The challenge of vaccinating in emergency settings: policy and advocacy implications

Abstract

Vaccination of populations living in complex humanitarian emergencies poses a unique set of challenges. Disrupted water and sanitation systems, destroyed health care systems, introduction and mixing of populations and crowding puts populations in complex emergencies at particular risk for vaccine-preventable diseases such as measles, cholera and polio. Guidance from the WHO, UNICEF and others help to provide a framework for vaccinating in emergencies. However, significant barriers remain. This presentation will outline these barriers, focusing on the perspectives and experiences of Médecins Sans Frontières, and describe opportunities to address key barriers and improve delivery of life saving immunizations to populations living in emergency. A review of the formal and grey literature was completed. Using a semi-structured questionnaire, key informants were interviewed from MSF and other important institutions. A key case study from MSF experience in Yida camp was analyzed. The literature review and key informant interviews identified several key barriers to implementing vaccination campaigns in humanitarian emergencies. Logistics, in particular requirements for cold chain and human resource mobilization. However, vaccine characteristics including dosage schedule, vaccine presentation and storage volume requirements and ease of manipulating vials were also deemed important considerations. Delays getting the vaccines to the field were noted at several places in the supply chain. Finally, price of certain key vaccines such as pneumococcal conjugate vaccine and the inability of humanitarian actors to access low prices represent an important malleable barrier. Key barriers to implementing vaccination activities in complex humanitarian emergencies must be addressed urgently in order to avert preventable deaths. Immediate action must be taken by manufacturers to evaluate thermostability of core vaccines used in emergencies in order to allow for use in the controlled temperature cold chain. Manufacturers and GAVI can also bring down prices for vaccines for use in emergency settings. Additional recommendations will be presented for important actors including manufacturers, GAVI, distributors and vaccine implementers.