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Impact of COVID-19 on Routine Immunization; Universal Health coverage

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CHAPTER 1

INTRODUCTION

1.1. Introduction

The health system has been flurried due to quick spread of Covid-19 and severely affected all
other health services. The secondary outbreaks of vaccine-preventable diseases followed by the
swift disruption of routine immunization services had also worsen the already existed inequality
in vaccination coverage. The impact of COVID-19 pandemic on routine immunization services
is one of the major concerns. The derailing impacts of pandemic on universal health coverage
particularly on vaccination of preventable diseases are widely discussed by observing the
individual immunization records as well as through other means all across the countries.
Advancement of health sector achieved over the last two decades are wiped out in this short
period of time. Demand and supply both are the underlying factors. The fear of catching
COVID-19 virus has kept away the people from uptake of essential health services. Moreover,
preventive measures such as social distancing & strict lockdown to curb the pandemic has
affected individual’s ability to reach the health services they need.

In the time of pandemic, it is very critical to achieve the optimal balance between fighting Covid
and maintaining universal health coverage. On the response side, a global disruption of life
saving services such as utilization of routine immunization can be seen as a result of Covid-19
progression. The resurgence of Covid-19 has jeopardized the global health system particularly
increasing the susceptibility of middle- & low-income countries to outbreaks of vaccine-
preventable diseases (VPDs). Reduction in childhood vaccine coverage rate due to (COVID-19)
outbreak is a serious public health threat.

The surge of pandemic has imposed an additional burden on the most vulnerable countries &
with already drained health systems such as a case of Sindh province of Pakistan with a
population bulk of about 48 million people. This is a reference study of Sindh province providing
supporting argument to this research with the help of individual immunization records from real-
time provincial Electronic Immunization Registry. In order to know the impact of COVID-19
restrictions on routine immunization pattern in Sindh Province, the data used was taken from the
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provincial Electronic Immunization Registry (the Zindagi Mahfouz Program; ZM EIR). The ZM
EIR which is an Android-based application, allowing vaccinators to enroll and track the
vaccination status, biodata & geographical location (name, sex, and date of birth) of children
using smartphones, which has enabled the collection of real-time data for the monitoring and
evaluation of service delivery.

Data is collected during the COVID-19 lockdown (Sept 23, 2019–March 22, 2020) and from the
first 6 weeks of the lockdown period (March 23–May 9, 2020). Research was conducted and
findings were made by comparing baseline period (6 months preceding the lockdown) with the
COVID-19 lockdown period. A noticeable reduction in the mean number of vaccinations was
seen due to multiple enlisted factors such as restriction on the movement, fear and reluctance of
caregivers in providing vaccination services, dysfunctional vaccination centers & lack of
preparedness. Furthermore, the number of unvaccinated children increases in the slum areas as
well as high risk union councils. In addition to this, facility-based births and educated as well as
more aware parents are not much reluctant to vaccinate their children with comparison to the
uneducated ones.