Covid-19 vaccine: the hurdles of reaching people caught in conflict

A Tigrayan girl who fled the conflict in Ethiopia's Tigray region at the Medecins Sans Frontieres (MSF) clinic at Umm Rakouba refugee camp in Qadarif, eastern Sudan, this month. Credit: AP Photo/Nariman El-Mofty.

There is growing concern that people in conflict settings could be overlooked in vaccination programmes.

With vaccines for Covid-19 soon to be available in some countries, concerns are rising that people who are affected by conflict and violence - particularly displaced people or marginalised communities - will be pushed to the back of the line, or missed out altogether.

“These populations face recurrent challenges in accessing health services, including vaccinations,” explained Esperanza Martinez, head of health at the International Committee of the Red Cross (ICRC), speaking to Geneva Solutions. “Countries in conflict often lack basic logistical and health infrastructure, resulting in vulnerable populations being deprived of most needed immunisations.”

Obstacles to access. Routine vaccination programmes for diseases such as measles and polio have been severely disrupted during the pandemic, as already fragile health systems in conflict settings have been overwhelmed. UNICEF reports that at least 80 million children under one year old are now at risk of contracting diseases  such as measles, diphtheria and polio.

“Countries in conflict might have inherent challenges for vaccination such as lack of a cold chain and storage capacities, poor health capacities due to breakdown of destruction of health services, lack of health personnel, precarious infrastructure, risks for health personnel, and roads that are cut off,” said Martinez.

The safety of healthcare workers who would distribute a Covid-19 vaccine in these areas is also a worry. Attacks on humanitarian personnel are on the rise, with many incidents linked to rife misinformation and mistrust surrounding the virus. The ICRC has called on authorities to ensure that healthcare workers will be protected during vaccine distribution, warning that programmes will fail otherwise.

“Any region experiencing conflict could see additional hurdles and barriers to the equitable distribution of the Covid-19 vaccine,” explained Martinez.

Equitable distribution. Despite international agreements to avoid so-called “vaccine nationalism” such as the global vaccine-sharing initiative Covax , wealthy countries have scrambled to buy up doses of the first vaccines over the past few weeks. While these countries have reserved far more doses than their populations will need, there has been little discussion on whether they will allot any of their own supply to countries experiencing humanitarian crises, including conflict.

Public health groups and humanitarian organisations including the ICRC have called on countries to commit a portion of their vaccine supply to a “humanitarian buffer” that would be used to vaccinate people living in rebel-held territories, asylum seekers in camps and others who are likely to be missed out by national governments.

The United Nations International Organisation for Migration (IOM) has also called for equal vaccine access for refugees in the European Union.

“It is for the sake of their safety and wellbeing of the entire host communities,” said Antonio Vitorino, director general of the IOM in a conference convened by the European Parliament last month. “Nobody is safe until everybody is safe.”

“When we have now news about a vaccine, the challenge that EU European member states are confronted with is to guarantee access to the vaccine to everybody that is in your territory, not just your citizens, but also all the refugees, displaced people and migrants that are in Europe,” he added.