Factors Affecting the Routine Immunization Activities During a Disease Outbreak, Epidemic and Covid-19 Pandemic in Africa

Abstract

Background: The emerging disease outbreaks and pandemics affect immunization activities. In Africa, it has contributed to a significant decline in vaccination coverage and the provision of essential health services. The contributing factors which affect the immunization activities are unclear and vary as per the country's situation and response strategy to the emerging outbreaks and pandemics. Hence, we aimed to explore those factors related to disease outbreak, epidemic, and covid-19 pandemic affecting the delivery of immunization services in Africa. Methods: Our study is qualitative exploratory research, which included five countries selected using convenience sampling according to the regional classification of Africa by ACDC. Factors affecting routine immunization activities in the countries were identified through interviews with relevant stakeholders involved in vaccination services. The interviewees were selected using snowballing sampling, 4 participants from each country, twenty key informants ranking (routine immunization directors, national immunization officers, EPI officers, and some health workers and caregivers) were included for open-ended and semi-structured virtual in-depth interviews. Additionally, some parents were interviewed for their perceptions about vaccinating their children during the current pandemic. We also did a literature review on the impact of previous emerging disease outbreaks on routine immunization activities in the countries and the current situation of the COVID-19 pandemic. Supportive trend data based on measles vaccination coverage and disease rates based on WHO country reports over time were included. Data generated from the literature review and in-depth interviews were transcribed verbatim and analyzed using thematic analysis. We used the thematic framework to organize our findings; each country was identified according to the following variables: Country name, the current situation of covid-19, covid-19 impact on the following factors (health system, governance, and community), and the impact of a previous disease outbreak on the measles immunization coverage. Findings were grouped according to the country's perspective. We compared factors during previous outbreaks and covid-19 pandemics in Africa and addressed some interventions that can support immunization activities during disease x outbreak. Results: 40% of our participants emphasized that fear of infection was behind the interruption in the immunization activities during covid-19 pandemics. 35% agreed that movement restrictions limited many activities. Resource limitation and misinformation comes as an individual barrier representing 10-15%. Some of the addressed health system factors included: surveillance defect, human resource shortage, lack of training, infrastructure, and PPE inadequacy. On the community base: misinformation, vaccine hesitancy and refusal, and fear of infection were identified. Governance factors included: movement restriction, travel ban, closed health facilities, lockdown, and social distancing factors were addressed. Few gaps were identified, as providing the proper training to the health workers and the caregivers, community engagement, national planning, building a proper registry system with implementing the proper plans for fast service recovery after a pandemic. By fulfilling those gaps, we may be able to provide better access to routine immunization during a disease outbreak, epidemic, and pandemic. Conclusions: The study addressed the various factors affecting Africa’s routine immunization activities during disease outbreaks and pandemics. It also addressed the impact of a previous disease outbreak on the measles immunization coverage, which may predict the covid-19 impact on the immunization coverage. It is, therefore, essential for decision-makers to address those factors to ensure immunization coverage without any missed opportunities. Keywords: vaccination, outbreaks, covid-19, factors, Africa, misinformation, hesitancy.