Pakistan: mounting challenges for immunisation

Pakistan is among the top five countries with the highest number of children under five dying. With one child dying every two minutes, Pakistan accounts for 5% of under-five deaths every year.

It’s now widely recognised that a significant proportion of these deaths can be prevented using simple, low-cost solutions such as vaccines.

Pakistan’s national coverage for routine immunisations stands at 88%, yet there is significant geographic diversity.

The disparities across society mean that children from the poorest households are much less likely to receive routine immunisations than those from wealthier ones.

This substantial gap between the richest and poorest is especially alarming considering the fact that Expanded Programme on Immunization (EPI) services are delivered free-of-charge in Pakistan.

Save the Children’s report – Immunisation for All: No child left behind – calls for equitable progress towards universal access to immunisation, integrated with other essential health services.

Progress stalled

A recent World Bank study found that EPI performance has remained stagnant over the past decade and the national programme reached only 40-60% of children age-appropriately.

In 2011, the 18^th Amendment Bill devolved social services, including health, to the federating units and the national EPI thus disintegrated into provincial programmes.

In the absence of a structured or extended handover of technical and managerial capacity to provinces, the systematic challenges on EPI performance and coverage seem to have magnified as a result – and now manifest as the recent measles outbreak in Sindh.

Save the Children is on the ground, working closely with the provincial Ministry of Health and World Health Organization (WHO) on a large measles immunisation campaign to reach 2.9 million children across eight districts in Sindh.

Longer-term support will be needed to overcome systematic challenges and strengthen local health systems in order to improve routine immunisation coverage and mitigate similar outbreaks in the future.

Reliance on imports

Vaccine production is another challenge. National-level stockouts of essential vaccines have been significantly reduced over the past decade owing to global procurements, yet the dependency on imported vaccines limits the capacity of the government to address systematic challenges on improving performance and coverage.

The Pakistan government spent over £3.5 billion on global vaccine procurement in 2011, despite the fact that the basic infrastructure and capacity to manufacture essential vaccines exists locally, in both the public and private sector.

There’s significant potential to locally produce quality vaccines, which would improve cost-effectiveness and focus the limited resources on improving EPI performance.

Health workers on the frontline

Ongoing conflict along the border with Afghanistan and prevailing insecurity in the country has further reduced access to the hardest-to-reach children.

The events of 2011 and ensuing backlash against immunisation have only made matters worse for children in Pakistan, changing attitudes and reversing progress that had been made over decades.

The trust deficit has been on the rise, resulting in unfortunate attacks on immunisation staff and health workers across Pakistan, ramifications of which are probably now being seen in northern Nigeria.

Pakistan remains one of the last frontiers in the fight against polio, and unless security-related barriers are overcome, global polio eradication won’t be achieved.

With health workers on the receiving end of the backlash, there is a need for protection and acceptance. This can only be achieved through consolidated efforts from community elders, religious leaders, civil society, academia, local authorities and representatives.

Civil society organisations have a crucial role to play in building both trust in the communities and capacity of health systems to ensure that every child in Pakistan can access immunisations so they can survive and thrive beyond five and meet their full potential for their community and country.