Assessing the impact of SMS-based interventions in promoting family planning uptake and modern contraceptive utilization in sub-Saharan Africa: a systematic review and meta-analysis.

Vaccination is critical for individual and population-based health protection both in general and in the context of emergencies such as the COVID-19 Pandemic [, ]. Vaccine hesitancy is defined by the World Health Organization (WHO) as “a motivational state of being conflicted about, or opposed to, getting vaccinated, this includes intentions and willingness” []. Even before the COVID-19 pandemic, vaccine hesitancy was declared by the WHO to be one of the ten greatest global health threats []. Prior to the pandemic, global immunization efforts had averted approximately 154 million deaths over the past half-century []. A meta-analysis of parents with children aged 0–6 years found a global pooled prevalence of routine childhood vaccination hesitancy of 21.1% with hesitancy levels lowest in the Americas (13.3%) and highest in the Eastern Mediterranean (27.9%) []. Between 1980 and 2019, global coverage for the original Expanded Program on Immunization nearly doubled, for example, Diphtheria-Tetanus-Pertussis (DTP3) coverage rose from 39.6% to 80.9% [, ]. During the COVID-19 pandemic routine immunization coverage dropped [, ] and vaccine hesitancy gained greater prominence amidst changing vaccine mandates, skepticism toward public health recommendations and greater dissemination of online disinformation [, ]. The COVID-19 pandemic triggered the largest sustained decrease in childhood vaccinations in 30 years, reversing decades of progress [, ]. Global DTP3 coverage fell to 81% in 2021 from the pre-pandemic baseline of 86% and only partially recovered to 85% [, , ]. Skepticism towards COVID-19 vaccines has negatively impacted confidence in routine childhood immunization and the post-COVID period has resulted in vaccine rates slipping worldwide with outbreaks of vaccine preventable diseases like measles, meningitis and yellow fever in previously vaccinated populations [, , , ]. Canada has historically had stable childhood vaccination coverage but continued to trail behind international peers ranking 28 among 29 peer nations for childhood immunization rates going into the COVID-19 pandemic (e.g. 90% coverage for measles and 92% coverage for polio in 2019) [, ]. At the time it was unclear how willing parents would be to vaccinate their children particularly with the introduction of novel mRNA vaccines [, , ]. Children in Canada became eligible for COVID-19 vaccination in May 2021 (ages 12–17 years), November 2021 (age 5–11 years) and July 2022 (age 6 months—5 years). In 2026 these mRNA COVID-19 vaccines remain recommended for Canadian children and have favourable safety and immunogenetic profiles reported [, , ]. Although Canada initially achieved high COVID-19 vaccine uptake among chidren, uptake was not universal and varied across age groups. Parent acceptance of vaccines were associated with the child’s age [] as well as other perceptions of safety and necessity [, ]. Uptake significantly declined as the pandemic progressed and post-pandemic rates of COVID-19 vaccine hesitancy have increased among parents []. Beyond the COVID-19 vaccine and mirroring the global trend of stagnation, the post-pandemic period has marked a decline in childhood immunization with up to 25% of Canadian parents reported delaying or missing a routine immunization since the pandemic [].