COVID-19-related disruption and resiliency in immunisation activities in LMICs: a rapid review

Abstract

AbstractObjectivesRapid review to determine the extent that immunisation services in LMICs were disrupted by the COVID-19 pandemic and what factors can be considered to build resilience in future.SettingWe searched PubMed on 28th Feb 2023 for studies published after 1st December 2019 in English that focused on LMICs.ParticipantsScreening and data extraction were conducted by two experienced reviewers with one reviewer vote minimum per study per stage. Of 3801 identified studies, 66 met the eligibility criteria.OutcomesRoutine vaccine coverage achieved; Supplementary immunisation activity timing; Vaccine doses given; Timing of vaccination; Supply chain changes; factors contributing to disruption or resilience.ResultsIncluded studies showed evidence of notable declines in immunisation activities across LMICs related to the COVID-19 pandemic. These have included reductions in achieved routine coverage, cancellation or postponement of campaigns, and underimmunised cohorts. Immunisation was most disrupted in the early months of the pandemic, particularly March to May 2020; however, the amount of recovery seen varied by country, age-group, and vaccine. Though many countries observed partial recovery beginning after lockdown policies were lifted in 2020, disruption in many countries has also continued into 2021. It has also been noted that clinician staff shortages and vaccine stock outs caused by supply chain disruptions contributed to immunisation delays but that concern over COVID transmission was a leading factor. Key resiliency factors included community outreach and healthcare worker support. Finally, whilst our search took place in February 2023, the latest dataset used across all studies was from November 2022 and many focused on 2020; as a result some of the study conclusions do not take recovery into account.ConclusionsThere is limited information on whether reductions in vaccination coverage or delays have persisted beyond 2021. Further research is needed to assess ongoing disruptions and identify missed vaccine cohorts.Strengths and limitations of this studyThe rapid synthesis of findings related to immunization disruption and recovery to-date allows for key insights to target missed cohorts and identify research gaps.We include a narrative analysis of disruption across LMICs; this review benefits from the inclusion of barriers, enablers, and resilience to/in service provision.The search strategy was limited to studies published on PubMed up to February 28th, 2023, meaning not all relevant research meeting inclusion criteria may have been captured.