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Addressing disruptions in childhood routine immunisation services during the COVID-19 pandemic: perspectives from Nepal, Senegal and Liberia

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Liberia
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BMJ
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Sameer M Dixit, Moussa Sarr, Daouda M Gueye, Kyle Muther, T Ruston Yarnko, Robert A Bednarczyk, Adolphus T Clarke, Fatoumata Diakhite, Aliou Diallo, Bonheur Dounebaine, Shankar B Duwadi, Anna S Ellis, Nancy Fullman, Nathaniel Gerthe, Jhalak S Gautam, Kyra A Hester, Gloria Ikilezi, Rokhaya S Mbengue, Souleymane Mboup, Birahim P Ndiaye, Rajesh Man Rajbhandari, David E Phillips, Matthew C Freeman

Summary box

  • While routine immunisation (RI) was among the health services most affected during the earlier phases of the COVID-19 pandemic, country programmes employed various mitigation strategies to maintain vaccine delivery and/or resume interrupted programming.

  • Perspectives from Nepal, Senegal and Liberia highlight six key components of addressing COVID-19’s effects on RI during the earlier phases of the pandemic: (1) prioritising continued services with strengthened infection prevention control; (2) engaging in effective communications and mobilisation activities, especially to offset misinformation about COVID-19 and vaccines; (3) identifying alternative locations and approaches to providing vaccine services (eg, conducting door-to-door vaccination if facility-based services were not possible); (4) instituting infection prevention controls and physical distancing measures (and adapting service provision accordingly); (5) setting up systems and strategies for reaching children who missed doses amid periods of disruption; and (6) conducting catch-up campaigns as soon as SARS-CoV-2 transmission risks can be minimised.

  • The ways in which COVID-19 has affected RI services have varied over time and across settings, underscoring the importance of contextually tailored mitigation efforts and adaptation, given evolving challenges amid an ongoing pandemic.

  • As countries roll out COVID-19 vaccines, it will be vital to avoid one-size-fits-all implementation strategies and to support the continuance of RI services through this next phase of COVID-19 response.

Introduction: Synthesising Lessons Learned For Addressing COVID-19 Effects on Routine Immunization (RI) through the Exemplars in Global Health Partnership (EGH)

RI emerged as one the most disrupted health services in early-2020 to mid-2020, a global systems shock associated with the COVID-19 pandemic. In May 2020, an estimated 80 million children were thought to be affected by interrupted vaccination services and campaigns, and over 60% of 105 countries reported at least partial RI disruptions to WHO.1 If left unaddressed, these disruptions are poised to halt or even reverse decades of global progress achieved in vaccine delivery and child health.

Yet with great challenges can come great opportunity: knowledge and strategies gained from navigating pandemic’s effects on service delivery could help pave the ways for innovation, adaptions and resilience in the ways that RI programmes are approached more broadly.

How countries have sought to address pandemic-related disruptions has undoubtedly—and rightfully—varied. The complexities of vaccine delivery and how they intersect with sociocultural mores, political commitment and technical requirements make locally relevant, tailored approaches fundamental to any successful RI programme. This is particularly true as COVID-19 continues to affect countries in different ways over time, a trend further fuelled in 2021 by unequitable COVID-19 vaccine roll-out and surges of new virus variants. Lessons learnt during earlier pandemic phases may help support health service continuity and adaptations throughout 2021, a challenge we will collectively face until SARS-CoV-2 is fully contained worldwide.

With this commentary, we discuss experiences from Nepal, Senegal and Liberia in addressing COVID-related disruptions of RI services in early-2020 to mid-2020. We represent a range of stakeholders brought together through the EGH partnership, an initiative focused on identifying lessons learnt from positive outliers in global health and harnessing the expertise of programme leaders, researchers and funders to better understand what underpins health gains and implementation success. As such, our perspectives may not be shared by others in RI programmes for a given context; further, they may not represent challenges and/or mitigation strategies occurring now.