To evaluate the safeguarding impact of government commitment (defined as the proportion of government expenditure relative to total expenditure) to health and immunisation financing in mitigating the disruptions to routine childhood vaccination during the COVID-19 pandemic.

A quasi-experimental difference-in-differences study with country fixed effect, leveraging the COVID-19 pandemic as a natural experiment.

Low-income and middle-income countries.

A cohort of 131 low- and middle-income countries from 2010 to 2023.

Our primary outcomes included the coverage rates for the third dose of the diphtheria-tetanus-pertussis containing vaccine (DTP3) and the first dose of the measles containing vaccine (MCV1).

Both high government commitment countries (ie, above the upper 20th percentile) and low government commitment countries (ie, below the upper 20th percentile) experienced declines in immunisation coverage over the 4 years following the COVID-19 pandemic, with DTP3 and MCV1 decreasing by 4 and 5 percentage points, respectively (p

Greater government commitment to health and immunisation financing may not be sufficient on its own to mitigate pandemic-related disruptions in routine childhood vaccination.