Vaccination is one of the most effective and cost-efficient public health interventions for preventing infectious diseases and reducing mortality, particularly among children. According to the World Health Organization (WHO), immunization currently prevents between 3.5 and 5 million deaths each year worldwide by protecting against diseases such as measles, poliomyelitis, diphtheria, tetanus, and pertussis [1].

Beyond its impact on mortality, vaccination is also one of the most cost-effective public health strategies, contributing significantly to the reduction of morbidity and to improvements in life expectancy across many regions of the world [2]. Despite these substantial advances, many low- and middle-income countries continue to face major challenges in achieving optimal vaccination coverage, largely due to structural, organizational, and human resource constraints that limit the effectiveness of immunization programs.

The success of vaccination programs depends not only on vaccine availability and the logistical organization of health services but also on the technical and scientific competencies of the healthcare professionals responsible for their implementation. Vaccinology, as a scientific discipline encompassing vaccine immunology, immunization program management, cold chain logistics, surveillance of vaccine-preventable diseases, and communication about vaccines, is therefore a critical component of health professional training. Adequate training in this field contributes to improving the quality of vaccine delivery, strengthening public trust in immunization programs, and reducing vaccine hesitancy [3][4].

In many high-income countries, vaccinology is systematically integrated into medical and paramedical curricula, enabling students to acquire both theoretical knowledge and practical skills necessary for planning, implementing, and evaluating immunization programs [5]. In contrast, in many developing countries—particularly in sub-Saharan Africa—vaccination education remains fragmented, insufficiently structured, or in some cases absent from health training programs.

Several studies have shown that inadequate training in vaccination constitutes a major barrier to strengthening health systems and improving immunization coverage. Commonly identified factors include a shortage of qualified instructors, insufficient up-to-date teaching resources, the absence of national training frameworks, and the prioritization of curative disciplines over preventive approaches within health training curricula [6]. These educational gaps may lead to insufficient preparedness among future healthcare professionals in managing immunization programs and may compromise the quality of vaccination services.

In the Democratic Republic of the Congo (DRC), the Instituts Supérieurs des Techniques Médicales (ISTM)—Higher Institutes of Medical Techniques—in Kinshasa play a strategic role in training paramedical professionals, including health technicians and nurses who operate on the front line of healthcare delivery. These professionals are essential actors in the implementation of the Expanded Program on Immunization (EPI), which aims to protect populations against vaccine-preventable diseases and improve public health at the national level. However, despite the importance of these programs, the formal integration of vaccination teaching into ISTM curricula remains limited and insufficiently documented.

In the city of Kinshasa, which hosts a significant proportion of the country’s paramedical training institutions, academic programs show varying levels of integration of vaccination-related content. Some institutions address vaccination indirectly through public health or pediatrics courses, while others lack a dedicated vaccinology module altogether. This situation raises important questions regarding the institutional, pedagogical, and organizational factors that may explain the absence or insufficient integration of this teaching within training programs.

Despite the strategic importance of vaccination for public health and health system performance, few studies have systematically examined the determinants of vaccinology integration in paramedical training programs in the Democratic Republic of the Congo. The lack of empirical evidence on this issue limits the ability of academic and health policymakers to implement curriculum reforms tailored to the needs of the health system.

In this context, the present study aims to analyze the factors underlying the non-integration of vaccination courses in the Instituts Supérieurs des Techniques Médicales of Kinshasa. More specifically, it seeks to identify the pedagogical, institutional, and organizational barriers that may influence the integration of this teaching into training curricula, with a view to proposing actionable strategies to strengthen the training of future healthcare professionals and support national immunization efforts.

The present study aimed to identify the factors underlying the non-integration of vaccination courses into the training programs of the Instituts Supérieurs des Techniques Médicales (ISTM) in Kinshasa. The findings highlight several institutional, pedagogical, and technological determinants that may influence the integration of vaccinology into paramedical curricula. In a context where vaccine-preventable diseases continue to impose a significant burden on health systems, strengthening the competencies of healthcare professionals remains a critical lever for improving the effectiveness of immunization programs [1][8].

The analysis of sociodemographic characteristics shows that the study population consisted predominantly of young students nearing the completion of their training. This demographic profile is consistent with observations from several health training institutions across Africa. For instance, Afolabi and Adebisi reported that students represent a key component of the future workforce involved in vaccination programs within African health systems [9]. These findings underscore the importance of strengthening vaccination-related competencies during initial training to ensure the availability of a qualified health workforce.

The results also indicate that the majority of participants recognize the importance of vaccination and support the introduction of a dedicated course within paramedical training programs. This positive perception is consistent with the work of Dubé, Vivion, and MacDonald, who demonstrated that health sciences students generally exhibit favorable attitudes toward vaccination and acknowledge its central role in preventing infectious diseases [3]. Similarly, Larson et al. emphasized that healthcare professionals’ knowledge and attitudes play a crucial role in shaping public confidence in immunization programs [4].

However, despite this favorable perception, a substantial proportion of participants reported never having received formal training in vaccination during their studies. This discrepancy between the recognition of vaccination importance and the absence of structured teaching reflects a challenge observed in several low-resource settings. Afolabi and Adebisi notably highlighted that gaps in the training of healthcare professionals constitute a major barrier to the effective implementation of immunization programs in Africa [9].

Although the results indicate a moderate to high level of knowledge among a substantial proportion of participants, these findings should be interpreted with caution. Indeed, the absence of formal training reported by a large proportion of participants suggests that this knowledge may have been acquired through informal sources, such as practical training or internships, participation in vaccination campaigns, or exposure to media and other forms of non-structured learning. Therefore, self-reported knowledge does not necessarily reflect adequate academic preparation for managing vaccination programs.

This distinction is particularly important within the framework of competency-based education, where theoretical knowledge alone is insufficient to ensure safe and effective clinical practice. In line with Miller’s pyramid of clinical competence, the assessment in this study primarily captures the “knows” level, without addressing higher levels such as “shows how” and “does”, which are essential for vaccination practice.

These findings underscore the importance of integrating structured and standardized vaccinology education into paramedical training programs in order to ensure both theoretical understanding and practical competency among future healthcare professionals.

The findings further reveal the critical role of institutional factors in the non-integration of vaccination courses. The lack of teaching resources, insufficient training of instructors, and limited availability of materials for practical sessions emerged as the main barriers identified by participants. These observations align with the conclusions of the Lancet Commission on the Education of Health Professionals, led by Frenk et al., which emphasized that many health training systems in low- and middle-income countries suffer from inadequate educational infrastructure and insufficient learning resources [6].

Another key finding of this study concerns the impact of digital infrastructure on the integration of vaccination education. Multivariate analysis showed that limited access to digital tools was one of the strongest factors associated with the non-integration of vaccination courses. In a context where higher education is increasingly shifting toward hybrid and digital learning approaches, UNESCO highlights that access to information and communication technologies is essential for improving the quality of university education [10].

The results also emphasize the importance of strengthening collaboration between training institutions and national immunization programs. According to the World Health Organization, partnerships between educational institutions and immunization programs can enhance students’ practical training and strengthen the competencies of future healthcare professionals [8].

At the global level, the WHO further underscores that health workforce training is a cornerstone for achieving the objectives of the Immunization Agenda 2030 [8]. In low- and middle-income countries, gaps in the training of healthcare professionals may limit the performance of vaccination programs and contribute to persistently low immunization coverage [1].

Despite certain limitations, including the high proportion of students in the sample and the cross-sectional nature of the study, this research represents one of the first empirical analyses of vaccinology integration into paramedical training programs in the Democratic Republic of the Congo. The findings provide valuable evidence to inform curriculum reforms and strengthen the training of healthcare professionals involved in immunization programs.

This study has several limitations. First, the majority of participants were students, which may limit the representativeness of the perspectives of teachers and academic decision-makers. Second, the cross-sectional design does not allow for the establishment of causal relationships between the variables studied. Third, some data were based on self-reported responses, which may introduce social desirability bias. Finally, as the study was conducted only in Kinshasa, caution should be exercised when generalizing the findings to all paramedical training institutions in the Democratic Republic of the Congo.

This study highlights that the non-integration of vaccination courses into the training programs of the Instituts Supérieurs des Techniques Médicales (ISTM) in Kinshasa results from a complex interplay of institutional, pedagogical, and technological factors. Despite a broadly favorable perception among both students and instructors regarding the importance of vaccination in the training of future healthcare professionals, the effective integration of structured vaccinology teaching remains limited in several institutions.

The findings indicate that the main barriers to course integration are related to the lack of teaching resources, insufficient training of instructors, limited access to educational materials and digital infrastructure, as well as institutional financial constraints. These factors contribute to a persistent gap between the needs of the health system in terms of vaccination and the competencies acquired by future healthcare professionals during their training.

In a context where vaccine-preventable diseases continue to pose a major public health challenge in the Democratic Republic of the Congo, strengthening vaccinology training emerges as a strategic priority to improve the quality of vaccination services and support national immunization efforts.

The integration of a structured vaccinology module into ISTM curricula, combined with the development of appropriate teaching resources and continuous professional development for instructors, could enhance the competencies of future healthcare providers and improve the performance of vaccination programs.

Based on the findings, several recommendations can be proposed to promote the sustainable integration of vaccinology teaching into paramedical training programs:

This study makes several scientific and operational contributions to the field of health professional training and public health in the Democratic Republic of the Congo.

First, it represents one of the earliest empirical investigations examining the determinants of vaccinology integration into paramedical training programs within the Instituts Supérieurs des Techniques Médicales (ISTM) in Kinshasa. By identifying institutional, pedagogical, and technological barriers to the integration of vaccination courses, this study contributes to the existing body of literature on health workforce education in low- and middle-income countries.

Second, the findings highlight existing gaps in the initial training of future healthcare professionals in vaccination, despite a broadly favorable perception of the importance of this field. These results provide evidence that can inform curriculum reforms within paramedical training institutions.

Third, this study offers practical avenues for improvement, including strengthening teachers’ pedagogical capacity, enhancing educational resources, and fostering partnerships between training institutions and national immunization programs.

Overall, this research contributes to ongoing efforts to strengthen the competencies of healthcare professionals and improve the performance of vaccination programs in the Democratic Republic of the Congo.

This research did not receive any specific funding from public, commercial, or not-for-profit organizations.

All authors have read and approved the final version of the manuscript.