Vaccine-preventable diseases remain an important cause of disease and death among children in conflict-affected settings. Reaching children with vaccines in conflict settings is a complex undertaking, involving many autonomous global, national and local actors, and, often, limited governmental effectiveness in the crisis setting. As a result, decision-making around vaccination services often lacks structure and transparency. Through this study, we aim to better understand how decisions are made about vaccines for children in conflict settings, including: which vaccines, how and where to deliver them and to whom. Using the study findings, we intend to generate and disseminate recommendations to different stakeholders to improve equitable delivery of vaccines to zero-dose children in conflict-affected settings.
Our multi-disciplinary team is made up of academics and practitioners from LSHTM, the SIDRA Institute Somalia, and the Public Health Training and Research Unit (PHTRU), Ahfad University for Women in Sudan.
With over 235 million people in need of humanitarian assistance in 2021, vaccine-preventable diseases (VPDs) in crisis-affected settings remain a pressing health concern. Worldwide, of 23 million children who did not complete their vaccinations in 2020, 17 million (75%) did not receive their first dose of the diphtheria, tetanus and pertussis vaccine.
About 9.6 million (42%) of these so-called ‘zero-dose’ children and communities are in conflict-affected settings. Typically characterised by displacement, violence, food insecurity, insufficient water and sanitation and overcrowding, crises largely affect populations with high baseline risk of infectious diseases resulting from inaccessible or underperforming health services, and high burden of malnutrition. This increases both transmission and case-fatality, and the risk of VPD outbreaks or setbacks to long-term vaccination programmes. The COVID-19 pandemic has led to worrisome declines in vaccination coverage and stretched capacity to deliver routine health services.
Governance of vaccination services in humanitarian responses is often unstructured and not evidence-based. Despite calls for a systematic, evidence-based and accountable approach to vaccine provision in humanitarian crises, in practice it is left to ‘decision-makers’ within each humanitarian crisis, who rarely, if ever, follow the aforementioned approach to select which vaccines to use, when and how. There is also a strong recognition of the need to improve financing mechanisms for vaccination in humanitarian settings, as affordable access to vaccines is a key challenge for both governments and humanitarian actors, though one that has been partially mitigated by the establishment of the Humanitarian Mechanism. Furthermore, there is a need to generate evidence on novel or underutilised delivery strategies to identify and reach under-immunised and zero-dose communities for routine vaccine delivery across different crisis typologies.
Understanding and strengthening vaccination governance, financing and delivery strategies is key to enabling the equitable delivery of vaccines to zero-dose and under-immunised communities in crisis settings.
Aims and Objectives
In RAISE, we aim to map and assess governance practices (including decision-making and financing) for vaccination services in a range of humanitarian responses; and to identify and formulate recommendations for practices for equitable vaccination delivery in these settings, with a specific focus on zero-dose communities. Which we will do by meeting the following three objectives:
- Objective 1: Conduct a scoping review of existing guidance on vaccination in crisis settings to characterise and assess the normative landscape for vaccination in these settings
We will conduct a comprehensive scoping review of existing guidance on vaccination in humanitarian crisis settings, ensuring that we are drawing on a wide variety of approaches. We will also assess the quality of these guidance documents.
- Objective 2: Conduct mixed methods research to explore current vaccination governance and financing practices and formulate concrete recommendations to improve them by determining what drives decision-making and current barriers, incentives and modalities of financing for vaccines in humanitarian settings
We will collect data on governance, decision-making and financing to map and describe current practices, and assess barriers and facilitators for design and funding of timely, equitable vaccination services across currently activated United Nations Office for the Coordination of Humanitarian Affairs (OCHA) responses. These include protracted crises, areas governed by non-state actors and internal and refugee displacement. We will also explore potential synergies between COVID-19 vaccination and programming for catch up vaccinations for children in zero-dose and under-immunised communities.
- Objective 3: Map and assess current delivery practices to reach zero-dose and under-vaccinated communities in different crisis typologies, with a view to documenting best practices, and formulating actionable recommendations for equitable, higher-coverage vaccine delivery
This third objective will be co-designed and led by our country partners SIDRA in Somalia and Adeela for Culture and Art and PHTRU, Ahfad University for Women in Sudan.
Broadly, we will conduct mixed methods case studies in Sudan and Somalia to document current vaccination delivery practices and to identify novel approaches across all the different components of vaccination microplanning (including community engagement), and successful examples of integration with other health service areas and/or other sectors of humanitarian response and civil society. These case studies will support developing actionable recommendations for equitable delivery practices to reach zero-dose and under-immunised communities in varied humanitarian crisis settings. To encourage change-making, we will disseminate and promote the research findings with all relevant stakeholders from local to national and regional/global levels.
Head of the Public Health Training and Research Unit (PHTRU) in the Nutrition and Health Center for Training and Research at Ahfad University for Women (AUW)
Majdi Sabahelzain is the Head of the Public Health Training and Research Unit (PHTRU) in the Nutrition and Health Center for Training and Research at Ahfad University for Women (AUW). He is the founding manager of the Tat3im Initiative, a member of the WHO-led project (Vaccine Safety Net). Tat3im Initiative is based in PHTRU and serves as an online platform that provides information about vaccines, immunization, and vaccine-preventable diseases to the public and healthcare providers. Dr Majdi leads research in different areas related to global health, epidemiology of vaccine-preventable, vaccine hesitancy, policy, and health system. He also works as a lecturer on public health, epidemiology and health promotion in the School of Health Sciences in AUW. He obtained his bachelor's degree in Pharmacy from Gezira University and MPH from the University of Medical Sciences and Technology in Sudan. He submitted his PhD dissertation about vaccine hesitancy and acceptance in Sudan at CAPHRI in Maastricht University in the Netherlands.
Amina Jama Mahmud
Director of Research and Senior Gender Advisor at the Somali Institute for Development and Research Analysis (SIDRA)
Amina Jama Mahmud is the Director of Research and Senior Gender Advisor at the Somali Institute for Development and Research Analysis (SIDRA) and an associate researcher at Uppsala University, Department of Women’s and Children’s Health, International Maternal and Child Health (IMCH). Amina’s research focuses on gender and social inclusion and health information systems. She has over 15 years’ professional experience in providing strategic leadership in evidence-based policymaking, innovative design, and implementation of needs-based, sustainable programs to improve health and livelihoods for vulnerable communities in Sweden and Somalia.
Ahmed Said Bile
Research Coordinator of Somali Institute for Development Research and Analysis (SIDRA)
Ahmed Bile is the Research Coordinator of Somali Institute for Development Research and Analysis (SIDRA). He holds a Master of Pharmacy from King’s College London and postgraduate certificates from the Centre for Pharmacy Postgraduate Education (CPPE - The University of Manchester) and the University of Greenwich. Ahmed has over 25 years’ experience in health teaching and research. Ahmed has a keen interest in health systems in fragile states (Somalia) especially in access to essential medicines, medicines information and human resource for health.
Researcher at Somali Institute for Development Research and Analysis (SIDRA)
Said Mohamoud is a researcher at Somali Institute for Development Research and Analysis (SIDRA) based in Somalia. Said holds a double master’s degree in Public Health and Health Management from American University of Beirut and International Telematic University of Uninettuno in Rome, respectively. Said has over five years’ experience in the design and implementation of public health research in fragile settings. His research mainly focuses on the health of displacement affected communities (maternal, child health and mental health), health information, and COVID-19 vaccination.
Mohamed Abdullahi Ali-Salad
Researcher and data analyst at Somali Institute for Development Research and Analysis (SIDRA)
Mohamed A Ali-Salad is a researcher and data analyst at Somali Institute for Development Research and Analysis (SIDRA) based in Garowe, Somalia. Mohamed serves as the Researcher for the RAISE Project by supporting the overall research activities (literature review, data collection, analysis, and research outputs). Mohamed received his MSc in Biostatistics and Epidemiology from SRM University, India. He teaches applied statistics at the University of Bosaso, Garowe campus, Somalia. Mohamed’s main areas of interest are the application of a range of analytical studies on health data, i.e. health information systems, health-seeking behaviour, immunization, and neonatal mortality.
Essam Al-deen Al-zain
A self-motivated engineer in mind, and a people person in heart, Essam is fluent in English with more than 6 years of customer relations and team building experience. Essam started working in the civil society to make a difference and change my country to the best version of it.
Majdi Hassan Mohamed
Human Resources Officer
Majdi Hassan Mohamed studied Electric Engineering before joined civil society organisations as a volunteer while university and stayed in the field to help meet local needs and support overcoming challenges.
Mohamed Abd Alazieme Alhag
Mohamed is a graduate of Khartoum University Faculty of Economic and Social Studies. Mohamed joined Adeela due to his interst in public work and issues of social change, art, understanding local and social racing to accommodate and produce knowledge tools in line with local reality.
The RAISE project is led by the London School of Hygiene and Tropical Medicine in partnership with the SIDRA institute in Somalia and the Public Health Training and Research Unit (PHTRU) at Ahfad University for Women and Adeela for Culture and Art in Sudan.
Adeela for Culture and Art
Adeela is a youth-led organization with a special focus on matters of peace, social justice and human rights in Sudan, it's goal is to highlight and tackle these issues along with the various difficulties and challenges that face Sudanese youth, using a modern and artistic approach.
Public Health Training and Research Unit (PHTRU) is a multidisciplinary unit that conducts research, training, and advocacy activities related to Public Health. PHTRU is based in Nutrition and Health Center for Training and Research (NHCTR) at Ahfad University for Women (AUW). Researchers at PHTRU conduct training, research, as well as implement and evaluate projects in infectious diseases, global health, maternal and child health, health systems research, social and behavioral determinants of health, environmental and occupational health, climate change, and health, public health nutrition, and non-communicable diseases. Additionally, PHTRU leads and supports the development and dissemination of compendiums of published evidence to drive advocacy activities for the inclusion and adoption of new public health interventions into action.
Somali Institute for Development Research and Analysis (SIDRA) is a private, not-for- profit research and policy analysis think tank whose primary mission is to provide quality research and development services to the public and private entities in Somalia in order to contribute to the attainment of the development priorities of the country. Our headquarter is in Garowe, the capital city of Puntland State of Somalia.
SIDRA provides a supportive environment for quality research, innovative solutions and effective implementation of Somalia development priorities.