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After 2 years of war that crippled the capacity of the Yemeni National Health System and left only 45% of health facilities functioning, Yemen faced increasing vaccine-preventable disease (VPD) outbreaks and may be at high risk of polio importation.
The aim of this study was to determine the impact of the 2015 war on the immunization coverage of children under 1 year.
Data on vaccination coverage for 2012-2015 were obtained from the national Expanded Program on Immunization (EPI). The vaccination coverage was calculated at the national and governorate levels by dividing the number of actually vaccinated children by the estimated population of children under 1 year.
Although there was an increase from 2012 to 2014 in the national coverage for penta-3 vaccine (82% in 2012 vs 88% in 2014) and measles vaccine (70% in 2012 vs 75% in 2014), the coverage was still below the national target (≥95%). Furthermore, the year 2015 witnessed a marked drop in the national coverage compared with 2014 for the measles vaccine (66% in 2015 vs 75% in 2014), but a slight drop in penta-3 vaccine coverage (84% in 2015 vs 88% in 2014). Bacillus Calmette–Guérin vaccine also showed a marked drop from 73% in 2014 to 49% in 2015. These reductions were more marked in governorates that witnessed armed confrontations (eg, Taiz, Lahj, and Sa’dah governorates). On the other hand, governorates that did not witness armed confrontations showed an increase in coverage (eg, Raymah and Ibb), owing to an increase in their population because of displacement from less secure and confrontation-prone governorates.
This analysis demonstrated the marked negative impact of the 2015 war on immunization coverage, especially in the governorates that witnessed armed confrontations. This could put Yemen at more risk of VPD outbreaks and polio importation. Besides the ongoing efforts to stop the Yemeni war, strategies for more innovative vaccine delivery or provision and fulfilling the increasing demands are needed, especially in governorates with confrontations. Enhancing EPI performance through supportable investments in infrastructure that was destroyed by the war and providing decentralized funds are a prerequisite.
Vaccination, one of the greatest achievements in medicine and public health, has greatly reduced morbidity, mortality, and health care costs [
The World Health Organization and the United Nations Children’s Fund developed the Global Immunization Vision and Strategy (GIVS) 2006-2015. One of the set goals of GIVS for any country is to reach at least 90% national vaccination coverage and at least 80% vaccination coverage in every district or equivalent administrative unit [
In Yemen, the strategy for the national Expanded Program on Immunization (EPI) 2011-2015 was to reach 95% coverage at the national level, and not less than 80% for diphtheria, tetanus, and pertussis at the district level by 2015 [
This study aimed to determine the immunization coverage of the children under 1 year, during the 2015 war.
A soft copy of data aggregated by EPI during 2015-2015 was obtained from EPI in Excel format, which collected data from all 23 governorates, 333 districts, and 3096 vaccination sites in Yemen. The data included the following variables: the total population, targeted children, and the number of vaccinated children by each vaccine type and governorate. The vaccination coverage was calculated at the national and governorate levels by dividing the number of actually vaccinated children by the estimated population of children under 1 year. The governorates were divided into confrontation and nonconfrontation governorates depending on the battle on the ground. Analysis was carried out using Epi Info 7.2 (CDC) and Excel. Data were described using graphs and percentages.
The immunization coverage increased for penta-3 vaccine and measles coverage of vaccination (MCV) during 2012-2014, but coverage dropped in 2015. Compared with the national target, the coverage was still below the national target (
Immunization coverage for penta-3 vaccine compared to the national target, 2012-2015.
Immunization coverage for measles compared to the national target, 2012-2015.
The first table in
The second table in
Despite recent progress in vaccination coverage in Yemen, a very scattered population, with more than 130,000 population sites all over the country, poses a major challenge. Furthermore, the current political situation and insecurity have negatively affected the progress. Our findings showed a gradual increase in the coverage of penta-3 vaccine and MCV during 2012-2014, compared with the year 2011 that witnessed the political crises and the Arab Spring. Such an increase might be owing to the relative political stability and improvement of security after the uprising came to a successful conclusion. However, Al Jawf and Sa’dah governorates did not show such an increase as they continue to suffer from insecurity and fights, in addition to having sparse population with difficult access to vaccines and poor community awareness and wrong beliefs regarding immunization [
The coverage remarkably dropped in 2015 owing to the eruption of the war. Such a drop was more apparent in governorates that witnessed confrontations such as Sa’dah, Lahj, and Taiz. For example, Taiz governorate showed a drop in penta-3 vaccine coverage from (102,455/110,755) 92.51% in 2014 to (83,182/113,535) 73.27% in 2015 and Sa’dah from (17,511/26,779) 65.64% to (13,849/27,754) 49.90%. However, the coverage increased in Ibb and Raymah governorates that were less affected by the war and showed an increase in their population because of displacement from less secure and confrontation-prone governorates. For example, Raymah showed an increase in penta-3 vaccine coverage from (15,868/18,255) 86.92% to (19,871/18,810) 105.64% and Ibb from (93,106/99,919) 93.18% to (103,435/102,417) 100.99% in 2015.
In conclusion, this analysis shows the marked negative impact of the 2015 war on immunization coverage, especially in the governorates that witnessed armed confrontations. This could put Yemen at more risk of VPD outbreaks and polio importation. Besides the ongoing efforts to stop the Yemeni war, strategies for more innovative vaccine delivery/provision and fulfilling the increasing demands are needed, especially in governorates with confrontations. Enhancing EPI performance through supportable investments in infrastructure that was destroyed by the war and providing decentralized funds are a prerequisite. Further studies to assess the effect of continuous war on vaccination coverage and to measure the resilience are recommended.
Immunization coverage (percentage) by vaccine type 2012-2015 and penta-3 coverage by governorates, 2012- 2015.
Expanded Program on Immunization
Global Immunization Vision and Strategy
measles coverage of vaccination
vaccine-preventable diseases
None declared.