Impact of COVID-19 on Routine Child Immunization Practices in Rwanda
Overview
The COVID-19 pandemic caused significant disruptions to routine immunization (RI) services in Rwanda, particularly during the initial lockdown in 2020. Despite adaptive measures by the Rwandan health system, temporary declines in vaccine coverage occurred, influenced by socio-demographic factors, misinformation, and vaccine hesitancy.
Background
Before the COVID-19 pandemic, Rwanda had high coverage of core childhood vaccines such as DTP3. The pandemic overwhelmed global health systems, disrupting essential services including routine immunization. Rwanda's prior experience with infectious disease preparedness and a resilient health system helped mitigate some impacts. However, lockdowns, fear of infection, and misinformation contributed to decreased vaccine uptake and hesitancy.
Data Highlights
Indicator
Pre-pandemic Coverage
Impact During Pandemic
DTP3 Coverage
Increasing trend 2015-2018
81% decline in 2021 globally; temporary drop in Rwanda during 2020 lockdown
Hospital Visits
Baseline
60% increase during pandemic
Health Centre Visits
Baseline
15% decrease during pandemic
Children Missing Vaccines Globally (2020)
N/A
23 million missed routine vaccinations; 30 million missed DPT3 doses; 27.2 million missed MCV1 doses
COVID-19 Vaccine Doses Received by Rwanda (March 2021)
Rwanda experienced temporary declines in routine immunization coverage during the early COVID-19 lockdown in 2020.
Adaptive strategies such as integrated service delivery, enhanced surveillance, community health worker involvement, and public health campaigns helped maintain immunization efforts.
Vaccine hesitancy increased due to misinformation, fear of contracting COVID-19 at health facilities, and diminished trust in health authorities.
Socio-demographic factors including parental attitudes, cultural and religious beliefs, and socioeconomic barriers influenced persistence of routine immunization.
Rwanda’s prior infectious disease preparedness and resilient health system mitigated more severe disruptions compared to other low-resource settings.
Global disruptions led to millions of children missing routine vaccines, highlighting the need for catch-up and recovery efforts.
Clinical Implications
Healthcare providers should address vaccine hesitancy by combating misinformation and building trust through community engagement. Maintaining integrated and flexible immunization services during public health crises is essential to prevent declines in vaccine coverage. Understanding socio-demographic determinants can guide targeted interventions to sustain routine immunization during disruptions.
Conclusion
The COVID-19 pandemic disrupted routine childhood immunization in Rwanda, but adaptive health system measures and socio-demographic understanding helped mitigate impacts. Continued efforts are needed to restore and sustain immunization coverage to prevent vaccine-preventable diseases.
by Edward Mbonigaba, Fengyun Yu, Mark Donald C. Reñosa, Frederick Nchang Cho, Qiushi Chen, Wenjin Chen, Claudia M. Denkinger, Shannon A. McMahon, Simiao Chen
