COVID-19-related disruptions to routine vaccination services in India: perspectives from pediatricians

Shet, Anita; Dhaliwal, Baldeep; Banerjee, Preetika; Carr, Kelly; DeLuca, Andrea; Britto, Carl; Seth, Rajeev; Parekh, Bakul Jayant; Basavaraj, GV; Shastri, Digant; Gupta, Piyush

doi:10.1101/2021.01.25.21250040

Cited by 5 publications

(3 citation statements)

References 14 publications

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“…Shet et al . [ 10 ] found a 50% decline in vaccination services in the month of June 2020 as reported by 83% of the 424 surveyed pediatricians. The authors also reported that 76% of the pediatricians expressed concerns about the gap in the coverage of RI.…”

Section: Findings and Discussionmentioning

confidence: 99%

Magnitude and causes of routine immunization disruptions during COVID-19 pandemic in developing countries

Sharma

Singh

et al. 2021

Journal of Family Medicine and Primary Care

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The ongoing pandemic of COVID-19 is a threat to various routine healthcare services. India’s routine immunization (RI) campaign is one of largest ever known. In this review, we discuss the magnitude of disruption of RI activities due to COVID-19 pandemic, various causes of it and recommend ways to reduce the disruptions. Prominent literature databases were searched till April 30, 2021 for articles reporting disruptions of RI due to COVID-19. One study from India and numerous from outside India reported significant declines in the vaccine coverage rates during the lockdown period, which ranged from March 2020 till August 2020 in different regions of the world. Some reported disruptions for all vaccines, while a few reported sparing of birth doses. Shortage of healthcare workers due for them being diverted to patient care services and their reduced movement due to lockdowns and non-availability of public transport were prominent causes. Parents avoided RI sessions as they feared them or their children getting infected. They also faced travel restrictions, just like the healthcare workers. Children of school entry age and those from poorer socio-demographic profile appeared to miss the doses more frequently. Ministry of Health and Family Welfare, India has issued guidelines for conducting fixed and outreach RI sessions while following COVID-appropriate behavior. Promptly identifying missed out children and scheduling catch-up sessions is required to sustain the gains made over the decades by the immunization program of India.

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Section: Findings and Discussionmentioning

confidence: 99%

Magnitude and causes of routine immunization disruptions during COVID-19 pandemic in developing countries

Sharma

Singh

et al. 2021

Journal of Family Medicine and Primary Care

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“…In Bangladesh, 40% of mothers reported disruptions to family planning services [21][22][23]. The findings on disruptions to child vaccination programs are more consistent across countries, as many countries temporarily paused mass vaccination campaigns between March and May 2020 [24][25][26].…”

Section: Introductionmentioning

confidence: 99%

Healthcare utilization and maternal and child mortality during the COVID-19 pandemic in 18 low- and middle-income countries: An interrupted time-series analysis with mathematical modeling of administrative data

et al. 2022

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Background The Coronavirus Disease 2019 (COVID-19) pandemic has had wide-reaching direct and indirect impacts on population health. In low- and middle-income countries, these impacts can halt progress toward reducing maternal and child mortality. This study estimates changes in health services utilization during the pandemic and the associated consequences for maternal, neonatal, and child mortality. Methods and findings Data on service utilization from January 2018 to June 2021 were extracted from health management information systems of 18 low- and lower-middle-income countries (Afghanistan, Bangladesh, Cameroon, Democratic Republic of the Congo (DRC), Ethiopia, Ghana, Guinea, Haiti, Kenya, Liberia, Madagascar, Malawi, Mali, Nigeria, Senegal, Sierra Leone, Somalia, and Uganda). An interrupted time-series design was used to estimate the percent change in the volumes of outpatient consultations and maternal and child health services delivered during the pandemic compared to projected volumes based on prepandemic trends. The Lives Saved Tool mathematical model was used to project the impact of the service utilization disruptions on child and maternal mortality. In addition, the estimated monthly disruptions were also correlated to the monthly number of COVID-19 deaths officially reported, time since the start of the pandemic, and relative severity of mobility restrictions. Across the 18 countries, we estimate an average decline in OPD volume of 13.1% and average declines of 2.6% to 4.6% for maternal and child services. We projected that decreases in essential health service utilization between March 2020 and June 2021 were associated with 113,962 excess deaths (110,686 children under 5, and 3,276 mothers), representing 3.6% and 1.5% increases in child and maternal mortality, respectively. This excess mortality is associated with the decline in utilization of the essential health services included in the analysis, but the utilization shortfalls vary substantially between countries, health services, and over time. The largest disruptions, associated with 27.5% of the excess deaths, occurred during the second quarter of 2020, regardless of whether countries reported the highest rate of COVID-19-related mortality during the same months. There is a significant relationship between the magnitude of service disruptions and the stringency of mobility restrictions. The study is limited by the extent to which administrative data, which varies in quality across countries, can accurately capture the changes in service coverage in the population. Conclusions Declines in healthcare utilization during the COVID-19 pandemic amplified the pandemic’s harmful impacts on health outcomes and threaten to reverse gains in reducing maternal and child mortality. As efforts and resource allocation toward prevention and treatment of COVID-19 continue, essential health services must be maintained, particularly in low- and middle-income countries.

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“…[Rana S 2021] In India, survey data of paediatric healthcare providers from April to June and September 2020 reported a greater than 50% drop in vaccination services by 83% of the respondents in June (n=424 respondents) and 33% in September (n=141). [Shet 2021] In Indonesia, 42% (480/1137) of survey respondents reported disruption of childhood vaccination services in local health facilities and 13% (193/1137) of respondents explained that their children could not be vaccinated because a healthcare facility temporarily stopped vaccination service. Of all respondents, 312 (27%) delayed vaccinating their children for a compulsory vaccination shot.…”

Section: Asiamentioning

confidence: 99%

The Impact of COVID-19 Restrictions on Childhood Vaccination Uptake: A Rapid Review

Heneghan

Brassey

Jefferson

2021

Preprint

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Background Vaccines are highly effective for preventing a range of childhood infections. However, there have been concerns about an alarming decline in vaccinations in 2020 due to the COVID-19 pandemic. Methods We performed a rapid review for studies that assessed childhood vaccination uptake during restrictive phases of the covid-19 pandemic. Results We found 35 published studies that compared changes in the pattern of childhood vaccinations before and during the pandemic. Thirteen were surveys; two mixed-methods surveys and interviews, three modelling studies and 17 retrospective cohort studies with historical controls. We also included ten reports by national or international agencies that had original data on vaccination uptake. Significant global disruptions to vaccine services were reported in Africa, Asia, America (including Latin America and the Caribbean) and Europe. We also found evidence of significant disruption to vaccine uptake for diphtheria tetanus pertussis, BCG, measles and polio. Countries, where vaccination rates were already suboptimal, had greater drops in uptake and there was evidence of smaller declines in younger children compared to older children. Children born to women who could not read and write were more likely to have an incompletely immunized child. Various initiatives were used to drive up vaccination rates post restrictions. Conclusions Obstacles to the delivery of vaccination services during the COVID-19 pandemic drove down immunisation rates, especially in disadvantaged people and poorer countries.

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COVID-19-related disruptions to routine vaccination services in India: perspectives from pediatricians

Cited by 5 publications

References 14 publications

Magnitude and causes of routine immunization disruptions during COVID-19 pandemic in developing countries

Magnitude and causes of routine immunization disruptions during COVID-19 pandemic in developing countries

Healthcare utilization and maternal and child mortality during the COVID-19 pandemic in 18 low- and middle-income countries: An interrupted time-series analysis with mathematical modeling of administrative data

The Impact of COVID-19 Restrictions on Childhood Vaccination Uptake: A Rapid Review

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