Estimating the Impact of the COVID-19 Pandemic on Childhood Immunization Using Subnational Exposure in Bangladesh

Background: The COVID-19 pandemic has already imposed significant mortality and morbidity burdens globally and non–COVID-related adverse health outcomes are increasingly receiving attention. Using variations in subnational-level exposure to COVID-19, this study explores how the pandemic has affected regular childhood immunization and vaccine deliveries in Bangladesh. Methods: We adopt an exposure index based on the number of migrants who returned from abroad before the lockdown was announced in Bangladesh. We link the upazila-level variations in migrant-induced exposure to the immunization gaps (the difference between the number of sessions planned and held) and deliveries of five regular childhood vaccines, namely, BCG, PCV, Pentavalent, and the two doses of MMR. We construct a balanced panel of 447 upazilas for five months (January to May 2020) and use fixed-effects models to identify the impacts of pandemic exposure on immunization gaps and vaccine deliveries. Findings: The immunization gap increased by 16.3 per cent (95% confidence interval [CI]: 14.4 to 18.3) in April and by 20.8 per cent (95% CI: 18.9 to 22.7) in May. Moreover, the regions with higher exposures recorded larger gaps; one-SD-higher exposure was associated with higher immunization gaps by 2.4 percentage points [pp] in April (95% CI: 0.5 to 4.3 pp) and 5.1 pp in May (95% CI: 3.3 to 7.0 pp). All five vaccines included in the analyses also registered additional declines in the worst-affected areas after the outbreak, which persisted for two months after the pandemic broke out in Bangladesh. Interpretation: A higher level of exposure to the pandemic can substantially increase gaps in regular childhood immunization and vaccine deliveries of different types. Such disruptions can impose a considerable non–COVID-19 disease burden affecting children and reverse some of the recent significant public health achievements in low- and middle-income countries, requiring careful policy interventions. Funding Information: The author does not have any funding source to declare. Declaration of Interests: The author does not have any conflict of interests to report.