Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
BOOK OF ABSTRACTS | HEALTH EQUITY
BOOKS OF ABSTRACTS | HEALTH EQUITY
Brief Research Article | HIV and AIDS
COMMENTARY
COMMENTARY | CHLAMYDIA
COMMENTARY | COVID-19 AND HIV/AIDS
COMMENTARY | COVID-19 VACCINE
COMMENTARY | DIGITAL HEALTH
COMMENTARY | EMERGENCY PRACTICE
COMMENTARY | HIV Testing
COMMENTARY | MALARIA
COMMENTARY | MATERNAL HEALTH
COMMENTARY | MATERNAL MORTALITY
COMMENTARY | MONKEYPOX
COMMENTARY | PERINATAL HIV TRANSMISSION
Editorial
EDITORIAL | POSTPARTUM HEMORRHAGE PREVENTION
LETTER TO EDITOR | INTERTRIGINOUS DERMATITIS
LETTER TO THE EDITOR | COVID-19 PANDEMIC
LETTER TO THE EDITOR | COVID-19 TEST
METHODOLOGY ARTICLE
METHODOLOGY ARTICLE | HIV
NARRATIVE REVIEW | MATERNAL HEALTH
NOTES FROM THE FIELD | COVID-19 PANDEMIC
NOTES FROM THE FIELD | MCH STUDENT ASSOCIATION
Original Article
ORIGINAL ARTICLE | ADOLESCENT HEALTH
ORIGINAL ARTICLE | AMERICAN INDIAN AND ALASKA NATIVE HEALTH
ORIGINAL ARTICLE | ANTENATAL CARE SERVICES
ORIGINAL ARTICLE | BIRTH INTERVAL
ORIGINAL ARTICLE | CAFFEINE AND CHILDHOOD OBESITY
ORIGINAL ARTICLE | CERVICAL PRECANCER
ORIGINAL ARTICLE | CHILD HEALTH
ORIGINAL ARTICLE | CHILD HEALTHCARE
ORIGINAL ARTICLE | CLUBFOOT
ORIGINAL ARTICLE | COMPLEMENTARY FEEDING PRACTICES
ORIGINAL ARTICLE | CONTINUUM OF CARE
ORIGINAL ARTICLE | COVID-19 DISEASE
ORIGINAL ARTICLE | COVID-19 IN PREGNANCY
ORIGINAL ARTICLE | COVID-19 OUTCOMES
ORIGINAL ARTICLE | DEPRESSION & HIV
ORIGINAL ARTICLE | DIETARY MICRONUTRIENTS AND HIV
ORIGINAL ARTICLE | HEALTHCARE SERVICES
ORIGINAL ARTICLE | HEAT-STABLE CARBETOCIN
ORIGINAL ARTICLE | HEAT-STABLE CARBETOCIN, PUBLIC-PRIVATE PARTNERSHIP
ORIGINAL ARTICLE | HEAT-STABLE CARBETOCIN, TRANEXAMIC ACID
ORIGINAL ARTICLE | HIV
ORIGINAL ARTICLE | HIV AND PREGNANT WOMEN
ORIGINAL ARTICLE | HIV INFECTION
ORIGINAL ARTICLE | HIV PREVENTION
ORIGINAL ARTICLE | HIV SCREENING
ORIGINAL ARTICLE | HIV TESTING
ORIGINAL ARTICLE | HIV Viral Load
ORIGINAL ARTICLE | HIV-TB CO-INFECTIONS
ORIGINAL ARTICLE | HIV/AIDS
ORIGINAL ARTICLE | HIV/AIDS IN ECUADOR
ORIGINAL ARTICLE | HOME DELIVERY
ORIGINAL ARTICLE | HOUSING AND HOUSING INEQUALITIES
ORIGINAL ARTICLE | IMMUNIZATION
ORIGINAL ARTICLE | IMMUNIZATION COVERAGE
ORIGINAL ARTICLE | INFLAMMATORY BOWEL DISEASE
ORIGINAL ARTICLE | LEISHMANIASIS
ORIGINAL ARTICLE | LIFE EXPECTANCY
ORIGINAL ARTICLE | MALARIA & HIV
ORIGINAL ARTICLE | MATERNAL HEALTH
ORIGINAL ARTICLE | MATERNAL HEALTH SERVICES
ORIGINAL ARTICLE | MATERNAL MORTALITY
ORIGINAL ARTICLE | MATERNAL OBESITY
ORIGINAL ARTICLE | MCH HEALTHCARE SERVICES
ORIGINAL ARTICLE | MORTALITY
ORIGINAL ARTICLE | MOTHER-TO-CHILD TRANSMISSION
ORIGINAL ARTICLE | NEONATAL MORTALITY
ORIGINAL ARTICLE | OBSTETRIC FISTULA REPAIR
ORIGINAL ARTICLE | OXYTOCIN VS MISOPROSTOL IN PPH
ORIGINAL ARTICLE | PEDIATRIC HIV
ORIGINAL ARTICLE | PERIODONTITIS
ORIGINAL ARTICLE | POSTPARTUM HEMORRHAGE
ORIGINAL ARTICLE | POSTPARTUM HEMORRHAGE MANAGEMENT
ORIGINAL ARTICLE | PPH IN HUMANITARIAN SETTINGS
ORIGINAL ARTICLE | PPH STUDY IN KENYA
ORIGINAL ARTICLE | PPH STUDY IN UGANDA
ORIGINAL ARTICLE | PRE-ECLAMPSIA
ORIGINAL ARTICLE | PREGNANCY
ORIGINAL ARTICLE | PRENATAL CARE
ORIGINAL ARTICLE | PUERPERAL SEPSIS
ORIGINAL ARTICLE | REPRODUCTIVE HEALTH
ORIGINAL ARTICLE | TEENAGE PREGNANCY
ORIGINAL ARTICLE | VACCINATION
ORIGINAL ARTICLE | VACCINE
ORIGINAL ARTICLE | VACCINE EQUITY
ORIGINAL ARTICLE | VIRTUAL PRENATAL CARE
ORIGINAL ARTICLE | WOMEN HEALTH
ORIGINAL ARTICLE | WOMEN’S HEALTH
ORIGINAL ARTICLE | YOUTH MORTALITY
Original Research | Article Healthcare
ORIGINAL RESEARCH ARTICLE | PEDIATRIC HIV
PROTOCOL | PREGNANCY
PUBLIC HEALTH PRACTICE | ACADEMIC DETAILING
PUBLIC HEALTH PRACTICE | CHILD DEVELOPMENT
PUBLIC HEALTH PRACTICE | CHILD HEALTH
PUBLIC HEALTH PRACTICE | HIV
PUBLIC HEALTH PRACTICE | MATERNAL HEALTH
PUBLIC HEALTH PRACTICE | OPT-OUT APPROACH IN HIV TESTING
PUBLIC HEALTH PRACTICE | PREGNANCY WHEEL
PUBLIC HEALTH PRACTICE | SURVEILLANCE
RESEARCH COMMENTARY
Review Article
SHORT RESEARCH COMMUNICATION
SHORT RESEARCH COMMUNICATION | COVID AND MENTAL HEALTH
SHORT RESEARCH COMMUNICATION | COVID MCH RESEARCH AGENDA
SHORT RESEARCH COMMUNICATION | COVID-19
SHORT RESEARCH COMMUNICATION | COVID-19 AND CHILD VACCINATION
SHORT RESEARCH COMMUNICATION | COVID-19 AND MATERNAL MORTALITY
SHORT RESEARCH COMMUNICATION | COVID-19 AND REMOTE WORKERS
SHORT RESEARCH COMMUNICATION | COVID-19 PANDEMIC DISPARITIES
SHORT RESEARCH COMMUNICATION | HEALTHCARE PROVIDER TRAINING
SHORT RESEARCH COMMUNICATION | MALARIA
SHORT RESEARCH COMMUNICATION | SINGLETONS, TWINS, MULTIPLE BIRTHS
SHORT RESEARCH COMMUNICATION | SURVEILLANCE SYSTEM FOR COVID-19
SHORT RESEARCH COMMUNICATION | WOMEN’S HEALTH
SYSTEMATIC REVIEW
SYSTEMATIC REVIEW ARTICLE | UTI AND PULMONARY INJURY
WAME STATEMENT
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
BOOK OF ABSTRACTS | HEALTH EQUITY
BOOKS OF ABSTRACTS | HEALTH EQUITY
Brief Research Article | HIV and AIDS
COMMENTARY
COMMENTARY | CHLAMYDIA
COMMENTARY | COVID-19 AND HIV/AIDS
COMMENTARY | COVID-19 VACCINE
COMMENTARY | DIGITAL HEALTH
COMMENTARY | EMERGENCY PRACTICE
COMMENTARY | HIV Testing
COMMENTARY | MALARIA
COMMENTARY | MATERNAL HEALTH
COMMENTARY | MATERNAL MORTALITY
COMMENTARY | MONKEYPOX
COMMENTARY | PERINATAL HIV TRANSMISSION
Editorial
EDITORIAL | POSTPARTUM HEMORRHAGE PREVENTION
LETTER TO EDITOR | INTERTRIGINOUS DERMATITIS
LETTER TO THE EDITOR | COVID-19 PANDEMIC
LETTER TO THE EDITOR | COVID-19 TEST
METHODOLOGY ARTICLE
METHODOLOGY ARTICLE | HIV
NARRATIVE REVIEW | MATERNAL HEALTH
NOTES FROM THE FIELD | COVID-19 PANDEMIC
NOTES FROM THE FIELD | MCH STUDENT ASSOCIATION
Original Article
ORIGINAL ARTICLE | ADOLESCENT HEALTH
ORIGINAL ARTICLE | AMERICAN INDIAN AND ALASKA NATIVE HEALTH
ORIGINAL ARTICLE | ANTENATAL CARE SERVICES
ORIGINAL ARTICLE | BIRTH INTERVAL
ORIGINAL ARTICLE | CAFFEINE AND CHILDHOOD OBESITY
ORIGINAL ARTICLE | CERVICAL PRECANCER
ORIGINAL ARTICLE | CHILD HEALTH
ORIGINAL ARTICLE | CHILD HEALTHCARE
ORIGINAL ARTICLE | CLUBFOOT
ORIGINAL ARTICLE | COMPLEMENTARY FEEDING PRACTICES
ORIGINAL ARTICLE | CONTINUUM OF CARE
ORIGINAL ARTICLE | COVID-19 DISEASE
ORIGINAL ARTICLE | COVID-19 IN PREGNANCY
ORIGINAL ARTICLE | COVID-19 OUTCOMES
ORIGINAL ARTICLE | DEPRESSION & HIV
ORIGINAL ARTICLE | DIETARY MICRONUTRIENTS AND HIV
ORIGINAL ARTICLE | HEALTHCARE SERVICES
ORIGINAL ARTICLE | HEAT-STABLE CARBETOCIN
ORIGINAL ARTICLE | HEAT-STABLE CARBETOCIN, PUBLIC-PRIVATE PARTNERSHIP
ORIGINAL ARTICLE | HEAT-STABLE CARBETOCIN, TRANEXAMIC ACID
ORIGINAL ARTICLE | HIV
ORIGINAL ARTICLE | HIV AND PREGNANT WOMEN
ORIGINAL ARTICLE | HIV INFECTION
ORIGINAL ARTICLE | HIV PREVENTION
ORIGINAL ARTICLE | HIV SCREENING
ORIGINAL ARTICLE | HIV TESTING
ORIGINAL ARTICLE | HIV Viral Load
ORIGINAL ARTICLE | HIV-TB CO-INFECTIONS
ORIGINAL ARTICLE | HIV/AIDS
ORIGINAL ARTICLE | HIV/AIDS IN ECUADOR
ORIGINAL ARTICLE | HOME DELIVERY
ORIGINAL ARTICLE | HOUSING AND HOUSING INEQUALITIES
ORIGINAL ARTICLE | IMMUNIZATION
ORIGINAL ARTICLE | IMMUNIZATION COVERAGE
ORIGINAL ARTICLE | INFLAMMATORY BOWEL DISEASE
ORIGINAL ARTICLE | LEISHMANIASIS
ORIGINAL ARTICLE | LIFE EXPECTANCY
ORIGINAL ARTICLE | MALARIA & HIV
ORIGINAL ARTICLE | MATERNAL HEALTH
ORIGINAL ARTICLE | MATERNAL HEALTH SERVICES
ORIGINAL ARTICLE | MATERNAL MORTALITY
ORIGINAL ARTICLE | MATERNAL OBESITY
ORIGINAL ARTICLE | MCH HEALTHCARE SERVICES
ORIGINAL ARTICLE | MORTALITY
ORIGINAL ARTICLE | MOTHER-TO-CHILD TRANSMISSION
ORIGINAL ARTICLE | NEONATAL MORTALITY
ORIGINAL ARTICLE | OBSTETRIC FISTULA REPAIR
ORIGINAL ARTICLE | OXYTOCIN VS MISOPROSTOL IN PPH
ORIGINAL ARTICLE | PEDIATRIC HIV
ORIGINAL ARTICLE | PERIODONTITIS
ORIGINAL ARTICLE | POSTPARTUM HEMORRHAGE
ORIGINAL ARTICLE | POSTPARTUM HEMORRHAGE MANAGEMENT
ORIGINAL ARTICLE | PPH IN HUMANITARIAN SETTINGS
ORIGINAL ARTICLE | PPH STUDY IN KENYA
ORIGINAL ARTICLE | PPH STUDY IN UGANDA
ORIGINAL ARTICLE | PRE-ECLAMPSIA
ORIGINAL ARTICLE | PREGNANCY
ORIGINAL ARTICLE | PRENATAL CARE
ORIGINAL ARTICLE | PUERPERAL SEPSIS
ORIGINAL ARTICLE | REPRODUCTIVE HEALTH
ORIGINAL ARTICLE | TEENAGE PREGNANCY
ORIGINAL ARTICLE | VACCINATION
ORIGINAL ARTICLE | VACCINE
ORIGINAL ARTICLE | VACCINE EQUITY
ORIGINAL ARTICLE | VIRTUAL PRENATAL CARE
ORIGINAL ARTICLE | WOMEN HEALTH
ORIGINAL ARTICLE | WOMEN’S HEALTH
ORIGINAL ARTICLE | YOUTH MORTALITY
Original Research | Article Healthcare
ORIGINAL RESEARCH ARTICLE | PEDIATRIC HIV
PROTOCOL | PREGNANCY
PUBLIC HEALTH PRACTICE | ACADEMIC DETAILING
PUBLIC HEALTH PRACTICE | CHILD DEVELOPMENT
PUBLIC HEALTH PRACTICE | CHILD HEALTH
PUBLIC HEALTH PRACTICE | HIV
PUBLIC HEALTH PRACTICE | MATERNAL HEALTH
PUBLIC HEALTH PRACTICE | OPT-OUT APPROACH IN HIV TESTING
PUBLIC HEALTH PRACTICE | PREGNANCY WHEEL
PUBLIC HEALTH PRACTICE | SURVEILLANCE
RESEARCH COMMENTARY
Review Article
SHORT RESEARCH COMMUNICATION
SHORT RESEARCH COMMUNICATION | COVID AND MENTAL HEALTH
SHORT RESEARCH COMMUNICATION | COVID MCH RESEARCH AGENDA
SHORT RESEARCH COMMUNICATION | COVID-19
SHORT RESEARCH COMMUNICATION | COVID-19 AND CHILD VACCINATION
SHORT RESEARCH COMMUNICATION | COVID-19 AND MATERNAL MORTALITY
SHORT RESEARCH COMMUNICATION | COVID-19 AND REMOTE WORKERS
SHORT RESEARCH COMMUNICATION | COVID-19 PANDEMIC DISPARITIES
SHORT RESEARCH COMMUNICATION | HEALTHCARE PROVIDER TRAINING
SHORT RESEARCH COMMUNICATION | MALARIA
SHORT RESEARCH COMMUNICATION | SINGLETONS, TWINS, MULTIPLE BIRTHS
SHORT RESEARCH COMMUNICATION | SURVEILLANCE SYSTEM FOR COVID-19
SHORT RESEARCH COMMUNICATION | WOMEN’S HEALTH
SYSTEMATIC REVIEW
SYSTEMATIC REVIEW ARTICLE | UTI AND PULMONARY INJURY
WAME STATEMENT
View/Download PDF

Translate this page into:

SHORT RESEARCH COMMUNICATION | COVID-19 AND CHILD VACCINATION
9 (
3
); 381-385
doi:
10.21106/ijma.401

COVID-19 and Child Vaccination: A Systematic Approach to Closing the Immunization Gap

Department of Public Health, Arcadia University, Glenside, PA, USA
College of Nursing and Public Health, Adelphi University, Garden City, NY, USA
Department of Family and Community Medicine; and Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX, USA

* Corresponding author email: olorunsaiyec@arcadia.edu

Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The COVID-19 pandemic threatens to set back major successes that have been achieved in global vaccine initiatives. We conducted a rapid review and synthesis of the literature on immunization provision and Utilization since the onset of the COVID-19 pandemic. A total of 11 papers comprising peer-reviewed articles and key policies and guidelines, published between January 1 and June 15, 2020, were analyzed. Widespread disruptions of routine immunization and vaccination campaigns were reported leaving millions of children worldwide at risk of measles outbreaks. We present an expanded model of the World Health Organization’s Global Routine Immunization Strategic Plan (GRISP) action areas as a tool to help countries quickly adapt to immunization challenges in the presence of COVID-19 and close the emerging immunization coverage gaps.

Keywords

Immunization
Child health
Vaccination
COVID-19
Essential health services
Corona virus

1. Introduction

While the world battles the Severe Acute Respiratory Syndrome-Coronavirus-2 2019 (COVID-19) pandemic, another crucial global health program is largely suspended, namely, the vaccination programs. Dealing with COVID-19 and not substantially sustaining the vaccine programs could potentially trigger new outbreaks of measles, polio, and other vaccine-preventable diseases. The COVID-19 pandemic threatens to set back the major progress that has been made in the global vaccine initiatives, putting more than 80 million children worldwide and, especially in poor countries at risk of vaccine-preventable diseases.1 Immunization is one of the most cost-effective and successful public health interventions to-date. Every $1 invested in child immunization is projected to yield a return of $16 resulting from illnesses averted, and up to $44 if the value of living longer and healthier lives were measured.2 Due to widespread stay-at-home orders and physical/social distancing measures implemented to curb the spread of the COVID-19 virus, several unintended outcomes including the freezing or drastic scale-down of immunization activities and other essential health services have occurred in several countries.3

We analyzed the immunization landscape in the wake of COVID-19, and proffer evidence-based recommendations to quickly close the emerging gaps in immunization coverage. Our findings will be beneficial to public health decision makers as countries loosen pandemic control restrictions and accelerate efforts to re-establish and strengthen immunization services to prevent outbreaks of communicable diseases.

2. Methods

We conducted a rapid review and synthesis of scientific and grey literature on immunization since the onset of the COVID-19 pandemic, published in English between January 1 and June 15, 2020. The search terms included keywords such as “immunization demand,” “availability of vaccination services,” “COVID-19 and child health,” and “impact of COVID-19 on immunization utilization”. We analyzed the retrieved information using two key themes: (1) provision of immunization services and (2) utilization of immunization services. Service provision included the availability/provision of routine immunization services and vaccination campaigns, availability of health workers/vaccinators, and guidelines and supplies for providing vaccination services safely in view of COVID-19. Service utilization encompassed caregiver awareness of continued availability of services, community mobilization, access-related factors such as transportation as a result of travel restrictions, and caregiver concerns for safety and physical distancing.

3. Results

A total of 147 results were generated. Of these, 11 relevant publications were retrieved, comprising six peer-reviewed articles, three from low- and middle-income countries (LMICs), two from high-income countries, and one a combination of both LMICs and high-income countries. Additionally, three key World Health Organization (WHO) guidelines and policy documents, and one report by the Measles and Rubella Initiative met the review criteria and were included in the analysis.

Service provision: Following WHO COVID-19 risk mitigation recommendations in March 2020, measles and polio campaigns have been suspended in 27 and 38 countries, respectively, as of mid-May.1 These comprise high-risk countries with recent or current outbreaks of measles (e.g., the Democratic Republic of Congo), and circulating vaccine-derived poliovirus (cVDPV), typically seen in areas with low coverage of oral polio vaccine.

Further, between March and June 2020, about 67 countries reported moderate-to-severe disruptions or outright suspension of routine immunizations services.1 In many LMICs experiencing measles outbreaks, the COVID-19-related suspension of vaccination services heightens the risk of spread and puts millions of children at risk of severe illness and, possibly, deaths.4 Infant vaccinations were also disrupted in India and across several LMICs.5 Widespread travel restrictions and border closures have negatively impacted the availability of vaccines and other supplies needed to provide safe vaccination services. A survey of frontline health workers from 81 LMICs and high-income countries reported shortages of healthcare providers due to illness, transportation challenges, fear of infection, and insufficient personal protective equipment (PPEs),3,5,6 and infection prevention and control measures.6 Similarly, stock-out of vaccines, supplies, and equipment due to transport restrictions and border closures,1 and redeployment of healthcare resources and providers to COVID-19 response efforts were reported.7

Service utilization: In many LMICs and high-income countries, frontline health workers reported seeing fewer patients for essential health services, and this was largely due to travel restrictions, caregiver concerns for safety, and fear of infection.3 In the United States, a study using data from immunization registries found notably fewer orders for non-influenza childhood vaccines between January and April 2020 compared to the same period in 2016-2019.8 The sharpest declines were in measles-containing vaccine orders. Similarly, lower age-appropriate coverage rates of non-influenza vaccinations were observed across milestone age cohorts assessed in May 2020 compared to the same period in 2016-2019, in Michigan, USA.9 In India, an alarming 69% reduction in measles-mumps-rubella vaccination coverage was reported from data from the National Health Mission.7

4. Discussion and Global Health Implications

The indirect toll of COVID-19 on childhood immunization and survival is dire. The pandemic and the mitigation measures adopted to control it have negatively affected the provision and utilization of child immunization services in LMICs and high-income countries, and threaten to undo the gains made in the control of vaccine-preventable diseases for the past two decades. This impact is particularly severe for vulnerable populations with low immunization coverage, where vaccination was suspended temporarily. As a result of the suspension of these services, the most vulnerable children are deprived of lifesaving vaccines and essential interventions. They are, therefore, at increased risk of outbreaks of vaccine-preventable diseases, which could be potentially life-threatening.

As economies reopen and movement restrictions are relaxed, countries must have a clear plan in place for rapidly closing the immunization gap resulting from the impact of the pandemic.10 The WHO and the Global Polio Eradication Initiative have issued guidelines for restarting vaccination campaigns and routine immunization services during the COVID-19 pandemic.10-12 The Global Routine Immunization Strategic Plan (GRISP)13 can provide a pragmatic and evidence-based framework for operationalizing these guidelines and getting countries and immunization programs ready to intensify immunization efforts. GRISP organizes strategies and practices to strengthen routine immunization systems into four primary areas of action, thereby enabling a systematic approach to improve immunization coverage. The GRISP framework, though familiar and already in use, was originally developed to strengthen routine immunization services. However, due to the unique challenges of the ongoing pandemic and decreasing immunization coverage, there is a need to incorporate additional action areas (such as vaccination campaigns and supplemental immunization activities) to rapidly increase coverage and ensure the safe provision of vital vaccination services. To address these limitations, we expanded the GRISP framework to include action areas for vaccine coverage improvement and system strengthening in consideration of the COVID-19 pandemic (Table 1).

Table 1 Adapted GRISP framework for rapidly closing the immunization gap in the COVID-19 pandemic era
GRISP Action Areasa COVID-19 Pandemic-Related Action Areasb
Maximize Reach
• Detect and reach the unreached
• Design services to reach all equitably
• Build capacity of vaccinators and managers
• Ensure vaccine quality and availability
• Create synergy with special vaccination efforts
• Integrate immunization services
• Make data-informed decisions on the best approaches to quickly and safely boost vaccination status in communities with poor coverage
• Train, remotely as much as possible, service providers and vaccinators in advance of restarting campaigns and routine immunization services
• Ensure availability of adequate infection prevention and control measures at all fixed sites, including functional handwashing stations, PPEs, sanitizers, designated waiting areas, and patient flow patterns to minimize contact with health workers and vaccinators
• Provide influenza vaccination for health workers and vulnerable population groups
• Prioritize epidemic-prone vaccines (measles, polio, diphtheria-pertussis) if necessary and extend intervals between doses in a multiple-dose vaccine series
Manage the Program
• Secure political commitment and partnerships
• Plan, budget and mobilize resources
• Ensure excellence in national leadership
• Set program policy and guidance
• Update national and local microplans to identify and develop appropriate plans for addressing resource gaps
• Plan for a phased transition towards full-scale campaigns and supplemental immunization activities (SIAs) as deemed safe.
• Communicate and distribute context-specific, written guidelines, and job aids to support health workers in delivering immunization services safely
• Implement and monitor adherence to infection prevention and control measures, new patient flow patterns, and screening and referral for COVID symptoms
• Adopt innovative supportive supervision strategies
Mobilize People
• Engage communities and create demand
• Mobilize and communicate for vaccination
• Address vaccine hesitancy and false perceptions
• Sensitize communities, using popular and culturally-acceptable media strategies, on the availability of essential services and routine immunization with location and schedules
• Communicate COVID-19 risk mitigation strategies adopted for service delivery (e.g., physical distancing, IPC, new patient flow patterns) with communities to gain confidence
• Engage stakeholders and community partners in collaborative efforts to address polio vaccine-preventable disease outbreaks and COVID-19
Monitor Progress
• Monitor program performance and disease occurrence
• Evaluate the program through surveys and reviews

• Strengthen surveillance and reporting systems for polio, measles and other VPDs
• Utilize VPD outbreak data to plan appropriate response strategies
• Continuously monitor COVID-19 infections in local areas to identify, isolate, refer and trace contacts of those infected with the virus
• Assess coverage data regularly for catch-up vaccination planning
• Monitor regularly vaccine stock, cold chain, and related immunization supplies
Existing GRISP recommendations;
Additional recommended action areas from WHO and Polio Eradication Initiative guidelines.

In the expanded framework, we consolidated action areas from GRISP, WHO guidelines for immunization services and campaigns during the COVID-19 pandemic, and the Global Polio Eradication Initiative guidelines. We present an adapted tool that builds upon the existing GRISP framework and bears the potential of dampening the increasing strains imposed by the ongoing COVID-19 pandemic on health systems, especially in the developing world. A prepared health system is required to respond to crisis-related immunization challenges and would be paramount for the successful and equitable rollout of the novel monovalent oral polio vaccine (mOPV) and a potential COVID-19 vaccine when available.

Compliance with Ethical Standards

Conflicts of Interest: The authors have no conflicts of interest.

Funding/Support: The publication of this article was partially supported by the Global Health and Education Projects, Inc. (GHEP) through the Emerging Scholars Grant Program (ESGP). The information, contents, and conclusions are those of the authors’ and should not be construed as the official position or policy of, nor should any endorsements be inferred by ESGP or GHEP.

Ethics Approval: The study is based on a review of existing literature and did not require ethics approval.

References

  1. . At least 80 million children under one at risk of diseases such as diphtheria, measles and polio as COVID-19 disrupts routine vaccination efforts warn GAVI, WHO, and UNICEF. Available at: https://www.who.int/news-room/detail/22-05-2020-at-least-80-million-children-under-one-at-risk-of-diseases-such-as-diphtheria-measles-and-polio-as-covid-19-disrupts-routine-vaccination-efforts-warn-gavi-who-and-unicef
  2. , , , . Return On Investment From Childhood Immunization In Low- And Middle-Income Countries 2011-20. Health affairs (Project Hope). 2016;35(2):199-207.
    [Google Scholar]
  3. , , , . Voices from the frontline:findings from a thematic analysis of a rapid online global survey of maternal and newborn health professionals facing the COVID-19 pandemic. BMJ Glob Health. 2020;5(6):e002967.
    [Google Scholar]
  4. . More than 117 million children at risk of missing out on measles vaccines, as COVID-19 surges 2020. Available at: https://measlesrubellainitiative.org/measles-news/more-than-117-million-children-at-risk-of-missing-out-on-measles-vaccines-as-covid-19-surges/
  5. , , , . Primary Health Care Facility Preparedness for Outpatient Service Provision During the COVID-19 Pandemic in India:Cross-Sectional Study. JMIR Public Health and Surveillance. 2020;6(2):e19927.
    [Google Scholar]
  6. , , . Has COVID-19 subverted global health? The Lancet 2020
    [Google Scholar]
  7. , . Effects of the COVID-19 pandemic on routine pediatric vaccine ordering and administration—United States 2020. MMWR Morbidity and Mortality Weekly Report 2020:69.
    [Google Scholar]
  8. , , , . Decline in Child Vaccination Coverage During the COVID-19 Pandemic - Michigan Care Improvement Registry, May2016-May 2020. MMWR Morb Mortal Wkly Rep. 2020;69(20):630-631.
    [Google Scholar]
  9. , , , . Protecting hard-won gains for mothers and newborns in low-income and middle-income countries in the face of COVID-19:call for a service safety net. BMJ Global Health. 2020;5(6):e002754.
    [Google Scholar]
  10. . World Health Organization 2020
  11. . Routine immunization services during the COVID-19 pandemic 2020
  12. . Polio eradication programme continuity:implementation in the context of the COVID-19 pandemic 2020
  13. . , ed. Global Routine Immunization Strategies and Practices (GRISP). .
Show Sections