Impact of the COVID-19 pandemic on immunization in Senegal

Impact of COVID-19 

• Health center staff were tasked with COVID-19 management and response, reducing their availability for other services.
• School closures halted school-based human papillomavirus vaccine service delivery.
• Mass gatherings were prohibited in mid-March 2020, postponing community-based outreach activities and mobilization.
• Patient attendance for vaccine services declined substantially, and some caretakers refused care when home visits were offered by community workers in full personal protective equipment.
• Rumors spread about an “eventual evil” COVID-19 vaccine trial in the country.
  
   

• “For COVID, people were not aware of the disease and were starting to flee the health structures, so we had to raise awareness to tell people that the coronavirus exists and that we still haven’t found a vaccine. In short, we had to tell people that the coronavirus exists, that there is no vaccine, and these are the barrier measures, but also that COVID was not a reason to desert the health structures, that it is necessary to continue to come to them to treat other various diseases: asthma, diabetes . . .” 
  —ACPP, Ziguinchor
• “Before, there was no problem even if there was reluctance. It’s not the same with what is happening to us now, with the advent of this pandemic. Currently, to tell the truth, it’s very difficult, but despite its difficulties we never gave up. At each session we try to educate people to tell them that what you hear in social media and what’s going on here is not the same. . . . I would even say that health workers are very exposed to the vaccination because as soon as you see us with a cooler, they say we brought the corona vaccines to kill their children. But we don't let that happen. Even before COVID, we did vaccinations, yes or no? They say they were vaccinating their children; I tell them it’s the same, as it has nothing to do with what people hear at the level of social networks. So, we’re still sitting on this communication to reassure them that there is nothing new.” 
  —Health post head nurse, Ziguinchor
   

Prioritize service delivery

• MSAS adapted WHO guidelines and gave instructions to all regions and health centers for implementation, allowing staff to tailor these guidelines to align with local needs and strategies across health system levels.
• Facility staff implemented infection prevention and control protocols, established physical distancing measures, procured personal protective equipment, and ran or participated in training webinars coordinated with national-level programs to prepare for continued immunization delivery.
• Facility-based routine immunization services continued, even as community-based outreach and mobilization services were temporarily suspended during public-gathering bans.
• Alternative hours were offered for vaccine administration (e.g., after work, during the weekends) in collaboration with community-based organizations.

• “Even during the first wave of COVID we had asked to stop the vaccinations, but the dean [of the school] had asked us to continue in order to reach the objectives. But it was done while respecting the precautions, and we finished quickly to avoid the gatherings. And even if the people refused to come, we went to get them.” 
  —ACPP, Ziguinchor
• “It caused us some difficulties, but it did not slow us down. We continued our activities by avoiding gatherings and we even suspended weighing. We couldn’t afford to do talks; we did interviews instead.” 
  —ACPP, Ziguinchor
• “We did not stop our activities. We made home visits, and we motivated the women by telling them that nothing has changed with regard to vaccination, even with COVID.” 
  —ACPP, Ziguinchor

Continue communication and outreach

• Health districts conducted media campaigns and broadcasting from cable channels, local TV channels, and radio spots to emphasize the importance of childhood immunization, particularly as EPI programs were scaling up mobilization efforts.
• ACPPs conducted house-to-house vaccination for HPV services amid continued closures of schools.
• Based on contact records kept at health district offices, facility staff texted or called parents whose children missed immunization visits.

• “People no longer want to take their children to the vaccination [days], on the pretext that in health structures there is the virus, and they do not want to be contaminated. That's why you have to enter in each house to talk to them, [to] convince them to come and visit the structures of health. The COVID-19 pandemic has nothing to do with immunizing children, but the families do not know. We just need to educate them and insist that they go immunize children. Awareness consists of this.” 
  —ACPP, Dakar
• “We know how to argue in front of our relatives with reliable examples, and that’s how we manage to control these rumors. For example, when a rumor was circulating that we wanted to vaccinate people against COVID against their knowledge, the ICP and I met with the population to dispel this rumor, and it has not circulated since.” 
  —ACPP, Tambacounda
• “We insist, on [each] vaccination, to say that COVID should not prevent you from continuing to vaccinate [your children], because . . . it is only one disease, while vaccination practically protects against 12 diseases, so we cannot, under the guise of COVID, let 12 diseases re-emerge.” 
  —Health district communication official, Tambacounda
• “With COVID, social mobilization was prohibited. What we could do was just make radio broadcasts and awareness caravans. At the level of structures, we were even forbidden to give talks. We tried to organize ourselves so that there was no regrouping, and we also talked about respecting the preventative measures such as washing hands and wearing a mask. We talked about it not only to community actors but also to the population.” 
  —Health district sexual and reproductive health coordinator, Tambacounda