Impact of COVID-19-related disruptions to measles, meningococcal A, and yellow fever vaccination in 10 countries

Abstract

Background: Childhood immunisation services have been disrupted by the COVID-19 pandemic. WHO recommends considering outbreak risk using epidemiological criteria when deciding whether to conduct preventive vaccination campaigns during the pandemic.

Methods: We used two to three models per infection to estimate the health impact of 50% reduced routine vaccination coverage in 2020 and delay of campaign vaccination from 2020 to 2021 for measles vaccination in Bangladesh, Chad, Ethiopia, Kenya, Nigeria, and South Sudan, for meningococcal A vaccination in Burkina Faso, Chad, Niger, and Nigeria, and for yellow fever vaccination in the Democratic Republic of Congo, Ghana, and Nigeria. Our counterfactual comparative scenario was sustaining immunisation services at coverage projections made prior to COVID-19 (i.e. without any disruption).

Results: Reduced routine vaccination coverage in 2020 without catch-up vaccination may lead to an increase in measles and yellow fever disease burden in the modelled countries. Delaying planned campaigns in Ethiopia and Nigeria by a year may significantly increase the risk of measles outbreaks (both countries did complete their supplementary immunisation activities (SIAs) planned for 2020). For yellow fever vaccination, delay in campaigns leads to a potential disease burden rise of >1 death per 100,000 people per year until the campaigns are implemented. For meningococcal A vaccination, short-term disruptions in 2020 are unlikely to have a significant impact due to the persistence of direct and indirect benefits from past introductory campaigns of the 1- to 29-year-old population, bolstered by inclusion of the vaccine into the routine immunisation schedule accompanied by further catch-up campaigns.

Conclusions: The impact of COVID-19-related disruption to vaccination programs varies between infections and countries. Planning and implementation of campaigns should consider country and infection-specific epidemiological factors and local immunity gaps worsened by the COVID-19 pandemic when prioritising vaccines and strategies for catch-up vaccination.

Funding: Bill and Melinda Gates Foundation and Gavi, the Vaccine Alliance.

Keywords: COVID-19; epidemiology; global health; human; mathematical modelling; measles; medicine; meningococcal disease; vaccination; yellow fever.

Figure 1.. Health impact of predicted total deaths for immunisation disruption scenarios and no disruption scenario for measles, meningococcal A, and yellow fever.

Model-predicted total deaths per 100,000 population per year for routine immunisation (RI) and campaign immunisation (SIAs – supplementary immunisation activities) disruption scenarios and no disruption scenario (BAU – business-as-usual scenario) for measles, meningococcal A, and yellow fever during 2020–2030.

Figure 2.. Health impact of excess deaths for immunisation disruption scenarios in comparison to no disruption scenario for measles, meningococcal A, and yellow fever.

Model-predicted excess deaths per 100,000 population per year for routine immunisation (RI) and campaign immunisation (SIAs – supplementary immunisation activities) disruption scenarios in comparison to no disruption scenario (BAU – business-as-usual scenario) for measles, meningococcal A, and yellow fever. Excess deaths are summed over 2020–2030.

Appendix 1—figure 1.. Health impact of predicted total disability-adjusted life years for immunisation disruption scenarios and no disruption scenario for measles, meningococcal A, and yellow fever.

Model-predicted total disability-adjusted life years (DALYs) per 100,000 population per year for routine immunisation (RI) and campaign immunisation (SIAs – supplementary immunisation activities) disruption scenarios and no disruption scenario (BAU – business-as-usual scenario) for measles, meningococcal A, and yellow fever during 2020–2030.

Appendix 1—figure 2.. Health impact of excess disability-adjusted life years for immunisation disruption scenarios in comparison to no disruption scenario for measles, meningococcal A, and yellow fever.

Model-predicted excess disability-adjusted life years (DALYs) per 100,000 population per year for routine immunisation (RI) and campaign immunisation (SIAs – supplementary immunisation activities) disruption scenarios in comparison to no disruption scenario (BAU – business-as-usual scenario) for measles, meningococcal A, and yellow fever. Excess DALYs are summed over 2020–2030.

Appendix 1—figure 3.. Health impact of normalised excess deaths for immunisation disruption scenarios in comparison to no disruption scenario for measles, meningococcal A, and yellow fever.

The normalised model-predicted excess deaths per year for routine immunisation (RI) and campaign immunisation (SIAs – supplementary immunisation activities) disruption scenarios in comparison to no disruption scenario (BAU – business-as-usual scenario) for measles, meningococcal A, and yellow fever. Excess deaths are summed over 2020–2030, and the excess deaths are normalised by setting the BAU to 0 and maximum to 1.

Appendix 1—figure 4.. Health impact of normalised excess disability-adjusted life years for immunisation disruption scenarios in comparison to no disruption scenario for measles, meningococcal A, and yellow fever.

The normalised model-predicted excess disability-adjusted life years (DALYs) per year for routine immunisation (RI) and campaign immunisation (SIAs – supplementary immunisation activities) disruption scenarios in comparison to no disruption scenario (BAU – business-as-usual scenario) for measles, meningococcal A, and yellow fever. Excess DALYs are summed over 2020–2030, and the excess DALYs are normalised by setting the BAU to 0 and maximum to 1.

Appendix 1—figure 5.. Health impact of predicted total deaths for immunisation disruption scenarios and no disruption scenario for measles.

Model-predicted total deaths per year for routine immunisation (RI) and campaign immunisation (SIAs – supplementary immunisation activities) disruption scenarios and no disruption scenario (BAU – business-as-usual scenario) for measles during 2020–2030 per modelling group.

Appendix 1—figure 6.. Health impact of predicted total deaths for immunisation disruption scenarios and no disruption scenario for meningococcal A.

Model-predicted total deaths per year for routine immunisation (RI) and campaign immunisation (SIAs – supplementary immunisation activities) disruption scenarios and no disruption scenario (BAU – business-as-usual scenario) for meningococcal A during 2020–2030 per modelling group.

Appendix 1—figure 7.. Health impact of predicted total deaths for immunisation disruption scenarios and no disruption scenario for yellow fever.

Model-predicted total deaths per year for routine immunisation (RI) and campaign immunisation (SIAs – supplementary immunisation activities) disruption scenarios and no disruption scenario (BAU – business-as-usual scenario) for yellow fever during 2020–2030 per modelling group.