Got Vaccines? Delivering Primary Care to Children in Conflict

By Leeam Azoulay, Consultant, Global Health Strategies

When a baby is born, one of her first encounters with a primary health care provider is when she is vaccinated. But what if this baby is born in a war-torn area? Data shows her chances of being immunized drop dramatically. In Syria, for example, immunization rates declined from 89% in 2010 to 61% in 2016, after five years of civil war. Such a drastic decline is not at all exceptional. Worldwide, almost two-thirds of children who have not been immunized with basic vaccines live in countries affected by conflict.

Conflicts can have a profound and debilitating impact on health systems — they can damage health infrastructure, cause access and security problems for health staff, and severely disrupt supply chains. These challenges are clearly reflected in many of the countries where less than 50% of children were immunized last year: Angola, Central African Republic, Chad, Equatorial Guinea, Guinea, Nigeria, Somalia, South Sudan, Syria and Ukraine. These are countries where the most urgent action needs to be taken.

Boy being given a dose of the polio vaccine in India. Photo Credit: Global Health Strategies

Delivering immunization in conflict zones may seem like an insurmountable challenge, but past immunization initiatives — most notably, the Global Polio Eradication Initiative (GPEI) — have been successful even in countries affected by conflict and in remote areas. There are important lessons to learn from the successes of GPEI in conflict zones, including access negotiations with state and non-state actors, taking community engagement seriously, and accounting for population movement and displacement. Most importantly, GPEI applied a tenacious and context-specific approach to reach children where they are.

Mother holding her baby daughter at a community health center in southern Sierra Leone. Photo Credit: Doune Porter / GAVI

There are many reasons to focus significant attention and resources on immunization in conflict zones and fragile settings. One of them is scale and impact — immunization is one of the most cost-effective public health interventions, and an estimated 1.5 million deaths could be avoided if global immunization coverage improves. Immunization also brings children and families into contact with health systems, allowing them to access other health services. In conflict and fragile settings, establishing and strengthening immunization systems can offer an entry point for a range of essential health services, laying the foundation for improved primary health care systems even under such difficult circumstances.

Health actors are keenly aware of the problem — and many are taking action. Gavi, the vaccine alliance, provides support to countries experiencing fragility or humanitarian emergencies as well as those facing a sudden influx of refugees. The World Health Organization (WHO) recently started using an immunization maturity grid to assess African countries’ capacity to deliver immunization and is providing intensified support to countries that are lagging behind. WHO and UNICEF have also teamed up with Médecins Sans Frontières (MSF) and Save the Children to launch the Humanitarian Mechanism to facilitate access to vaccines for displaced people in humanitarian emergencies.

But it’s time for the conversation to expand beyond the experts. If we are serious about achieving universal health coverage by 2030, there is an urgent need to understand what this will look like in conflict and fragile settings. Solutions will require coordination between many actors at multiple levels — from humanitarian and development actors to regional blocs, and from local leaders and civil society to donors. More than technical solutions, improving access to immunization will require political leaders, activists and ordinary people to stand up and say that the status quo is unacceptable. Collectively, we can and must do more to prevent immunization rates from dropping so dramatically during periods of conflict and to reestablish routine immunization again quickly after it ends. Reaching every child with life-saving immunizations is a goal everyone can agree on — and that’s a good place to start.