Table 1.
Vaccine antigen-specific benefits and risks of sustaining routine childhood immunisation in Africa during the COVID-19 pandemic
| Vaccination schedule | Deaths averted by vaccination (95% UI) | Excess COVID-19 deaths (95% UI) | Benefit–risk ratio (95% UI) | |
|---|---|---|---|---|
| Diphtheria | 6, 10, 14 weeks | 12 944 (10 180–16 539) | 5674 (846–16 830) | 2 (0–7) |
| Tetanus | 6, 10, 14 weeks | 69 254 (54 268–87 343) | 5674 (846–16 830) | 12 (2–39) |
| Pertussis | 6, 10, 14 weeks | 271 422 (207 238–344 147) | 5674 (846–16 830) | 48 (8–155) |
| Hepatitis B | 6, 10, 14 weeks | 3827 (2578–5826) | 5677 (846–16 837) | 1 (0–2) |
| Haemophilus influenzae type b | 6, 10, 14 weeks | 54 840 (49 521–61 230) | 5696 (849–16 896) | 10 (2–30) |
| Streptococcus pneumoniae | 6, 10, 14 weeks | 46 494 (40 002–55 014) | 5052 (752–14 979) | 9 (2–29) |
| Rotavirus | 6, 10 weeks | 10 666 (9578–11 890) | 2391 (364–7221) | 4 (1–14) |
| Measles (MCV1) | 9 months | 194 388 (181 469–209 379) | 1896 (228–5778) | 103 (16–332) |
| Rubella (RCV1) | 9 months | 1147 (738–1679) | 744 (85–2264) | 2 (0–5) |
| Neisseria meningitidis serogroup A | 9 months | 460 (335–665) | 280 (34–856) | 2 (0–6) |
| Yellow fever | 9 months | 23 345 (17 426–30 929) | 875 (100–2664) | 27 (4–87) |
| Measles (MCV2; EPI-3) | 15–18 months | 10 282 (9354–11 237) | 751 (81–2277) | 14 (2–45) |
| EPI-1* | 6, 10, 14 weeks | 471 068 (406 088–548 290) | 5696 (849–16 896) | 82 (14–261) |
| EPI-2† | 9 months | 219 726 (204 572–235 744) | 1896 (228–5778) | 116 (18–374) |
| EPI‡ | 6, 10, 14 weeks; 9 months; 15–18 months | 701 828 (635 416–782 050) | 8341 (1280–25 029) | 84 (14–267) |
The benefit–risk ratio estimates (median estimates and 95% UIs) show the child deaths averted by sustaining routine childhood immunisation in Africa per COVID-19 death attributable to excess severe acute respiratory syndrome coronavirus 2 infections acquired through visiting routine vaccination service delivery points. Note that the vaccine-preventable death estimates are vaccine antigen-specific, whereas the excess deaths are dependent on the number of required visits. Because vaccination visits EPI-1 and EPI-2 group the delivery of several vaccines, these have a higher benefit–risk ratio than that for individual antigens. EPI=Expanded Programme on Immunization. UI=uncertainty interval.
EPI-1 includes three-dose vaccinations for diphtheria, tetanus, and pertussis, hepatitis B, Haemophilus influenzae type b, and Streptococcus pneumoniae, and vaccination for rotavirus.
EPI-2 includes the first dose of vaccination for measles (MCV1) and rubella (RCV1) and vaccination for Neisseria meningitidis serogroup A and yellow fever.
EPI includes all vaccinations in EPI-1 and EPI-2, as well as the second dose for measles (MCV2; EPI-3).