Pre-pandemic national immunisation programme strength and health workforce capacity improved routine immunisation resilience during the COVID-19 pandemic

IF 3.9 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health Pub Date : 2025-06-10 DOI:10.1016/j.puhe.2025.105813

Beth Evans , Laurent Kaiser , Olivia Keiser , Thibaut Jombart

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引用次数: 0

Abstract

Objectives

The adverse impact of the COVID-19 pandemic on Routine Immunisation (RI) coverage has been well-documented: most countries experienced backsliding or stagnation in coverage. Qualitative surveys indicated potential causes of declines, including reduced health care seeking behaviour, lockdowns, and overwhelmed health systems. We investigate country-level determinants of RI resilience during COVID-19 globally to inform the evidence base on maintaining robust immunisation systems in times of crises.

Study design

Ecological, secondary data analysis with multivariate modelling.

Methods

We employ two methods: stepwise linear regression based on a causal inference framework, and Random Forest regression on a dataset comprising 13 potential determinants (spanning pre-pandemic immunisation programme performance, health workforce capacity, health systems strength, financing, global health security preparedness, COVID-19 burden, COVID-19 policy responses) and covering 151 countries from 2020 to 2022.

Results

We provide evidence that stronger pre-pandemic immunisation programmes (p < 0.0001) and more health workers (p = 0.0065), once above minimum thresholds (78 % Diphtheria-Tetanus-Pertussis third-dose coverage and 58 health workers per 10,000 people), are associated with improved RI resilience. Random Forest analysis suggests health financing and health system strength impact RI resilience. Reassuringly, we do not find evidence that COVID-19 vaccination campaigns nor pandemic containment policies impacted RI – counter to qualitative survey indications.

Conclusion

Our findings underscore the role of robust immunisation programmes and sufficiently sized health workforces in mitigating RI disruption during global health crises, once above minimum thresholds. A large fraction of variation in pandemic RI resilience remained unexplained through our population-level analyses.

查看原文本刊更多论文

大流行前国家免疫规划强度和卫生人力能力在COVID-19大流行期间提高了常规免疫复原力

COVID-19大流行对常规免疫（RI）覆盖率的不利影响已有充分记录：大多数国家的覆盖率出现倒退或停滞。定性调查显示了下降的潜在原因，包括寻求卫生保健行为减少、封锁和不堪重负的卫生系统。我们在全球范围内调查COVID-19期间免疫接种恢复力的国家层面决定因素，为在危机时期维持强有力的免疫系统提供证据基础。研究设计：采用多变量模型进行生态、二次数据分析。方法采用两种方法：基于因果推理框架的逐步线性回归和随机森林回归，该数据集包含13个潜在决定因素（涵盖大流行前免疫规划绩效、卫生人力能力、卫生系统强度、融资、全球卫生安全准备、COVID-19负担、COVID-19政策应对），涵盖2020年至2022年的151个国家。结果我们提供的证据表明，更强有力的大流行前免疫规划(p <；0.0001)和更多的卫生工作者（p = 0.0065），一旦超过最低阈值（白喉-破伤风-百日咳第三剂覆盖率为78%，每1万人中有58名卫生工作者），就与增强抗感染能力有关。随机森林分析表明，卫生筹资和卫生系统强度影响国际卫生组织的恢复力。令人放心的是，我们没有发现证据表明COVID-19疫苗接种运动或大流行遏制政策影响了国际扶轮，这与定性调查的迹象相反。结论：我们的研究结果强调了在全球卫生危机期间，一旦超过最低阈值，强有力的免疫规划和足够规模的卫生工作人员在减轻RI中断方面的作用。通过我们的人口水平分析，大流行RI恢复力的很大一部分变化仍然无法解释。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Public Health 医学-公共卫生、环境卫生与职业卫生

CiteScore

7.60

自引率

0.00%

发文量

280

审稿时长

37 days

期刊介绍： Public Health is an international, multidisciplinary peer-reviewed journal. It publishes original papers, reviews and short reports on all aspects of the science, philosophy, and practice of public health.