Impact of the SARS-CoV-2 pandemic on routine immunisation services: evidence of disruption and recovery from 170 countries and territories
Open accessAbstract
BACKGROUND: The SARS-CoV-2 pandemic has revealed the vulnerability of immunisation systems worldwide, although the scale of these disruptions has not been described at a global level. This study aims to assess the impact of COVID-19 on routine immunisation using triangulated data from global, country-based, and individual-reported sources obtained during the pandemic period. METHODS: This report synthesised data from 170 countries and territories. Data sources included administered vaccine-dose data from January to December, 2019, and January to December, 2020, WHO regional office reports, and a WHO-led pulse survey administered in April, 2020, and June, 2020. Results were expressed as frequencies and proportions of respondents or reporting countries. Data on vaccine doses administered were weighted by the population of surviving infants per country. FINDINGS: A decline in the number of administered doses of diphtheria-pertussis-tetanus-containing vaccine (DTP3) and first dose of measles-containing vaccine (MCV1) in the first half of 2020 was noted. The lowest number of vaccine doses administered was observed in April, 2020, when 33% fewer DTP3 doses were administered globally, ranging from 9% in the WHO African region to 57% in the South-East Asia region. Recovery of vaccinations began by June, 2020, and continued into late 2020. WHO regional offices reported substantial disruption to routine vaccination sessions in April, 2020, related to interrupted vaccination demand and supply, including reduced availability of the health workforce. Pulse survey analysis revealed that 45 (69%) of 65 countries showed disruption in outreach services compared with 27 (44%) of 62 countries with disrupted fixed-post immunisation services. INTERPRETATION: The marked magnitude and global scale of immunisation disruption evokes the dangers of vaccine-preventable disease outbreaks in the future. Trends indicating partial resumption of services highlight the urgent need for ongoing assessment of recovery, catch-up vaccination strategy implementation for vulnerable populations, and ensuring vaccine coverage equity and health system resilience. FUNDING: US Agency for International Development.
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The COVID-19 crisis and its cascading effects placed extraordinary pressure on health systems, immunisation supply chains, and health spending, and combined with social distancing and stay-at-home measures severely limited the ability of health workers and those in need of care to provide and access services.
“The crisis and its cascading effects placed extraordinary pressure on health systems and providers, immunisation supply chains, and health spending, which—combined with social distancing and stay-at-home measures—severely limited the ability of health workers and those in need of care to provide and access services.62”
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Progress and Challenges in Measles and Rubella Elimination in the WHO European Region
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Seasonal influenza vaccination in the Americas: Progress and challenges during the COVID-19 pandemic
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Global pandemic preparedness: learning from the COVID-19 vaccine development and distribution
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Measuring National Immunization System Performance: A Systematic Assessment of Available Resources
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Pandemic’s influence on parents’ attitudes and behaviors toward meningococcal vaccination
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Malawian caregivers’ experiences with HPV vaccination for preadolescent girls: A qualitative study
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Neonatal, Infant, and Child Mortality in India: Progress and Future Directions
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Self-citationImpact of the COVID-19 Pandemic on HPV Vaccinations in Switzerland and Greece: Road to Recovery
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Self-citationTrends of measles in Tanzania: A 5-year review of case-based surveillance data, 2018-2022
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- Authors
- Shet, A., Carr, K., Danovaro-Holliday, M. C., Sodha, S. V., Prosperi, C., Wunderlich, J., Wonodi, C., Reynolds, H. W., Mirza, I., Gacic-Dobo, M., O'Brien, K. L., & Lindstrand, A.
- Affiliations
- Johns Hopkins University (US)
- World Health Organization (CH)
- Gavi (CH)
- United Nations Children's Fund (US)
- Corresponding author
- Shet, Anita
- Lindstrand, Ann
- Venue
- The Lancet Global Health
- Publisher
- Elsevier BV
- Published
- 2022-02
- Volume
- 10
- Issue
- 2
- Pages
- e186-e194
- ISSN
- 2214-109X (ISSN-L)
- PMC
- PMC8691849
- OpenAlex
- W4200055909
- Cited by
- 363
- References
- 24
- Citations by year
- 2026: 48 · 2025: 64 · 2024: 93 · 2023: 93 · 2022: 63 · 2021: 2
- FWCI
- 34.67
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet Global Health (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- USAID
- Topics
- Social Sciences › Health › Vaccine Coverage and Hesitancy
- Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Keywords
- COVID-19 pandemic, SARS-CoV-2, routine immunization, vaccine doses administered, measles-containing vaccine, catch-up vaccination, health workforce shortage, health system resilience, vaccine-preventable disease outbreaks
- MeSH terms
- Vaccination Coverage, Vaccine-Preventable Diseases, COVID-19, SARS-CoV-2, Humans, Global Health, World Health Organization, Immunization Programs, Pandemics
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