Sustaining immunization activities and preventing vaccine-preventable outbreaks during conflict can be achieved through pre-emptive preparedness measures and concerted programmatic and financial support from governments and partners.
Key Evidence: The results of a 2016 cross-sectional polio serosurvey found that the Jordan Ministry of Health’s proactive campaign to locate and vaccinate high-risk populations has been successful in maintaining high population immunity — even with a recent influx of refugees from Syria. The study included a community sample of 479 children under 5 years living in areas of Jordan identified as high risk due to being hard-to-reach, having high numbers of refugees, and lower vaccine coverage (under 90%). Polio immunity was found to be over 96% for polio types 1, 2, and 3 even for children living in refugee camps.
Key Evidence: In Afghanistan, delivering health services through sustained, scheduled mobile health teams in remote and conflict-affected villages improved coverage of maternal and child health interventions, including immunization. The proportion of children under 1 year receiving their first dose of measles vaccine was higher in districts that had received mobile health team services for at least the previous 3 years (73.8%) compared to control districts in the same province (57.3%). The researchers concluded that incorporating mobile clinics into health system infrastructure in a systematic way can effectively improve health for hard to reach mothers and children in remote and conflict-affected areas.
Key Evidence: A large measles outbreak of 1,700 cases occurred in the Rohingya refugee population in Cox’s Bazar, Bangladesh in 2017. In response, two reactive vaccination campaigns delivered the measles and rubella (MR) vaccine to children aged 6 months to 15 years old. This modeling study found that these reactive vaccination campaigns rapidly curbed outbreak transmission, averting an estimated 77,000 measles cases in the refugee camp. This demonstrates that reactive vaccination campaigns can be highly effective in preventing large measles outbreaks in the context of refugee camps, even when prior vaccination rates are low.
Key Evidence: During the conflict in Yemen, efforts spearheaded by WHO, with coordination among partners and effective use of resources, especially GAVI, resulted in continued high pentavalent vaccine coverage decreasing only 3% from 2010 to 2015. Yemen also remained polio-free through 2015 and smoothly introduced two new vaccines (MR and IPV).
Key Evidence: During the humanitarian crisis in the Syrian Arab Republic, the constant support from WHO, UNICEF, and local NGOs resulted in immunizations against VPDs reaching over 90% of children.