How Did Senegal Mitigate the Impact of COVID-19 on Routine Childhood Immunizations?

By: Dr. Moussa Sarr: PI & Head of Development and Cooperation Group and Mr. Daouda Gueye: Project Manager – The Institute for Health Research, Epidemiological Surveillance and Training (IRESSEF)

Over the last 20 years, Senegal has made significant investments in improving child health outcomes – cutting under-five mortality by more than half. COVID-19 has threatened to undermine that progress, including progress on routine childhood immunization. Senegal’s creative and evolving response to this challenge provides lessons for how health systems can respond to current and future health crises.

During crises, health systems face two simultaneous challenges: they must respond to the unanticipated crisis (in this case, COVID-19), while also maintaining the delivery of essential health services, including immunization services.

In the context of the COVID-19 pandemic, health leaders around the world met these challenges by implementing Infection Prevention Control protocols, while adapting the delivery of essential healthcare to maximize safety and confidence for patients and providers alike. These adaptations took the form of conducting childhood vaccine services outside or in a separate tented area from the rest of the health facility; reducing patient loads per hour to ensure sufficient time for sanitation and ventilation; and conducting drive-through or walk-up services in open spaces with clearly marked distancing areas.

Yet amid these adaptations, lockdowns still interrupted vaccine supplies and distribution. PPE shortages left health workers unprotected, and misinformation tempered demand for health services. As a result, the World Health Organization estimates 80 million children under the age of one were affected by disruptions to immunization services by May 2020.

These challenges held true in Senegal as well. Interviews with health leaders in Senegal revealed that COVID-19 impacted both the supply of and demand for routine childhood vaccinations.

Despite Senegal’s history of high acceptance and uptake of childhood vaccines and strong trust in community health workers, fear of infection and misinformation reduced demand for immunization services dramatically. “Patients had deserted the health centers for fear of being infected…we could stay for a week without receiving a patient,” said one health provider.

In mid-March 2020, the government of Senegal prohibited large public gatherings and suspended all in-person instruction at schools in response to the pandemic. This meant that outreach-based services and community mobilization activities such as those conducted by the Badiènou Gokh, community health workers who promote vaccination through music and in-person communication campaigns, were postponed. And since schools are typically the main platform for HPV vaccination in Senegal, HPV vaccinations were interrupted.

Senegal’s efforts to address these challenges demonstrates how countries can develop more resilient immunization delivery systems. The key is quickly recognizing the emerging challenges and leveraging existing programmatic strengths to adapt accordingly.

For example, clinic staff use existing childhood immunization records to identify children who are missing vaccinations and send text message reminders to their families. And, as community mobilization resumes, Senegal is leveraging its extensive and trusted cadre of community health workers, for both outreach and service delivery, including going home-to-home to provide vaccination visits. Moreover, as clinics and outreach programs restart immunization activities, they are providing greater flexibility (in terms of location and timing) for scheduling catch-up doses.

Senegal has also launched media campaigns disseminated through local TV channels and radio spots to remind the public of the importance of childhood immunizations and to correct misinformation.

These insights and others are included in preprint paper currently under peer review. The paper examines how three countries identified as Exemplars—Liberia, Nepal, and Senegal—responded to the pandemic, and the findings provide guidance on how leaders can adapt and adopt these countries’ successful strategies to strengthen the equitable and sustainable delivery of childhood immunizations.

Our key findings on how countries can mitigate COVID-19’s effects on routine immunization include:

  • Prioritizing continued services with strengthened infection prevention control
  • Identifying alternative locations and approaches to providing vaccine services (e.g., conducting door-to-door vaccination if facility-based services are not possible)
  • Engaging in effective communications and mobilization activities, especially to offset misinformation about COVID-19 and vaccines
  • Setting up systems and strategies for reaching children who missed doses amid periods of disruption
  • Conducting catch-up campaigns as soon as COVID-19 transmission is under control

We recognize that COVID-19’s impact on routine immunization services varies across settings, and that there is no one-size-fits-all implementation strategy that will solve this challenge for all geographies. At the same time, Senegal and other countries, now one year into the pandemic, have demonstrated lessons for how countries can maintain routine immunization services and develop strategies for more resilient health systems in the future.

For the latest WHO guidance on immunization activities during COVID-19 click here.