[Effects of the COVID-19 pandemic on the immunization program for children under 5 years of age in EcuadorEfeitos da pandemia de COVID-19 no programa de imunização de menores de cinco anos no Equador].

Objective: To estimate the effect of the COVID-19 pandemic on the supply, uptake, coverage, and timeliness of vaccination in children under 5 years of age in Ecuador. Methods: Concurrent mixed-methods design with two rapid evaluation cycles. In each cycle, questionnaires and semi-structured interviews were administered to health personnel and mothers of children under 5. The instruments explored the immunization program in terms of supply (availability of material and personnel) and uptake (demand and access). To estimate vaccination coverage, we randomly sampled children under 5 in five provinces and analyzed monthly administrative program records for the period 2017-2020. Results: Approximately 50% of respondents perceived a reduction in personnel and supplies for the program. The demand for care declined 26% between 2020 and 2021, mainly due to fear of contracting COVID-19 in health facilities. Access to program services was affected by changes in schedules, ventilated spaces, and the provision of virtual care, none of which were well accepted by the population. Only 50% of children under 1 year of age completed their full vaccination schedule, and most vaccines were not administered in a timely manner. Conclusions: The COVID-19 pandemic had a negative impact on the immunization program in terms of supply and uptake. This led to a precipitous decline in the coverage and timeliness of vaccination, which have fallen to suboptimal levels in children under 5 in Ecuador. This has increased the risk of children contracting vaccine-preventable diseases.