Abstract
BackgroundThe COVID-19 pandemic has disrupted the delivery of immunisation services globally. Many countries have postponed vaccination campaigns out of concern about infection risks to the staff delivering vaccination, the children being vaccinated, and their families. The World Health Organization recommends considering both the benefit of preventive campaigns and the risk of SARS-CoV-2 transmission when making decisions about campaigns during COVID-19 outbreaks, but there has been little quantification of the risks.MethodsWe modelled excess SARS-CoV-2 infection risk to vaccinators, vaccinees, and their caregivers resulting from vaccination campaigns delivered during a COVID-19 epidemic. Our model used population age structure and contact patterns from three exemplar countries (Burkina Faso, Ethiopia, and Brazil). It combined an existing compartmental transmission model of an underlying COVID-19 epidemic with a Reed-Frost model of SARS-CoV-2 infection risk to vaccinators and vaccinees. We explored how excess risk depends on key parameters governing SARS-CoV-2 transmissibility, and aspects of campaign delivery such as campaign duration, number of vaccinations, and effectiveness of personal protective equipment (PPE) and symptomatic screening.ResultsInfection risks differ considerably depending on the circumstances in which vaccination campaigns are conducted. A campaign conducted at the peak of a SARS-CoV-2 epidemic with high prevalence and without special infection mitigation measures could increase absolute infection risk by 32 to 45% for vaccinators and 0.3 to 0.5% for vaccinees and caregivers. However, these risks could be reduced to 3.6 to 5.3% and 0.1 to 0.2% respectively by use of PPE that reduces transmission by 90% (as might be achieved with N95 respirators or high-quality surgical masks) and symptomatic screening.ConclusionsSARS-CoV-2 infection risks to vaccinators, vaccinees, and caregivers during vaccination campaigns can be greatly reduced by adequate PPE, symptomatic screening, and appropriate campaign timing. Our results support the use of adequate risk mitigation measures for vaccination campaigns held during SARS-CoV-2 epidemics, rather than cancelling them entirely.
Highlights
The COVID-19 pandemic has disrupted the delivery of immunisation services globally
Our objective was not to predict the actual SARS-CoV-2 epidemics experienced by these particular countries, but rather to generate plausible scenarios using alternative demography and contact patterns to examine the implications for the risk associated with vaccination campaigns
Our base case simulations resulted in epidemics that are similar across country settings (Fig. 1)
Summary
The COVID-19 pandemic has disrupted the delivery of immunisation services globally. The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has severely disrupted healthcare service delivery globally. The same survey reported that one of the most severely disrupted services has been the delivery of both outreach and facility-based immunisation. This disruption has resulted from multiple factors including interruption of supply chains, limitations on travel, and diversion of finances and healthcare workers due to COVID-19 and the associated response. One important reason for the disruption has been concern around the potential for SARS-CoV-2 transmission during the provision of immunisation, through delivery of vaccination campaigns [2]. There is particular concern over putting vaccination staff at increased risk of COVID-19, since healthcare workers are already at high risk of COVID-19 [3], and healthcare workforce pressures are acute due to the need to care for COVID-19 patients
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