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 readinessIntent to vaccinateCommunity access
Vaccination driver definition
 Health system supply and capacity, via health facilities, to adequately meet the demand of patients who seek vaccine servicesDemand for vaccine services by caretakers that, in the absence of all other barriers, would result in children being vaccinatedAbility 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 availability and/or hours of operation.

  • Inadequate PPE, sanitation and infection control supplies.

  • Deployment of staff for COVID-19 response.19

  • Staff shortages due to COVID-19 infections, fear of exposure and/or burnout.

  • Fear of virus exposure at healthcare settings.6

  • Individuals instructed to postpone or delay non-urgent healthcare services due to concerns about overburdening healthcare facilities.

  • Misinformation or rumours on COVID-19 and vaccination safety.

  • Postponement or cancellation of mass vaccination campaigns, as well as new vaccine introductions.2

  • Restrictions on movement outside of residences and physical access to vaccine services due to social distancing policies and lockdown measures enacted to curb viral transmission.2

Country-reported types of disruptions (via Exemplars in Global Health5)
  • 50% of the country’s immunisation service centres ceased operations after lockdown measures were enacted at the end of March 2020 (ie, from 16 000 to 8000).

  • Hospitals, inclusive of their outpatient departments, shut down frequently from COVID-19 cases among healthcare professionals.

  • Nepal halted measles-rubella campaign in mid-April 2020 due to safety concerns.

  • Health centre staff were tasked with COVID-19 management and response, reducing their availability for other services.

  • Patient attendance substantially declined for vaccine services, and some caretakers refused care when home visits were offered by community workers in full PPE.

  • Rumours spread about an ‘eventual evil’ COVID-19 vaccine trial in the country.

  • School closures halted school-based human papillomavirus service delivery.

  • Mass gatherings were prohibited in mid-March 2020, postponing community-based outreach activities and mobilisation.

  • Health facility-based outreach activities were suspended.

  • Initial gaps in PPE availability for staff occurred.

  • Growing vaccine hesitancy took place, fuelled by rumours of COVID-19 vaccines being tested on citizens.

  • Early days of the country’s state of emergency and curfew were associated with declines in the uptake of RI services.

  • Vaccination driver definitions are adapted from the Phillips and colleagues’ framework on determinants of vaccination.8 9 Reported pandemic-related disruptions in Nepal, Senegal and Liberia are based on information provided by coauthors via direct correspondence and responses provided through guided interviews (online supplemental file 1).

  • EPI, Expanded Programme on Immunization; PPE, personal protective equipment; RI, routine immunisation.