# The impacts of COVID-19 on routine immunization for children in Rwanda

## TL;DR

This study examines how the COVID-19 pandemic affected routine childhood immunization in Rwanda and finds that strong social norms and prior public health investments helped maintain immunization rates.

## Contribution

The study highlights how Rwanda's prior pandemic preparedness and cultural support for vaccination mitigated the impact of the pandemic on immunization.

## Key findings

- 92.2% of mothers reported that their religion promotes immunization, and 91.6% said their culture supports vaccination.
- Rwanda's prior investments in public health systems helped maintain routine immunization despite the pandemic.
- Socio-demographic factors like education and income were significantly linked to cultural support for immunization.

## Abstract

The Coronavirus Disease 2019 (COVID-19) pandemic had a direct impediment to the provision of critical health services worldwide, and one of the most affected areas was routine immunisation programmes. This caused a significant drop in child immunisation rates, especially in the early stages of the pandemic. This research aimed to investigate the socio-demographic predictors of the continued persistence of routine immunisation services in Rwanda during the COVID-19 pandemic.

The survey was done between January 3 and March 31, 2022 among mothers living in five districts in Rwanda. The goal of the study was to investigate issues that affect the willingness of mothers to vaccinate their children during the COVID-19 pandemic. The main outcome measure was the willingness to vaccinate children, which was divided into willing, uncertain, and unwilling. The analysis of the correlation between the maternal sociodemographic factors and the outcome variable was performed by the multinomial logistic regression model in the case when the effect of the pandemic on the attitudes to vaccination could potentially affect the outcome.

Two thousand four hundred and fifty-five out of the two thousand four hundred and fifty-five mothers surveyed indicated that their religion endorsed immunisation of two thousand four hundred and fifty-five mothers, 92.2% and their culture advocated immunization of two thousand four hundred and fifty-five mothers, 91.6%. The cultural and traditional support to immunization was significantly linked to the marital status, educational level, and average monthly income (p < 0.05). In terms of perceptions of vaccine safety, 77.3% of participants were concerned with serious adverse effects of vaccines in general, and 58.7% were in particular concerned with COVID-19 vaccinations, and only eight point 1% questioned the overall safety of COVID-19 vaccines. With the exception of age, marital status, and the number of children in the vaccination-aged group, all the other socio-demographic variables were significantly correlated with perceived risks of vaccination (p < 0.05).

Our cross-sectional survey (N = 2,045 mothers; data collection 3 January-31 March 2022) suggests that Rwanda, like any other country in the world was affected by the pandemic. However, the shocks of the pandemic in Rwanda did not significantly affect routine immunisation because her prior investments, especially the systems and practices established during the Ebola pandemic (surveillance, infection-prevention and control [IPC], rapid risk-communication and outreach networks) could well have alleviated the harmful effect of the COVID-19 pandemic on the usual childhood immunisation as noted by World Health Organization. (2019, July 24). WHO applauds. This survey evidence indicates that pro-vaccination social norms are also strong: 92.2% of survey participants reported that their religion promotes immunisation, and 91.6% indicated that their culture promotes vaccination. These social and community support levels align with a system that emphasised the need for regular immunisation during the pandemic.

Not applicable.

The online version contains supplementary material available at 10.1186/s12879-026-12623-0.