{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T07:53:01Z","timestamp":1788076381240,"version":"build-2784847793"},"reference-count":99,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIRx Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec sec-type=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The COVID-19 pandemic disrupted essential health care services globally, including routine childhood immunization programs. Ecuador faced significant challenges in maintaining vaccination coverage during this period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"objective\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The aim of this study is to analyze the impact of the COVID-19 pandemic on routine childhood vaccination coverage in Ecuador by comparing prepandemic (2019) and pandemic (2020\u20102021) data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective observational study analyzed vaccination coverage data from the Ministry of Public Health of Ecuador and demographic data from the National Institute of Statistics and Censuses. We examined routine childhood vaccination coverage for children under 24 months across all 24 provinces. Statistical analyses were performed using SPSS (version 28.0), including descriptive statistics and comparative analysis. Coverage rates were calculated as percentages of children in target age groups receiving recommended doses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A significant decline in routine childhood vaccination coverage was observed during the pandemic. BCG vaccine coverage decreased from 86.4% in 2019 (n=286,569) to 80.7% in 2020 (n=266,961) and 75.3% in 2021 (n=248,812). Pentavalent vaccine third dose coverage dropped from 85.0% to 68.0% across the same period. The most dramatic decline was seen in measles-mumps-rubella vaccine second dose coverage, falling from 75.7% in 2019 to 58.4% in 2021. Coastal and highland provinces experienced the most severe reductions, with approximately 137,000 fewer doses administered in 2020 compared to stable prepandemic levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The COVID-19 pandemic significantly impacted routine childhood vaccination coverage in Ecuador, with sustained declines through 2021. Regional disparities were evident, with vulnerable populations facing greater challenges accessing immunization services. Urgent interventions, including catch-up campaigns and strengthened health systems, are needed to restore coverage levels and prevent outbreaks of vaccine-preventable diseases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/75293","type":"journal-article","created":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T02:30:06Z","timestamp":1755657006000},"page":"e75293-e75293","source":"Crossref","is-referenced-by-count":5,"title":["Impact of the COVID-19 Pandemic on Routine Childhood Vaccination Coverage in Ecuador From 2019 to 2021: Comparative Analysis"],"prefix":"10.2196","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4571-1618","authenticated-orcid":false,"given":"Jose","family":"Sanchez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0308-1626","authenticated-orcid":false,"given":"Alejandro Arjuna","family":"Rodriguez Sr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0659-8751","authenticated-orcid":false,"given":"Kimberlly Pamela Montenegro","family":"Cuello Sr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,10,17]]},"reference":[{"key":"R1","unstructured":"WHO Director-General\u2019s opening remarks at the media briefing on COVID-19. World Health Organization. Mar 11, 2020. URL: https:\/\/www.who.int\/director-general\/speeches\/detail\/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 [Accessed 06-10-2025]"},{"issue":"10","key":"R2","doi-asserted-by":"publisher","first-page":"e1264","DOI":"10.1016\/S2214-109X(20)30308-9","article-title":"Routine childhood immunisation during the COVID-19 pandemic in Africa: a benefit-risk analysis of health benefits versus excess risk of SARS-CoV-2 infection","volume":"8","author":"Abbas","journal-title":"Lancet Glob Health"},{"issue":"9","key":"R3","doi-asserted-by":"publisher","first-page":"e1118","DOI":"10.1016\/S2214-109X(20)30290-4","article-title":"Impact of COVID-19 lockdown on routine immunisation in Karachi, Pakistan","volume":"8","author":"Chandir","journal-title":"Lancet Glob Health"},{"key":"R4","unstructured":"The impact of COVID-19 on immunization services: a baseline for monitoring and evaluation. World Health Organization; 2020. URL: https:\/\/tinyurl.com\/5d4kc7m3 [Accessed 14-10-2025]"},{"issue":"2","key":"R5","doi-asserted-by":"publisher","first-page":"e186","DOI":"10.1016\/S2214-109X(21)00512-X","article-title":"Impact of the SARS-CoV-2 pandemic on routine immunisation services: evidence of disruption and recovery from 170 countries and territories","volume":"10","author":"Shet","journal-title":"Lancet Glob Health"},{"issue":"19","key":"R6","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2020.25.19.2000848","article-title":"Early impact of the coronavirus disease (COVID-19) pandemic and physical distancing measures on routine childhood vaccinations in England, January to April 2020","volume":"25","author":"McDonald","journal-title":"Euro Surveill"},{"issue":"10299","key":"R7","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1016\/S0140-6736(21)01337-4","article-title":"Estimating global and regional disruptions to routine childhood vaccine coverage during the COVID-19 pandemic in 2020: a modelling study","volume":"398","author":"Causey","journal-title":"The Lancet"},{"issue":"6","key":"R8","doi-asserted-by":"publisher","first-page":"1314","DOI":"10.1038\/s41591-022-01750-1","article-title":"COVID-19 and resilience of healthcare systems in ten countries","volume":"28","author":"Arsenault","journal-title":"Nat Med"},{"issue":"5","key":"R9","doi-asserted-by":"publisher","DOI":"10.3390\/vaccines12050458","article-title":"The impact of the coronavirus pandemic on vaccination coverage in Latin America and the Caribbean","volume":"12","author":"Castro-Aguirre","journal-title":"Vaccines (Basel)"},{"key":"R10","unstructured":"Esquema nacional de inmunizaci\u00f3n [Website in Spanish]. Ministerio de Salud P\u00fablica del Ecuador. 2019. URL: https:\/\/confianzaenlasvacunasla.org\/wp-content\/uploads\/2020\/11\/Ecuador-ESQUEMA-DE-VACUNACION-DIC2019.pdf"},{"key":"R11","volume":"42","author":"Torres","journal-title":"Rev Panam Salud Publica"},{"key":"R12","unstructured":"Immunization in the Americas: 2019 summary. Pan American Health Organization; 2019. URL: https:\/\/www.paho.org\/en\/documents\/immunization-americas-2019-summary [Accessed 14-10-2025]"},{"key":"R13","unstructured":"Encuesta nacional de salud y nutrici\u00f3n ENSANUT-ECU 2018 [Report in Spanish]. Instituto nacional de estad\u00edstica y censos del Ecuador; 2018. URL: https:\/\/anda.inec.gob.ec\/anda\/index.php\/catalog\/891 [Accessed 14-10-2025]"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.12688\/f1000research.154766.1","article-title":"Vaccination against COVID-19 in a geographically dispersed and underserved population, challenges and solutions in access and distribution of vaccines","volume":"13","author":"Mafla-Viscarra","journal-title":"F1000Res"},{"issue":"19","key":"R15","doi-asserted-by":"publisher","first-page":"591","DOI":"10.15585\/mmwr.mm6919e2","article-title":"Effects of the COVID-19 pandemic on routine pediatric vaccine ordering and administration - United States, 2020","volume":"69","author":"Santoli","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"7","key":"R16","doi-asserted-by":"publisher","first-page":"e901","DOI":"10.1016\/S2214-109X(20)30229-1","article-title":"Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study","volume":"8","author":"Roberton","journal-title":"Lancet Glob Health"},{"issue":"10200","key":"R17","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1016\/S0140-6736(19)30721-4","article-title":"Causes of severe pneumonia requiring hospital admission in children without HIV infection from Africa and Asia: the PERCH multi-country case-control study","volume":"394","author":"O\u2019Brien","journal-title":"The Lancet"},{"issue":"12","key":"R18","doi-asserted-by":"publisher","first-page":"4768","DOI":"10.1080\/21645515.2021.1974323","article-title":"Impact of COVID-19 pandemic on routine immunizations: evidence from the Pan American Health Organization\u2019s Regional Immunization Program","volume":"17","author":"Ota","journal-title":"Hum Vaccin Immunother"},{"issue":"25","key":"R19","doi-asserted-by":"publisher","first-page":"3404","DOI":"10.1016\/j.vaccine.2021.04.046","article-title":"Missed childhood immunizations during the COVID-19 pandemic in Brazil: analyses of routine statistics and of a national household survey","volume":"39","author":"Silveira","journal-title":"Vaccine (Auckl)"},{"issue":"9596","key":"R20","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"von Elm","journal-title":"Lancet"},{"key":"R21","unstructured":"Bolet\u00edn de indicadores de la estrategia nacional de inmunizaci\u00f3n [Website in Spanish]. Ministerio de Salud P\u00fablica del Ecuador. 2019. URL: https:\/\/www.salud.gob.ec\/boletin-de-indicadores-de-la-estrategia-nacional-de-inmunizacion\/ [Accessed 14-10-2025]"},{"key":"R22","unstructured":"Proyecciones poblacionales y estudios demogr\u00e1ficos [Website in Spanish]. Instituto Nacional de Estad\u00edstica y Censos del Ecuador. 2019. URL: https:\/\/www.ecuadorencifras.gob.ec\/proyecciones-poblacionales\/ [Accessed 14-10-2025]"},{"issue":"7","key":"R23","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000097","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"6","author":"Moher","journal-title":"PLoS Med"},{"key":"R24","unstructured":"WHO recommendations for routine immunization - summary tables. World Health Organization. 2020. URL: https:\/\/www.who.int\/teams\/immunization-vaccines-and-biologicals\/policies\/who-recommendations-for-routine-immunization---summary-tables [Accessed 14-10-2025]"},{"issue":"50","key":"R25","doi-asserted-by":"publisher","first-page":"7187","DOI":"10.1016\/j.vaccine.2019.06.087","article-title":"Building sustainable health systems: immunization delivery across the continuum of care","volume":"37","author":"Bravo","journal-title":"Vaccine (Auckl)"},{"key":"R26","unstructured":"WHO position papers - recommendations for routine immunization. World Health Organization. 2019. URL: https:\/\/www.who.int\/publications\/m\/item\/table1-summary-of-who-position-papers-recommendations-for-routine-immunization [Accessed 14-10-2025]"},{"issue":"33","key":"R27","doi-asserted-by":"publisher","first-page":"5325","DOI":"10.1016\/j.vaccine.2011.05.035","article-title":"A summary of global routine immunization coverage through 2010","volume":"29","author":"Brown","journal-title":"Vaccine (Auckl)"},{"key":"R28","unstructured":"Downloading IBM SPSS Statistics 28. IBM. 2021. URL: https:\/\/www.ibm.com\/support\/pages\/downloading-ibm-spss-statistics-28 [Accessed 14-10-2025]"},{"issue":"6975","key":"R29","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1136\/bmj.310.6975.298","article-title":"Statistics notes: the normal distribution","volume":"310","author":"Altman","journal-title":"BMJ"},{"issue":"6522","key":"R30","doi-asserted-by":"publisher","first-page":"746","DOI":"10.1136\/bmj.292.6522.746","article-title":"Confidence intervals rather than P values: estimation rather than hypothesis testing","volume":"292","author":"Gardner","journal-title":"Br Med J (Clin Res Ed)"},{"key":"R31","unstructured":"Fotheringham AS Brunsdon C Charlton M . Quantitative Geography: Perspectives on Spatial Data Analysis. SAGE Publications; 2000. URL: https:\/\/www.perlego.com\/book\/861255\/quantitative-geography-perspectives-on-spatial-data-analysis-pdf [Accessed 14-10-2025]"},{"issue":"3","key":"R32","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1109\/MCSE.2007.55","article-title":"Matplotlib: a 2D graphics environment","volume":"9","author":"Hunter","journal-title":"Comput Sci Eng"},{"issue":"20","key":"R33","doi-asserted-by":"publisher","first-page":"2191","DOI":"10.1001\/jama.2013.281053","article-title":"World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects","volume":"310","author":"World Medical Association","journal-title":"JAMA"},{"key":"R34","unstructured":"Guideline on good pharmacovigilance practices (GVP): module VIII - post-authorisation safety studies. European Medicines Agency; 2017. URL: http:\/\/www.sefap.it\/web\/upload\/WC500129137.pdf [Accessed 14-10-2025]"},{"issue":"9302","key":"R35","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1016\/S0140-6736(02)07451-2","article-title":"Bias and causal associations in observational research","volume":"359","author":"Grimes","journal-title":"Lancet"},{"issue":"6","key":"R36","doi-asserted-by":"publisher","DOI":"10.3390\/vaccines10060857","article-title":"Routine immunization programs for children during the COVID-19 pandemic in Ecuador, 2020-hidden effects, predictable consequences","volume":"10","author":"Su\u00e1rez-Rodr\u00edguez","journal-title":"Vaccines (Basel)"},{"issue":"18","key":"R37","doi-asserted-by":"publisher","first-page":"2457","DOI":"10.1016\/j.vaccine.2021.03.064","article-title":"Factors associated with routine immunization coverage in Peru\u2019s rural areas: results from a national survey","volume":"39","author":"Vel\u00e1squez-Hurtado","journal-title":"Vaccine (Auckl)"},{"issue":"1","key":"R38","first-page":"25","volume":"25","author":"Exp\u00f3sito","journal-title":"Vaccimonitor"},{"issue":"7","key":"R39","doi-asserted-by":"publisher","first-page":"e744","DOI":"10.1016\/S2214-109X(18)30247-X","article-title":"Burden of Streptococcus pneumoniae and Haemophilus influenzae type b disease in children in the era of conjugate vaccines: global, regional, and national estimates for 2000-15","volume":"6","author":"Wahl","journal-title":"Lancet Glob Health"},{"issue":"10","key":"R40","doi-asserted-by":"publisher","first-page":"958","DOI":"10.1001\/jamapediatrics.2018.1960","article-title":"Rotavirus vaccination and the global burden of rotavirus diarrhea among children younger than 5 years","volume":"172","author":"Troeger","journal-title":"JAMA Pediatr"},{"issue":"45","key":"R41","doi-asserted-by":"publisher","first-page":"1700","DOI":"10.15585\/mmwr.mm6945a6","article-title":"Progress toward regional measles elimination - worldwide, 2000-2019","volume":"69","author":"Patel","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"3","key":"R42","doi-asserted-by":"publisher","first-page":"5660","DOI":"10.37811\/cl_rcm.v8i3.11769","article-title":"Caracterizaci\u00f3n de las zonas de riesgo susceptibles a enfermedades prevenibles por vacunaci\u00f3n en menores de 5 a\u00f1os Quito-Ecuador [Article in Spanish]","volume":"8","author":"Arce Becerra","journal-title":"Ciencia Latina"},{"issue":"2","key":"R43","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1093\/heapol\/czac094","article-title":"The impact of the COVID-19 pandemic on childhood vaccination coverage in Burkina Faso","volume":"38","author":"Freeman","journal-title":"Health Policy Plan"},{"key":"R44","doi-asserted-by":"publisher","DOI":"10.1016\/j.lana.2021.100060","article-title":"Surveillance of routine childhood vaccinations during the COVID-19 pandemic in Honduras","volume":"3","author":"Diaz","journal-title":"Lancet Reg Health Am"},{"issue":"33","key":"R45","doi-asserted-by":"publisher","first-page":"4676","DOI":"10.1016\/j.vaccine.2019.06.076","article-title":"Geographic barriers to routine childhood immunization in marginalized areas of Colombia: systematic review","volume":"37","author":"Meneses","journal-title":"Vaccine (Auckl)"},{"key":"R46","unstructured":"COVID-19 situation report #50. Gavi The Vaccine Alliance. 2021. URL: https:\/\/www.gavi.org\/progress-report-2021"},{"key":"R47","unstructured":"The state of the world\u2019s children 2021. On my mind: promoting, protecting and caring for children\u2019s mental health. UNICEF; 2021. URL: https:\/\/www.unicef.cn\/media\/20961\/file\/ON%20MY%20MIND%20-%20Promoting,%20protecting%20and%20caring%20for%20children%E2%80%99s%20mental%20health.pdf [Accessed 14-10-2025]"},{"issue":"3","key":"R48","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1016\/j.anpedi.2020.09.011","article-title":"Impacto de la pandemia por SARS-CoV-2 sobre la actividad de los centros de vacunaci\u00f3n infantil [Article in Spanish]","volume":"94","author":"Moraga-Llop","journal-title":"An Pediatr (Barc)"},{"issue":"8","key":"R49","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1004070","article-title":"Healthcare utilization and maternal and child mortality during the COVID-19 pandemic in 18 low- and middle-income countries: an interrupted time-series analysis with mathematical modeling of administrative data","volume":"19","author":"Ahmed","journal-title":"PLoS Med"},{"issue":"7","key":"R50","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1093\/cid\/cir007","article-title":"\u201cHerd immunity\u201d: a rough guide","volume":"52","author":"Fine","journal-title":"Clin Infect Dis"},{"key":"R51","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m2392","article-title":"Routine vaccination during covid-19 pandemic response","volume":"369","author":"Saxena","journal-title":"BMJ"},{"issue":"6","key":"R52","doi-asserted-by":"publisher","DOI":"10.2196\/27632","article-title":"Assessing COVID-19 vaccine hesitancy, confidence, and public engagement: a global social listening study","volume":"23","author":"Hou","journal-title":"J Med Internet Res"},{"issue":"5","key":"R53","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1016\/j.vaccine.2020.12.054","article-title":"Childhood vaccinations: hidden victims of COVID-19","volume":"39","author":"Zhong","journal-title":"Vaccine (Auckl)"},{"key":"R54","doi-asserted-by":"publisher","DOI":"10.7554\/eLife.67023","article-title":"Impact of COVID-19-related disruptions to measles, meningococcal A, and yellow fever vaccination in 10 countries","volume":"10","author":"Gaythorpe","journal-title":"Elife"},{"issue":"13","key":"R55","doi-asserted-by":"publisher","first-page":"2056","DOI":"10.1016\/j.vaccine.2022.02.047","article-title":"Sustaining vaccination coverage during the COVID-19 pandemic: lessons learned from China\u2019s experiences","volume":"40","author":"Chen","journal-title":"Vaccine (Auckl)"},{"issue":"10","key":"R56","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-043763","article-title":"Access to primary healthcare during lockdown measures for COVID-19 in rural South Africa: an interrupted time series analysis","volume":"10","author":"Siedner","journal-title":"BMJ Open"},{"key":"R57","doi-asserted-by":"publisher","DOI":"10.7189\/jogh.11.03085","article-title":"Digital health and COVID-19: using technology to accelerate the achievement of nutrition outcomes","volume":"11","author":"Cardoso","journal-title":"J Glob Health"},{"issue":"1","key":"R58","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-019-7725-3","article-title":"The immunisation of children in Ethiopia: descriptive analysis using the 2016 Ethiopian demographic and health survey data","volume":"19","author":"Tegegne","journal-title":"BMC Public Health"},{"issue":"8","key":"R59","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1007\/s10654-020-00671-y","article-title":"Vaccine hesitancy: the next challenge in the fight against COVID-19","volume":"35","author":"Dror","journal-title":"Eur J Epidemiol"},{"issue":"1","key":"R60","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.44984","article-title":"Prenatal health behaviors and birth weight among children born during the COVID-19 pandemic","volume":"5","author":"Kiely","journal-title":"JAMA Netw Open"},{"issue":"10317","key":"R61","doi-asserted-by":"publisher","first-page":"2186","DOI":"10.1016\/S0140-6736(21)02507-1","article-title":"Promoting COVID-19 vaccine acceptance: recommendations from the Lancet Commission on Vaccine Refusal, Acceptance, and Demand in the USA","volume":"398","author":"Omer","journal-title":"The Lancet"},{"issue":"2","key":"R62","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1136\/archdischild-2020-318988","article-title":"Vaccine hesitancy in low- and middle-income countries: potential implications for the COVID-19 response","volume":"106","author":"Bhopal","journal-title":"Arch Dis Child"},{"issue":"2","key":"R63","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1007\/s10900-020-00958-x","article-title":"COVID-19 vaccination hesitancy in the United States: a rapid national assessment","volume":"46","author":"Khubchandani","journal-title":"J Community Health"},{"issue":"7","key":"R64","doi-asserted-by":"publisher","first-page":"1599","DOI":"10.1080\/21645515.2018.1459252","article-title":"Measuring trust in vaccination: a systematic review","volume":"14","author":"Larson","journal-title":"Hum Vaccin Immunother"},{"issue":"34","key":"R65","doi-asserted-by":"publisher","first-page":"4161","DOI":"10.1016\/j.vaccine.2015.04.036","article-title":"SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: definition, scope and determinants","volume":"33","author":"MacDonald","journal-title":"Vaccine (Auckl)"},{"issue":"3","key":"R66","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1016\/j.vaccine.2019.10.088","article-title":"Barriers to vaccination in Latin America: a systematic literature review","volume":"38","author":"Guzman-Holst","journal-title":"Vaccine (Auckl)"},{"key":"R67","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2020.00517","article-title":"Child healthcare and immunizations in sub-Saharan Africa during the COVID-19 pandemic","volume":"8","author":"Buonsenso","journal-title":"Front Pediatr"},{"issue":"12","key":"R68","doi-asserted-by":"publisher","first-page":"e420","DOI":"10.1016\/S1473-3099(17)30307-9","article-title":"The basic reproduction number (R0) of measles: a systematic review","volume":"17","author":"Guerra","journal-title":"Lancet Infect Dis"},{"issue":"47","key":"R69","doi-asserted-by":"publisher","first-page":"1323","DOI":"10.15585\/mmwr.mm6747a6","article-title":"Progress toward regional measles elimination - worldwide, 2000-2017","volume":"67","author":"Dabbagh","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"11","key":"R70","doi-asserted-by":"publisher","first-page":"1012","DOI":"10.1056\/NEJMoa1200850","article-title":"Waning protection after fifth dose of acellular pertussis vaccine in children","volume":"367","author":"Klein","journal-title":"N Engl J Med"},{"key":"R71","unstructured":"Polio-free Americas: 25 years and counting. Pan American Health Organization; 2019. URL: https:\/\/www.paho.org\/sites\/default\/files\/csp30-19-e-keeping-the-region-free-of-polio_0.pdf [Accessed 14-10-2025]"},{"key":"R72","unstructured":"Framework for decision-making: implementation of mass vaccination campaigns in the context of COVID-19. World Health Organization; 2020. URL: https:\/\/www.who.int\/publications\/i\/item\/WHO-2019-nCoV-Framework_Mass_Vaccination-2020.1 [Accessed 14-10-2025]"},{"key":"R73","unstructured":"Guidance on developing a national deployment and vaccination plan for COVID-19 vaccines. World Health Organization; 2020. URL: https:\/\/www.who.int\/publications\/i\/item\/WHO-2019-nCoV-Vaccine_deployment-2020.1 [Accessed 14-10-2025]"},{"issue":"5","key":"R74","doi-asserted-by":"publisher","first-page":"e715","DOI":"10.1016\/S2214-109X(22)00005-5","article-title":"The Lancet Global Health Commission on financing primary health care: putting people at the centre","volume":"10","author":"Hanson","journal-title":"Lancet Glob Health"},{"issue":"1","key":"R75","doi-asserted-by":"publisher","DOI":"10.1080\/17482631.2020.1757336","article-title":"Vaccine hesitancy among general practitioners in Southern France and their reluctant trust in the health authorities","volume":"15","author":"Wilson","journal-title":"Int J Qual Stud Health Well-being"},{"issue":"4","key":"R76","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1136\/bmjinnov-2021-000708","article-title":"Digital health solutions in response to the first wave of COVID-19 pandemic: a comprehensive review of experiences from Iran","volume":"7","author":"Alizadeh Khasraghi","journal-title":"BMJ Innov"},{"key":"R77","doi-asserted-by":"publisher","DOI":"10.1186\/s12960-016-0106-y","article-title":"Systematic review on human resources for health interventions to improve maternal health outcomes: evidence from low- and middle-income countries","volume":"14","author":"Lassi","journal-title":"Hum Resour Health"},{"issue":"4","key":"R78","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1007\/s00038-012-0337-1","article-title":"Socio-economic disparities in mortality due to pandemic influenza in England","volume":"57","author":"Rutter","journal-title":"Int J Public Health"},{"key":"R79","unstructured":"Maintaining essential health services: operational guidance for the COVID-19 context. World Health Organization; 2020. URL: https:\/\/www.who.int\/publications\/i\/item\/WHO-2019-nCoV-essential_health_services-2020.2 [Accessed 14-10-2025]"},{"issue":"1","key":"R80","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-017-2626-0","article-title":"Determinants of effective vaccine coverage in low and middle-income countries: a systematic review and interpretive synthesis","volume":"17","author":"Phillips","journal-title":"BMC Health Serv Res"},{"issue":"12","key":"R81","doi-asserted-by":"publisher","first-page":"e1397","DOI":"10.1016\/S2214-109X(18)30482-0","article-title":"Health policy and system support to optimise community health worker programmes: an abridged WHO guideline","volume":"6","author":"Cometto","journal-title":"Lancet Glob Health"},{"issue":"1","key":"R82","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1186\/s12913-022-07978-8","article-title":"COVID-19 and provision of sexual and reproductive health services in Uganda: health workers\u2019 experiences and perspectives","volume":"22","author":"Okullo","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"R83","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-022-14662-4","article-title":"The impact of COVID-19 on routine childhood immunization in Bangladesh: a mixed-method study exploring parental and health worker perspectives","volume":"22","author":"Khan","journal-title":"BMC Public Health"},{"issue":"3","key":"R84","doi-asserted-by":"publisher","first-page":"666","DOI":"10.1093\/ije\/dym018","article-title":"Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: a systematic review and annotated bibliography","volume":"36","author":"Sanderson","journal-title":"Int J Epidemiol"},{"issue":"49","key":"R85","doi-asserted-by":"publisher","first-page":"7789","DOI":"10.1016\/j.vaccine.2020.10.027","article-title":"Parents\u2019 and guardians\u2019 views on the acceptability of a future COVID-19 vaccine: a multi-methods study in England","volume":"38","author":"Bell","journal-title":"Vaccine (Auckl)"},{"issue":"33","key":"R86","doi-asserted-by":"publisher","first-page":"10321","DOI":"10.1073\/pnas.1504019112","article-title":"Countering antivaccination attitudes","volume":"112","author":"Horne","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"5","key":"R87","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1177\/003591576505800503","article-title":"The environment and disease: association or causation?","volume":"58","author":"HILL","journal-title":"Proc R Soc Med"},{"key":"R88","unstructured":"Openshaw S . The modifiable areal unit problem. In: Concepts and Techniques in Modern Geography. Vol 38. 1984:1-41. ISBN: 0860941345"},{"issue":"9548","key":"R89","doi-asserted-by":"publisher","first-page":"1729","DOI":"10.1016\/S0140-6736(06)69566-4","article-title":"Benchmarking of performance of Mexican states with effective coverage","volume":"368","author":"Lozano","journal-title":"The Lancet"},{"issue":"3","key":"R90","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001405","article-title":"Strengthening the expanded programme on immunization in Africa: looking beyond 2015","volume":"10","author":"Machingaidze","journal-title":"PLoS Med"},{"issue":"2","key":"R91","doi-asserted-by":"publisher","first-page":"e152","DOI":"10.1016\/S2214-109X(17)30472-2","article-title":"Monitoring universal health coverage within the Sustainable Development Goals: development and baseline data for an index of essential health services","volume":"6","author":"Hogan","journal-title":"Lancet Glob Health"},{"key":"R92","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/civ528","article-title":"Progress on introduction and impact of meningococcal serogroup A vaccine in the meningitis belt","volume":"61 Suppl 5","author":"Minta","journal-title":"Clin Infect Dis"},{"issue":"18","key":"R93","doi-asserted-by":"publisher","first-page":"2548","DOI":"10.1016\/j.vaccine.2021.03.013","article-title":"Estimates of the global burden of COVID-19 and the value of broad access to the COVID-19 vaccine","volume":"39","author":"Wigley","journal-title":"Vaccine (Auckl)"},{"issue":"2","key":"R94","first-page":"59","volume":"41","author":"Keja","journal-title":"World Health Stat Q"},{"key":"R95","unstructured":"GAVI Alliance strategy 2021-2025. GAVI; 2020. URL: https:\/\/tinyurl.com\/mr29pyjz [Accessed 14-10-2025]"},{"issue":"10238","key":"R96","doi-asserted-by":"publisher","first-page":"1687","DOI":"10.1016\/S0140-6736(20)31089-8","article-title":"Has COVID-19 subverted global health?","volume":"395","author":"Cash","journal-title":"Lancet"},{"issue":"20","key":"R97","doi-asserted-by":"publisher","first-page":"2027","DOI":"10.1001\/jama.2020.20590","article-title":"Answering key questions about COVID-19 vaccines","volume":"324","author":"Goodman","journal-title":"JAMA"},{"key":"R98","unstructured":"Immunization agenda 2030: a global strategy to leave no one behind. World Health Organization; 2020. URL: https:\/\/www.who.int\/docs\/default-source\/immunization\/strategy\/ia2030\/ia2030-document-en.pdf [Accessed 14-10-2025]"},{"key":"R99","volume":"6","author":"Bloom","journal-title":"World Econ"}],"container-title":["JMIRx Med"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/xmed.jmir.org\/2025\/1\/e75293","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:06:16Z","timestamp":1782842776000},"score":1,"resource":{"primary":{"URL":"https:\/\/xmed.jmir.org\/2025\/1\/e75293"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,17]]},"references-count":99,"URL":"https:\/\/doi.org\/10.2196\/75293","relation":{},"ISSN":["2563-6316"],"issn-type":[{"value":"2563-6316","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,17]]},"article-number":"v6i10e75293"}}