Prioritise continued immunisation services at both national and local levels.

Nepal government and Ministry of Health and Population supported uninterrupted RI service, even during lockdown periods.

Nepal introduced the rotavirus vaccine in July 2020, which occurred during a national lockdown period.

Facility-based RI services were sustained, even as community-based outreach and mobilisation services were temporarily suspended during gathering bans.

In Laos, RI services were conducted at fixed sites with physical distancing during national lockdown.2

In Afghanistan, efforts to maintain RI services included strong engagement with religious and community leaders and trainings on vaccine-preventable disease surveillance for volunteers.20

Conduct effective communications and outreach efforts to combat misinformation and engender trust in COVID-19 guidance and RI efforts.

Media campaigns and broadcasting were conducted through cable channels, local TV channels and radio spots to emphasise the importance of childhood immunisation, particularly as EPI programmes were scaling up mobilisation efforts.

Liberia’s EPI developed and implemented multistage risk communication strategic action plan to address widespread rumours and vaccine hesitancy identified through a vaccine perception study in Montessrado and Margibi counties.

Virtual campaigns were conducted with Paraguay’s President and Minister of Health via social media.21

In Cambodia, mobile teams of community health workers with long-standing ties to communities were dispatched for targeted outreach services.15

Sri Lanka’s Ministry of Health leveraged mass media to inform populations that essential health services had resumed, including vaccination, and urged community members to bring children to clinics.22

Identify alternative locations, infrastructure and service delivery platforms outside of traditional health clinics.

In districts with measles outbreaks, 94 ORI centres were set up to facilitate faster catch-up and response, aiming to ensure ORI centres were within a 30 minute walk for the majority of populations.

Health workers offered alternative hours for vaccine administration (eg, after work, during the weekends) in collaboration with community-based organisations.

Community health workers conducted house-to-house vaccination for HPV services amid continued closures of schools.

In Brazil, vaccination posts were set up in empty locations due to lockdown measures (eg, schools).21

Drive-through and home-based vaccination services were conducted in Brazil, Chile and El Salvador.21

In Bolivia, ‘immunisation brigades’ were deployed to high-risk populations at nursing homes and jails.21

Institute IPC and physical distancing measures, and adapt service provision practices accordingly.

Nepal government developed PPE guidelines and ensured all vaccinators received masks and eyewear, and full PPE whenever possible (ie, gloves, footwear, and overalls in addition to masks and eyewear).

Formal IPC training occurred and distancing measures were implemented prior to field mobilisation when measles–rubella campaigns resumed in June 2020.

Nepal’s EPI implemented maximum safety and infection control during rotavirus introduction in July 2020.

Ministry of Health and Social Actions adapted WHO guidelines and gave instructions to all regions and health centres for implementation, allowing staff to tailor these guidelines to align with local needs and strategies across health system levels.

Facility staff implemented IPC protocols, established physical distancing measures and procured PPE, and ran or participated in training webinars coordinated with national-level programmes to prepare for continued immunisation service delivery.

Drawing from WHO guidance, Liberia’s EPI developed country-specific IPC guides and implemented training at facilities for vaccinators to support safe administration practices and reduce exposure risk.

Working with country partners, the EPI team ensured expanded access at least basic PPE, strengthening both the protection of vaccinators and trust among individuals seeking services at facilities and/or being met by vaccinators through community outreach campaigns.

In Pakistan, polio vaccine workers were trained to administer vaccines without touching children, and were provided with full PPE. 23

The Solomon Islands introduced rotavirus vaccine via a phased province-by-province approach rather than the centralised introduction model, advising people not to travel outside of their home provinces to reduce transmission risk.24

In Uganda, government cars were respurposed as shuttles to drive patients and caregivers to clinics to access health services including immunisations.20

In Sri Lanka, patients were limited to one child or family per hour for immunisation services, and sought to give multiple catch-up vaccinations and/or vaccinate all children in a given family per visit when possible.15 22

In Paraguay, tents were set up outside of health centres to separate people seeking vaccination from patients who are ill.21

In Ethiopia, a mass measles campaign targeting 14.4 million children was extended for a longer time period to limit crowding, and conducted vaccinations in outside, well-ventilated areas with physical distancing and sanitation protocols.25

Set up systems to track missed doses—and target follow-up efforts—in areas with the largest disruptions.

Based on contact records kept at district offices, facility staff texted or called parents whose children missed immunisation visits.

In Karachi, Pakistan, children who missed doses were identified and their parents were sent text messages about service resumption via the city’s Electronic Immunisation Registry mobile application.26

In Ghana, parents of children who missed vaccination visits were called about catch-up services and scheduling home visits as needed.27

Conduct catch-up campaigns as soon as SARS-CoV-2 transmission risks can be effectively mitigated.

In Nepal, a mass measles–rubella vaccination campaign was resumed in June 2020 after activities were halted in mid-April due to safety concerns.15

In Liberia, ‘periodic intensification of RI’ (ie, campaign-style vaccine services) were conducted in at least 11 districts by August 2020.

RI services began to resume alongside multistage risk communications plan and expanded safety protocols.

Postponed polio vaccination campaigns were resumed with extensive PPE and safety protocols in several countries, including Syria in June 2020,15 28 Burkina Faso29and Pakistan23 in July 2020, among others.

In Zambia, the June 2020 Child Health Week was leveraged to include catch-up campaigns for inactivated polio vaccines and HPV vaccination.24