Why vaccination should be a top priority in relief efforts after Venezuela’s earthquake doublet

The earthquake doublet that struck Venezuela on June 24, 2026, and most severely affected Caracas and La Guaira, has exacerbated humanitarian and public health crises [1]. Emergency response understandably focuses first on search and rescue, trauma care, shelter, safe water, sanitation, and restoration of essential services. However, vaccination should not be deferred until a later recovery phase. It should be recognized as an operational component of emergency health response from the earliest days after a disaster [2].

Earthquakes do not intrinsically cause epidemics [3]. Rather, they create conditions in which pre-existing immunity gaps, population displacement, overcrowding, interruption of health services, loss of vaccination records, and damage to cold-chain and surveillance systems can allow otherwise preventable transmission [4]. In Venezuela, these risks are amplified by a prolonged severe humanitarian crisis and longstanding disruptions affecting access to health care, medicines, water, sanitation, electricity, transport, laboratory services, and routine immunization [5]. For example, Venezuela’s Expanded Programme on Immunization (EPI) has long omitted the pneumococcal conjugate vaccine, leaving successive birth cohorts without routine protection against severe pneumococcal disease [4].

At the time of writing, the post-earthquake vaccination response appears to remain anchored in Venezuela’s Ministry of Health and its EPI. Publicly reported measures include Pan American Health Organization (PAHO) support to the Ministry of Health, coordination for the procurement and delivery of vaccines, medicines, and supplies, and incorporation of shelters and field hospitals into early-warning activities for vaccine-preventable and other outbreak-prone diseases. However, no publicly accessible national post-earthquake vaccination directive has been clearly identified that specifies vaccine priorities by phase, target groups in shelters and health-care facilities, procedures for people with lost or uncertain records, cold-chain redistribution, emergency stock requests, documentation, and follow-up. Such a directive should be issued or updated urgently, led by the Ministry of Health through the EPI, and implemented in collaboration with subnational health authorities, scientific societies, PAHO, the United Nations Children's Fund (UNICEF), and community partners [4,6].

The immediate vaccination priority is tetanus prevention integrated into trauma care. People injured by debris, metal, glass, crush injuries, or soil-contaminated wounds require prompt wound cleaning, clinical assessment, tetanus vaccination, and tetanus immunoglobulin when indicated. This intervention must be incorporated into triage and surgical care, with referral pathways and rapid redistribution mechanisms when immunoglobulin is unavailable locally [6].

At the same time, emergency response must preserve and rapidly restore routine immunization. Children, adolescents, and adults who have missed doses, lost vaccination cards, or have an unverified immunization history should not be excluded from protection. Vaccination teams should use age-appropriate catch-up schedules without restarting interrupted series, prioritizing measles-rubella, polio, diphtheria-tetanus-pertussis–containing vaccines, hepatitis B, and other nationally recommended vaccines (or received by donations) [[2], [3], [4]].

This approach is especially important in shelters, camps, and collective settings, where crowding and disrupted access to primary care may increase the consequences of immunity gaps. In camps or shelters where displacement is prolonged, and access to safe water, sanitation, and food hygiene is disrupted, hepatitis A vaccination should also be considered for susceptible displaced people according to national guidance, product availability, and local risk assessment, particularly when cases, documented exposure, or credible risk of fecal–oral transmission is identified [7,8]. This measure should be integrated with safe water, sanitation, hygiene, food-safety measures, and surveillance, rather than used as a substitute for them. Influenza and COVID-19 vaccination should be prioritized for eligible people at increased risk of severe disease, including older adults, pregnant women, people with chronic conditions or immunosuppression, health workers, and humanitarian responders. Vaccinating responders is not only an occupational health measure; it also helps protect affected communities and preserve the operational capacity of overstretched health services [9,10].

The principal challenge is operational. Vaccines can only protect when they are available, safely stored, transported, administered, documented, and linked to follow-up. Relief efforts should therefore support rapid stock assessment; protection and restoration of cold-chain capacity; availability of diluents, syringes, safety boxes, fuel, transport, and trained personnel; mobile vaccination teams for shelters and isolated communities; and simple paper-based or electronic mechanisms for documenting doses and identifying missed opportunities (Table 1) [11].

Table 1.

Operational vaccination priorities after Venezuela’s earthquake doublet.

Phase	Vaccination priority	Operational steps and accountable outputs
First 72 hours	Integrate vaccination into emergency triage and prevent immediate missed opportunities.	The Ministry of Health/EPI and subnational teams should issue or activate a short post-earthquake vaccination directive; map functional vaccination points, shelters, field hospitals, and referral centers; assess stocks of vaccines, tetanus immunoglobulin, syringes, safety boxes, cold-chain capacity, fuel, transport, and personnel; and integrate tetanus prophylaxis into wound triage. Outputs should include a daily stock-and-cold-chain report, a list of functioning vaccination sites, and a redistribution plan for vaccines and immunoglobulin.
Days 3–28	Restore routine immunization and implement catch-up vaccination in shelters and affected communities.	Mobile teams and temporary vaccination points should prioritize children with missed or uncertain doses, people with lost cards, pregnant women, older adults, people with chronic diseases or immunosuppression, health workers, and responders. In camps or shelters with prolonged WASH disruption, food-hygiene concerns, documented exposure, or suspected hepatitis A transmission, teams should assess the feasibility of targeted hepatitis A vaccination for susceptible displaced people, alongside WASH and surveillance interventions. Vaccination should follow age-appropriate catch-up schedules without restarting interrupted series. Outputs should include documented doses, updated or replacement vaccination cards, defaulter lists, referral for incomplete schedules, and weekly reporting of coverage gaps by shelter or municipality.
Supply continuity	Reduce supply disruption and prevent fragmented donations.	National authorities, PAHO, UNICEF, and partners should use a rapid gap analysis to request and route vaccines, immunoglobulin, cold-chain equipment, injection supplies, fuel, and transport support. PAHO procurement mechanisms and donor financing should be used where appropriate for quality-assured emergency replenishment. Bilateral donations should be accepted only after verification of product registration, expiry dates, batch traceability, labeling, cold-chain integrity, and compatibility with national schedules. Outputs should include a consolidated national request list, batch-tracking records, and coordinated distribution through the EPI.
Recovery phase	Rebuild immunization records and strengthen routine services.	EPI teams should reconcile paper and electronic records, complete delayed schedules, restore cold-chain equipment, relink vaccination to primary care and surveillance, and use community outreach to recover children and adults who were missed during displacement. Outputs should include restored registries, completed catch-up schedules, repaired or replaced cold-chain equipment, and integration of vaccination monitoring into recovery health services.

These actions must be led by Venezuela’s Ministry of Health through the EPI, in coordination with subnational health authorities, affected communities, and humanitarian partners. Supply disruption should be addressed through a rapid national gap analysis by antigen, dose presentation, location, expiry date, cold-chain status, syringes, safety boxes, immunoglobulin, fuel, transport, and workforce availability. PAHO’s emergency appeal and its regional procurement mechanisms, including the Revolving Fund for vaccines and the Strategic Fund for essential medicines and public-health supplies, could help convert donor financing into quality-assured products, cold-chain inputs, injection supplies, and emergency replenishment. UNICEF and other humanitarian partners can complement this by supporting last-mile delivery, cold-chain repair, outreach in shelters, community mobilization, and documentation. Bilateral donations from countries in the region should be channeled through the national EPI and PAHO coordination mechanisms, with prior verification of product registration, expiry dates, batch traceability, labeling, cold-chain integrity, and compatibility with national schedules. Parallel campaigns, uncoordinated donations, and disconnected records risk fragmenting the response at the moment when continuity is most needed [12].

The technical working groups of the EPI should be formally established, bringing together leading Venezuelan scientific bodies, including the national associations of pediatrics, infectious diseases, and public health, as well as the Academy of Medicine, to provide coordinated expert guidance. Their participation is essential to strengthen evidence-based decision-making, ensure the continuity of vaccination strategies, and support the national authorities in addressing current gaps in supply, coverage, and epidemiological risk [4].

Venezuela’s earthquake doublet is a reminder that vaccination is not optional in recovery. It is a life-saving intervention that protects injured people, reduces susceptibility among displaced populations, safeguards responders, and helps prevent a seismic emergency from becoming a second, avoidable public-health crisis. Embedding vaccination into relief efforts also helps restore trust in essential health services, reconnect families with primary care, identify missed opportunities, and rebuild immunization systems that were already fragile before the disaster. In this context, preparedness means not only procuring vaccines, but ensuring that every eligible person can receive them safely, promptly, and with proper documentation.

CRediT authorship contribution statement

Alfonso J. Rodriguez-Morales: Conceptualization, Writing – original draft. Rest of Authors: Writing – review & editing.

Declaration of competing interest

The authors declare no conflict of interest.