Childhood vaccinations in conflict-affected settings: a case study from a frozen conflict zone

BACKGROUND: Disruptions in healthcare are common in conflict-affected settings, particularly in frozen conflict zones where an already fragile health system is affected by the uncertain geopolitical context. Childhood vaccinations are vital in such settings to prevent illness in an already vulnerable population. To better understand health services in a frozen conflict zone, we examined vaccination coverage among children in Nagorno-Karabakh. METHODS: Multistage cluster sampling was used to sample households in Nagorno-Karabakh during the summer of 2022. From each household, one woman between the ages of 18 and 49 participated in an interviewer-administered survey. Vaccination status was reported by mothers who had at least one child less than 5 years-old. RESULTS: Among the 299 mothers with at least one child under 5 years-old, 288 (96.3%) reported all children as vaccinated, 4 (1.3%) reported some as vaccinated, and 7 (2.3%) reported all as unvaccinated. Among those vaccinated, 279 (95.5%) reported their children as fully vaccinated while 12 (4.1%) were not up to date, mostly due to illness at time of vaccination (41.7%). Similarly, women with only some children vaccinated reported illness as the main reason (50.0%). Women whose children were unvaccinated cited lack of trust (42.8%) and general unwillingness (42.8%) as the main reasons. A majority of the mothers (94.6%) reported receiving a call from the local polyclinic to remind them of the next vaccination and most (91.0%) sought reliable information about vaccinations from physicians. CONCLUSIONS: Vaccination coverage was high demonstrating the ability of Nagorno-Karabakh to provide health services. Most women were informed by the clinic and consulted with their physicians which should be utilized to enhance child health services. Future studies should examine vaccination access and delivery in Nagorno-Karabakh to provide a model for vaccination services and to bolster health security in frozen conflict zones. KEY MESSAGES: • Despite healthcare-related challenges in a frozen conflict zone, vaccination delivery services in Nagorno-Karabakh were effective, with almost all children under 5 years-old fully vaccinated. • Reminders from clinics and trust in physicians likely influenced vaccination coverage in Nagorno-Karabakh and should be considered to build sustainable vaccination systems in frozen conflict zones.