The article assesses the status of routine immunization coverage in the World Health Organization (WHO) African Region three years after the start of the COVID-19 pandemic. Data from the WHO and UNICEF Estimates of National Immunization Coverage (WUENIC) 2022 revision were analyzed. In 2022, coverage for the first and third doses of the diphtheria–tetanus–pertussis-containing vaccine (DTP1 and DTP3, respectively) and the first dose of the measles-containing vaccine (MCV1) was estimated at 80%, 72%, and 69%, respectively, all below the 2019 levels. Only 13 of the 47 countries (28%) achieved the global target coverage of 90% or above with DTP3 in 2022. From 2019 to 2022, 28.7 million zero-dose children were recorded, representing 19.0% of the target population. Ten countries accounted for 80.3% of all zero-dose children, including the four most populated countries. Reported administrative coverage greater than WUENIC-reported coverage was found in 19 countries, highlighting routine immunization data quality issues. The WHO African Region has not yet recovered from COVID-19 disruptions to routine immunization. Governments are urged to prioritize investments to restore immunization services, catch up on the vaccination of zero-dose and under-vaccinated children, and improve data quality. The study highlights the need for targeted interventions to address the challenges of reaching zero-dose children and improving immunization coverage in the region.The article assesses the status of routine immunization coverage in the World Health Organization (WHO) African Region three years after the start of the COVID-19 pandemic. Data from the WHO and UNICEF Estimates of National Immunization Coverage (WUENIC) 2022 revision were analyzed. In 2022, coverage for the first and third doses of the diphtheria–tetanus–pertussis-containing vaccine (DTP1 and DTP3, respectively) and the first dose of the measles-containing vaccine (MCV1) was estimated at 80%, 72%, and 69%, respectively, all below the 2019 levels. Only 13 of the 47 countries (28%) achieved the global target coverage of 90% or above with DTP3 in 2022. From 2019 to 2022, 28.7 million zero-dose children were recorded, representing 19.0% of the target population. Ten countries accounted for 80.3% of all zero-dose children, including the four most populated countries. Reported administrative coverage greater than WUENIC-reported coverage was found in 19 countries, highlighting routine immunization data quality issues. The WHO African Region has not yet recovered from COVID-19 disruptions to routine immunization. Governments are urged to prioritize investments to restore immunization services, catch up on the vaccination of zero-dose and under-vaccinated children, and improve data quality. The study highlights the need for targeted interventions to address the challenges of reaching zero-dose children and improving immunization coverage in the region.