Immunization as an essential health service: guiding principles for immunization activities during the COVID-19 pandemic and other times of severe disruption
Due to empirical evidence, field observations and survey data collected since 11 March 2020, the date WHO officially declared COVID-19 a pandemic, the global Disease eradication, elimination and control, and reduced burden of disease (mortality, morbidity, disabilities) of the disease on immunization programmes is increasingly documented and understood. The knowledge gained has informed the formulation of the recommended approaches and guiding principles expressed in this document.
Immunization is an essential health service that protects the health and well-being of communities and is thus fundamental for well-functioning countries and their economies. Immunization activities should be prioritized and safeguarded for continuity to the greatest extent possible during times of severe disruption to service delivery or utilization. Re-deployment of health workers responsible for immunization services during periods of crisis should be minimized or avoided if possible, as it can lead to long-term negative consequences. Even brief disruption or postponement of an immunization service could lead to increases in individuals susceptible to outbreak-prone vaccine preventable diseases (VPDs) in the short term, such as measles; and, in the longer term, increased risk for chronic diseases such as hepatocellular carcinoma due to hepatitis B virus, and cervical cancer due to human papilloma virus. The critical importance of preserving immunization activities is supported by modelling, which estimates that routine vaccines prevent at least 80 deaths in children in Africa for each death in an older household member due to infection with SARS-CoV-2 acquired during a routine immunization clinic visit. Strengthening infection prevention and control measures (IPC), training health workers on IPC and ensuring adequate supplies of personal protective equipment (PPE) can further reduce health facility-acquired infection.
This document, endorsed by the WHO Strategic Advisory Group of Experts on Immunization, provides guiding principles to support countries in their decision-making regarding provision or resumption of immunization services during severe disruptive events such as COVID-19, natural disasters or humanitarian emergencies. It incorporates the Immunization Agenda 2030 principles of being people-centred, country-owned, partnership-based and data-guided.