Impact of COVID-19 lockdown on routine immunisation in Karachi, Pakistan

We compared the ZM EIR data from Karachi in the 6 months before the COVID-19 lockdown (Sept 23, 2019–March 22, 2020) with those from the first 6 weeks of the lockdown period (March 23–May 9, 2020). Of a total of 701 324 records, 608 832 children (aged 0–23 months) were immunised during the baseline period and 92 492 were immunised during the lockdown period. The mean number of daily immunisation visits (accounting for all antigens) decreased by 52·8% (from 5184 to 2450 visits) during the lockdown compared with baseline. The decrease in the mean number of daily immunisation visits was steeper in the earlier weeks of the lockdown (appendix p 1). On average, 2734 children per day missed routine immunisation during the lockdown in Karachi. Further analysis of data from after the lockdown was lifted on May 10, 2020, showed a steady recovery in coverage rates (appendix p 1). From May 10, 2020, to June 6, 2020, the mean number of daily immunisation visits was reduced by 27·2% compared with baseline (from 5184 to 3772 visits).

Outreach services were affected more than fixed-centre services, with a reduction in immunisation doses given of 88·6% for outreach and 38·7% for fixed (appendix p2) between the baseline period and the lockdown period. This decline can be attributed to a combination of demand and supply factors. Restrictions on movement and concerns around COVID-19 transmission might have prevented caregivers from accessing immunisation services. Of all the 321 operational immunisation centres, 50 (16%) had no client flow. The supply side was also adversely affected, as 48 (18%) of all 271 immunisation centres were closed. We postulate that fear of infection because of a lack of preparedness contributed to a decrease in the mean proportion of vaccinators who attended work during the lockdown compared with baseline (25 931 [78·7%] of 32 960 person-days vs 112 131 [91·6%] of 122 461 person-days).