Crossing frontlines to deliver life-saving vaccines in Sudan
Cross-border negotiations could clear new routes for vaccines to be delivered to children in war-torn Sudan.
- 15 October 2024
- 5 min read
- by Priya Joi
Across Sudan, the sound of childhood laughter has been replaced by gunfire and bombing. The country’s youth have been caught in the crossfire of a devastating civil conflict, which has driven nearly 5 million children from their homes since erupting in April last year.
Breakdowns in vaccine supply routes and a fragile health system has meant that children have struggled to receive lifesaving vaccines protecting them from diseases such as measles, rubella or polio. A staggering 43% of children in Sudan are now missing out on these basic vaccines.
Now, however, there is hope. Efforts to ease vaccine supply routes into the country are finally bearing fruit, in a development that would allow immunisation to reach millions of children.
“We are getting ready for a massive vaccine catch-up effort in 2025, which is urgently needed to protect extremely vulnerable children,” says Anne Cronin, Gavi's Senior Country Manager for Sudan. This effort will be facilitated by the creation of two new routes for vaccine delivery into the country.
Since April 2023, the sole current entry point to get vaccines into the country is in Port Sudan in the east, but conflict between different armed forces has meant that sending supplies across the country has been extremely challenging.
Despite the difficulties in moving supplies in the middle of conflict, Save the Children has been able to deliver vaccine supplies to South Kordofan state and resume vaccination services with full strategies in 11 out of 14 localities, including two areas controlled by non-government forces and localities that are very hard-to-reach localities due to the security situation and rough road.
We’ve achieved this through integration of our immunisation services with other ongoing humanitarian interventions (e,g. emergency response and primary health care services that we deliver).
- Asrar Fadulelsied, Immunization Project Manager, Save the Children International, Sudan Country Office.
Long-running cross-border negotiations have meant that an additional route through Chad in the west and another through South Sudan could become operational in the coming months, says Cronin.
This will be a critical move in protecting the country’s children, who are already at extreme risk of infection.
Concurrent disease outbreaks
The conflict, alongside increased climate change-related weather events, has already led to outbreaks of life-threatening diseases such as cholera, dengue and malaria.
On 12 August 2024, Sudan’s Federal Ministry of Health declared a cholera outbreak after a new wave of cholera cases was reported. Between 22 July and 15 September, 8,457 cases and 299 deaths were reported across eight states in Sudan.
Earlier this month, UNICEF airlifted 1.4 million cholera vaccine doses with Gavi support to inoculate more than a million people in River Nile, Kassala and Gedaref states. This followed 404,000 doses sent in September for Kassala State.
“We are racing against time. With heavy rains and flooding, diseases can spread more rapidly and severely worsen the outlook for the children in the affected states and beyond,” said Sheldon Yett, UNICEF Representative to Sudan.
There is an urgent need for the malaria vaccine too, and the approval of vaccine roll-out had been put on hold in 2023 due to the conflict. The vaccine is now set to be rolled out on November 3.
Keeping vaccines flowing
Sudan has been beset by violence for decades, and when fighting erupted during Ramadan in April 2023 much of the capital city, Khartoum, was destroyed. So too were vaccine stores, disrupting the ability of organisations such as Gavi and partners, including Save the Children and UNICEF, to distribute vaccines to the rest of the country.
Vaccine delivery in Sudan has never been easy. The country is immense – it is the third largest country in Africa, half the size of Europe. Repeated humanitarian crises over decades and disruptions to immunisation programmes during the COVID-19 pandemic meant that some parts of the country were only just starting to see vaccine deliveries resume before the current conflict broke out.
Nevertheless, Sudan has been progressive in vaccine introductions. It was the first country in the meningitis belt of Africa to roll out the meningitis A vaccine in 2016.
In 2018, the percentage of children in Sudan who had never received a single dose of basic vaccines (‘zero-dose’ children) was just 1% and the number of children reached with DTP1 (the first dose of the vaccine against diphtheria, tetanus and pertussis) was 98%.
That has shifted radically since the conflict began. In 2023 only 67% of vaccines provided by Gavi could be delivered. By August 2024, only 16% of 2024’s allocation had been delivered.
With the expectation that the new routes will lead to a huge uptick in immunisation rates, around 71% of 2024’s doses are planned for delivery by the end of this year.
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Forging new supply lines
When it became impossible to use Khartoum as a base for delivering vaccines, Port Sudan became the only entry point, and Gavi and partners had to build the supply lines that would take doses through the country.
“We were literally crossing frontlines to do so,” says Cronin. “At one point we managed to bring a convoy as far as Al-Fashir in North Darfur, and the EPI manager from West Darfur negotiated the transport of vaccines to the rest of Darfur.”
Since the war broke out, only two rounds of vaccines have been able to be delivered, which speaks to the difficulty of the process.
Medicines have been transported more easily because unlike vaccines, they don’t require a cold chain or a system of refrigeration keeping them at a temperature usually around 2°C to 8°C.
Now, Gavi is working with UNICEF to set up a cold chain hub in Abeche in Chad to be able to create a supply line with Al Junayneh, an hour’s drive away in Sudan. “Fridges are due to arrive any month now,” says Cronin. The hope is to set up a second hub through South Sudan, most likely through Renk.
She concludes: “Gavi and partners remain optimistic that we can reverse the downward trend of immunisation coverage due to the resilient leadership of the Federal Ministry of Health and the strong community groups and mothers who continue to demand and avail vaccination services.”
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