Childhood immunisations in India during the COVID-19 pandemi
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The COVID-19 pandemic has led to major disruptions in the delivery of essential health services including routine immunization services in many countries, setting the stage for potentially serious population health effects. The WHO reported major disruptions to vaccination services in countries around the world and estimated that approximately 80?million children under the age of 1 were living in countries where routine immunization services were disrupted and could potentially be at risk of developing a vaccine-preventable illness.1 Evidence from previous epidemics has demonstrated that even temporary interruptions of routine immunization services can lead to secondary public health crises, such as outbreaks of vaccine-preventable diseases, amplifying morbidity and mortality. This commentary explores the possible effects of the COVID-19 pandemic on routine immunizations in India.

Results from a survey of Indian pediatricians amplify a growing chorus around the globe calling for a focus on vaccine-preventable illnesses, even as COVID-19 cases grow worldwide. This comes at a pivotal time in India’s ongoing pursuit to improve immunization coverage. The national immunization program run by the Government of India is one of the largest in the world, with an annual reach of over 26?million children and 29?million pregnant women.4 Mission Indradhanush was launched in 2014 to extend this reach and achieve full immunization for 90% of children, and the program was further intensified in 2019. While remarkable progress has been made, there is evidence of existing inequalities in coverage.

Early in the pandemic, soon after the lockdown was announced, there were major disruptions in health services, especially in women and children’s services. Movement restrictions were likely to have disrupted strategies used by Mission Indradhanush, including community mobilization, door-to-door campaigns, and monitoring events. The National Health Mission’s health management and information system reported a substantial decrease in routine immunization services relative to the previous year, indicating that in March 2020 at least 100?000 and 200?000 children missed their BCG and pentavalent (diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenza type b) vaccines, respectively.