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. 2020 Sep:98:161-165.
doi: 10.1016/j.ijid.2020.06.072. Epub 2020 Jun 24.

COVID-19 and routine childhood immunization in Africa: Leveraging systems thinking and implementation science to improve immunization system performance

Abdu A Adamu  1 , Rabiu I Jalo  2 , Desire Habonimana  3 , Charles S Wiysonge  4
Affiliations

COVID-19 and routine childhood immunization in Africa: Leveraging systems thinking and implementation science to improve immunization system performance

Abdu A Adamu et al. Int J Infect Dis. 2020 Sep.

Abstract

One of the routine health services that is being disrupted by coronavirus disease 2019 (COVID-19) in Africa is childhood immunization. This is because the immunization system relies on functioning health facilities and stable communities to be effective. Its disruption increases the risk of epidemics of vaccine-preventable diseases, which could increase child mortality. Therefore, policymakers must quickly identify robust and context-specific strategies to rapidly scale-up routine immunization in order to mitigate the impact of COVID-19 on their national immunization performance. To achieve this, we propose a paradigm shift towards systems thinking and use of implementation science in immunization decision-making. Systems thinking can inform a more nuanced and holistic understanding of the interrelationship between COVID-19, its control strategies, and childhood immunization. Tools like causal loop diagrams can be used to explicitly illustrate the systems structure by identifying feedback loops. Once mapped and leverage points for interventions have been identified, implementation science can be used to guide the rapid uptake and utilization of multifaceted evidence-based innovations in complex practice settings. As Africa re-strategizes for the post-2020 era, these emerging fields could contribute significantly in accelerating progress towards universal access to vaccines for all children on the continent despite COVID-19.

Keywords: Africa; COVID-19; Immunization; Implementation science; Systems thinking.

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Figures

Figure 1
Figure 1
DTP3 coverage for countries in the WHO-AFRO region.
Figure 2
Figure 2
A causal loop diagram showing the relationship between COVID-19 and the immunization system (B = balancing loop; R = reinforcing loop).
See this image and copyright information in PMC

References

    1. Adamu Aa, Gadanya Ma, Jalo Ri, Uthman Oa, Nnaji Ca, Bello Iw. Assessing readiness to implement routine immunization among patent and proprietary medicine vendors in Kano, Nigeria: a theory-informed cross-sectional study. Expert Rev Vaccines [Internet] 2020;19(4):395–405. doi: 10.1080/14760584.2020.1750379. Apr 2 [cited 2020 May 28] Available from: - DOI - PubMed
    1. Ataguba J.E., Ojo K.O., Ichoku H.E. Explaining socio-economic inequalities in immunization coverage in Nigeria. Health Policy plan. 2016;31(9):1212–1224. - PubMed
    1. Cabore J.W., Karamagi H.C., Kipruto H., Asamani J.A., Droti B., Seydi A.B.W. The potential effects of widespread community transmission of SARS-CoV-2 infection in the World Health Organization African Region: a predictive model. BMJ Global Health [Internet] 2020;5(5):e002647. https://gh.bmj.com/content/5/5/e002647 May 1 [cited 2020 May 27] Available from: - PMC - PubMed
    1. Carey G., Malbon E., Carey N., Joyce A., Crammond B., Carey A. Systems science and systems thinking for public health: a systematic review of the field. BMJ Open. 2015;5(12) - PMC - PubMed
    1. Chen J. Pathogenicity and transmissibility of 2019-nCoV—A quick overview and comparison with other emerging viruses. Microbes Infect [Internet] 2020;22(2):69–71. http://www.sciencedirect.com/science/article/pii/S1286457920300265 Mar 1 [cited 2020 May 27] Available from: - PMC - PubMed