Immunization Practices in the Context of COVID-19 Pandemic: Would It Increase

Disparities in Immunization Coverage in Indonesia?

By: Farah Dina

In July 2018, WHO reported Indonesia as the ten countries which dealing with the
heaviest challenges in immunization practice. Based on combined survey results, there were
more than 70% of children that not get complete basic immunization. In Indonesia, there
are still some discrepancies in immunization coverage between each community group. For
example, the quintile 1 (poorest) group had the lowest level of immunization coverage.
Furthermore, differences between maternal education levels also affected target
achievement of coverage. Referring to RISKESDAS 2013, the percentage of complete basic
immunization in Indonesia was still on 59.2%, the current pandemic, COVID-19, could be
considered as a new disruption to immunization coverage in Indonesia.
Disruption to the implementation of immunization could result in an outbreak of
other vaccine-preventable diseases. If those conditions happen, there would be increasing
the morbidity and mortality in children. According to the Indonesia Health Survey within the
Ministry of Health, cooperates with UNICEF, it was reported that immunization service at
90% posyandu and 65% puskesmas have been through visit disruptions since the COVID-19
pandemic. As observed, measles vaccination coverage data from January until March 2020
decreased by 13% compared to the same period in 2019.
UNICEF has analyzed some disruption causes of immunization implementation
during the COVID-19 pandemic. Limited vaccinators due to the job transfer for handling
COVID-19, school closure, decreasing of vaccines provision funding, and high COVID-19 local
transmission in puskesmas area, are some disruption factors. Parents also concern about
COVID-19 exposure to their children when performing immunization visits. A lot of health-
care facilities have provided services through telemedicine, but immunization services only
can be done by direct visits.
As responses to those disruptions to routine immunization programs that would
impact the burden of the health system and decrease vaccination demand caused by
physical distancing or community's reluctance, the WHO releases immunization guidelines
in dealing with COVID-19. Consideration of immunization implementation in an area
depends on local government rules about physical distancing, the incidence of vaccine-
preventable disease, COVID-19 local transmission area status, population demography, and
migration patterns. If there are adequate health workers and vaccine supplies,
immunization should be done by maintaining physical distancing through infection
prevention and control protocols. Besides, the mass campaign about vaccination and rebuild
the stopped or delayed immunization programs must be carried out as soon as possible
when the risk of COVID-19 local transmission decreases.
Indonesian Pediatric Society has declared recommendations to adhere to the
vaccination schedules. In areas with high COVID-19 local transmission, immunization
practice could be postponed in a one-month duration. These decisions are expected to
become some solutions in reducing the disparities of immunization coverage in the COVID-
19 pandemic era.

Reference:
1. IDAI. 2020. Jadwal Imunisasi Anak Pada Situasi Pandemi Covid-19
2. https://www.unicef.org/indonesia/press-releases/more-than-half-of-health-
facilities-report-significant-disruptions-to-immunization-services
3. https://apps.who.int/iris/bitstream/handle/10665/331590/WHO-2019-nCoV-
immunization_services-2020.1-eng.pdf
4. https://www.unicef.org/indonesia/sites/unicef.org.indonesia/files/2020-
05/Immunization-Rapid-Assessment-2020.pdf
5. https://www.cdc.gov/mmwr/volumes/69/wr/mm6920e1.htm
6. https://www.who.int/gho/health_equity/explorations-of-inequality-childhood-
immunization