Between War and Pestilence: The Impact of Armed Conflicts on Vaccination Efforts: a review of literature

Fausto Ciccacci^1*Emanuela Ruggieri¹Paola Scarcella²Stefania Moramarco¹Mariachiara Carestia¹Daniele Di Giovanni¹Loredana Andreea Silaghi¹Annamaria Doro Altan³Stefano Orlando¹

• ¹Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
• ²Libera Università Maria SS. Assunta, Rome, Lazio, Italy
• ³Università Link Campus, Rome, Lazio, Italy

Armed conflicts profoundly undermine vaccination efforts, disrupting healthcare systems, displacing populations, and enabling the resurgence of vaccine-preventable diseases (VPDs). This narrative review explores the relationship between conflict and immunization coverage through an analysis of 18 studies across diverse regions, including Syria, Nigeria, Afghanistan, Iraq, and Ukraine. Evidence reveals that countries affected by war account for a disproportionate share of global polio and measles cases, often due to damaged infrastructure, interrupted cold chains, and vaccine hesitancy exacerbated by political instability and misinformation. Refugee populations, particularly children, face additional barriers such as poor access, low vaccine literacy, and economic hardship. Despite these challenges, innovative responses have emerged: mobile vaccination teams, negotiated access with armed groups, integration with other humanitarian services, and the use of digital tracking technologies have helped mitigate immunization gaps. However, these are often temporary solutions. Sustainable vaccination coverage requires not only emergency interventions but also long-term conflict resolution. Ceasefires and humanitarian pauses have allowed short-term immunization campaigns, yet their effectiveness is limited without durable peace and systemic rebuilding. The findings highlight the need for coordinated global efforts to protect immunization programs in conflict zones and to uphold vaccination as both a public health priority and a human right.