War and political motive for vaccine access suppression; Qualitative Explorations of Barriers to Child Vaccination Service in war-torn Tigray, north Ethiopia

Introduction: Despite fast improvements in global vaccination service delivery networks, populations in conflict zones frequently have limited or no access to life-saving vaccines. The COVID-19 pandemic and the devastating war in Tigray significantly affected access to child vaccination. Timely, context-specific, and empirical evidence is crucial to designing recovery strategies to make vaccination accessible in conflict settings. The current study aimed to explore barriers to accessing child vaccination services in a war-torn Tigray region, in Northern Ethiopia. Methods A qualitative study was employed to explore the barriers to accessing child vaccination services among children aged 0–24 months. Three Focused Group Discussions, four in-depth interviews with women having children aged 0–24 months, and six Key Informant Interviews were included in the study. Discussions and interviews were facilitated using semi-structured guides, audio-taped, transcribed verbatim, and coded and analyzed using Atlas. ti version 9.0. Data were thematically analyzed. Results During the war in Tigray, there were barriers to accessing vaccination services for children aged 0–23 months, primarily due to vaccination service supply denial, security concerns to parents about visiting health facilities, damage and looting of health facilities, community and care providers displacement, and a gap in health system leadership communication and service monitoring. Participants frequently also described the consequences of service denial, such as a delay in vaccination initiation, an increase in the prevalence of vaccine-preventable diseases and child mortality, during a search for vaccine service increased security, and the economic burden of mothers and parents, traveling long distances to see traditional healers and holy water. Conclusion & recommendations : during the conflict in Ethiopia, Tigray region, mainly because of supply denial and security concern-related barriers, children aged 0–23 months old were denied their fundamental health right to get life-saving vaccines and other systematic approaches tested during the conflict were not tried in our study area. Because of the life-saving vaccination service discontinuation, many children were left unvaccinated; vaccine-preventable morbidities and mortalities existed, and people were returning to traditional medicinal practice. Addressing the barriers in conflict zone areas needs systematic strategic approaches, and advocacy for vaccination service access during a conflict unconditionally.