Impact of COVID-19 on routine immunisation in South-East Asia and Western Pacific: Disruptions and solutions

Abstract

Background: Data on COVID-19-induced disruption to routine vaccinations in the South-East Asia and Western Pacific regions (SEAR/WPR) have been sparse. This study aimed to quantify the impact of COVID-19 on routine vaccinations by country, antigen, and sector (public or private), up to 1 June 2020, and to identify the reasons for disruption and possible solutions.

Methods: Sanofi Pasteur teams from 19 countries in SEAR/WPR completed a structured questionnaire reporting on COVID-19 disruptions for 13-19 routinely delivered antigens per country, based on sales data, government reports, and regular physician interactions. Data were analysed descriptively, disruption causes ranked, and solutions evaluated using a modified public health best practices framework.

Findings: 95% (18/19) of countries reported vaccination disruption. When stratified by country, a median of 91% (interquartile range 77-94) of antigens were impacted. Infancy and school-entry age vaccinations were most impacted. Both public and private sector healthcare providers experienced disruptions. Vaccination rates had not recovered for 39% of impacted antigens by 1 June 2020. Fear of infection, movement/travel restrictions, and limited healthcare access were the highest-ranked reasons for disruption. Highest-scoring solutions were separating vaccination groups from unwell patients, non-traditional vaccination venues, virtual engagement, and social media campaigns. Many of these solutions were under-utilised.

Interpretation: COVID-19-induced disruption of routine vaccination was more widespread than previously reported. Adaptable solutions were identified which could be implemented in SEAR/WPR and elsewhere. Governments and private providers need to act urgently to improve coverage rates and plan for future waves of the pandemic, to avoid a resurgence of vaccine-preventable diseases.

Funding: Sanofi Pasteur.

Keywords: Asia; COVID-19; Disruption; Immunisation; Preventive care; Public health; Routine vaccination; Vaccination coverage rates; Vaccines.

Fig. 1

Proportion of antigens impacted by country. The denominator was defined as number of antigens for whom countries answered anything except ‘not applicable’. Median and IQR values overall are presented in the text (Section 3.1). AU, Australia; BN, Brunei; CN, China; HK, Hong Kong; ID, Indonesia; IN, India; JP, Japan; KH, Cambodia; KR, South Korea; MM, Myanmar; MY, Malaysia; NP, Nepal; NZ, New Zealand; PH, Philippines; PK, Pakistan; SG, Singapore; TH, Thailand; TW, Taiwan; VN, Vietnam.

Fig. 2

Number of antigens impacted by country and by age Median and IQR values overall are presented in the text (Section 3.1). AU, Australia; BN, Brunei; CN, China; HK, Hong Kong; ID, Indonesia; IN, India; JP, Japan; KH, Cambodia; KR, South Korea; MM, Myanmar; MY, Malaysia; NP, Nepal; NZ, New Zealand; PH, Philippines; PK, Pakistan; SG, Singapore; TH, Thailand; TW, Taiwan; VN, Vietnam.

Fig. 3

Proportion of countries impacted by antigen Median and IQR values overall are presented in the text (Section 3.2). BCG, bacillus Calmette-Guérin; HiB, Haemophilus influenzae B; HPV, human papilloma virus; IPV, inactivated polio vaccine; OPV, oral polio vaccine. *denotes antigens potentially within combination vaccines.

Fig. 4

Weighted average rank of reasons for disruption Score of nine is highest-ranked reason for disruption, zero represents not stated as a reason. HCP, healthcare provider.