Five things to know about Gavi’s humanitarian partnership immunising children in conflict zones
Delivering vaccines in hostile environments requires a blend of immunisation programming and neutral, humanitarian work.
- 20 January 2025
- 4 min read
- by Priya Joi
Getting vaccines to children who never receive a single dose of basic vaccines – so-called ‘ zero-dose’ children – is a challenge.
Decades of work boosting access to immunisation in even the world’s most difficult contexts means that now the vast majority of children in lower-income countries have access to these life-savers. The communities that remain out of reach still lack access for a multitude of tough, complex reasons that don’t lend themselves to simple solutions.
One of these core reasons is insecurity or conflict. To reach children in these contexts – arguably the world’s most challenging – Gavi set up ZIP – the Zero-dose Immunization Programme – in 2021. This is a humanitarian partnership led by two on-the-ground consortia: REACH (led by the International Rescue Committee) and RAISE 4 Sahel (led by World Vision).
1. Life-saving vaccines reached children who would otherwise never have received one
ZIP tracks data on four key doses: pentavalent vaccine dose 1 (penta1) and dose 3 (penta3), and meningococcal conjugate vaccine (MCV) dose 1 and dose 2 (MCV2). These doses represent critical milestones on the path to full immunisation. Tracking doses disaggregated by age (e.g. infants 0–11 months, children 12–23 months, children 24–59 months) gives Gavi information about both routine and catch-up immunisation in ZIP communities.
From December 2022 through June 2024, ZIP provided 845,000 first doses and 479,000 last doses of vaccines to infants and children in communities where national immunisation programmes (NIPs) face barriers associated with conflict or crisis across 11 African countries.
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2. Key to this success was a pragmatic approach and innovative thinking
The humanitarian partnership was set up with the realisation that while national immunisation programmes are Gavi’s key partner in delivering vaccines, national health systems are not typically equipped to negotiate and sustain safe access in insecurity, conflict or crisis settings. Critical gaps are left when national immunisation programmes’ operations are restricted or compromised.
Crucially, ZIP did not substitute for government programming where the national immunisation programme could roll out vaccines with Gavi support. Successful ZIP programming has balanced coordination with Ministries of Health and the national immunisation programme.
3. Gavi has had to develop conflict-sensitive immunisation programming
Establishing immunisation services through ZIP has challenged norms and expectations that required an agility in responding to what works and what doesn’t.
It was initially expected that ZIP partners would use humanitarian approaches to negotiate access to communities before reverting to standard EPI (Expanded Programme on Immunisation) practices.
However, ZIP showed that reverting to business as usual doesn’t work in this setting. Significant changes were needed to meet the standards for conflict-sensitive immunisation programming.
4. Maintaining neutrality has been key to ensuring access
ZIP has established immunisation systems and services in challenging settings, including:
- Disputed areas occupied by militias from two states;
- Semi-autonomous or separatist areas;
- Locations occupied by non-state armed groups;
- Camps for internally displaced people (IDP) or refugees;
- Communities fleeing conflict or crisis; and
- Marginalised populations.
ZIP partners maintain neutrality throughout vaccine programming and this has been critical in negotiating the access and visits required. ZIP partners use ongoing situation monitoring and rely on a network of local partners that can adjust and adapt to changing security and population needs.
Established best practices for humanitarian responses also include:
- Participation in response coordination and planning often led by OCHA or WHO Health Clusters;
- Accountability to affected populations and community-inclusive programming; and
- Gender-sensitive approaches that uphold protection from sexual exploitation and abuse.
5. Prioritising ‘zero-dose’ children drew attention away from the vital task of rebuilding routine immunisation
At the start, ZIP focused on identifying and understanding zero-dose children. Along with ‘Zero-Dose’ in the programme title, this established a strong impression that immunising zero-dose children was the main goal of ZIP. This meant that in some locations, routine immunisation was neglected in favour of door-to-door campaigns to find zero-dose children.
This shows that when a national immunisation programme experiences conflict or crisis, vaccine supply and demand must urgently be established to meet the needs of children from birth to the age of five, as allowed within national policy. This must include both routine and catch-up immunisation.
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