Background: National immunization programs globally are at risk of suspension due to the severe health system constraints and physical distancing measures in place to mitigate the ongoing COVID-19 pandemic. Our aim is to compare the health benefits of sustaining routine childhood immunization in Africa against the risk of acquiring SARS-CoV-2 infections through visiting routine vaccination service delivery points.
Findings: For every one excess Covid-19 death attributable to SARS-CoV-2 infections acquired during routine vaccination clinic visits, there could be 140 (37 – 549) deaths in children prevented by sustaining routine childhood immunization in Africa. The benefit-risk ratio for the vaccinated children, siblings, parents or adult care-givers, and older adults in the households of vaccinated children are 53,000 (3,400 – 21,865,000), 47,000 (3,000 – 19,340,000), 2,000 (410 – 12,000), and 154 (40 – 617) respectively. In the alternative scenario that approximates the health benefits to only the child deaths averted from measles outbreaks, the benefit-risk ratio to the households of vaccinated children is 5 (1 – 21) under these highly conservative assumptions and if the risk to only the vaccinated children is considered, the benefit-risk ratio is 2,000 (131 – 839,000).
Interpretation: Our analysis suggests that the health benefits of deaths prevented by sustaining routine childhood immunization in Africa far outweighs the excess risk of Covid-19 deaths associated with vaccination clinic visits. However, there are other factors that must be considered for strategic decision making to sustain routine childhood immunization in African countries during the Covid-19 pandemic. These include logistical constraints of vaccine supply chain problems caused by the Covid-19 pandemic, reallocation of immunization providers to other prioritized health services, healthcare staff shortages caused by SARS-CoV-2 infections among the staff, decreased demand for vaccination arising from community reluctance to visit vaccination clinics for fear of contracting SARS-CoV-2 infections, and infection risk to healthcare staff providing immunization services as well as to their households and onward SARS-CoV-2 transmission into the wider community.
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