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COVID-19 continues to strain, stress, and stretch health systems globally. With the development of the COVID-19 vaccines, there are many issues still lurking behind the widespread coverage; one of which is COVID-19 vaccine nationalism and African countries are not exempted from these issues. This is evident in that many countries in the African region missed the earlier targets set by World Health Organization (WHO) for COVID-19 vaccination coverage. The WHO further set a target of 70% coverage of the COVID-19 vaccines for all countries by June 2022. In this article, we discuss the possible reasons why many African countries are struggling and may not achieve the COVID-19 vaccination target in 2022. With the fundamental issues facing COVID-19 vaccination ranging from nationalism to hesitancy, it is important that stakeholders continue to work harder to ensure that the continent is not left behind in the race to keep the world free and safe from the sting of the COVID-19 pandemic.

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Background The burden of malaria remains the highest in sub-Saharan Africa and South Sudan is not an exception. The country has borne the brunt of years of chronic warfare and remains endemic of malaria, with increasing mortality and morbidity. Limited data still exists on factors influencing the recurrence of severe malaria, especially in emergency contexts such as South Sudan, affected by various conflicts and humanitarian situations. This study therefore aimed to investigate factors influencing severity of occurrence malaria in selected primary healthcare centres in South Sudan. This would assist and guide in malaria prevention, treatment, and eradication efforts. Methods We conducted an unmatched case-control study using routinely collected clinic data for individuals aged 1 year and above who received a diagnosis of severe malaria at 3 primary healthcare centres (PHCC); Malual Bab PHCC, Matangai PHCC and Malek PHCC between September 15, 2019 to December 15, 2019 in South Sudan. Patient characteristics were analyzed using simple descriptive statistics. Inferential statistics were also conducted to identify the associated factors influencing recurrence of severe malaria. All analyses were conducted using R Version 3.6.2. Results A total of 289 recurrent malaria cases were included in this study. More than half of the participants were female. Overall, the prevalence of severe recurrent malaria was 66.1% (191) while 74.4% (215) did not complete malaria treatment. Among those who did not complete malaria treatment, 76.7% (165) had severe recurrent malaria, while among those who completed malaria treatment 35.1% (26) had severe recurrent malaria (p < 0.001). There is a significant association between marital status (OR 0.33, 95% CI 0.19–0.56, p < 0.001), employment status (OR 0.35, 95% CI 0.14–0.87, p = 0.024), the use of preventive measures (OR 3.82, 95% CI 1.81–8.43, p < 0.001) and nutrition status (OR 0.22, 95% CI 0.13–0.37, p < 0.001). When adjusted for employment, marital status, nutritional and prevention measures in turns using Mantel–Haenszel test of association, this effect remained statistically significant. Conclusions Our study showed that there is a high prevalence of severe recurrent malaria in South Sudan and that a significant relationship exists between severe recurrent malaria and antimalarial treatment dosage completion influenced by certain personal and social factors such as marital status, employment status, the use of preventive measures and nutrition status. Findings from our study would be useful for effective response to control and prevent malaria in endemic areas of South Sudan.