Peer-reviewed article
Routine childhood immunisation during the COVID-19 pandemic in Africa: a benefit–risk analysis of health benefits versus excess risk of SARS-CoV-2 infection
Kaja Abbas, Simon R. Procter, Kevin van Zandvoort, Andrew David Clark, Sebastian Funk et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study compares the health benefits of continuing childhood immunisation programmes in Africa during COVID-19 against the risk of children acquiring SARS-CoV-2 at vaccination clinics. Using mathematical modelling with country-specific mortality data, researchers found that sustaining routine immunisation prevents far more child deaths than would be caused by COVID-19 exposure at clinics. The analysis concludes that immunisation programmes should continue in Africa despite pandemic constraints, though other practical challenges need consideration.
Key points
- In the high-impact scenario, for every one excess COVID-19 death from vaccination clinic visits, 84 deaths in children are prevented by sustaining immunisation
- The benefit–risk ratio for vaccinated children themselves is 85,000 to 1 in favour of continuing immunisation
- Even in the low-impact scenario considering only measles, the benefit–risk ratio for vaccinated children is 3,000 to 1
- Benefits extend beyond vaccinated children to siblings and household members, though with lower ratios for older adults
- The analysis assumes 60% population infection rate by end of COVID-19 risk period and household transmission patterns
Limitations
This is a mathematical modelling study based on assumptions about infection rates, transmission patterns, and country-specific mortality data; it cannot provide direct empirical evidence of what actually occurred in real vaccination programmes during COVID-19, nor does it address implementation challenges like staff shortages or vaccine supply disruptions.
Abstract
Background National immunisation programmes globally are at risk of suspension due to the severe health system constraints and physical distancing measures in place to mitigate the ongoing COVID-19 pandemic. We aimed to compare the health benefits of sustaining routine childhood immunisation in Africa with the risk of acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection through visiting routine vaccination service delivery points. Methods We considered a high-impact scenario and a low-impact scenario to approximate the child deaths that could be caused by immunisation coverage reductions during COVID-19 outbreaks. In the high-impact scenario, we used previously reported country-specific child mortality impact estimates of childhood immunisation for diphtheria, tetanus, pertussis, hepatitis B, Haemophilus influenzae type b, Streptococcus pneumoniae , rotavirus, measles, meningitis A, rubella, and yellow fever to approximate the future deaths averted before 5 years of age by routine childhood vaccination during a 6-month COVID-19 risk period without catch-up campaigns. In the low-impact scenario, we approximated the health benefits of sustaining routine childhood immunisation on only the child deaths averted from measles outbreaks during the COVID-19 risk period. We assumed that contact-reducing interventions flattened the outbreak curve during the COVID-19 risk period, that 60% of the population will have been infected by the end of that period, that children can be infected by either vaccinators or during transport, and that upon child infection the whole household will be infected. Country-specific household age structure estimates and age-dependent infection-fatality rates were applied to calculate the number of deaths attributable to the vaccination clinic visits. We present benefit–risk ratios for routine childhood immunisation, with 95% uncertainty intervals (UIs) from a probabilistic sensitivity analysis. Findings In the high-impact scenario, for every one excess COVID-19 death attributable to SARS-CoV-2 infections acquired during routine vaccination clinic visits, 84 (95% UI 14–267) deaths in children could be prevented by sustaining routine childhood immunisation in Africa. The benefit–risk ratio for the vaccinated children is 85 000 (4900–546 000), for their siblings (<20 years) is 75 000 (4400–483 000), for their parents or adult carers (aged 20–60 years) is 769 (148–2700), and for older adults (>60 years) is 96 (14–307). In the low-impact scenario that approximates the health benefits to only the child deaths averted from measles outbreaks, the benefit–risk ratio to the households of vaccinated children is 3 (0·5–10); if the risk to only the vaccinated children is considered, the benefit–risk ratio is 3000 (182–21 000). Interpretation The deaths prevented by sustaining routine childhood immunisation in Africa outweigh the excess risk of COVID-19 deaths associated with vaccination clinic visits, especially for the vaccinated children. Routine childhood immunisation should be sustained in Africa as much as possible, while considering other factors such as logistical constraints, staff shortages, and reallocation of resources during the COVID-19 pandemic. Funding Gavi, the Vaccine Alliance; Bill & Melinda Gates Foundation.