Impact of the COVID-19 pandemic on the coverage and timeliness of routine childhood vaccinations in the Gambia, 2015-2021

Abstract

Introduction: The COVID-19 pandemic caused widespread morbidity and mortality and resulted in the biggest setback in routine vaccinations in three decades. Data on the impact of the pandemic on immunisation in Africa are limited, in part, due to low-quality routine or administrative data. This study examined coverage and timeliness of routine childhood immunisation during the pandemic in The Gambia, a country with an immunisation system considered robust.

Methods: We obtained prospective birth cohort data of 57 286 children in over 300 communities in two health and demographic surveillance system sites, including data from the pre-pandemic period (January 2015-February 2020) and the three waves of the pandemic period (March 2020-December 2021). We determined monthly coverage and timeliness (early and delayed) of the birth dose of hepatitis B vaccine (HepB0) and the first dose of pentavalent vaccine (Penta1) during the different waves of the pandemic relative to the pre-pandemic period. We implemented a binomial interrupted time-series regression model.

Result: We observed no significant change in the coverage of HepB0 and Penta1 vaccinations from the pre-pandemic period up until the periods before the peaks of the first and second waves of the pandemic in 2020. However, there was an increase in HepB0 coverage before as well as after the peak of the third wave in 2021 compared with the pre-pandemic period (pre-third wave peak OR = 1.83, 95% CI 1.06 to 3.14; post-third wave period OR=2.20, 95% CI 1.23 to 3.92). There was some evidence that vaccination timeliness changed during specific periods of the pandemic. Early Penta1 vaccination decreased by 70% (OR=0.30, 95% CI 0.12 to 0.78) in the period before the second wave, and delayed HepB0 vaccination decreased by 47% (OR=0.53, 95% CI 0.29 to 0.97) after the peak of the third wave in 2021.

Conclusion: Despite the challenges of the COVID-19 pandemic, The Gambia's routine vaccination programme has defied the setbacks witnessed in other settings and remained resilient, with coverage increasing and timeliness improving during the second and third waves. These findings highlight the importance of having adequate surveillance systems to monitor the impact of large shocks to vaccination coverage and timeliness.

Keywords: COVID-19; Child health; Epidemiology; Immunisation.

Figure 1

(A) Detailed timeline showing the evolution and measures implemented to control the spread of COVID-19 in The Gambia, March 2020–December 2021. (B) Map of The Gambia showing the location of all the communities covered by the Basse and Farafenni Health and Demographic Surveillance Sites. *In figure 1A, red lines indicate case confirmation, new variants and waves. Blue lines indicate preventive measures implemented by government reduce impact of the pandemic. HDSS, health and demographic surveillance system.

Figure 2

Observed hepatitis B vaccine (HepB0) (A) and pentavalent vaccine (Penta1) (B) coverage, counterfactual scenario and changes (level and slope) due to the pandemic overall, in Farafenni and Basse. *Red-dotted lines indicate when the first case of COVID-19 was confirmed in The Gambia, the peaks of the first, second and third waves. Blue line indicates observed coverage and 95% credible intervals; red line=counterfactual scenario and 95% credible interval; yellow line indicates the change in slope for the proportion of children vaccinated.

Figure 3

Observed hepatitis B vaccine (HepB0) (A) and pentavalent vaccine (Penta1) (B) delayed vaccination, counterfactual scenario and changes (level and slope) due to the pandemic overall, in Farafenni and Basse. *Red-dotted lines indicate when the first case of COVID-19 was confirmed in The Gambia, the peaks of the first, second and third waves; blue line indicates observed coverage and 95% credible intervals; red line=counterfactual scenario and 95% credible interval; yellow line indicates the change in slope for the proportion of children vaccinated.

Figure 4

Observed mean number of days with delayed hepatitis B vaccine (HepB0) vaccination per monthly birth cohort in the pre-pandemic compared with the pandemic period overall, in Farafenni and Basse.

Figure 5

Observed hepatitis B vaccine (HepB0) (A) and pentavalent vaccine (Penta1) (B) early vaccination, counterfactual scenario, and changes (level and slope) due to the pandemic overall, in Farafenni and Basse. *Red-dotted lines indicate when the first case of COVID-19 was confirmed in The Gambia, the peaks of the first, second and third waves; blue line indicates observed coverage and 95% credible intervals; red line=counterfactual scenario and 95% credible interval; yellow line indicates the change in slope for the proportion of children vaccinated.