Somalia, a country with a long history of instability, has a fragile healthcare system that is consistently understaffed. A large number of healthcare workers (HCWs) have become infected during the coronavirus disease-19 (COVID-19) pandemic. This report presents the preliminary findings of COVID-19 infection in Somali HCWs, the first of such information from Somalia. This preliminary retrospective study analysed available data on infection rates among Somali HCWs. As of 30 September 2020, 3700 cases of COVID-19, including 98 deaths, had been reported in Somalia; 191 (5%) of these cases were HCWs. During the first 180 days of the outbreak, 311 HCWs were tested for COVID-19 and 191 tested positive (positivity rate: 61%). During the epidemic’s peak, HCWs represented at least 5% of cases. Of the 191 infected cases, 52 (27%) were doctors, 63 (33%) were nurses, seven (4%) were laboratory technicians, and 36% were other staff. More information must be sought to put measures in place to protect the health and safety of HCWs in Somalia’s already understaffed and fragile healthcare system.

Somalia is a complex and fragile setting with a demonstrated potential for disruptive, high-burden measles outbreaks. In response, since 2018, Somalian authorities have partnered with UNICEF and the WHO to implement measles vaccination campaigns across the country. In this paper, we create a Somalia-specific model of measles transmission based on a comprehensive epidemiological dataset including case-based surveillance, vaccine registries, and serological surveys. We use this model to assess the impact of these campaign interventions on Somalian’s measles susceptibility, showing, for example, that across the roughly 10 million doses delivered, 1 of every 5 immunized a susceptible child. Finally, we use the model to explore a counter-factual epidemiology without the 2019–2020 campaigns, and we estimate that those interventions prevented over 10,000 deaths.

Coverage of COVID-19 vaccines in Somalia remains low, including among health workers. This study aimed to identify factors associated with COVID-19 vaccine hesitancy among health workers. In this cross-sectional, questionnaire-based study, 1476 health workers in government and private health facilities in Somalia’s federal member states were interviewed face-to-face about their perceptions of and attitudes toward COVID-19 vaccines. Both vaccinated and unvaccinated health workers were included. Factors associated with vaccine hesitancy were evaluated in a multivariable logistic regression analysis. Participants were evenly distributed by sex, and their mean age was 34 (standard deviation 11.8) years. The overall prevalence of vaccine hesitancy was 38.2%. Of the 564 unvaccinated participants, 39.0% remained hesitant. The factors associated with vaccine hesitancy were: being a primary health care worker (adjusted odds ratio (aOR) = 2.37, 95% confidence interval (CI): 1.15–4.90) or a nurse (aOR = 2.12, 95% CI: 1.05–4.25); having a master’s degree (aOR = 5.32, 95% CI: 1.28–22.23); living in Hirshabelle State (aOR = 3.23, 95% CI: 1.68–6.20); not having had COVID-19 (aOR = 1.96, 95% CI: 1.15–3.32); and having received no training on COVID-19 (aOR = 1.54, 95% CI: 1.02–2.32). Despite the availability of COVID-19 vaccines in Somalia, a large proportion of unvaccinated health workers remain hesitant about being vaccinated, potentially influencing the public’s willingness to take the vaccine. This study provides vital information to inform future vaccination strategies to achieve optimal coverage.

In 2015, the 62nd session of the Regional Committee [RC] of the Eastern Mediterranean Region [EMR] endorsed the Eastern Mediterranean Vaccine Action Plan 2016–2020 (EMVAP) that included postponement of the measles elimination target to before 2020. However, the EMR does not have a regional rubella control or elimination goal. We reviewed the progress of measles and rubella surveillance in context of measles elimination in the Eastern Mediterranean Region during 2019–2022. We compiled data on coverage, reported cases, surveillance indicators, incidence, and genotypes. We conducted an age-cohort analysis to estimate the size of the susceptible population using coverage and SIAs coverage data. We reviewed the dossiers of countries that applied to the Regional Verification Commission [RVC] for the verification of measles and rubella elimination. Between 2019 and 2022, the regional coverage of the vaccine against measles and rubella was stable at 83% for the first dose [MCV1] and increased from 75% to 78% for the second dose [MCV2] after a dip during COVID-19. In the EMRO, eighteen countries are using MR (measles–rubella) and/or measles–mumps–rubella (MMR) vaccines and four are using measles vaccines. The reported regional measles incidence per 1,000,000 was 23.3 in 2019, decreased to 7.4 in 2020, and re-increased to 50 in 2022, with two main genotypes–D8 and B3–in circulation. Both genotypes are considered to be actively circulating in eighteen countries, with different circulating variants of each genotype. There were no genotyping data available from four countries. Measles and rubella surveillance indicators deteriorated in the region. The number of susceptible individuals exceeded one birth cohort in nine of the 22 countries. In 2019–2022, Bahrain, Egypt, Iran, and Oman were verified to have eliminated measles and rubella. While four countries eliminated measles and rubella and another five progressed toward measles and rubella elimination, however, immunity gaps and reported incidence increased in eleven countries. Countries approaching elimination need to prepare verification dossiers, while others need to increase their routine coverage, conduct follow-up campaigns, and improve surveillance. Submission of progress reports to the RVC will measure progress toward the goal.

This paper describes the design and methods of a serosurvey conducted in Somalia in 2021. The study had several concurrent aims: a) to estimate seroprevalence of antibodies to SARS-CoV-2, b) to obtain age-specific data on susceptibility to poliovirus, measles, rubella, diphtheria, and tetanus; and c) to estimate seroprevalence of pathogens causing malaria and neglected tropical diseases. Participants were recruited from persons seeking care at government health facilities as well as friends and family members who accompanied those seeking care. Respondents answered interview questions to establish their demographic profile, their COVID-19 exposure and experience, and, for children, their routine immunization status. Each participant contributed a sample of blood for serum or dried blood spots. Serum samples were analyzed in Somalia for SARS-CoV-2 and dried blood spots were analyzed at the US Centers for Disease Control and Prevention (US CDC) for the other diseases and antigens of interest. This manuscript describes the study design, logistics, laboratory methods, and data management steps used to compile the study dataset. Study results will be reported in a series of manuscripts to follow.

Background: Measles and rubella remain key indicators of immunization system performance and are central to the Immunization Agenda 2030 (IA2030). Disruptions caused by the COVID-19 pandemic have widened immunity gaps and accelerated resurgence of vaccine-preventable diseases across multiple regions. This study assesses progress toward measles and rubella elimination in the WHO Eastern Mediterranean Region (EMR) during 2023–2024. Methods: We conducted a retrospective descriptive analysis of measles and rubella surveillance data, WHO/UNICEF Estimates of National Immunization Coverage (WUENIC), and Joint Reporting Form (eJRF) data for all 22 EMR countries and territories. Key indicators included disease incidence, MCV1 and MCV2 coverage, surveillance performance metrics, and verified elimination status. Results: Regional measles incidence increased from 110.8 to 116.3 per million population, while rubella incidence more than doubled from 1.9 to 4.3 per million. Large outbreaks in Yemen, Iraq, and Afghanistan disproportionally drove regional trends. MCV1 coverage remained stable at approximately 80%, while MCV2 coverage increased marginally from 73% to 75%. Only nine of 22 countries achieved ≥95% coverage for both doses in 2024. Persistent zero-dose populations, high dropout rates, and ongoing immunity gaps sustained transmission across multiple settings. Conclusions: The EMR remains off track to achieve measles and rubella elimination by 2030. Accelerated, equity-focused efforts are urgently needed to strengthen routine immunization systems, reduce zero-dose population, enhance surveillance capacity, and improve outbreak response—particularly in fragile and conflicted-affected settings.