Report from the Field: The Impact of COVID-19 on Local Health Department Immunization Programs

Jun 26, 2020 | Kimberly Sharpe-Scott

Local health departments (LHDs) are on the frontlines of the coronavirus (COVID-19) pandemic, serving as chief community health strategists in counties and cities across the country. LHD Immunization Programs have been called upon to contribute their clinical, epidemiological, and health education expertise to the nation’s COVID-19 response efforts. In doing so, these health departments have needed to alter their provision of routine, essential public health services, including immunization.

A recent Morbidity and Mortality Report, “Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration — United States, 2020,” detailed a significant decrease in orders placed since the start of the pandemic for VFC-funded, ACIP-recommended childhood vaccines. These findings provided an early glimpse of the impact of social distancing and stay-at-home orders on the provision of routine healthcare, and highlighted the importance of ensuring that immunization services are maintained to protect individuals and communities from the threat of vaccine-preventable diseases and outbreaks.

To further examine the impact of COVID-19 on immunization, NACCHO conducted the Impact of COVID-19 on Local Health Department Immunization Programs assessment. The assessment was distributed online via Qualtrics Survey SoftwareTM to a sample of LHD immunization programs throughout the country. Participants were asked to respond to questions regarding the impact of COVID-19 on their immunization program’s workforce, funding, coverage rates, activities and services, and adoption of new or innovative service delivery strategies. 146 LHD immunization staff completed the assessment, providing further insight into local public health immunization programs.

Impact of COVID-19 on LHD Immunization Programs and Services

Nearly 90% of respondents indicated that immunization programs and services have been impacted by the COVID-19 response. The most frequently reported immunization activities that have been altered include the provision of clinical services (83%), education/outreach/training/partnership activities (68%), routine VFC-related activities (60%), school assessments or audits (32%), and vaccine-preventable disease surveillance and outbreak control efforts (26%). Most respondents (88%) indicated that program staff have been re-assigned due to the LHD’s need to respond to COVID-19. Similar to national findings, 62% of respondents noted a decline in local vaccination coverage rates. Notably, 17% indicated the need to re-direct funding from immunization program budgets to the COVID-19 response.

Innovative Service Delivery Strategies

Adult and childhood immunization are the most frequently provided clinical services by LHDs, and many of these health departments serve as safety net providers for this essential service. Prompted by the impact of COVID-19, LHD immunization programs are exploring innovative and re-designed methods to continue offering vaccination services and counseling during a time of social distancing and stay-at-home orders.

Local immunization programs that have remained opened during the pandemic have adopted alternative service delivery strategies including the provision of online/telehealth to conduct immunization education and events, adjusted appointments and clinic schedules, home visits, or drive-thru vaccination clinics. In efforts to ensure vaccination for those who are most at-risk for contracting or developing severe complications due to a vaccine-preventable disease, some LHD immunization programs indicated prioritizing the provision of services to certain patient groups. These include those that are immunocompromised, pregnant, age birth to 24 months, or individuals requiring specific services such as rabies vaccines or series completion/catch-up vaccination.

To further address patients’ safety concerns, several respondents indicated conducting health pre-screenings before a patient’s arrival as well as outreach to parents informing them of clinic protocols in place to mitigate the risk of exposure to COVID-19 during a clinic visit. Though many LHDs indicated remaining open since the start of the pandemic, several have needed to temporarily suspend all routine immunization services. As stated by one respondent,

“We have suspended all immunization services during COVID-19. We are now trying to figure out how to safely resume services with all of the restrictions in place.”

How can NACCHO and other national, federal, and state partners support LHD immunization programs during the COVID-19 pandemic?

NACCHO aims to serve as a voice, catalyst, and advocate for LHDs, and with the impact of the COVID-19 pandemic, participant responses reflect that NACCHO’s assistance, as well as that of national, federal and state partners, is needed now more than ever.

LHDs emphasized the need for increased programmatic funding and support for routine and the eventual incorporation of COVID-19 vaccination services. Participants overwhelmingly indicated a need for increased workforce and the procurement of ancillary supplies especially since COVID-19 comes after years of budget cuts, when local public health is already “woefully underfunded.” As the back-to-school and influenza seasons quickly approach, one survey respondent indicated,

We are in need of more funding for immunization nurses at the local county health department. I worry that we will be completely OVERWHELMED with ten times more patients than normal since, for months now, children have not been getting their vaccines. More funding is needed for nurses to give current vaccines and help with COVID-19 immunizations.”

Additionally, many respondents expressed a need for training and technical assistance in developing educational materials to emphasize the importance of maintaining immunizations during a pandemic. Several assessment participants also indicated an interest in learning from other LHDs about innovative strategies or best practices for service delivery. Other requests included:

  • assistance in helping community immunization providers re-open;
  • enhanced bi-directional communication with state immunization programs to better facilitate coordination and messaging;
  • advocating for relaxed immunization grant program requirements due to the impact of COVID-19; and ultimately,
  • advocating for the development and distribution of a safe and effective COVID-19 vaccine.

Immunization remains one of the most successful and safest public health measures available to populations worldwide, with an unparalleled record of disease reduction and prevention.

As the world and nation face this historic pandemic, it is important to note that 71% of respondents expressed that their LHD is prepared to administer the COVID-19 vaccine once it becomes available. These LHDs have been and will continue to be on the front lines ensuring that their communities receive life-saving vaccines. NACCHO applauds LHD Immunization Programs as they respond and adapt to COVID-19 while promoting and protecting the public health, well-being, and safety of the nation’s communities.

For an overview of assessment findings, view the infographic. For additional information about the Impact of COVID-19 on Local Health Department Immunization Programs assessment, please contact NACCHO’s Immunization Program at

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