Pan American Health Organization · 2020
PAHO guidance for maintaining essential immunization services during COVID-19, including prioritisation strategies and infection prevention measures.
- Issuer
- Pan American Health Organization
- Edition
- 2020
- Audience
- National immunization programme managers, public health officials, vaccination service providers
- Evidence
- Expert consensus from PAHO Technical Advisory Group and WHO Strategic Advisory Group of Experts (SAGE) on immunization
- Reviewed
- 20 Oct 2026 · GMJ
What this guideline says
GMJ summary
This PAHO guidance addresses the critical challenge of maintaining immunization programmes during the COVID-19 pandemic. It provides a risk-stratified approach to continuing vaccination services based on health system capacity, SARS-CoV-2 transmission context, and the burden of vaccine-preventable diseases. The document emphasizes that vaccination should be considered an essential health service that should not be interrupted, drawing on lessons from the 2014-2015 Ebola epidemic where health system failures led to more deaths from measles, malaria, HIV/AIDS, and tuberculosis than from Ebola itself.
The guidance outlines three scenarios: continuing full vaccination services when health system capacity is intact; prioritizing vulnerable populations (older adults, people with chronic diseases, health personnel, pregnant women, children under 5 years) when capacity is limited; and temporarily suspending services when vaccination cannot be performed safely. It recommends prioritizing influenza vaccination (particularly in the Southern Hemisphere) and measles vaccination, whilst temporarily suspending mass vaccination campaigns due to transmission risks. The document provides detailed operational guidance on infection prevention and control measures at vaccination posts, including triage, social distancing, and hand hygiene protocols.
The guidance also addresses the restoration of services after disruption, emphasizing the need for intensified catch-up vaccination and potential expansion of campaign target age groups to address immunity gaps. It stresses the importance of maintaining surveillance systems for vaccine-preventable diseases with epidemic potential and global elimination targets, even when laboratory capacity is redirected to COVID-19 testing.
Key points
For clinicians — doses and thresholds as stated in the guideline
- SARS-CoV-2 has an incubation period of 2 to 14 days; person-to-person transmission is documented
- Prioritize influenza vaccination for health personnel, older adults, people with chronic diseases, and pregnant women in countries applying Southern Hemisphere vaccine schedules
- Consider zero-dose measles strategy for children aged 6-11 months in municipalities with active outbreaks
- Defer all vaccination for COVID-19 cases until complete recovery and for contacts until 14-day quarantine is completed
- Temporarily suspend mass vaccination campaigns due to risk of strengthening SARS-CoV-2 transmission
- Maintain vaccination of newborns as a priority in all settings, as institutional births will continue
- Conduct vaccination in well-ventilated areas with hand sanitizer containing 60-80% alcohol available
- Continue surveillance for VPDs with global mandates (measles, rubella, neonatal tetanus, polio) and epidemic potential (influenza, meningococcus, yellow fever, diphtheria)
Scenarios for maintaining routine vaccination during COVID-19 pandemic
Table extracted from the guideline
| Scenario | Recommendation |
|---|---|
| If the capacity of the health system is intact and the provision of essential health services continues | Vaccination should be conducted through fixed posts, mobile posts, and coverage extension activities, guaranteeing fulfillment of the recommended measures for infection prevention and control and safe vaccination. The population should be informed on the continuation of vaccination services, and the importance of attending scheduled vaccination appointments. |
| When only limited service provision is available | Prioritize vaccination of vulnerable populations with the highest risk of morbidity and mortality from VPDs (for example, older adults, people with chronic diseases, health personnel, pregnant women, children under 5 years of age, communities with active outbreaks of measles, diphtheria, yellow fever). |
| If vaccination cannot be performed safely, and the risk of SARS-CoV-2 transmission increases | Suspend vaccination activities until the risk of SARS-CoV-2 transmission has been reduced and the capacity of the health system has recovered sufficiently to resume these activities. |
Source: Pan American Health Organization, The Immunization Program in the Context of the COVID-19 Pandemic. Reproduced in summary form.
From the guideline
Verbatim
“WHO recommends that vaccination should be considered an essential health service that should not be interrupted.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As someone who has worked closely with WHO on health systems strengthening in Georgia, I recognize the critical importance of this guidance for our region. The 2014-2015 Ebola epidemic's lesson—that health system failures caused more deaths from preventable diseases than the outbreak itself—should guide our COVID-19 response. For Georgian clinicians, I would emphasize the practical scenario-based framework that balances infection control with immunization coverage, particularly the prioritization of influenza vaccination for our ageing population and healthcare workers who have borne immense burden during this pandemic. The realistic caveat for Georgia is cold chain capacity: our mountainous terrain and rural health posts may struggle to expand storage if vaccine deliveries accumulate during service disruptions, requiring immediate assessment of both public and private facilities with functional cold chains as this guidance recommends. The emphasis on maintaining polio and measles surveillance even when laboratory capacity is strained by COVID-19 testing is particularly relevant given our regional context and cross-border population movements.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 20 Oct 2026
Applicability
Georgia and the South Caucasus
This guidance is directly applicable to Georgia and the South Caucasus region, which have faced challenges in maintaining routine immunization coverage during the COVID-19 pandemic. Georgia’s National Immunization Program would need to adapt these recommendations to local transmission dynamics and health system capacity, particularly given the country’s mountainous terrain and dispersed rural populations that may complicate mobile vaccination strategies. The emphasis on maintaining surveillance for polio and measles is particularly relevant given the region’s proximity to areas with ongoing transmission risks. National programmes should assess cold chain capacity in both public and private facilities, ensure adequate personal protective equipment supplies for vaccination teams, and establish clear communication channels with communities about service continuity. The guidance on prioritizing influenza vaccination is relevant for Georgia’s autumn immunization planning, whilst the operational recommendations on infection prevention can be integrated into existing vaccination post protocols across primary healthcare facilities.
Questions this guideline answers
Quick answers
Should routine childhood vaccinations continue during the COVID-19 pandemic?
Yes, vaccination should be considered an essential health service. The decision depends on health system capacity and SARS-CoV-2 transmission context. When capacity is intact, continue all services with infection prevention measures. When limited, prioritize vulnerable populations including children under 5 years. Only suspend if vaccination cannot be performed safely.
Can I vaccinate someone diagnosed with COVID-19 or their contacts?
Although there are no known medical contraindications, defer all vaccination for COVID-19 cases until complete recovery according to established criteria, and for contacts until they complete 14-day quarantine after last exposure.
Should mass vaccination campaigns proceed during the pandemic?
Temporarily suspend mass vaccination campaigns due to risk of strengthening SARS-CoV-2 transmission. Countries planning measles, rubella or HPV follow-up campaigns should continue micro-planning but postpone implementation. For VPD outbreak response, evaluate risk-benefit considering health system capacity and potential impact on both VPD and COVID-19 transmission.
What infection prevention measures are needed at vaccination posts?
Conduct sessions in well-ventilated, frequently disinfected areas. Provide hand sanitizer (60-80% alcohol) or chlorinated water at entrance. Limit to one companion. Perform triage for respiratory symptoms before admission—if present, offer medical mask, do not vaccinate, and refer for evaluation. Avoid crowding through scheduled appointments, small frequent sessions, and outdoor spaces with social distancing.
Related on GMJ
Interconnected resources
Dictionary of Public Health
GMJ News coverage
- UK flu and COVID-19 surveillance data to May 2027 shows continued monitoring amid seasonal trendsOct 2026
- Community Health Workers Boost COVID-19 Testing Among Formerly Incarcerated PeopleAug 2026
- The Pennsylvania Measles Deaths Are a Failure of Will, Not EpidemiologyOct 2026
- Bangladesh's Measles Crisis: How a Vaccination Success Turned Into 120,000 CasesOct 2026
Quality & accreditation
- ASF PHC — Standard 4 — Acute & Same-Day Care · Primary Health Clinic
- ASF PHC — Standard 7 — Governance & Staffing · Primary Health Clinic
- ASF Hospital — Standard 5 — Safety & Emergency Preparedness
- ASF Medical Transport — Standard 5 — Infection Prevention & Control
- ASF Laboratory — Standard 7 — Examination: Process & Safety
- ASF Hospital — Standard 11 — Critical Care
- ASF Medical Transport — Standard 6 — Emergency Response During Transport
Other guidelines on this topic
- Recommendations for Heating, Ventilation, and Air Conditioning in Health Care Facilities
- Considerations on Social Distancing and Travel-Related Measures in the Context of the Response to COVID-19 Pandemic
- Guidance for Ethics Oversight of COVID-19 Research in Response to Emerging Evidence
- Key Considerations for Integrating Gender Equality into Health Emergency and Disaster Response: COVID-19
- Care for health workers exposed to the new coronavirus (COVID-19) in health facilities
- Issuer
- Pan American Health Organization
- Type
- Procedures, manuals, guidelines
- Status
- Current
- Published
- 2020-01-01
- Scope
- Region of the Americas, applicable globally
- Audience
- National immunization programme managers, public health officials, vaccination service providers
- Licence
- CC BY-NC-SA 3.0 IGO
- Evidence
- Expert consensus from PAHO Technical Advisory Group and WHO Strategic Advisory Group of Experts (SAGE) on immunization
- Record history
- Created 20 Oct 2026 · updated 20 Oct 2026 · next check Apr 2027
Pan American Health Organization. The Immunization Program in the Context of the COVID-19 Pandemic (26 March 2020). Washington, D.C.: PAHO; 2020. (PAHO/FPL/IM/COVID-19/20-0005). Licence: CC BY-NC-SA 3.0 IGO.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
Was this article helpful?
