Integration of COVID 19 Vaccination into Routine Immunization Services in Belize

The study described the process and outcome of integration of COVID 19 vaccination into routine immunization services in Belize which was initiated in April 2022. The process was guided using the five components of the immunization system; program management and coordination; service delivery, vaccine supply and cold chain logistic, Surveillance and monitoring; and advocacy and social mobilization and communication as the implementation framework. Collaboration between COVID-19 vaccination and other existing immunization delivery platforms targeting different age groups was the service delivery approach adopted for the integration. Fixed health facilities, mobile clinics and home visits were used as the delivery strategies for integration. The fixed health facilities offered both routine and COVID19 vaccination daily and the same time while the mobile teams were deployed based on schedule to villages that are far to reach from the fixed health facilities and communities with lowest vaccination coverages were prioritized for both routine and COVID19 vaccination. The mobile and home visit teams also tracked and provided mop up vaccination for missed children to reduce the zero-dose children. The results showed that the integration of COVID 19 vaccination has no negative effect on the coverage of routine vaccination, with increase in the coverage of both routine immunization and COVID 19 vaccination following integration. The coverage of 1st dose and 3rd dose of Pentavalent vaccine increased by 7 percent and 10 percent respectively between April 2021- March 2022 (pre-integration) and April 2022- March 2023(post integration) though not statistically significant (p>0.5). The coverage of population who received at least one dose of COVID 19 vaccine and those fully vaccinated increased from 54.3 percent and 51 percent to 65 percent and 55.7percent respectively between 31st March 2022 and 31st March 2023.

The study contributes to the existing literature on integration of COVID 19 vaccination into routine immunization services which is essential to ensure sustained and equitable access to COVID-19 vaccine and improve uptake of other routine vaccines to address the continued backslide in routine vaccination due to the COVID 19 pandemic.