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Dr Claudia TruppaRegional Primary Health Care Program Manager
International Committee of the Red CrossBeirut, 12th of May 2017
IMMUNIZATION IN CONFLICT SETTINGS
IMMUNIZATION IN CONFLICT SETTINGS
OUTLINEOUTLINE
• Introduction
• Magnitude of the Problem
• Literature Review
• State of the Art
• The Case of Lebanon
• Conclusions
INTRODUCTIONINTRODUCTION
INTRODUCTIONINTRODUCTION
INTRODUCTIONINTRODUCTION
INTRODUCTIONINTRODUCTION
Taiz, Dahra area of Janad district. Amidst the destruction, the civilian population struggle to survive. Every day brings new challenges and new dangers. CC BY-‐NC-‐ND/ICRC/A. Mahyoub
Eastern Aleppo, Syria, 30/11/2016. (S Turkmani/Syrian Arab Red Crescent)
A displaced family in Sana'a. Two years of conflict in Yemen has forced over two million people to flee their homes. CC BY-‐NC-‐ND / ICRC / Mohammed Yaseen Ahmed Ibrahim
Rural Homs, Malaha village, Syria. ICRC supported Mobile Health Unit. Women and children queuing.Photo by Pawel Krzysiek/ICRC
Taiz, Yemen.Water, food and other essential items remain in short supply.CC BY-‐NC-‐ND/ICRC/A. Mahyoub
Taiz, Yemen. Dozens of people line to buy wheat amid extreme food shortages across the country. Ninety percent of the country’s food is imported. CC BY-NC-ND/ICRC/A. Mahyoub
IMMUNIZATION IN CONFLICT SETTINGS –MAGNITUDE OF THE PROBLEMIMMUNIZATION IN CONFLICT SETTINGS –MAGNITUDE OF THE PROBLEM
• Almost 2/3 of all unvaccinated children live in conflict-‐affected Countries (UNICEF 2016)
• Increased health expenditure for clinical care of cases
• Vaccine Preventable Diseases mortality increases during war times (e.g. measles mortality in refugee camps 30% vs <1% in non-‐conflict settings)
• DALYs lost
IMMUNIZATION IN CONFLICT SETTINGS –MAGNITUDE OF THE PROBLEMIMMUNIZATION IN CONFLICT SETTINGS –MAGNITUDE OF THE PROBLEM
Gaza. An ambulance destroyed during 2014 conflict.ICRC Archives
IMMUNIZATION IN CONFLICT SETTINGS –LITERATURE REVIEWIMMUNIZATION IN CONFLICT SETTINGS –LITERATURE REVIEW
Vaccine Preventable Diseases (VPD)
Source: WHO 2013, Vaccination in acute humanitarian emergencies: a framework for decision making
= VPD frequently reported during humanitarian emergencies
IMMUNIZATION IN CONFLICT SETTINGS –LITERATURE REVIEWIMMUNIZATION IN CONFLICT SETTINGS –LITERATURE REVIEW
• Limited evidence available (natural disasters > man-‐made disasters)
• Dysfunctional health systems in conflict (infrastructure, logistic, human resources)
• ICRC role in ensuring immunization services to bridge the gap towards SDGs 2030
IMMUNIZATION IN CONFLICT SETTINGS –LITERATURE REVIEWIMMUNIZATION IN CONFLICT SETTINGS –LITERATURE REVIEW
Factors to be taken into account in assessment and decision making process:
1. Epidemiological
2. Vaccine related
3. Contextual
4. Ethical
IMMUNIZATION IN CONFLICT SETTINGS –STATE OF THE ARTIMMUNIZATION IN CONFLICT SETTINGS –STATE OF THE ART
Vaccination Strategies
• No outbreak confirmed AND functional EPI: Step-‐up Routine Vaccination Program
• No outbreak confirmed AND poorly functioning EPI: Additional National Immunization Days
• Confirmed outbreak OR dysfunctional EPI: Mass Vaccination Campaign
IMMUNIZATION IN CONFLICT SETTINGS –STATE OF THE ARTIMMUNIZATION IN CONFLICT SETTINGS –STATE OF THE ART
Level of recommendation VPD
Universally recommended • Measles• Polio (if threatening eradication program)• Tetanus (for wounded and pregnant women)
Recommended preemptively only in endemic areas • Cholera
Recommended only after onset of an outbreak • Hepatitis A• Meningococcal meningitis• Yellow fever
Generally not recommended for mass vaccination campaigns
• DPT• Influenza• Typhoid fever
IMMUNIZATION IN CONFLICT SETTINGS –STATE OF THE ARTIMMUNIZATION IN CONFLICT SETTINGS –STATE OF THE ART
Summary of recommendations
Adapted and modified from “Vaccination in humanitarian emergencies: literature review and case studies”. SAGE Working Group Report, 2012
THE CASE OF LEBANONTHE CASE OF LEBANON
The Lebanese Ministry of Public Health Vaccination Campaigns and the ICRC support
CONCLUSIONSCONCLUSIONS
• Whether to vaccinate or not during an armed conflict is a decision based on the careful evaluation of multiple complex factors
• Mass vaccination campaigns are a quick and effective approach to increase vaccination coverage in conflict-‐affected area and in populations not directly concerned but that can be affected by spill-‐over effects
• Routine immunization services remain the most effective way of ensuring sustained coverage, and should be resumed as early as possible
• With displaced population, integration of the humanitarian response into the existing EPI is a successful strategy to both rapidly increasing coverage and strengthening health systems in the long term
Some referencesSome references
Thank you for your kind attentionThank you for your kind attention