Shots in the Dark: Immunisation in Zones of Armed Conflict in Sub-Saharan Africa

Sub-Saharan Africa’s population continues to suffer from a considerable burden related to infectious diseases. Against the latter, prevention by vaccination is not merely effective: importantly, it is an economical and feasible means of relieving poorly resourced health systems of major stress. The history of immunisation in the region cannot be told without reference to the story of efforts to reach difficult-to-access outlying areas, often impeded by armed conflict. Getting to the areas concerned creates opportunity for a broad spectrum of health interventions, including inter alia, immunisation, mass drug administration (MDA) and screening programmes. A complete history of the struggle for this kind of access is challenging to reconstruct, as it is a politically sensitive topic both for the internationally recognised governments lacking control over their de jure territories and for the intergovernmental organisations that have to work with said governments as their primary partners. In this chapter, we undertake to tell a rudimentary history of the interaction between programmes (and campaigns) of immunisation and armed conflict in Sub-Saharan Africa. We conclude our overview with an assessment of recent developments during the SARS-CoV-2/COVID-19 pandemic and the implications these hold for global security. The latter section also offers a chance to review the tentative narrative emerging from the preceding historical overview, according to which a post-colonial/Cold War era of more centralised and governance-orientated insurgent movements was ensued by the dark times of post-Cold War “new wars” and, especially post-2011, an even darker era of increasingly violent Islamist insurgencies. Regardless of its merits, this narrative stands in contrast with the great overall progress made in the region prior to the SARS-CoV-2/COVID-19 pandemic, including in terms of the actual (albeit uneven) increase of vaccination coverage and the eradication of certain diseases.