The impact of the Covid-19 pandemic on the uptake of routine maternal and infant vaccines globally: A systematic review

Abstract

Maintaining routine vaccination coverage is essential to avoid outbreaks of vaccine-preventable diseases. We aimed to understand the international impact of the COVID-19 pandemic on routine vaccination in pregnant women and children aged 0-5-years-old. A systematic review of quantitative and mixed methods studies exploring changes in vaccination coverage, vaccination services, and vaccine confidence since the start of the Covid-19 pandemic was conducted. MEDLINE, EMBASE, CINHAL, PsychINFO, Web of Science, Google Scholar, World Health Organisation, UK Government Joint Committee on Vaccination and Immunisation (including EU and US equivalents), and SAGE Journals were searched between 15-17th June 2021. Selected studies included pregnant women, health professionals, and/or infants aged 0-5-years-old including their parents (population); reported on the Covid-19 pandemic (exposure); presented comparisons with pre-COVID-19 pandemic period (comparator) and reported changes in routine maternal and infant vaccination coverage, services, and confidence (outcomes). Sources published only in non-English language were excluded. The Newcastle Ottawa Scale was used to assess study quality and risk of bias (ROB), and a narrative synthesis was undertaken. This review has been registered with PROSPERO (CRD42021262449). 30 studies were included in the review; data from 20 high-income countries (HICs), seven low- and middle-income countries (LMICs), and three regional studies (groups of countries). 18 studies had a low ROB, 12 had a higher risk, however both low and high ROB studies showed similar results. Two studies meeting the inclusion criteria discussed changes in routine vaccinations for pregnant women while 29 studies discussed infants. Both groups experienced declines in vaccination coverage (up to -79%) with larger disruptions in the accessibility and delivery of vaccination services reported within LMICs compared to HICs. Changes in vaccine confidence remained unclear. The COVID-19 pandemic resulted in decreased vaccine coverage and reduced routine vaccination services for pregnant women and infants, impacts on vaccine confidence requires more research.

Malawian caregivers’ experiences with HPV vaccination for preadolescent girls: A qualitative study

“…The impact of the COVID-19 pandemic on immunization coverage remains to be seen although our data suggest it has affected attitudes about, and access to, the HPV vaccine. Many countries saw disruptions to vaccination programs, including HPV vaccination, particularly early in the pandemic, although these disruptions varied greatly in extent, duration, and mitigation [38] , [39] , [40] , [41] , [42] , [43] . We urgently need more data about how the pandemic has affected attitudes about, access to, and norms around vaccines, particularly non-routine vaccination like the HPV vaccine, which may face different barriers than childhood vaccines due to its timing and setting.…”

Review of pediatric emergency care and the COVID‐19 pandemic

“…trending. 43,44 The full consequences for missed in-person, well-child visits and decreased routine vaccination rates and the potential future impact on pediatric emergency care are yet unknown.…”

“…The effect of these missed in‐person appointments for children may be far reaching, including delays in diagnoses that have significant impact on a child's life, as well as susceptibility to disease that may lead to downstream infections and future morbidity and mortality 42 . Additionally, since the start of the pandemic, routine immunization rates in the United States and globally have been down trending 43,44 . The full consequences for missed in‐person, well‐child visits and decreased routine vaccination rates and the potential future impact on pediatric emergency care are yet unknown.…”

Time series analysis of routine immunisation coverage during the COVID-19 pandemic in 2021 shows continued global decline and increases in Zero Dose children

“…It is now widely recognised that routine immunisation (RI) was disrupted globally during the start of the COVID-19 pandemic and throughout 2020 [1][2][3][4]. Single-country studies, and literature reviews have reported delays and interruptions in service delivery, decreases in attendance, and/or full suspension of services during the pandemic, e.g., during periods of quarantine or implementation other nonpharmaceutical interventions.…”