COVID-19 and missed or delayed vaccination in 26 middle- and high-income countries: An observational survey

Abstract

Background The COVID-19 pandemic has disrupted vaccination services and raised the risk of a global resurgence of preventable diseases. We assessed the extent of and reasons for missed or delayed vaccinations (hereafter ‘missed’) in middle- and high-income countries in the early months of the pandemic. Methods Participants were 28,429 adults from 26 middle- and high-income countries. From May to June 2020, participants completed an online survey on missed vaccination. Analyses separated missed childhood and adult vaccination in middle-and high-income countries. Results Respondents were 28,429 adults from 26 middle- and high-income countries. Overall, 9% of households had missed a vaccine, and 13% were unsure. More households in middle- than high-income countries reported missed childhood vaccination (7.6% vs. 3.0%) and missed adult vaccination (9.6% vs. 3.4%, both p <.05). Correlates of missed childhood vaccination in middle-income countries included COVID-19 risk factors (respiratory and cardiovascular disease), younger age, male sex, employment, distress, larger household size, and more children. In high-income countries, correlates of missed childhood vaccination also included immunodeficiency disorders, but did not include sex or household size. Fewer correlates were associated with missed adult vaccination other than COVID-19 risk factors and distress. Common reasons for missed vaccinations were worry about getting COVID-19 at the vaccination clinic (15%) or when leaving the house (11%). Other reasons included no healthcare provider recommendation, clinic closure, and wanting to save services for others. Interpretation Missed vaccination was common and more prevalent in middle- than high-income countries. Missed vaccination could be mitigated by emphasizing COVID-19 safety measures in vaccination clinics, ensuring free and accessible immunization, and clear healthcare provider recommendations

The Impact of COVID-19 Pandemic on Inequity in Routine Childhood Vaccination Coverage: A Systematic Review

“…The included studies used several approaches to study inequities in childhood vaccination inequities. Country-level income categories as defined by the World Bank ( accessed on 3 May 2022) to study variations in routine vaccination rates were reported for child populations in two studies for low-income countries (studies from Ethiopia [ 25 , 26 ]), three for lower-middle-income countries (studies from India [ 20 ] and Pakistan [ 14 , 16 ]), three for upper-middle-income countries (studies from Brazil [ 27 ], China [ 28 ] and Colombia [ 21 ]), four for high-income countries (three US studies [ 22 , 23 , 24 ] and UK [ 15 ]) and in a study comparing nine middle-income countries with 16 high-income countries [ 29 ].…”

“…Approaches for data collection varied across the studies. In four of them, the data collection was performed using a structured interview plus vaccination card records [ 16 , 20 , 25 , 27 ], four studies used a structured interview/survey only [ 15 , 26 , 28 , 29 ] and five studies used administrative records [ 14 , 21 , 22 , 23 , 24 ].…”

“…Reported age groups differed in the selected studies. Children under two years of age were studied in eight studies [ 14 , 15 , 16 , 20 , 24 , 25 , 26 , 27 ], children and adolescents aged 0–18 years were reviewed in two studies [ 22 , 29 ] and children aged 3–17 years were included in the remaining study [ 28 ].…”

“…Coverage change during the pandemic was reported for the education level of the responding parent in six studies [ 14 , 16 , 20 , 25 , 26 , 28 ]. Race/ethnicity was also reported [ 16 , 22 , 23 ], and employment [ 29 ] and wealth were measured at the country level based on World Bank criteria [ 29 ]. Further, the household level assessed by assets and building characteristics of the home [ 27 ] was used as an equity stratifier; of particular interest was the use of the Hindu system of low assets or low caste with its rigid hierarchical groups based on work and religion [ 20 ].…”

“…The risk of bias was lowest for three of the included studies [ 14 , 25 , 27 ], with maximum stars for all three scale domains (8 stars). Eight studies [ 15 , 20 , 21 , 22 , 24 , 26 , 28 , 29 ] had a moderate risk of bias (7 or 6 stars) and two studies [ 16 , 23 ] had a high risk of bias (<6 stars).…”