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

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. In May 2020, an estimated 80 million children were thought to be affected by interrupted vaccination services and campaigns,2 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.3 4 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. On their own, each of these disruptions could negatively impact vaccination rates; in combination, they formed substantial obstacles to RI programmes as a whole.Table 1 Summary of main types of pandemic-related disruptions for childhood RI, by vaccination driver, with global examples and reports from Nepal, Senegal and Liberia Vaccination driver Facility readiness Intent to vaccinate Community access Vaccination driver definition Health system supply and capacity, via health facilities, to adequately meet the demand of patients who seek vaccine services Demand for vaccine services by caretakers that, in the absence of all other barriers, would result in children being vaccinated Ability to carry out vaccination via barriers and facilitators between facility readiness and vaccination intent Examples of documented disruptions related to COVID-19 Delayed shipments of vaccine stocks and key supplies due to travel restrictions and reduced flight availability.18 Reduced or halted service avail