Peer-reviewed article
The impact of COVID-19 on routine child immunisation in South Africa
Sangiwe Moyo, Anushka Ashok, Saransh Sharma, Rebecca Nyankieya, Ram Prasad et al. ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This qualitative study looked at how COVID-19 affected routine childhood immunisation in South Africa. Researchers interviewed 51 parents and caregivers of children under five who missed or delayed vaccine doses in 2020-2022, and 12 healthcare providers in public immunisation services. During lockdowns, many caregivers feared COVID-19 infection at clinics more than they feared missing vaccines. Vaccine shortages, little communication about routine immunisation, and health worker anxiety and burnout were also reported. The authors say immunisation has shifted from an almost automatic habit to a more active decision, which risks backsliding in future pandemics.
Key points
- Most caregivers saw the risk of COVID-19 infection during a clinic visit as more important than the risk of missing immunisation doses during lockdowns.
- Caregivers reported minimal exposure to routine immunisation communication.
- Caregivers reported shortages of routine vaccines at public health facilities.
- Healthcare workers experienced anxiety and burnout.
- After the pandemic, some caregivers moved to active decision-making about immunisation and delayed vaccinating their children; some held a 'bad vaccine' mental model linked to COVID vaccines that could raise doubts about routine vaccines.
Limitations
This is a qualitative study of purposively selected participants, so it cannot show how common these views are or measure the actual drop in immunisation coverage. It does not test any intervention.
Abstract
Abstract Background The COVID-19 pandemic disrupted immunisation programs worldwide, reversing gains that had brought vaccine-preventable diseases largely under control. This study explored the impact of COVID-19 on the uptake of routine child immunisation services in South Africa. Methods We conducted qualitative research using in-depth interviews with 51 purposively selected parents/caregivers of children below the age of five who missed or delayed one or more scheduled immunisation doses in 2020-2022 and with 12 healthcare providers who provided public immunisation services during the pandemic. Findings During the pandemic lockdowns, most caregivers perceived the risk of their child being infected with COVID-19 during a clinic visit as more salient than the risk of missing immunisation doses. Caregivers reported minimal exposure to routine immunisation communication, as well as shortages of routine vaccines for children at public health facilities; healthcare workers experienced anxiety and burnout. There was a post-pandemic shift to more active decision-making about immunisation, which had previously been an almost automatic behaviour, leading some caregivers to delay vaccinating their children. There was also evidence of a “bad vaccine” mental model among some caregivers regarding COVID vaccinations, which could lead to doubts about the safety of routine childhood vaccinations. Interpretation The shift from default to active decision-making highlights a risk that routine immunisation will backslide in future pandemics. Governments should build resilient health systems at all levels and communicate clearly about the benefits and availability of RIs and the safety of vaccinations in general, alongside supply-side interventions. Funding Final Mile Consulting funded this study.