JMIRx Medxmed34JMIRx MedJMIRx Med2563-6316JMIR PublicationsToronto, Canadav6i1e8484810.2196/84848Peer-Review ReportPeer Review of “Impact of the COVID-19 Pandemic on Routine Childhood Vaccination Coverage in Ecuador From 2019 to 2021: Comparative Analysis”AdekolaAdelekeSyracuse UniversitySyracuseNYUnited StatesGroverAbhinav2025171020256e848482509202524092025© Adeleke Adekola. Originally published in JMIRx Med (https://med.jmirx.org), 17.10.2025. 2025

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIRx Med, is properly cited. The complete bibliographic information, a link to the original publication on https://med.jmirx.org/, as well as this copyright and license information must be included.

https://www.medrxiv.org/content/10.1101/2025.03.26.25324742v1https://med.jmirx.org/2025/1/e84851https://med.jmirx.org/2025/1/e75293COVID-19 pandemicvaccination coverageEcuadorimmunizationroutine vaccinationhealth disparitiesvaccine hesitancy

This is the peer-review report for “Impact of the COVID-19 Pandemic on Routine Childhood Vaccination Coverage in Ecuador From 2019 to 2021: Comparative Analysis.”

Round 1 ReviewGeneral Comments

This manuscript [1] presents a thorough and compelling analysis of the impact of the COVID-19 pandemic on routine and COVID-19 vaccination coverage in Ecuador. Using national and regional data from 2019 to 2021, the authors provide clear evidence of declining immunization rates across a range of vaccines, emphasizing the public health implications of disrupted vaccination services. The use of comparative and trend analyses, as well as spatial disaggregation by region, strengthens the study’s findings. The paper is timely, well-organized, and contributes valuable insights for health system resilience in the face of future public health crises.

Specific CommentsMajor Comments

1. Clarity on methodology: The study uses observational comparative analysis and descriptive statistics but would benefit from additional details on the specific statistical tests used (eg, Joinpoint regression) and any confidence intervals or measures of significance included.

2. Policy and programmatic implications: While the discussion clearly outlines the negative impact on vaccination coverage, the manuscript could be strengthened by offering more specific recommendations for public health policy, especially regarding catch-up campaigns or digital infrastructure improvements to track immunization.

3. Sociodemographic context: The analysis highlights disparities but could be improved by integrating more granular sociodemographic information (eg, income, ethnicity, rurality) to provide a deeper understanding of inequities in coverage and guide targeted interventions.

Minor Comments

4. Language and style: The manuscript would benefit from light editing to improve flow and reduce minor typographical and grammatical errors.

5. Figure/table integration: Tables are rich in data, but would be more useful if the text referenced key figures and included short interpretation notes to help readers navigate large data points.

6. Redundancy in the Introduction: Some repetition in the early paragraphs could be streamlined to maintain reader engagement.

None declared.

ReferencesSanchezJ RodriguezAA CuelloKPM Impact of the COVID-19 Pandemic on Routine Childhood Vaccination Coverage in Ecuador From 2019 to 2021: Comparative AnalysisJMIRx Med20256e7529310.2196/75293