In the vast landscapes of Somalia, where challenges of fragility and mobility are a norm, a crucial battle is being fought – the fight to vaccinate zero-dose and under-immunised children. Somalia finds itself among the 20 countries grappling with the highest numbers of children who haven’t received a single vaccine dose. In this war against preventable diseases, a recent qualitative study sheds light on the intricacies of vaccination delivery strategies in a fragile context.

The study, conducted in three diverse regions of Somalia, unfolds a narrative that transcends geographical boundaries – from rural and remote areas to nomadic pastoralists, internally displaced persons (IDPs), and urban poor populations. It unveils the vulnerability of certain groups, where nomadic populations, IDPs, and those residing in Al-Shabaab-controlled regions emerge as the hardest hit.

The study, carried out by engaging government officials, NGO staff, vaccinators, and community members, emphasises the urgent need for tailored strategies. It reveals that despite the contextual diversity of these population groups, the lack of targeted, population-specific approaches and meaningful community engagement poses a significant hurdle in effectively reaching zero-dose children.

The stark reality presented in the 2020 Somalia Health and Demographic Survey (SHDS) unveils that over 60 percent of Somali children haven’t received a single vaccine dose. The survey, a beacon after 30 years, excluded large areas in South-central Somalia under Al-Shabaab control, indicating a potential higher prevalence of unvaccinated children in these hard-to-reach regions.

While national immunisation policies aim to vaccinate all children under two years against various diseases, the data from WHO and UNICEF reveal a stark contrast. Only 37 percent of target children received the BCG vaccine, and 42 percent got their third dose of the DTP-containing vaccine.

Nomadic populations, constituting around 26% of the Somali population, face unique challenges. The study identifies poor infrastructure, distance to services, and the nomadic lifestyle as barriers to childhood immunisation. The absence of targeted strategies aggravates the situation. Though some efforts have been made in Puntland to draft targeted vaccination strategies for nomadic populations, implementation remains pending.

Internally displaced persons, numbering approximately 3.8 million in Somalia, present another challenge. Limited data on their vaccination status impedes efforts to reach zero-dose children among these communities. Barriers include limited knowledge, illiteracy, fear of side effects, vaccine stock-outs, and inconvenient health facility hours. 

Communities living in remote areas under Al-Shabaab control face a different set of challenges. Insecurity and the government’s inability to reach these communities create structural barriers, resulting in high proportions of zero-dose and under-immunised children. 

This study uncovers critical health and immunisation data gaps in Somalia, emphasising the need for reliable data to ensure equitable access to essential health services. Governance, an essential health systems’ building block, plays a pivotal role. The absence of women’s voices in higher policy and decision-making spaces is noted, hinting at gender disparities in the health system. 

In conclusion, the study spotlights the importance of context-specific strategies and targeted interventions. The three identified subgroups – nomadic populations, IDPs, and those in Al-Shabaab-controlled areas – collectively represent a significant portion of the Somali population. The urgency to adopt tailored policies and delivery strategies, along with improving governance, engaging communities, and allocating adequate resources, cannot be overstated. 

To bridge the vaccination gap and reduce disparities, the feature calls for creative solutions – engaging local capacity, using alternative service delivery routes, generating demand through understandable vaccine information, and implementing effective monitoring and evaluation systems. The key to success lies in understanding the diverse contexts, subgroup characteristics, and social dynamics, fostering a united front in the fight for a healthier Somalia. 

References: 

Bile, A. S., Ali-Salad, M. A., Mahmoud, A. J., Singh, N. S., Abdelmagid, N., Sabahelzain, M. M., Checchi, F., Mounier-Jack, S., & Nor, B. (2024). Assessing vaccination delivery strategies for zero-dose and under-immunised children in the fragile context of Somalia. Vaccines, 12(2), 154. https://doi.org/10.3390/vaccines12020154