Abstract
Childhood immunisation services have been disrupted by the COVID-19 pandemic. WHO recommends considering outbreak risk using epidemiological criteria when deciding whether to conduct preventive vaccination campaigns during the pandemic. We used two to three models per infection to estimate the health impact of 50% reduced routine vaccination coverage in 2020 and delay of campaign vaccination from 2020 to 2021 for measles vaccination in Bangladesh, Chad, Ethiopia, Kenya, Nigeria, and South Sudan, for meningococcal A vaccination in Burkina Faso, Chad, Niger, and Nigeria, and for yellow fever vaccination in the Democratic Republic of Congo, Ghana, and Nigeria. Our counterfactual comparative scenario was sustaining immunisation services at coverage projections made prior to COVID-19 (i.e. without any disruption). Reduced routine vaccination coverage in 2020 without catch-up vaccination may lead to an increase in measles and yellow fever disease burden in the modelled countries. Delaying planned campaigns in Ethiopia and Nigeria by a year may significantly increase the risk of measles outbreaks (both countries did complete their supplementary immunisation activities (SIAs) planned for 2020). For yellow fever vaccination, delay in campaigns leads to a potential disease burden rise of >1 death per 100,000 people per year until the campaigns are implemented. For meningococcal A vaccination, short-term disruptions in 2020 are unlikely to have a significant impact due to the persistence of direct and indirect benefits from past introductory campaigns of the 1- to 29-year-old population, bolstered by inclusion of the vaccine into the routine immunisation schedule accompanied by further catch-up campaigns. The impact of COVID-19-related disruption to vaccination programs varies between infections and countries. Planning and implementation of campaigns should consider country and infection-specific epidemiological factors and local immunity gaps worsened by the COVID-19 pandemic when prioritising vaccines and strategies for catch-up vaccination. Bill and Melinda Gates Foundation and Gavi, the Vaccine Alliance.
Highlights
Childhood immunisation services have been disrupted by the COVID-19 pandemic in at least 68 countries during 2020 with around 80 million under 1-year-old children being affected (Nelson, 2020; Science (AAAS), 2020; United Nations Children’s Fund (UNICEF), 2020; World Health Organization (WHO), 2020a)
Routine immunisation was one of the most disrupted services relative to other essential health services based on a WHO pulse survey in May and June 2020 that was focused on continuity of essential health services during the COVID-19 pandemic (WHO, 2020c)
We present output from an average scenario, which is defined differently across models based on their characteristics: model projection from mean or median (YF/Imperial) of input parameters, median projection from posterior of fitted force of infection (YF/Notre Dame), mean of stochastic output projections
Summary
Childhood immunisation services have been disrupted by the COVID-19 pandemic in at least 68 countries during 2020 with around 80 million under 1-year-old children being affected (Nelson, 2020; Science (AAAS), 2020; UNICEF, 2020; WHO, 2020a) This has occurred for several reasons – the diversion of health care staff, facilities, and finances to deal with COVID-19 treatment and response; reluctance of individuals to bring children to be vaccinated due to fear of infection; barriers to travel due to local physical distancing measures; disruptions in vaccine supply chains; lack of personal protective equipment; and decisions to stop or postpone vaccination campaigns to reduce the risk of transmission during such campaigns. The guidance recommended a temporary suspension of mass vaccination campaigns, but continuation of routine immunisation services by the health systems while maintaining physical distancing and infection prevention and control measures for COVID-19. Planning and implementation of campaigns should consider country and infection-specific epidemiological factors and local immunity gaps worsened by the COVID-19 pandemic when prioritising vaccines and strategies for catch-up vaccination
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