Covid-19 has placed a tremendous burden on our health system and as the world rushes to develop a vaccine, we must continue to protect our people from vaccine-preventable diseases.
As a practicing paediatrician, I can already see a rising trend in preventable diseases due to the disruption to vaccinations during the lockdown. Despite the longstanding presence of a measles vaccine in our routine immunisation programme, there has been a recent increase in the number of measles cases in Sindh and even child deaths due to complications.
This is extremely concerning as measles has a transmission rate of at least six times higher than the coronavirus. Moreover, complications from measles harm one’s immunity and can leave a child more likely to contract pneumonia and diarrhoea, the two leading causes of child death in Pakistan.
The 2019 Ebola outbreak in the Democratic Republic of Congo provided a harsh reminder about the need to prevent measles. While the country was right to focus on fighting Ebola, a lack of attention to immunisation resulted in 6,000 preventable deaths from measles, according to the World Health Organization (WHO) and furthered strained a health system already battling an epidemic. It is important to note that measles isn’t just a problem for the developing world. Last year, the US reported over 1,000 cases of measles — a 25-year high — and the UK has also lost its measles-free status.
Besides measles, Pakistan has also experienced a spike in polio cases. We currently stand at 39 cases and are likely to exceed the 2019 figure of 146 cases: a development that will result in Pakistan continuing to be maligned in the international media and global health circles. To control polio transmission, renewed vaccination efforts through nationwide mass polio campaigns and strengthening of routine immunisation are needed.
Pakistan has the world’s third highest number of unvaccinated children at 1.4 million, according to WHO’s 2019 data and our nationwide immunisation coverage stands at a poor 72%, according to the Global Vaccine Alliance, which means that nearly one in four children are exposed to preventable diseases.
We must not lose further ground in this critical area of health. Immunisation activities can continue through basic health units, EPI centres and hospitals while observing physical distancing and by allowing only a certain number of individuals in a centre at a time. Another option is to vaccinate children while they remain in the vehicle they travelled in to minimise crowding. Adopting innovative approaches at existing health centres will ensure that mandatory childhood vaccinations remain unaffected during the pandemic.
Policymakers must start to plan catch-up campaigns for measles and polio that can be launched with appropriate precautions as soon as things return to normal. If we do not develop a plan for continuing routine immunisation services, the country will be at risk of an increase in cases of measles, pertussis, diphtheria and polio.
We also need clear messages from the government and paediatricians on the importance of continuing routine immunisation. I’ve been in touch with many parents who are confused about whether they should bring their child for vaccination or not. We should simply say: vaccinate your child on time and on schedule.
As the world observes World Immunisation Week, policymakers in the health sector face a difficult predicament. While they must ramp up the country’s ability to respond to Covid-19, they must also engage in strategic planning and coordinated action to maintain essential health service delivery such as immunisation to promote better overall health in the long-term.
Published in The Express Tribune, April 29th, 2020.
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