Measles and the public health crisis

There is a public health crisis in Pakistan that is decades old and has strong resemblances to the national education crisis — underfunding, poor management and ‘cultural’ resistances. There are primary healthcare services in every province that include a community component, with vaccination and health awareness part of that. Punjab is the best-served province in terms of primary healthcare but still falls far below international standards in terms of things like herd-immunity to childhood illnesses that are entirely preventable.

There is an alarmingly high incidence of measles cases such that the numbers are suggestive of a province wide outbreak. There has been a sharp increase over the last four weeks in Lahore, Rawalpindi and Gujranwala and 73 union councils have reported a spike in numbers, with 31 deaths in the last three months. The Expanded Programme on Immunisation (EPI) has responded, and considers the reporting of five or more cases in any union council to be an ‘outbreak’.

This is the time of year when measles is at its most virulent. Unvaccinated children especially those under five years are extremely vulnerable and as noted above fatalities are not uncommon. The geographic spread of cases being reported — they are widely separated — suggests at the very least that the EPI coverage is falling short, either through lack of resources or lack of commitment within primary healthcare services. There is none of the cultural taboo surrounding polio vaccination, and there are no anti-vaccination campaigns that would impede mass vaccination. In theory at least there should be no widespread measles outbreak in what is — in theory — the best resourced of all the provinces in terms of primary healthcare. That there is such an outbreak is cause for concern, and any incoming government, federal or provincial, needs to pay closer attention to the health of the nation than is currently the case.

 

Published in The Express Tribune, May 30^th, 2018.

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