Background: The COVID-19 pandemic caused a major disruption to the delivery of healthcare services,including routine immunization, leading to a sharp decline in vaccine coverage. In 2021, 25 million childrenmissed their routine vaccinations, the highest in nearly 20 years. In Uganda, urban areas like Kampala havebeen hit particularly hard, with only 41.4% of children fully vaccinated. Nationwide childhood vaccinationcoverage has dropped to 85%, well below pre-pandemic levels of over 90%. This drop has resulted in morechildren being partially vaccinated or missing vaccines altogether, leaving the population vulnerable tooutbreaks of diseases like measles and polio. The Ministry of Health's expanded program on immunisation,which includes static and outreach services, has tried to maintain access, but physical barriers, socioculturalissues, and knowledge gaps continue to affect vaccine uptake, especially in marginalized and hard-to-reachcommunities. In response to these challenges, the assistant commissioner for health information reachedout to ACRES for support in characterizing problem of low vaccine coverage in peri-urban areas of Kampalaand Wakiso.Rapid Response question: Why vaccine coverage, which dropped during the COVID-19 pandemic, is notrecovering, particularly in Kampala and Wakiso?Findings: The findings indicate that the COVID-19 pandemic greatly impacted vaccine coverage, leading toa slow recovery to pre-pandemic levels. Key factors contributing to this decline include:The continued strain of the pandemic due to the emergence of new COVID-19 variants has required ongoingsurveillance and research, diverting resources from routine vaccination programs. This reallocation of fundshas strained the delivery of essential vaccines, hindering recovery efforts.The pandemic also exacerbated vaccine hesitancy, fueled by misinformation and distrust in healthauthorities. Rapid vaccine development during the pandemic raised safety concerns and led to a decline inpublic confidence, affecting not only COVID-19 vaccinations but also routine immunizations. For instance, inUganda, the requirement for written consent for COVID-19 vaccination further diminished trust in healthinstitutions, complicating efforts to achieve immunization goals.Economic hardships caused by the pandemic disproportionately affected vulnerable urban populations,increasing poverty and unemployment. These challenges made healthcare, including vaccines, lessaccessible. Studies revealed that children both in urban slums and non-slum areas were often only partiallyvaccinated, with barriers including hidden costs like having to buy immunisation cards, funds for transportto health facilities, lack of awareness about vaccination schedules and service delivery issues like vaccinestockouts and long wait times.Conclusion: The slow recovery of vaccination coverage after COVID-19 comes down to a mix of ongoingchallenges. The pandemicâs continued strain, especially with new variants coming up, has shifted resourcesand attention to COVID-19 vaccines, leaving routine vaccinations struggling. On top of that, vaccinehesitancy that increased during the pandemic periodâdriven by misinformation and mistrustâhas madepeople more skeptical of all vaccines, not just COVID-19 related ones. For the urban poor, the loss of incomeand slow economic recovery due to the pandemic has made it even harder to access healthcare because ofhidden costs associated with vaccination services, worsening existing inequalities. All these factorsâalongwith issues like lack of awareness, and poor health educationâare slowing down the return to pre-pandemicvaccination levels in Uganda.
