Armed conflicts are a concern for human development and public health and represent a major impediment for realizing Sustainable Development Goal #3: to ensure healthy lives and promote well-being for all at all ages. Vaccination programs can be highly politicized and subjected to major security constraints in war zones, reducing their effectiveness. This article studies how armed conflict impacts immunization rates among children, combining two large datasets. We use health data for 15 conflict-affected countries in sub-Saharan Africa, including multiple Demographic and Health Survey rounds for most. We exploit the fact that age-appropriate vaccinations should take place in the child's first year of life and compare children aged one to five with varying degrees of (local) conflict exposure in their first year of life within the same countries and communities. We differentiate between the effects of local and country-level exposure to conflict on childhood immunization rates. The regression results show that conflict has a nonmonotonic effect on vaccination rates with minor (major) conflicts being associated with higher (lower) full immunization rates. We argue that in the case of minor conflicts, local-level health care access drives the results, whereas for major conflicts it is mainly national channels that drive the result.

中文翻译：

---

公共卫生与武装冲突：系统性中断时期的免疫接种

武装冲突是对人类发展和公共卫生的关注，是实现可持续发展目标 3 的主要障碍：确保健康生活并促进各年龄段所有人的福祉。疫苗接种计划可能会高度政治化，并在战区受到重大安全限制，从而降低其有效性。本文结合两个大型数据集研究武装冲突如何影响儿童的免疫接种率。我们使用了撒哈拉以南非洲 15 个受冲突影响国家的健康数据，包括针对大多数国家的多轮人口和健康调查。我们利用了一个事实，即应该在孩子身上进行适合年龄的疫苗接种” s 生命的第一年，并比较 1 至 5 岁儿童在同一国家和社区的生命第一年中不同程度的（当地）冲突暴露。我们区分地方和国家层面的冲突暴露对儿童免疫接种率的影响。回归结果表明，冲突对疫苗接种率具有非单调影响，较小（主要）冲突与较高（较低）完全免疫接种率相关。我们认为，在轻微冲突的情况下，地方一级的医疗保健服务推动了结果，而对于重大冲突，主要是国家渠道推动了结果。回归结果表明，冲突对疫苗接种率具有非单调影响，较小（主要）冲突与较高（较低）完全免疫接种率相关。我们认为，在轻微冲突的情况下，地方一级的医疗保健服务推动了结果，而对于重大冲突，主要是国家渠道推动了结果。回归结果表明，冲突对疫苗接种率具有非单调影响，较小（主要）冲突与较高（较低）完全免疫接种率相关。我们认为，在轻微冲突的情况下，地方一级的医疗保健服务推动了结果，而对于重大冲突，主要是国家渠道推动了结果。