Leach Katie, Checchi Francesco
Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, United Kingdom.
Vaccine. 2022 May 9;40(21):2970-2978. doi: 10.1016/j.vaccine.2022.03.034. Epub 2022 Mar 24.
The risk factors that emerge with the onset and protraction of humanitarian crises leave populations at a heightened risk of excess morbidity and mortality from vaccine-preventable diseases (VPDs). There is currently little clarity on which vaccines are being used in crises throughout the world, and whether vaccination decisions correspond to local disease threats. This review aimed to collect and analyse such information.
We reviewed vaccination services from January 2015 to June 2019 across all 25 humanitarian responses that had an activated coordination mechanism during this period. A range of online sources and informants within the humanitarian sector were consulted to compile data on which vaccines were provided in each crisis, and the modality and timing of vaccine provision. The package of vaccination services since the start of each crisis was then compared with local disease burden (baseline + excess due to crisis-emergent risk factors).
The range of vaccines used in humanitarian crises appears limited. When offered, vaccines were primarily delivered through the pre-existing routine schedule, with few supplementary actions taken in recognition of the need for rapidly enhancing population immunity. Vaccine packages mostly did not address the actual range of VPDs that likely accounted for substantial disease risk.
This review suggests inconsistencies and inequities in vaccine provision to crisis-affected populations. A consistent, standardised and broader approach to vaccine use in crises is needed.
人道主义危机爆发及持续过程中出现的风险因素，使人们因疫苗可预防疾病（VPD）而出现超额发病和死亡的风险增加。目前，对于全球危机中正在使用哪些疫苗，以及疫苗接种决策是否与当地疾病威胁相对应，几乎没有明确的认识。本综述旨在收集和分析此类信息。
我们回顾了2015年1月至2019年6月期间所有25次人道主义应对行动中的疫苗接种服务，这些应对行动在此期间都启动了协调机制。我们咨询了一系列在线资源和人道主义部门的信息提供者，以汇编每次危机中提供了哪些疫苗以及疫苗提供的方式和时间的数据。然后将每次危机开始以来的疫苗接种服务套餐与当地疾病负担（基线+因危机出现的风险因素导致的超额负担）进行比较。
人道主义危机中使用的疫苗种类似乎有限。在提供疫苗时，主要是按照预先存在的常规时间表进行接种，几乎没有采取补充措施来认识到迅速增强人群免疫力的必要性。疫苗套餐大多没有涵盖可能导致重大疾病风险的实际VPD范围。
本综述表明，在向受危机影响人群提供疫苗方面存在不一致和不公平现象。在危机中需要采取一致、标准化和更广泛的疫苗使用方法。
