Routine Child Immunization during the COVID-19 Global Pandemic in Eswatini: Challenges, Loss of Gains and Benefits

Abstract

Introduction: Timely uptake of immunisations by all children at immunisation ages is key towards maintaining good health and protecting lives of the 80 million children worldwide. Disruptions of healthcare systems due to the impact and spread of coronavirus disease (SARS-CoV-2) created an issue of public health importance that required to be addressed in order to preserve gains in child survival statistics.

Method: This analysis aimed at assessing the performance of child immunisation initiatives in Eswatini during COVID-19.  Data on child immunisation before and during COVID-19 (i.e. before December, 2019 and for the year January to December 2020) was sourced from vaccination records kept by the Expanded Programme on Immunisation (EPI) and from the Health Management Information System (HMIS) of the Ministry of Health in Eswatini.

Results: Most child immunization rates for different diseases in 2019, before COVID-19, were generally above the cumulative target. The only disease with cumulative immunisation rates below the cumulative target was MR2. The cumulative number of children unimmunised against MR1 shows an exponential increase in 2020 following implementations of strategies to reduce spread of COVID-19. Our study suggests that the implementation of routine immunisations between March 2019 and 2020 suffered logistical constraints such as: the supply of vaccines, delivery cold chain problems, staff shortage due to reallocation of nurses and doctors to work on COVID-19 and some testing positive to SARS-CoV-2 infection and having to go into quarantine and isolation.

Discussion: Delayed or missed immunisations created a large cohort of children that became susceptible to infection due to lost herd immunity. Increased number of unimmunised children against MR1 and the other vaccine preventable childhood diseases while the country focused on reducing transmission of COVI-19 is likely to have created a large pool of susceptible children from which epidemics could arise. As such, the reported outbreaks of mumps, measles, etc, could be as a result of the large pool of unvaccinated children resultant from COVID-19 partial lockdown.

Conclusion: Epidemics of some of these vaccine preventable childhood diseases could result in catastrophic consequences of unimaginable proportions and deaths among children. Therefore, efforts should always be made to ensure gains in routine child immunisations are never lost during epidemics such as COVID-19.