The COVID-19 pandemic decreased child routine vaccination coverage and increased vaccine delays in India.

Washington, DC /Bengaluru, India – Researchers from the One Health Trust (OHT), with support from the Value of Vaccination Research Network through a grant from the Bill & Melinda Gates Foundation, estimated the effect of the pandemic on the coverage and timeliness of routine childhood immunization in India through April 2021. While other studies have analyzed the impact of the COVID-19 pandemic on routine childhood immunization using methodologically limited administrative dose data and telephone surveys in the early stages of the pandemic, OHT researchers used data from India’s National Family Health Survey 2019-2021 (NFHS-5), a large-scale nationally representative child health survey conducted between June 2019 and April 2021 to estimate these effects using a robust modelling framework.

OHT researchers used a mother fixed-effects regression model – accounting for secular trends and child varying factors – to compare COVID-affected children with their COVID-unaffected siblings (n=59,144). Children who were eligible for a vaccine after January 30, 2020 (date of the first COVID-19 case detected in India) were considered the COVID-affected group and those eligible for a vaccine after this date were included in the COVID-unaffected group. The routine vaccine doses considered for the study were the Bacillus Calmette–Guérin (BCG), hepatitis B birth dose (hepB0), DPT1 (diphtheria, pertussis, and tetanus, first dose), DPT2, DPT3, polio1, polio2, polio3, and measles first dose (MCV1).

The results, revealing a marked decrease in routine childhood immunization rates during the pandemic, have important implications for India’s immunization program and COVID-19 recovery policies. The already significant burden of child illness and mortality will be greatly exacerbated by decreased vaccination coverage. Vaccine-preventable illnesses, such as meningitis, measles, pneumonia, and diarrheal illnesses, are estimated to kill 400,000 children under the age of five in India annually. Increased vaccination delays or missed doses have significant effects on morbidity and mortality, particularly for infectious diseases like measles that can reduce immunity to other infections.

Overall the key findings of the study are as follows:

• Children born in India after COVID-19 emergence had 2 percent to 10 percent lower probability of immunization and 3 percent to 5 percent lower probability of timely vaccination as compared with their siblings who were born prior to the pandemic.
• For overall vaccination coverage, vaccines given later in the immunization schedule had greater delay than early-dose vaccines.
• Immunization coverage was lower in COVID-affected children as compared with unaffected children, ranging from 2 percent lower for BCG and hepB0 to 9 percent for DPT3 and 10 percent for polio3.
• There was no significant difference in MCV1 coverage.
• Among population subgroups, COVID-affected male children and those from rural areas experienced the highest reduction in vaccine coverage.

According to the study’s lead author, Dr. Amit Summan, “Our study highlights that even in the relatively late stages of the pandemic — until April 2021 —routine childhood immunization rates had not recovered to pre-pandemic levels and the effects are potentially severe for dropout vaccination, that is, older children not finishing their full vaccination schedules. Similar effects are now being discovered across low- and middle-income countries, highlighting the urgent need for catch-up vaccination campaigns and investments in health systems to increase their resilience to shocks such as COVID-19.”

# # # # #

About the One Health Trust 

The One Health Trust (OHT) uses research and stakeholder engagement to improve the health and well-being of our planet and its inhabitants. OHT continues and builds on the work of the Center for Disease Dynamics, Economics & Policy (CDDEP), which for more than a decade has conducted vitally important research on major global health challenges, including Covid-19, antimicrobial resistance, hospital infections, tuberculosis, malaria, pandemic preparedness and response, vaccines, medical oxygen shortages, and noncommunicable diseases. OHT’s work now expands to take on issues related to climate change, biodiversity protection, and the effect of changing human diets on the planet. 

At OHT, we believe that answers to the world’s most critical questions lie between disciplines. Accordingly, our researchers employ a range of expertise—from economics, epidemiology, disease modeling, and risk analysis to clinical and veterinary medicine, geographic information systems, and statistics—to conduct actionable, policy oriented research. 

OHT has offices in Washington, D.C., and Bangalore, India, with researchers based in North America, Africa, and Asia. Our projects lead to policy recommendations and scientific studies published in leading journals. We are experienced in addressing country-specific and regional issues as well as global challenges. Our research is renowned for innovative approaches to design and analysis, and we communicate our work to diverse stakeholders.