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

The COVID-19 pandemic has inflicted multifaceted disruptions to routine immunisation from global to local levels, affecting every aspect of vaccine supply, access, and demand. Since March 2020, country programmes have implemented a range of strategies to either continue vaccination services during COVID-19 measures like lockdown and/or resume services when risks of SARS-CoV-2 transmission could be appropriately mitigated. Through the Exemplars in Global Health partnership in Liberia, Nepal, and Senegal, we conducted interviews with immunisation programme managers and ministry of health leadership to better understand how they have addressed the myriad vaccination challenges posed by the ongoing pandemic. From establishing alternative modes of service delivery to combatting vaccine distrust and rumours via risk communication campaigns, many routine immunisation programmes have demonstrated how to adapt, resume, and/or maintain vital vaccination efforts during the COVID-19 crisis. Yet millions of children remain un- or under-vaccinated worldwide, and the same programmes striving to implement catch-up services for missed doses and postponed mass campaigns will also soon be tasked with COVID-19 vaccine deployment. As laid bare by the current pandemic, the worlds gains against vaccine-preventable diseases are fragile: enshrined by a delicate global ecosystem of logistics, supply, and procurement, the success of routine immunisation ultimately rests upon dedicated programme staff, the resources and support available to them, and then the trust in and demand for vaccines by their recipients. Our collective lessons learned during COVID-19 offer insights in programme adaptation and resilience that, if prioritised, could strengthen equitable, sustainable vaccine delivery for all populations. Summary boxO_LIKey message 1: As the COVID-19 pandemic affected routine immunisation services worldwide, country programmes have used a range of mitigation strategies to maintain vaccine delivery and/or resume interrupted programming. Interviews with immunisation programme managers and Ministry of Health staff provided key perspectives and lessons learned on how countries have approached routine immunisation services during the COVID-19 crisis. C_LIO_LIKey message 2: Key themes for mitigating COVID-19s effects on routine immunisation included prioritising continued services with strengthened infection prevention control; identifying alternative locations and approaches to providing vaccine services (e.g., conducting door-to-door vaccination if facility-based services were not possible); engaging in effective communications and mobilisation activities, especially to offset misinformation about COVID-19 and vaccines; setting up systems and strategies for reaching children who missed doses amid periods of disruption; and conducting catch-up campaigns as soon as SARS-CoV-2 transmission risks could be minimised. C_LIO_LIKey message 3: The ways in which COVID-19 has affected routine immunisation services have varied over time and across settings, underscoring the importance of contextually-tailored mitigation efforts and adaptation given evolving challenges amid an ongoing pandemic. As countries prepare and initiate roll-out COVID-19 vaccines, it will be vital to avoid one-size-fits-all implementation strategies and support the continuance of routine immunisation services through this next phase of COVID-19 response. C_LI