Examining the Pervasiveness of the Impact of COVID-19 and Associated Lockdown Policies on Pneumococcal Conjugate Vaccine (PCV) Coverage

Abstract The COVID-19 pandemic resulted in significant reductions in the immunization rate of routine pneumococcal conjugate vaccines (PCV) worldwide due to disruptions in vaccine supply chains, shortages of healthcare workers, facility closure or overcrowding, and parents’ concerns that their children would become infected with COVID-19 (SeyedAlinaghi et al., 2022; Basu et al., 2023; Lan et al., 2023; Hora et al., 2023). Our research utilizes a longitudinal difference-in-difference approach, to quantify the immediate impact that the COVID-19 pandemic and country-specific pandemic response measures had on routine PCV vaccine coverage, and the relative speed at which routine PCV coverage rebounded toward pre-pandemic levels in the post-2020 period between countries that adopted specific types of lockdown measures and those that did not. We also examine whether immunization catch-up campaign capacity and preparedness mitigate the impact of COVID-19 and pandemic response policies or resulted in faster recovery of PCV vaccination to pre-pandemic levels. We utilize data from the World Health Organization (2023) on PCV coverage from 2014 to 2023 and Hale et al. (2021) on country-specific lockdown policy enactment during the COVID-19 pandemic for 106 countries. Across all countries, the pandemic had a detrimental impact on PCV coverage. Pandemic lockdown policies, however, had a mixed impact on PCV coverage. Countries that enacted school closures and strict stay-at-home orders saw no significant differences in the effect of COVID-19 on PCV coverage compared with countries that did enact school closures, and these countries did not experience any differences in the speed of PCV vaccination coverage recovery post-pandemic than countries that did not enact school closures. Likewise, countries that enacted workplace closures showed no differences in the immediate effect of COVID-19 on PCV coverage compared with countries that did not enact workplace closures. However, countries that enacted workplace closures recovered PCV coverage in the post-period slightly faster than countries that did not enact workplace closures (0.893 percentage points per year, 95% CI = [0.078, 1.709]), even after controlling for the severity of the pandemic, indicating that workplace closure had the lowest longer-term disruptive impact on PCV coverage among all the lockdown policies employed. While catch-up campaigns resulted in significant coverage gains in the pre-pandemic period (1.50 percentage points per year 95% CI= [0.202, 2.979]), experience with implementing successful catchup campaigns did not mitigate the impact of COVID-19 or lockdown policy on PCV coverage. These findings suggest that capacity and training alone is insufficient for health systems preparedness, and pandemic response plans need to ensure adequate healthcare workforce, supply chain security, and health financing for impact mitigation in order to protect routine vaccination rates from decreasing during future pandemics and other public health disasters. Competing Interest Statement The authors have declared no competing interest. Funding Statement This research was supported with funding from the Bill & Melinda Gates Foundation under INV-003813 Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All data produced in the present study are available upon reasonable request to the authors