The new WHO decision-making framework on vaccine use in acute humanitarian emergencies: MSF experience in Minkaman South Sudan.

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Confl Health. 2018 Mar 26;12:11. doi: 10.1186/s13031-018-0147-z. eCollection 2018.

The new WHO decision-making framework on vaccine use in acute humanitarian emergencies: MSF experience in Minkaman South Sudan.

Rull M1 Masson S2 Peyraud N1 Simonelli M1 Ventura A3 Dorion C1 Luquero FJ2 Uzzeni F3 Cigleneki I1.

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Abstract

INTRODUCTION:

The main causes of death during population movements can be prevented by addressing the populations basic needs. In 2013 the World Health Organization (WHO) issued a framework for decision making to help prioritize vaccinations in acute humanitarian emergencies. This article describes MSFs experience of applying this framework in addition to addressing key population needs in a displacement setting in Minkaman South Sudan.

CASE DESCRIPTION:

Military clashes broke out in South Sudan in December 2013. By May 2014 Minkaman a village in the Lakes State hosted some 85000 displaced people. MSF arrived in Minkaman on 28 December 2013 and immediately provided interventions to address the key humanitarian needs (health care access to drinking water measles vaccination). The WHO framework was used to identify priority vaccines: those preventing outbreaks (measles polio oral cholera vaccine and vaccine against meningococcal meningitis A (MenAfrivac®)) and those reducing childhood morbidity and mortality (pentavalent vaccine that combines diphtheria tetanus whooping cough hepatitis B and Haemophilus influenzae type B; pneumococcal vaccine; and rotavirus vaccine). By mid-March access to primary and secondary health care was ensured including community health activities and the provision of safe water. Mass vaccination campaigns against measles polio cholera and meningitis had been organized. Vaccination campaigns against the main deadly childhood diseases however were not in place owing to lack of authorization by the Ministry of Health (MoH).

CONCLUSIONS:

The first field use of the new WHO framework for prioritizing vaccines in acute emergencies is described. Although MSF was unable to implement the full package of priority vaccines because authorization could not be obtained from the MoH a series of mass vaccination campaigns against key epidemic-prone diseases was successfully implemented within a complex emergency context. Together with covering the populations basic needs this might have contributed to reducing mortality levels below the emergency threshold and to the absence of epidemics. For the WHO framework to be used to its full potential it must not only be adapted for field use but most importantly national decision makers should be briefed on the framework and its practical implementation.

KEYWORDS:

Cholera; Crude mortality rate; Diarrheal diseases; Measles; Respiratory infections; Safe drinking water; South Sudan; Under 5 mortality rate; Vaccine preventable outbreaks

PMID: 29599819 PMCID: PMC5868060 DOI: 10.1186/s13031-018-0147-z

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