Abstract

Vaccination is an important and cost-effective disease prevention and control strategy. Despite progress in vaccine development and immunization delivery systems worldwide, populations in areas of conflict (hereafter, “conflict settings”) often have limited or no access to lifesaving vaccines, leaving them at increased risk for morbidity and mortality related to vaccine-preventable disease. Without developing and refining approaches to reach and vaccinate children and other vulnerable populations in conflict settings, outbreaks of vaccine-preventable disease in these settings may persist and spread across subnational and international borders. Understanding and refining current approaches to vaccinating populations in conflict and humanitarian emergency settings may save lives. Despite major setbacks, the Global Polio Eradication Initiative has made substantial progress in vaccinating millions of children worldwide, including those living in communities affected by conflicts and other humanitarian emergencies. In this article, we examine key strategic and operational tactics that have led to increased polio vaccination coverage among populations living in diverse conflict settings, including Nigeria, Somalia, and Pakistan, and how these could be applied to reach and vaccinate populations in other settings across the world.

Highlights

  • Vaccination remains one of the most cost-effective disease prevention strategies, averting millions of childhood illnesses and deaths every year [1, 2]

  • Because complex humanitarian emergency needs often coexist in many conflict settings, coordinating vaccine delivery efforts with other ongoing humanitarian response activities may be key to improving immunization coverage and efficient use of public health resources

  • Recent Global Polio Eradication Initiative (GPEI) experience increasingly highlights the role of armed conflicts as key drivers of poor immunization coverage, even in middle-income settings [4, 14]

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Summary

Approaches to Vaccination Among Populations in Areas of Conflict

Chimeremma Nnadi1, Andrew Etsano2, Belinda Uba3, Chima Ohuabunwo1, Musa Melton3, Gatei wa Nganda1, Lisa Esapa1, Omotayo Bolu1, Frank Mahoney1, John Vertefeuille1, Eric Wiesen1, and Elias Durry1 1Global Immunization Division, Centers for Disease Prevention and Control, Atlanta, Georgia

STRATEGIC APPROACHES TO VACCINATION IN CONFLICT AND
Security Assessments
Negotiating Secure Physical Access
Engaging Local Communities and Understanding Their Felt Needs
Coordinating Vaccine and Other Humanitarian Aid Delivery
OPERATIONAL APPROACHES TO VACCINE DELIVERY IN CONFLICT
Vaccination During Days of Tranquility
Barrier Vaccination Zones
Collaborating With Military or and Other Security Personnel
Permanent Vaccination Teams
DISCUSSION
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