Keeping childhood immunisation rates stable during the COVID-19 pandemic.

Vaccination teams all over the world grew concerned about how to ensure stable childhood immunisation rates once local COVID-19 outbreaks turned into national outbreaks. Childhood immunisation team members in the Lothian area of Scotland were equally concerned. Lothian comprises Edinburgh and the surrounding area; it has a population of around 900 000 people and around 10 000 births per year. In previous years, attendance at the five routine vaccination appointments in children (aged 0–5 years) has been very high, leading to coverage of more than 95% (as recommended by WHO) for most vaccines.

During the first wave of the COVID-19 pandemic in spring, 2020, 22% of infants in the WHO European Region had their vaccination courses interrupted. A drop in vaccination rates of almost 20% during the first UK lockdown was reported in England. However, in Lothian, attendance at childhood immunisation clinics remained stable in the weeks during lockdown (appendix).

When the Scottish Vaccination Transformation Programme was designed in 2018, a strong emphasis was placed on the needs of children and adults who require vaccinations. This programme provided the foundation for local adaptations to immunisation efforts by the childhood immunisation team in Lothian during the first wave of the COVID-19 pandemic. Several adaptations had an important role in keeping attendance rates stable.

First, vaccinations were delivered via fixed-point clinics at various locations that were accessible by public transport. Children who could not attend clinics owing to shielding could be vaccinated by mobile teams. All vaccinations were delivered with appropriate personal protective equipment in place, in line with guidance at the time.

Second, changes were made to how data were collected. All vaccination data are held centrally in the Scottish Immunisation Recall System. Public Health Scotland collects and publishes vaccination uptake data for Scotland. Data published in previous years began with vaccinations completed when children reached 12 months of age. By contrast, during the pandemic, much shorter periods of time were required to monitor immunisation clinic attendance (appendix) and uptake of vaccinations.

Third, efforts were made to establish trust and ensure that children and their families felt looked after. All families received a personal reminder via telephone from a trained operator on the day before their vaccination date. Families were asked not to attend if they were displaying any signs of COVID-19. Any concerns were discussed, questions answered, and arrangements made if an interpreter was required. If a child could not be accompanied to the clinic, the option of a visit to the child's home by a mobile team was offered. In addition, postcards were handed out by health visitors to families to remind them of upcoming vaccinations. This effort was supported by national communication teams through messages on printed media, social media, and a dedicated homepage for families.

Finally, funding of the immunisation programme was secure as the Scottish Government reconfirmed its commitment to support all vaccination efforts during lockdown via a letter from the chief medical officer in Scotland. Staff were protected to continue in their existing roles and were not added to the COVID-19 response staff pool.

These adaptations ensured the safe and successful delivery of vaccinations to children in Lothian, Scotland, during the first wave of the COVID-19 pandemic, as shown by stable clinic attendance rates in the region.