Rebuilding Trust on Routine Immunization in Era of COVID-19 Fear-Role that Civil Society Organizations can Play Hands-in-Hand with Immunization Program.

Abstract

To the Editor, The COVID-19 pandemic has drastically impacted the health and socioeconomic condition of this symbiotic globe [1]. The aforementioned impact as well as the one on quality of life has been much more devastating for developing countries, such as the ones supported by the Global Alliance for Vaccines and Immunization (GAVI) [4] All GAVI-supported countries pledged to achieve 100 percent of immunization but one in every 10 children globally still has no access to vaccines, leaving millions of zero-dose children behind [6]. Where the supply-side in these countries is struggling to deliver vaccination services after COVID-19, the demand is facing “double burden” now. Communities often harbor lots of “myths and misconceptions” pertaining to vaccines and vaccination services [7]. The exacerbation of existing fear within communities to access vaccination services and anxiety among frontline health workers to safely deliver vaccination present as key hurdles, reflected by a much smaller number of children being vaccinated in this period [8–10]. The consequences of this have been compounded by restrictions on movement, suspension of public transport, and concerns about exposure to COVID-19. At the same time, the health workforce is absent from their duties either due to travel restrictions, self-quarantine, sickness, lack of personal protective equipment (PPE) and concerns about COVID-19 exposure [11, 12]. There is a resultant visible impact seen on immunization services such as the 52.8% decrease in immunization visits seen in the Sindh province, Pakistan. This translated into around 2,734 missed children daily only in Karachi, the most populous city of Sindh province. These missed children are at the highest risk of developing VPDs [13]. Many immunization campaigns like “polio and zero dose” were or are still suspended in countries including Pakistan, and bring about a risk of spread of these VPDs and consequent morbidity and mortality [14, 15]. Currently, countries are lifting lockdown restrictions and restoring the health services. However, due to the unpredictability of the situation and decrease in vaccination coverage, exceptional strategies are needed. Expanded Program on Immunization (EPI) alone cannot compensate for the loss of missed children so far and months of effort are required to reach the point where we were before COVID-19. Integrated systems and synergy across the partners are a need of the hour. In some semblance of hope, Pakistan has an existing infrastructure of CSOs which operate as the key players in delivering Edited by: Raquel Lucas, University Porto, Portugal