From Ukraine to Syria, Afghanistan to Myanmar, and across the Horn of Africa, civilians are under attack. Human rights are increasingly flouted by governments and non-state actors alike, creating an age of impunity that undermines the very foundation of our international system.
Among the myriad of consequences is the ravaging of already weak health systems intended to serve the world’s most vulnerable populations. As a result, millions face overlapping threats to their health: armed conflict, an ongoing global pandemic, and a lack of essential health services – including lifesaving immunisation.
This new reality has forced the humanitarian aid and health sectors to reconsider how to support the delivery of healthcare in conflict-affected environments and how to better meet the needs of people caught in the middle.
Healthcare is often a casualty of war, with substantially more deaths attributable to disease and malnutrition than combat, and cascading consequences for the health of the country and its neighbours. Access to routine immunisation is the canary in the coal mine – a key measure of a health system’s strength and reach.
UNICEF and WHO recently issued a warning, pointing to declining rates of vaccination due to conflict and Covid-19 that have led to measles outbreaks, including in Somalia, Yemen, and Ethiopia. In Yemen, where eight years of war has destroyed the health system, a child dies every 10 minutes from a vaccine-preventable disease.
Current approaches to routine immunisation rely on the reach of national governments and health systems. But with more people than ever displaced by conflict, insecurity, and climate change – more than 100 million – and 60–80 million people living in territories controlled by an armed group, business as usual is insufficient to meet the growing scope of needs.
To effectively serve them, a new approach is needed: one that is more flexible, more innovative, and that brings healthcare directly to people where they are.
Vaccines save between three and five million lives annually. Last year, more than 12 million children in lower-income countries did not receive a single vaccine shot, leaving them vulnerable to deadly and debilitating infectious diseases.
A paradigm shift in strategy
These children, known as “zero-dose children,” account for half of all vaccine-preventable deaths and half of all deaths of children under five. Ensuring access to routine vaccinations for every child – especially those in conflict-affected, remote, and urban environments beyond the reach of government services – is one of the best tools to promote children’s health and enable them to live long, healthy lives.
A new partnership between Gavi and the IRC recently launched to address the immunisation gap in Ethiopia, Somalia, South Sudan, and Sudan – countries facing compounded conflict and crisis. This strategy represents a paradigm shift in how to reach zero-dose children and builds new approaches centered on their unique needs and realities.
It combines the power of Gavi’s vaccine alliance with the infrastructure and experience of the IRC, and a network of partners, in logistics and service delivery across conflict-affected environments and areas controlled by armed groups.
With mass displacement, increasingly mobile populations, and a record drought threatening the lives and livelihoods of millions, delivering services in border regions with low health coverage is paramount. Across Ethiopia, Somalia, South Sudan, and Sudan, more than 12 million people are internally displaced; this number is expected to grow as the drought intensifies.
To expand access in these challenging situations, services must be responsive: permanent and mobile vaccination posts will be deployed in consultation with local organisations, community leaders, and health workers – as well as national authorities and non-state armed groups, whose cooperation is needed to guarantee access and safety at border points and within regions under their control.
Families should not have to sacrifice other basic needs to access quality healthcare. By leveraging existing touch points for caregivers and children, including primary health, post-natal, nutrition, family planning, women’s and girl’s safe spaces, and cash assistance programs, the partnership can reach more zero-dose children with much needed routine immunisations while connecting their families to other critical healthcare and humanitarian services.
The evidence is clear: vaccines are one of the most cost-effective investments in health and development in history. Now is the time to finally close the vaccine gap through new strategies, partnerships, and investments to protect the health of zero-dose children.
Because if we don’t reach them with their first shots, we may miss our chance – and they may miss their shot at a healthy future.
If the opposite of impunity is accountability, then governments, international organisations, and the private sector must be accountable to civilians in crisis by ensuring access to the lifesaving health services that are among their basic human rights – beginning in their first year of life. This innovative, new partnership offers a model to do just that.
- David Miliband is President and CEO of the International Rescue Committee (IRC) and Anuradha Gupta is Deputy CEO of Gavi, the Vaccine Alliance
Protect yourself and your family by learning more about Global Health Security
