Sustaining Immunization Under the Roar of Cannons: Lessons Learned from Sudan, June 2023 to December 2024

Abstract

<i>Background: </i>Immunization is known to be a cost-effective intervention; addressing more than (20) diseases. The Expanded Program on Immunization (EPI) was established to ensure target population, especially children, benefit from life-saving immunization services. Securing resources, establishing systems, and demand generation are crucial for successful immunization programs. The ongoing conflict in Sudan, resulting in displacement of over 10 million people, had severely affected country’s immunization services. This study explores the impact of the conflict on Sudan’s EPI and examines the strategies employed to mitigate these challenges. <i>Methods: </i>A qualitative synthesis and desk review were conducted to explore the best practices, innovations, challenges, and lessons learned from June 2023- to December 2024. Five of the authors collaborated to identify sources and extracted data from the EPI reports and records. Two other authors verified the outcomes and complemented it using meeting memos. Compiled findings were shared with other authors for review and feedback. Data was manually organized and analyzed using a thematic analysis. Key themes reflected the situation of EPI program before the conflict, the impact of war on the program, and the response of EPI program. Thematic areas encompassed human resources, cold chain, routine immunization, supplementary immunization activities, surveillance and outbreak investigation. <i>Results: </i>By the end of 2024, the EPI in Sudan started to reverse the decline in immunization services’ coverage and accessibility resulting from war. Modification of service delivery strategies; contemplating the security status district by district was key success factor. Furthermore, program’s resilience was supported by a dedicated, committed, and responsive EPI teams at national and sub-national levels, operating in collaboration and coordination with partners, motivated by a unified vision encapsulated in the slogan “Despite what is happening, vaccination must continue”. <i>Conclusions: </i>To sustain the immunization services in Sudan, the EPI prioritized the cohesion and solidarity of the team, adopting a collaborative approach. This durable essence of unity was especially evident is expanding partnership in security compromised states.