review was conducted in line with the Arksey and O’Malley framework and reported using PRISMA-ScR, literature published in English (2000–2025) was searched in Scopus, PubMed, AJOL, and Google Scholar. Two reviewers independently screened studies using Rayyan, and data were thematically synthesised across five adaptation domains. Results 216 search results were obtained of which five met inclusion criteria at the last stage of screening. Data from these studies revealed that extreme heat, flooding, and drought compromise vaccine storage, transport, and last-mile delivery, disproportionately affecting remote and rural communities. Adaptation strategies included solar-powered refrigeration, community-based equipment maintenance, infrastructural reinforcements, flood-control measures, and integration of early warning systems. However, most interventions remain localised, with limited evaluation of scalability, cost-effectiveness, or equity outcomes. Discussion Evidence underscores the need for climate-informed policies, renewable energy innovations, and capacity building to strengthen vaccine cold chains and ensure equitable immunisation coverage. Integrating climate-resilience into national immunisation programs is essential for safeguarding progress toward Universal Health Coverage and achieving the Immunisation Agenda 2030 goals in SSA. Conclusion Despite the adverse effects of climate change on vaccine delivery systems in SSA, there are few adaptation strategies in place especially in rural areas, conflict zones and remote communities. Technological innovations such as thermo-stable vaccines and community specific strategies should be developed to mitigate these effects.