An evaluation of the early impact of the COVID-19 pandemic on Zambia's routine immunization program

Amy K Winter; Saki Takahashi; Andrea C Carcelen; Kyla Hayford; Wilbroad Mutale; Francis D Mwansa; Nyambe Sinyange; David Ngula; William J Moss; Simon Mutembo

doi:10.1371/journal.pgph.0000554

An evaluation of the early impact of the COVID-19 pandemic on Zambia's routine immunization program

PLOS Glob Public Health. 2023 May 2;3(5):e0000554. doi: 10.1371/journal.pgph.0000554. eCollection 2023.

Authors

Affiliations

¹ Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia, United States of America.
² Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
³ Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
⁴ School of Public Health, University of Zambia, Lusaka, Zambia.
⁵ Child Health Unit, Directorate of Public Health and Research, Ministry of Health, Lusaka, Zambia.
⁶ Field Epidemiology Training Program, Zambia National Public Health Institute, Lusaka, Zambia.

Abstract

Implications of the COVID-19 pandemic for both populations and healthcare systems are vast. In addition to morbidity and mortality from COVID-19, the pandemic also disrupted local health systems, including reductions or delays in routine vaccination services and catch-up vaccination campaigns. These disruptions could lead to outbreaks of other infectious diseases that result in an additional burden of disease and strain on the healthcare system. We evaluated the impact of the COVID-19 pandemic on Zambia's routine childhood immunization program in 2020 using multiple sources of data. We relied on administrative vaccination data and Zambia's 2018 Demographic and Health Survey to project national disruptions to district-specific routine childhood vaccination coverage within the pandemic year 2020. Next, we leveraged a 2016 population-based serological survey to predict age-specific measles seroprevalence and assessed the impact of changes in vaccination coverage on measles outbreak risk in each district. We found minor disruptions to routine administration of measles-rubella and pentavalent vaccines in 2020. This was in part due to Zambia's Child Health Week held in June of 2020 which helped to reach children missed during the first six months of the year. We estimated that the two-month delay in a measles-rubella vaccination campaign, originally planned for September of 2020 but conducted in November of 2020 as a result of the pandemic, had little impact on modeled district-specific measles outbreak risks. This study estimated minimal increases in the number of children missed by vaccination services in Zambia during 2020. However, the ongoing SARS-CoV-2 transmission since our analysis concluded means efforts to maintain routine immunization services and minimize the risk of measles outbreaks will continue to be critical. The methodological framework developed in this analysis relied on routinely collected data to estimate disruptions of the COVID-19 pandemic to national routine vaccination program performance and its impact on children missed at the subnational level can be deployed in other countries or for other vaccines.

Copyright: © 2023 Winter et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

This work was financially supported by the Bill and Melinda Gates Foundation (https://www.gatesfoundation.org) in the form of a grant (OPP1094816) awarded to AKW, ACC, KH, WJM, and SM. No additional external funding was received for this study. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.