Peer-reviewed article
Impact of COVID-19 pandemic on childhood immunization coverage in Indonesia: lesson learned from a nationwide analysis of the Expanded Programme on Immunization.
Amalia Nurina, Evelyn Puspaningrum, Gertrudis Tandy, Debsy Pattilima, Badriul Hegar et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how the COVID-19 pandemic affected childhood immunization rates across 514 districts in Indonesia. National immunization coverage dropped from 83.2% before the pandemic to 75.0% in the first year, then recovered to 88.6% in the second year. Districts with high COVID-19 cases, fewer midwives, and more facility-based births were most affected. The findings show that pandemic impacts on immunization were uneven and linked to local health system capacity.
Key points
- National immunization coverage fell 8.2 percentage points in the first pandemic year (83.2% to 75.0%), affecting 69.3% of districts
- Coverage ratio in year one was 0.92 (95% CI 0.89-0.94) compared to pre-pandemic levels
- High COVID-19 incidence was associated with decline (adjusted odds ratio 2.19)
- Low midwife adequacy was the strongest predictor of coverage decline (adjusted odds ratio 5.84 for lowest vs. highest)
- Recovery occurred in year two (88.6% coverage), though 36.2% of districts remained affected
Limitations
The study is observational and cannot establish causation, only associations. It does not explain the mechanisms by which specific health system factors disrupted immunization delivery.
Abstract
BACKGROUND: The COVID-19 pandemic disrupted childhood immunization programmes in many countries worldwide. However, evidence on its impact in low and middle-income countries remains limited. This study examined the impact of the COVID-19 pandemic on childhood immunization coverage across 514 districts in Indonesia and identified district-level associated factors. METHODS: We conducted a nationwide longitudinal analysis of the Expanded Programme on Immunization to compare immunization coverage before and after the pandemic. The outcome variable was the annual childhood immunization coverage (proportion of children aged 0-12 months who have received all recommended doses of childhood immunization as per the national immunization schedule). The independent variables include COVID-19 burden and vaccination rates, health system and human development indicators. Mixed-effect logistic regression was done to assess association between the independent and outcome variables. RESULTS: At the national level, the coverage was 83.2% in pre-pandemic, 75.0% in the first year of pandemic, and 88.6%, in the second. In the first year, 69.3% of districts experienced significant decline, with a lower national coverage ratio of 0.92 (95% confidence interval 0.89-0.94). In the second year, 36.2% districts were still affected. The multivariable analysis showed that a significant decline in coverage during the first pandemic year was associated with high COVID-19 incidence (adjusted odds ratio 2.19, 95%CI 1.01-4.73 for the highest vs. lowest group), low midwife adequacy (5.84, 2.40-14.16 for the lowest vs. the highest group, 2.61, 1.26-5.40 for low-middle vs. the highest group), and a high proportion of health facility-based births (2.98, 1.49-5.98 for middle-high vs. the lowest group). CONCLUSIONS: The COVID-19 pandemic was negatively and unevenly associated with childhood immunization in Indonesia, with greatest impacts in districts facing a higher COVID-19 burden and weaker health system capacity. These findings underscore the need for targeted efforts to strengthen the local health system for future health crises.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Existing Expanded Programme on Immunization (routine childhood immunization services)
- Population
- Children aged 0-12 months across 514 districts in Indonesia
Key finding
National coverage declined from 83.2% pre-pandemic to 75.0% in first pandemic year (relative risk 0.92)