Published: 2022-09-28

The impact of COVID-19 pandemic response on uptake of routine immunizations and the assessment of a “catch-up” drive in the Gwalior district of Madhya Pradesh, India

Ishant Kumar, Manish Chaturvedi, Deeksha Singh


Background: In the year 2020, immunization services were disrupted worldwide due to COVID-19 pandemic and lockdowns. However, immunization services were soon reinstated to avoid vaccine preventable disease (VPD) outbreaks. The study was conducted to assess the impact of Covid-19 pandemic on routine immunization uptake and to assess the measures taken by the State government for the prevention of potential outbreaks; thereby suggesting measures to nullify the negative impact of COVID-19 (if any) on the immunization coverage in the district.

Methods: It was a descriptive and qualitative study, conducted at two rural blocks of the Gwalior district namely Ghatigaon and Hastinapur. The one-year immunization records were analysed and healthcare workers and parents of dropout children were interviewed.

Results: In Gwalior, the fully immunized child (FIC) coverage dropped to approximately 70% from an average of 90% over the last four years.Forty children were due for vaccination in April 2020 when the services were shut due to lockdown. As compared to pre-Covid lockdown period, the average number of children turning up for immunization, the enrolments of new-borns for BCG vaccination and follow-up vaccinations dropped during lockdown. The most common reason for decline was the fear of contracting COVID-19 infection.

Conclusions: Immunization services should be maintained as much as COVID-19 response measures allow. Decisions related to the operation of immunization services should be taken based on a detailed assessment of the VPD epidemiology, COVID-19 transmission scenario with corresponding mitigation measures and healthcare resources.


COVID-19, Pandemic, Immunization, Vaccine

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Singh V. The Effect of COVID-19 Pandemic on Immunization Services in India - Possible Challenges and way forward. Epidem Int. 2020;5(2):53-60.

Guidance on routine immunization services during COVID-19 pandemic in the WHO European Region, 20 March 2020 (produced by WHO/Europe), 2020. Available at: 2020/guidance-on-routine-immunization-services-during-covid-19-pandemic-in-the-who-european-region,-20-march-2020-produced-by-whoeurope. Accessed on 01 June 2022.

Immunization-One of the most effective and cost-effective ways to protect children’s lives and futures, 2018. Available at: what-we-do/immunization. Accessed on 01 June 2022.

National Immunization Schedule (NIS) for Infants, Children and Pregnant Women. Available at: Accessed on 01 June 2022.

Nelson R. COVID-19 disrupts vaccine delivery: The impact of the ongoing pandemic of coronavirus 2019 on immunisation campaigns in low- and middle-income countries is concerning. Lancet 2020;20(5): 546.

Santoli JM, Lindley MC, DeSilva MB, Kharbanda EO, Daley MF, Galloway L, et al. Effects of the COVID-19 Pandemic on routine pediatric vaccine ordering and administration-United States, 2020. Morb Mortal Weekly Rep. 2020:69;591-3.

McDonald HI, Tessier E, White JM, Woodruff M, Knowles C, Bates C, et al. Early impact of the coronavirus disease (COVID-19) pandemic and physical distancing measures on routine childhood vaccinations in England, January to April 2020. Euro Surveill. 2020;25(19):2000848.

Chandir S, Siddiqi DA, Setayesh H, Khan AJ. Impact of COVID-19 lockdown on routine immunisation in Karachi, Pakistan. Lancet Glob Health. 2020;8(9): e1118-20.

Alsuhaibani M, Alaqeel A. Impact of the COVID-19 pandemic on routine childhood immunization in Saudi Arabia. Vaccines. 2020;8(4):581.

Hard fought gains in immunization coverage at risk without critical health services, warns WHO, 2020. Available at: detail/23-04-2020-hard-fought-gains-in-immunization-coverage-at-risk-without-critical-health-services-warns-who. Accessed on 01 June 2022.

Chandir S, Siddiqi DA, Mehmood M, Setayesh H, Siddique M, Mirza A, et al. Impact of COVID-19 pandemic response on uptake of routine immunizations in Sindh, Pakistan: An analysis of provincial electronic immunization registry data. Vaccine 2020;38:7146-55.

Ram Mohan A, Awofeso N, Fernandez RC. Paternal education status significantly influences infants’ measles vaccination uptake, independent of maternal education status. BMC Public Health. 2012;12:336.

Torun SD, Bakırcı N. Vaccination coverage and reasons for non-vaccination in a district of Istanbul. BMC Public Health. 2006;6:125.

Public health data. Available at: https://www. Accessed on 01 June 2022.

National Family Health Survey-5. Available at: pdf. Accessed on 01 June 2022.

Immunization in the context of COVID-19 pandemic: frequently asked questions (‎‎‎‎FAQ). Available at: 331818. Accessed on 01 June 2022.

Planning and implementing high-quality supplementary immunization activities for injectable vaccines, 2016. Available at: https://www.who. int/immunization/diseases/measles/SIA-Field-Guide.pdf. Accessed on 01 June 2022.

Recommendations for interrupted or delayed routine immunization - summary of WHO. Available at: Accessed on 01 June 2022.

Guiding principles for immunization activities during the COVID-19 pandemic: interim guidance, 26 March 2020. World Health Organization. Available at: Accessed on 01 June 2022.