Peer-reviewed article
The future impact of zero-dose children in inaccessible conflict-affected areas of Somalia: aligned with the immunization agenda 2030.
Hussein SA, Osman MM, Hassan MM, Hassan YSA, Hussein AA et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This review examines zero-dose children (those who have never received a vaccine dose) in conflict-affected areas of Somalia, where about 60% of children remain unvaccinated. Zero-dose hotspots are concentrated in rural, nomadic, and conflict-affected zones, with major barriers including insecurity, limited healthcare access, supply chain disruptions, and community mistrust. Despite progress since 2000 with measles vaccination coverage rising to 71% for the first dose, reaching unvaccinated children in inaccessible areas remains a critical challenge aligned with the Immunization Agenda 2030.
Key points
- About 60% of children in Somalia are zero-dose, compared to 18 million globally, with over half of global zero-dose children in conflict or humanitarian settings
- Lower Juba region reached a peak of 62% zero-dose prevalence, with hotspots concentrated in rural, nomadic, and conflict-affected zones
- Key barriers include insecurity, limited access, disrupted supply chains, workforce shortages, and demand-side barriers such as mistrust and misinformation
- Humanitarian efforts are frequently hindered by checkpoints, blockades, and security concerns that prevent vaccine delivery
- Measles vaccination coverage (MCV-1) improved from 50% in 2000 to 71% by 2024, and MCV-2 from 5% to 55%, showing recent progress
Limitations
This is a narrative review synthesizing existing literature rather than primary research, so it cannot directly measure the impact of specific interventions or provide quantitative evidence on effectiveness. The review cannot determine causality or provide comparative effectiveness data between different approaches to reaching zero-dose children.
Abstract
Background The Immunization Agenda 2030 (IA2030), led by WHO and partners, targets the global challenge of zero-dose children, who face higher risks of vaccine-preventable diseases. Globally, 18 million children remain zero-dose, with over half in conflict or humanitarian settings. In Somalia, about 60% of children are zero-dose, and during the 2022-2024 drought, over 70,000 deaths occurred, with nearly 40% among children under five. This review explores the burden, determinants, and geographic distribution of zero-dose children in Somalia's conflict-affected regions. Methods This narrative review followed SANRA guidance. We searched PubMed, Scopus, Web of Science, Google Scholar, and key institutional sites (WHO, UNICEF, ReliefWeb, MoH Somalia, NGOs) for English-language literature (1990-July 31, 2025). From 197 records were identified, 82 new studies were included, resulting in a total of 279 studies after de-duplication and two-reviewer screening. Evidence was synthesized thematically and aligned to Immunization Agenda 2030 (IA2030) priorities. Results Zero-dose hotspots are concentrated in rural, nomadic, and conflict-affected zones, with Lower Juba reaching a peak of 62%. Key challenges include insecurity, limited access, disrupted supply chains, workforce shortages, and demand-side barriers like mistrust and misinformation. Humanitarian efforts are frequently hindered by checkpoints, blockades, and security concerns. From 2000 to 2024, Somalia's routine immunization program showed significant progress, with MCV-1 coverage rising from 50 to 71%, and MCV-2 from 5 to 55%, as per the WHO/UNICEF WUENIC data for the African region. Conclusion Zero-dose children in inaccessible Somali districts are a pressing equity and health-security challenge. Sustaining recent national gains while fulfilling Immunization Agenda 2030 (IA2030)'s "leave no one behind" requires tailored outreach to remote communities, strengthened surveillance and e-registries for defaulter tracing, resilient cold-chain and WASH linkages, empowered community health workers (especially women), negotiated humanitarian access, and a progressive domestic co-financing roadmap alongside partner support.