Infectious Disease Risk and Vaccination in Northern Syria after 5 Years of Civil War: The MSF Experience

Pereira, Alan de Lima; Southgate, Rosamund J.; Ahmed, Hikmet; O’Connor, Penelope; Cramond, Vanessa; Lenglet, Annick

doi:10.1371/currents.dis.bb5f22928e631dff9a80377309381feb

Cited by 11 publications

(4 citation statements)

References 7 publications

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“…From the screening and assessment of the grey literature and of the reference lists of relevant systematic reviews, a further 24 eligible publications were identified. From the total of 194 eligible publications18–211 included in our review (table 1; online supplementary appendix B), we captured 392 reported instances of infectious disease intervention delivery. Publication frequency varied since the beginning of the review study period in 1990, with peaks in 1996 and again in 2013 (n=26), and remaining high since then (figure 2).…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, conflict-affected countries are potential zones of new emergence such as the case of Ebola imported into the Democratic Republic of Congo (DRC), and conflict often triggers the resurgence of previously controlled vaccine-preventable diseases (VPD) due to severed access to standard prevention and treatment services 4 5. For instance, despite fairly high preconflict VPD vaccination coverage rates in Syria, reports of measles outbreaks and acute flaccid paralysis related to poliovirus have become increasingly common 6. UNICEF figures show that in Syria, routine administration of first-dose measles-containing-vaccine decreased from 82% coverage in 2010 to 54% in 2014 7.…”

Section: Introductionmentioning

confidence: 99%

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Delivering infectious disease interventions to women and children in conflict settings: a systematic review

et al. 2020

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BackgroundConflict has played a role in the large-scale deterioration of health systems in low-income and middle-income countries (LMICs) and increased risk of infections and outbreaks. This systematic review aimed to synthesise the literature on mechanisms of delivery for a range of infectious disease-related interventions provided to conflict-affected women, children and adolescents.MethodsWe searched Medline, Embase, CINAHL and PsychINFO databases for literature published in English from January 1990 to March 2018. Eligible publications reported on conflict-affected neonates, children, adolescents or women in LMICs who received an infectious disease intervention. We extracted and synthesised information on delivery characteristics, including delivery site and personnel involved, as well as barriers and facilitators, and we tabulated reported intervention coverage and effectiveness data.ResultsA majority of the 194 eligible publications reported on intervention delivery in sub-Saharan Africa. Vaccines for measles and polio were the most commonly reported interventions, followed by malaria treatment. Over two-thirds of reported interventions were delivered in camp settings for displaced families. The use of clinics as a delivery site was reported across all intervention types, but outreach and community-based delivery were also reported for many interventions. Key barriers to service delivery included restricted access to target populations; conversely, adopting social mobilisation strategies and collaborating with community figures were reported as facilitating intervention delivery. Few publications reported on intervention coverage, mostly reporting variable coverage for vaccines, and fewer reported on intervention effectiveness, mostly for malaria treatment regimens.ConclusionsDespite an increased focus on health outcomes in humanitarian crises, our review highlights important gaps in the literature on intervention delivery among specific subpopulations and geographies. This indicates a need for more rigorous research and reporting on effective strategies for delivering infectious disease interventions in different conflict contexts.PROSPERO registration numberCRD42019125221.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Delivering infectious disease interventions to women and children in conflict settings: a systematic review

et al. 2020

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“…COVID-19 vaccine hesitancy is a global phenomenon that also affects Syria, despite previous high uptake of routine vaccination. 20 Identifying the main issues affecting ongoing COVID-19 vaccine hesitancy in Syria has ramifications for routine vaccination and value for future epidemics. Our findings support and help explain survey findings from both Mohamad et al and Shibani et al 12 , 14 They also add contextual nuance to vaccine hesitancy as experienced in conflict-affected settings, where fears for survival and distrust of authorities can amplify the power of misinformation and disinformation.…”

Section: Discussionmentioning

confidence: 99%

“In general people aren’t excited about the vaccine…” : Frontline perspectives on COVID-19 vaccine hesitancy across Syria

Alhaffar,

Douedari,

Howard

2023

Human Vaccines & Immunotherapeutics

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COVID-19 vaccine hesitancy is a new phenomenon in Syria, about which relatively little is known. We aimed to explore this, drawing from 37 semi-structured interviews with frontline health-workers and service-users across Syria’s major military areas-of-control. We found COVID-19 vaccine hesitancy was common and increasing among service-users and less common, but still present, among health-workers in all areas. Interrelated reasons included pragmatic fears of novel vaccine risks, unreliable information, and conflict-related hesitancies as a form of resistance or reasserting some perceived control, particularly outside Al-Assad government-controlled areas. Vaccine hesitancy has thus become a socio-political issue, requiring macro-level responses, across Syria.

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“…Health system shocks that disrupt the vaccine ecosystem may include conflict and political unrest through destruction and/or displacement of healthcare facilities, healthcare workers, infrastructure, resources and equipment. 13 Moreover, ecosystem disruptions can result in VPD outbreaks and losses in programme development investments. 14 Since early 2020, the global COVID-19 pandemic has caused substantial disruption to routine vaccination across the life course.…”

Section: What This Study Addsmentioning

confidence: 99%

Understanding the factors that shape vaccination ecosystem resilience: a qualitative assessment of international expert experiences and perspectives

May,

Roach,

Maravic

et al. 2024

bmjph

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Introduction‘Shocks’ or external stressors to vaccination programmes can lead to decreased vaccination coverage rates. The capacity of vaccination ecosystems to effectively respond and adapt to shocks demonstrates programme resilience. This study sought to describe components that contribute to resilience in national immunisation programmes.MethodsMixed-methods study comprising in-depth interviews and surveys with n=30 vaccination programme experts in eight countries (Brazil, Costa Rica, Greece, Japan, Nigeria, Philippines, Spain and the USA). We elicited data on country-specific shocks, associated effects and factors that facilitated or impeded programme resilience. Interviews and open-ended survey responses were analysed qualitatively, with closed-ended survey questions analysed using descriptive statistics.ResultsExperts described immediate effects of shocks including decreased vaccine uptake and negative perceptions of vaccination from the public and media. Late emerging impacts included increased vaccine hesitancy and vaccine-preventable disease (VPD) rates. Stakeholder education, immunisation information systems (IIS) and programme financing were key factors to strengthening programme resilience. Appropriately trained frontline healthcare personnel can counter vaccine misinformation that otherwise erodes trust and contributes to hesitancy. The COVID-19 pandemic also exposed structural weaknesses in programme resilience, with experts highlighting the need for robust IIS and workforce support to mitigate burnout and strengthen resilience when a shock occurs.ConclusionsOur findings provide preliminary insights into factors that experts believe to be associated with vaccination programme resilience. Anticipating, adapting and responding to shocks is central to strengthening systems, ensuring ecosystem resilience and protecting against current and future VPD threats.

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Infectious Disease Risk and Vaccination in Northern Syria after 5 Years of Civil War: The MSF Experience

Cited by 11 publications

References 7 publications

Delivering infectious disease interventions to women and children in conflict settings: a systematic review

Delivering infectious disease interventions to women and children in conflict settings: a systematic review

“In general people aren’t excited about the vaccine…” : Frontline perspectives on COVID-19 vaccine hesitancy across Syria

Understanding the factors that shape vaccination ecosystem resilience: a qualitative assessment of international expert experiences and perspectives

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