Operational Considerations for Immunization Services During COVID-19 in Non-US Settings Focusing on Low-Middle Income Countries


Immunization services have been disrupted significantly during the COVID-19 pandemic, threatening the achievements in the eradication and elimination of major vaccine preventable diseases (VPDs) like polio and measles. More than 80 million children under the age of one are estimated to be affected by disruptions in routine immunization services in more than 68 countries and are at risk of polio, measles, diphtheria, pertussis, tetanus, hepatitis B, Hemophilus influenza type b, pneumococcus, and rotavirus infections 1. As of June 1, 2020, approximately 125 mass vaccination campaigns against polio, measles, meningitis A, yellow fever, typhoid, cholera, and tetanus had been postponed.

In many countries, immunization services have been disrupted as a result of:

  • Unavailability of healthcare workers as a result of their deployment to the COVID-19 response.
  • Lack of personal protective equipment (PPE) to conduct immunization activities during COVID-19.
  • Healthcare workers’ fear about contracting COVID-19.
  • Lack of vaccines due to closure of country borders as a result of COVID-19.
  • Reduced demand for immunization services due to unwillingness or inability of parents to leave their homes due to fear of COVID-19.


The purpose of this document is to provide operational considerations for the implementation of immunization services during the COVID-19 pandemic in non-US settings. Its intended users are CDC country offices, immunization program managers, and staff from partner immunization programs. These considerations are meant to supplement—not replace—any local health and safety laws, rules, and regulations. 

This document provides a summary of global guidance on immunization services during COVID-19 as of June 12, 2020. It complements and provides reference to more detailed technical guidance from the World Health Organization, UNICEF, and the Global Polio Eradication Initiative including the following:

Implementation of vaccination sessions during COVID-19

  • Immunization services are essential and should be maintained as possible during the COVID-19 pandemic to prevent outbreaks of vaccine preventable diseases (VPDs) and protect children 2,3.
  • Immunization delivery strategies need to be adapted depending on the VPD risk and COVID-19 situation in each country (see Table) 3-6.
  • National Immunization Technical Advisory Groups (NITAGs) should be involved in decision making with regards to scheduling and implementation of routine immunization services and mass vaccination campaigns.
  • Healthcare workers should regularly inform communities about the status and availability of routine immunization services and mass campaigns. Regular communication will help to reduce confusion about availability and purpose of immunization services, increase awareness of the necessary precautions in place at the immunization session site to prevent SARS-CoV-2 transmission and prepare community members who need to attend the vaccination session.
  • It is likely that measures to reduce SARS-CoV-2 transmission and ensure the health and safety of both health workers and clients will remain in place for some time. Special considerations for setting up the vaccination site and maintaining good infection prevention and control (IPC) practices should be followed 4 (see Annex in Framework for decision-making: implementation of mass vaccination campaigns in the context of COVID-19: Interim guidanceexternal icon for detailed IPC and PPE recommendations)
    • Recommendations for vaccination site:
      • Conduct vaccination in a well-aerated area and implement frequent disinfection focusing on high-touch surfaces, using products effective against SARS-CoV-2external icon.
      • Reconfigure waiting rooms to allow for at least 2 meters (6 feet) distance between people and limit entry to only one companion per vaccination recipient. In situations where people will form lines, encourage people to stay at least 2 meters (6 feet) apart by providing signs or other visual cues such as tape or chalk marks.
      • Consider increasing the duration of the vaccination session and/or number of vaccination sites so that people can maintain physical distancing of at least 2 meters (6 feet).
      • People with pre-existing medical conditions should have separate vaccination sessions.
      • Separate vaccination sites from curative services by using different locations or allocating different hours.
      • Alcohol-based hand sanitizer with a minimum of 60% alcohol or a hand washing station with soap and water, paper towels, and trash can (hands-free) need to be available and should be used by every person entering the vaccination site and by healthcare workers to perform hand hygiene after every client.
      • Maintain 2 meters (6 feet) distance when possible between people at the vaccination site.
      • Prior to entry into the vaccination site, screen vaccination recipients and companions for COVID-19 symptoms and exposure risk. Those who screen positive should be offered a mask then referred to the relevant part of the health system for further COVID-19 evaluation. If feasible offer vaccination at the COVID-19 evaluation site or, if not feasible, postpone vaccination for 14 days after symptom resolution or 2 negative tests conducted at least 24 hours apart.
    • Recommendations for vaccinators
      • Vaccinators should not come to the vaccination session if they have symptoms suggestive of COVID-19 or have been exposed to a person infected with SARS-CoV-2. Please see return to work guidance for healthcare professionals for further details on when vaccinators can return to work.
      • Maintain hand hygiene after interaction with each client/vaccine recipient by washing hands with soap and water for at least 20 seconds or using hand sanitizer with a minimum of 60% alcohol.
      • Vaccinators should wear masks throughout the vaccination session, especially in areas with widespread community transmission of COVID-19.

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