Reducing Childhood Immunization to Scale Up COVID-19 Immunization in Low- and Lower Middle-Income Countries: Impact on Under-Five Mortality

Abstract

Background: Since the onset of COVID-19 pandemic, many of the routine childhood immunization campaigns have been postponed or cancelled in many low and lower-middle income countries (LLMICs). In this study, we evaluated the impact of reduction in routine childhood immunization coverage in 75 LLIMCs on the under-five mortality.Method: We estimated the impact on under-five mortality of a 10%-point reduction in the childhood immunization coverage. The analysis was done based on the reported child mortality due to diphtheria, tetanus, pertussis, Haemophilus influenzae type b, Streptococcus pneumoniae , rotavirus, measles and tuberculosis, the baseline coverage of each vaccine in each country and the efficacy of each vaccine.Findings: We estimated a total of 188 078 under-five deaths per 10%-point reduction in childhood immunization coverage in LLMICs. Approximately 61% of the deaths would occur in Sub-Saharan Africa. More than half of the deaths would be due to whooping cough and diarrheal diseases. Furthermore, 31 of 41 Sub-Saharan African countries would have more than 50 extra deaths per 100 000. The most affected countries would be Chad, Niger, and the Central African Republic with 150 or more extra deaths per 100 000. Among the Asian LLMICs, Myanmar and Tajikistan would have the highest number of deaths.Interpretation: Shifting resources from routine childhood immunization to COVID-19 vaccine programs would increase under-five mortality from vaccine preventable diseases. Therefore, maintaining childhood immunization coverage is crucial along with the measures to control COVID-19 pandemic.Funding: This study has been funded by NORAD and Trond Mohn Foundation.Declaration of Interest: None to declare.