At the peak of the SARS-CoV-2 (COVID-19) pandemic, the medical field understandably shifted its efforts to treating patients with COVID-19 and developing vaccines. As people quarantined, other routine medical treatments became less common. One such treatment was routine immunization.
April 24 to 30, 2022 is World Immunization Week, as the World Health Organization (WHO) seeks to promote vaccinations for protection against disease around the world.¹ Routine immunization against conditions like measles, diphtheria, and tetanus were commonplace worldwide long before the COVID-19 pandemic. But as the pandemic grew, routine immunization was disrupted. How can this disruption be addressed?
How COVID-19 Affected Routine Immunization Rates in Children
Though we may not know the entire scope, it is clear that the beginning of the pandemic significantly disrupted routine immunization around the world. A recent study in The Lancet Global Health used WHO data to get a sense of routine immunization disruption in 2020.² In April of 2020, over 50% of WHO member states or countries in the African region, the Americas, the Eastern Mediterranean region, and the South-East Asian region reported disruption to routine immunization sessions. The Americas saw reduced demand for vaccination services in 80% of countries, while 50% had difficulty getting vaccination supplies and 67% had limited workforce availability.
The result of these disruptions was a significant drop-off in administered vaccination doses for much of 2020 compared to similar months in 2019. Globally, there was a decrease of greater than 30% in administered doses of the diphtheria-pertussis-tetanus-containing vaccine (DTP) and the measles-containing vaccine (MCV1) in April 2020 compared to April 2019. In the WHO South-East Asian region, it was over 50%. The Americas saw a 30% year-over-year decrease in MCV1 doses in April 2020, with numbers increasing in May and June before falling again in July.
The researchers concluded that the data showed a large disruption, and that while there was in time a partial resumption, more was needed for an effective catch-up.
Addressing and Mitigating Disruption in Childhood Immunization Rates
How can these disruptions be addressed and mitigated now following the peak of the COVID-19 pandemic? A 2021 study in BMJ Global Health looked into how Nepal, Senegal, and Liberia worked to address its effects, and found potential solutions for the rest of the world.³ Routine immunization efforts suffered at the beginning of the pandemic in these countries for a number of reasons; delayed shipments of vaccination supplies, fear of COVID-19 exposure, and difficulty accessing vaccination, among others.
Some of the ways these countries addressed those concerns and tried to mitigate disruption included:
- Implementing more communication and outreach programs
- Increasing alternative delivery options for vaccination, including additional hours and home visits
- Leveraging current records to track which patients are missing doses
- Conducting catch-up services and campaigns once COVID-19 risks could be mitigated
These attempts at mitigation, the researchers concluded, were important components of addressing disruption in childhood immunizations. However, they also stressed that one-size-fits-all strategies to get patients caught up should be avoided.
1. World Immunization Week 2022. World Health Organization. https://www.who.int/campaigns/world-immunization-week/world-immunization-week-2022. Accessed April 22, 2022.
2. Shet A, Carr K, Danovaro-Holliday MC, et al. Impact of the SARS-CoV-2 pandemic on routine immunisation services: evidence of disruption and recovery from 170 countries and territories. Lancet Glob Health. 2022;10(2):e186-e194. doi:10.1016/S2214-109X(21)00512-X
3. Dixit SM, Sarr M, Gueye DM, et al. Addressing disruptions in childhood routine immunisation services during the COVID-19 pandemic: perspectives from Nepal, Senegal and Liberia. BMJ Glob Health. 2021;6(7):e005031. doi:10.1136/bmjgh-2021-005031