JMIR Publications

Background:

Background: The COVID-19 pandemic caused global disruptions to essential healthcare services, particularly affecting routine childhood immunization programs. Low- and middle-income countries (LMICs) were disproportionately impacted. In Ecuador, the national immunization program faced pre-existing challenges with coverage disparities across different geographical regions and socioeconomic groups before the pandemic. Objective: To analyze the impact of the COVID-19 pandemic on routine childhood vaccination coverage in Ecuador by comparing data from the pre-pandemic year (2019) with the pandemic period (2020-2021) and to identify geographical disparities in vaccination access. Methods: This retrospective observational study analyzed vaccination data from the Ministry of Public Health of Ecuador and demographic data from the National Institute of Statistics and Censuses (INEC). The study examined routine vaccination coverage for children under 24 months across all 24 provinces. A comparative analysis of coverage rates between the pre-pandemic and pandemic periods was conducted using descriptive statistics. Results: A significant decline in routine childhood vaccination coverage was observed between 2019 and 2021. Coverage for the BCG vaccine decreased from 86.4% in 2019 to 75.3% in 2021. Third-dose coverage for the pentavalent vaccine dropped from 85.0% to 68.0% over the same period. The most pronounced decline occurred in the second dose of the MMR vaccine, with coverage falling from 75.7% in 2019 to 58.4% in 2021. The most severe reductions were concentrated in the Coastal and Highland provinces. Conclusions: The COVID-19 pandemic significantly impacted routine childhood vaccination coverage in Ecuador, with sustained declines through 2021 that exacerbated existing regional disparities. The resulting coverage gaps place children at an increased risk of vaccine-preventable disease outbreaks. Urgent interventions, including targeted catch-up campaigns and health system strengthening, are necessary to restore coverage levels and enhance resilience against future health emergencies.

Objective:

Based on the study provided, the objective was to analyze the impact of the COVID-19 pandemic on routine childhood vaccination coverage in Ecuador by comparing pre-pandemic (2019) and pandemic period (2020-2021) data. The study's primary goal was to quantify this impact and to identify geographical disparities in vaccination access during this time.

Methods:

The study employed a retrospective, observational design to analyze and compare routine childhood vaccination coverage. It examined the pre-pandemic period (2019) against the pandemic period (2020-2021). Key aspects of the methodology include: Data Sources: The research utilized vaccination coverage data from the Ministry of Public Health (MSP) of Ecuador and demographic data from the National Institute of Statistics and Censuses (INEC). Study Population: The analysis focused on children under 24 months of age across all 24 provinces of Ecuador. Vaccination Metrics: Coverage rates were analyzed for vaccines in the national schedule, including BCG, Pentavalent, MMR, Rotavirus, and Polio, among others. Rates were calculated as the percentage of children in the target age group who received the recommended doses. Data Analysis: Statistical analyses were performed using SPSS version 28.0. The methods included descriptive statistics, comparative analysis to calculate absolute and relative changes in coverage, and geographical analysis to identify regional variations in pandemic impact. Ethical Considerations: The study used secondary, publicly available, and anonymized government data; therefore, ethical approval from an institutional review board was not required

Results:

The study found a clear and significant pattern of declining routine childhood vaccination coverage in Ecuador between 2019 and 2021. Key vaccine-specific declines include: BCG Vaccine: Coverage decreased from 86.4% in 2019 to 75.3% in 2021, a cumulative drop of 11.1 percentage points. Pentavalent Vaccine: Third dose coverage fell from 85.0% in 2019 to 68.0% in 2021. Rotavirus Vaccine: This vaccine was among the most affected, with second dose coverage plummeting from 84.6% in 2019 to 60.5% in 2021. Measles-Mumps-Rubella (MMR) Vaccine: The second dose coverage experienced a dramatic drop, falling from 75.7% in 2019 to 58.4% in 2021. Significant geographical disparities were observed, with the Coastal and Highland regions experiencing the most severe reductions in coverage. The sustained decline through 2021 indicated persistent challenges to the health system, with coverage rates for many vaccines falling below the critical 80% threshold, thereby increasing the risk of vaccine-preventable disease outbreaks.

Conclusions:

The COVID-19 pandemic profoundly and negatively impacted routine childhood vaccination coverage in Ecuador, with declines persisting through 2021. This collateral damage to essential health services has placed children at an increased risk of outbreaks from vaccine-preventable diseases. The pandemic also exacerbated existing health inequities, as vulnerable populations and certain geographical regions faced compounded challenges in accessing immunization services. The study concludes that urgent interventions are required to address the coverage gaps. Priority actions should include implementing targeted mass catch-up vaccination campaigns, strengthening routine immunization services, and developing more resilient health systems capable of maintaining essential services during future health emergencies.

Clinicaltrial: