Impact of COVID-19 pandemic on childhood immunization coverage in Indonesia: lesson learned from a nationwide analysis of the Expanded Programme on Immunization
4 affiliations
- 1Oxford University Clinical Research Unit Indonesia, Faculty of Medicine, Universitas Indonesia
- 2Directorate of Immunization, Ministry of Health of Republic of Indonesia
- 3Indonesia Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia
- 4PARTICIPATE Lab, Public Health Program, Monash University Indonesia
Abstract
Background The COVID-19 pandemic disrupted childhood immunization programmes in many countries worldwide. However, evidence on its impact in low and middle-income countries remains limited. This study examined the impact of the COVID-19 pandemic on childhood immunization coverage across 514 districts in Indonesia and identified district-level associated factors. Methods We conducted a nationwide longitudinal analysis of the Expanded Programme on Immunization to compare immunization coverage before and after the pandemic. The outcome variable was the annual childhood immunization coverage (proportion of children aged 0–12 months who have received all recommended doses of childhood immunization as per the national immunization schedule). The independent variables include COVID-19 burden and vaccination rates, health system and human development indicators. Mixed-effect logistic regression was done to assess association between the independent and outcome variables. Results At the national level, the coverage was 83.2% in pre-pandemic, 75.0% in the first year of pandemic, and 88.6%, in the second. In the first year, 69.3% of districts experienced significant decline, with a lower national coverage ratio of 0.92 (95% confidence interval 0.89–0.94). In the second year, 36.2% districts were still affected. The multivariable analysis showed that a significant decline in coverage during the first pandemic year was associated with high COVID-19 incidence (adjusted odds ratio 2.19, 95%CI 1.01–4.73 for the highest vs. lowest group), low midwife adequacy (5.84, 2.40–14.16 for the lowest vs. the highest group, 2.61, 1.26–5.40 for low-middle vs. the highest group), and a high proportion of health facility-based births (2.98, 1.49–5.98 for middle-high vs. the lowest group). Conclusions The COVID-19 pandemic was negatively and unevenly associated with childhood immunization in Indonesia, with greatest impacts in districts facing a higher COVID-19 burden and weaker health system capacity. These findings underscore the need for targeted efforts to strengthen the local health system for future health crises.
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BibTeX
@article{nurina2026impact,
title = {{Impact of COVID-19 pandemic on childhood immunization coverage in Indonesia: lesson learned from a nationwide analysis of the Expanded Programme on Immunization}},
author = {Amalia Nurina and Evelyn Puspaningrum and Gertrudis Tandy and Debsy Pattilima and Badriul Hegar and Grace Wangge and Raph L. Hamers and Iqbal RF Elyazar and Henry Surendra},
journal = {BMC Medicine},
year = {2026},
month = jul,
doi = {10.1186/s12916-026-05084-4},
url = {https://doi.org/10.1186/s12916-026-05084-4},
note = {CC BY},
}
RIS
TY - JOUR
TI - Impact of COVID-19 pandemic on childhood immunization coverage in Indonesia: lesson learned from a nationwide analysis of the Expanded Programme on Immunization
AU - Amalia Nurina
AU - Evelyn Puspaningrum
AU - Gertrudis Tandy
AU - Debsy Pattilima
AU - Badriul Hegar
AU - Grace Wangge
AU - Raph L. Hamers
AU - Iqbal RF Elyazar
AU - Henry Surendra
PY - 2026
DA - 2026/07/01
JO - BMC Medicine
DO - 10.1186/s12916-026-05084-4
UR - https://doi.org/10.1186/s12916-026-05084-4
AB - Background The COVID-19 pandemic disrupted childhood immunization programmes in many countries worldwide. However, evidence on its impact in low and middle-income countries remains limited. This study examined the impact of the COVID-19 pandemic on childhood immunization coverage across 514 districts in Indonesia and identified district-level associated factors. Methods We conducted a nationwide longitudinal analysis of the Expanded Programme on Immunization to compare immunization coverage before and after the pandemic. The outcome variable was the annual childhood immunization coverage (proportion of children aged 0–12 months who have received all recommended doses of childhood immunization as per the national immunization schedule). The independent variables include COVID-19 burden and vaccination rates, health system and human development indicators. Mixed-effect logistic regression was done to assess association between the independent and outcome variables. Results At the national level, the coverage was 83.2% in pre-pandemic, 75.0% in the first year of pandemic, and 88.6%, in the second. In the first year, 69.3% of districts experienced significant decline, with a lower national coverage ratio of 0.92 (95% confidence interval 0.89–0.94). In the second year, 36.2% districts were still affected. The multivariable analysis showed that a significant decline in coverage during the first pandemic year was associated with high COVID-19 incidence (adjusted odds ratio 2.19, 95%CI 1.01–4.73 for the highest vs. lowest group), low midwife adequacy (5.84, 2.40–14.16 for the lowest vs. the highest group, 2.61, 1.26–5.40 for low-middle vs. the highest group), and a high proportion of health facility-based births (2.98, 1.49–5.98 for middle-high vs. the lowest group). Conclusions The COVID-19 pandemic was negatively and unevenly associated with childhood immunization in Indonesia, with greatest impacts in districts facing a higher COVID-19 burden and weaker health system capacity. These findings underscore the need for targeted efforts to strengthen the local health system for future health crises.
SN - 1741-7015
ER -