Child Immunization during COVID-19: A Mixed Methods Case Study of Pathanamthitta District, Kerala.

Background: Child immunization is a critical public health intervention to reduce the risk of infectious diseases. However, emergencies from disease, calamity, or conflict significantly disrupt the provision of immunization services through the primary healthcare system. This study aims to assess the impact of the Coronavirus Disease-2019 (COVID-19) pandemic on routine immunization in selected public health facilities in Pathanamthitta district, Kerala, and understand aspects of planning and service delivery and the perspectives of primary stakeholders. Materials and Methods: This mixed methods study of concurrent nested design in a Critical Realist paradigm assesses immunization patterns of 292 two-year-olds who sought routine immunization in 2020 and 2021. Quantitative data were analyzed using descriptive statistics in SPSS v. 16, and thematic analysis was performed on qualitative data. Triangulation of results involved comparing both datasets to generate a discussion of themes corresponding to immunization coverage and outcomes. Results: Immunization coverage across vaccines dropped in March 2020, followed by intense catching-up efforts in the subsequent months. Median delays in immunization uptake in the sample during the state lockdown (42 days) were higher than those experienced during the national lockdown (25 days). COVID-induced anxiety in parents, physical infrastructure, and accessibility of the health centers determined children's right to vaccines during the pandemic. Conclusion: Decontextualized guidelines, continuation with existing microplans, infrastructural deficiencies, and poor vaccine perceptions of parents/guardians triggered delays in vaccine uptake and a far-from-perfect immunization service delivery. Programme planning and implementation issues should be mitigated to prepare for future health emergencies without disrupting immunization services.