Sabahelzain Majdi M, Dwyer Harriet, Abimbola Seye, Leask Julie
The University of Sydney School of Public Health, Sydney, New South Wales, Australia
Public Health, Ahfad University for Women School of Health Sciences, Omdurman, Khartoum, Sudan.
BMJ Glob Health. 2025 Jan 30;10(1):e016496. doi: 10.1136/bmjgh-2024-016496.
The Sahel region is a geographical belt in Africa that stretches from the Atlantic Ocean to the Red Sea, between the Sahara Desert in the north and the Savannah in the south. It is characterised by challenging environmental crises and conflicts. This analysis highlights the potential implications of conflict on vaccination across five Sahel countries, including Burkina Faso, Chad, Mali, Niger and Sudan, from 2019 to 2023. It also presents recommendations to improve vaccination coverage in these settings. The WHO Immunisation Data Portal was used to extract data about vaccination coverage and disease outbreaks. With the increasing complexity of humanitarian access in the Sahel, there has been an accumulation of the number of zero-dose and underimmunised children. In 2023 alone, most of these countries had a significant proportion of zero-dose children, particularly Sudan (43%), Mali (22%) and Chad (16%). Nearly half of children in Sudan (49%), 33% in Chad and 23% in Mali are underimmunised. Measles vaccine coverage was consistently below 90% in these countries, except for Burkina Faso. The trend of polio outbreaks (circulating vaccine-derived poliovirus) across these countries showed fluctuations in the number of cases, with Niger having reported several cases over this period, and Chad having 101 cases reported in 2020 alone. Despite relatively high coverage, there were significant outbreaks of polio in Burkina Faso, Sudan and Mali in 2020, which reflects the potential impact of the COVID-19 pandemic. Lessons can be learnt from past diplomatic and programmatic successes, while investments in innovative and flexible approaches may help increase the reach of vaccination programmes in inaccessible areas.
萨赫勒地区是非洲的一个地理区域，从大西洋延伸至红海，位于北部的撒哈拉沙漠和南部的萨凡纳之间。该地区面临着严峻的环境危机和冲突。本分析着重探讨了2019年至2023年期间冲突对包括布基纳法索、乍得、马里、尼日尔和苏丹在内的五个萨赫勒国家疫苗接种的潜在影响。同时还提出了提高这些地区疫苗接种覆盖率的建议。利用世界卫生组织免疫数据门户提取了有关疫苗接种覆盖率和疾病暴发的数据。随着萨赫勒地区人道主义援助准入的复杂性增加，零剂次和未充分免疫儿童的数量不断累积。仅在2023年，这些国家中的大多数都有相当比例的零剂次儿童，尤其是苏丹（43%）、马里（22%）和乍得（16%）。苏丹近一半的儿童（49%）、乍得33%的儿童和马里23%的儿童未得到充分免疫。除布基纳法索外，这些国家的麻疹疫苗接种覆盖率一直低于90%。这些国家脊髓灰质炎疫情（循环疫苗衍生脊髓灰质炎病毒）的趋势显示病例数有波动，在此期间尼日尔报告了多起病例，仅2020年乍得就报告了101例。尽管覆盖率相对较高，但2020年布基纳法索、苏丹和马里仍出现了严重的脊髓灰质炎疫情，这反映了新冠疫情的潜在影响。可以从过去的外交和项目成功经验中吸取教训，而对创新和灵活方法的投资可能有助于扩大疫苗接种计划在难以到达地区的覆盖范围。
