20 April 2023 —  The IRC welcomes UNICEF’s latest report, State of the World’s Children, For Every Child, Vaccination, and joins the call for greater investment in improving access to vaccinations for children in humanitarian settings.

While global immunisation coverage has increased dramatically in the past two decades, this is driven largely by gains in stable contexts. Children in humanitarian settings, including in conflict-affected, remote regions, and cross-border communities disproportionately lack access to this foundational health service.  UNICEF’s report rightly calls out this inequity citing that “some 40% of the world’s children who had not been immunised lived in fragile or conflict-affected settings.”

Extending immunisation access to children in crisis and conflict settings is a priority for IRC’s health work.  The IRC-led Reaching Every Child in Humanitarian Settings (REACH) Consortium, funded by Gavi, the Vaccine Alliance, aims to apply novel solutions at scale to close the immunisation gap in Ethiopia, Somalia, South Sudan, and Sudan. In REACH’s operating areas, the IRC and partners estimated through a first-of-its-kind survey that among a total population of 6.8 million children under five, 1.9 million (28%) qualify as zero-dose, those who do not receive a single dose of the diphtheria, tetanus, and pertussis-containing vaccine. Another 2.9 million children (43%) qualify as under-immunised, meaning they have not received their full schedule of vaccinations and remain vulnerable to preventable infectious diseases.

Powered by a network of global and local partners, the REACH Consortium works to extend services to those beyond the reach of government systems and ensure that no child is left behind, regardless of where they live. The Consortium seeks to expand coverage in 122 districts comprised of conflict settings, regions under partial or no government control, and regions with large populations of internally displaced peoples (IDPs), refugees, and nomadic communities.

To achieve unprecedented reach in settings affected by conflict, crisis, and extreme resource limitations, IRC is developing innovative solutions and designing strategies to sustainably reach zero-dose and under-immunised children with vaccination services. Here are 4 innovations IRC is scaling:

  1. Optimising immunisation service locations and delivery tactics to improve access.  To improve access to immunisation, the Consortium seeks to diversify the locations for vaccine delivery using tools including geospatial information systems (GIS), population data, and IOM’s Displacement Tracking Matrix. The consortium draws on a diverse toolkit of delivery tactics including the use of fixed, mobile, and cross-border vaccination strategies, as well as large-scale outreach and vaccination campaigns. It also strives to inform methodology for service delivery. By differentiating delivery strategies, implementers can overcome access barriers and bring vaccination services directly to children and their caregivers across a range of systemic barriers.  
  2. Combining immunisation with key health and socio-economic services.  To increase access, the REACH Consortium is integrating immunisation with other cross-sector services and programmes. For example, childhood and livestock immunisation may occur at one point, such as a market, so that families can care for both their children and livelihoods at the same time, providing both a health and economic benefit. The increase of immunisation services in remote, conflict-affected, cross-border, nomadic, and missed communities reduces the opportunity cost, thereby addressing a key caregiver concern.
  3. Negotiating humanitarian access for immunisation service provision. In the 122 districts in Ethiopia, Somalia, South Sudan, and Sudan being covered by the REACH Consortium, just 38% of locations have full humanitarian access while 32% have partial and 30% have none as of March 2023. The project is employing a phased delivery approach beginning with the more accessible areas while simultaneously analysing the unique context in each location and developing action plans, including the potential to directly negotiate with armed groups, to ensure accessibility. 
  4. Utilising civil society-led models for effective, inclusive vaccination programmes. The NGO-led model leverages civil society and local actors who have the infrastructure, experience, and access to deliver services in humanitarian settings. The Consortium is using this model to build and sustain trust in health workers and vaccines by enabling communities to work with familiar community health workers and NGOs. This promotes context-specific interventions and combats misinformation and vaccine hesitancy.

“For decades, the IRC has responded to the dire consequences of polio, measles, and other vaccine preventable disease outbreaks that devastate families and communities in humanitarian contexts. Meanwhile, far too many children are missing out on routine immunisation in the places where we work.  The coverage gap is growing as childhood vaccinations plummeted during the COVID-19 pandemic: 67 million children missed out on the routine vaccines that protect them from preventable deaths.  The IRC is leveraging lessons learned from the REACH Consortium and plans to apply our findings to other humanitarian contexts to ensure that every child is protected from vaccine preventable diseases.”

Mesfin Teklu Tessema, Senior Technical Director of Health at the IRC and External Advisory Group Member of UNICEF’s State of the World’s Children 2023