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Cradle to early grave

Inaccessibility of vaccination centres among parents has caused measles and diphtheria cases to spike

By Muhammad Ilyas/Tufail Ahmed/Wisal Yousafzai |
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PUBLISHED May 19, 2024

Although the outbreak of Covid-19 was a catastrophic blow for countries the world over, its prevention and control was especially taxing in Pakistan. Apart from the nation’s limited healthcare resources, the non-cooperation of the public cooked up all sorts of conspiracy theories on the potential side effects of the coronavirus vaccine, and impeded the national vaccination drive.

While the imposition of vocational and travel restrictions on unvaccinated citizens was partly successful in curbing the public’s propaganda against the Covid-19 vaccine, similar scepticism towards other vaccination campaigns, like those against measles and diphtheria, continues to imperil the lives of millions of children across the nation.

According to the World Health Organisation (WHO), measles is a highly contagious disease that spreads through the air, causing patients to develop respiratory issues and skin rashes. Similarly, diphtheria is an air-borne disease caused by a bacterium that targets the respiratory organs leading to a fever, sore throat and swelling of the neck glands. Both measles and diphtheria are most fatal in children below the age of five, thereby mandating routine immunisation against the diseases as a paramount stepping-stone towards safeguarding community health.

Despite the passage of four decades since the initiation of the UNICEF-funded Expanded Program of Immunisation (EPI) in 1978, routine childhood immunisation remains a challenge in Pakistan. A lack of awareness among parents on the importance of childhood vaccination before the age of five coupled with limited and inconsistent immunisation programs in the country have allowed fatal contagious diseases like measles, diphtheria, tuberculosis, typhoid, chickenpox and even smallpox (which has been eradicated worldwide) to take countless innocent infants to the grave.

One such hapless child was Saima’s son who lost his life to diphtheria in infancy. Based in Lahore, Saima lived in a joint family system. Her in-laws’ strong disapproval of immunisation programs discouraged her from getting her child vaccinated on time. “Unfortunately, when I finally came to realise the importance of childhood vaccinations, it was too late. My baby’s life could not be saved,” grieved Saima, who now urges other parents to ensure that their little ones receive their due vaccinations at the right age.

Jameela, from Karachi, also did not vaccinate her elder two children against childhood diseases due to which they suffered from episodes of measles and diphtheria. “With the birth of our third child, we finally started taking immunisation seriously,” she said. Jameela felt that introducing vaccination services at the Union Council level could improve accessibility of immunisation programs.

In South Waziristan, Bakhtwar Gul could not access consistent immunisation programs in Khyber-Pakhtunkhwa (K-P) for his children. “In our area, no vaccinators are normally available for administering the measles vaccine to our children,” shared Gul. This year alone, 14 children have died due to measles in the province.

Dr Aftab Hussain, a Karachi-based medical expert, argues that the inaccessibility of vaccination centres compounded with a lack of awareness among parents is the root cause behind the failure of immunisation campaigns in Pakistan. “Vaccinations are administered at selected centres only. As a result, many parents are unable to reach them due to high transport fares. Even when some parents manage to reach the centres, a shortage of vaccines prevents their children from receiving the required dosage,” said Dr Hussain, who urged vaccination teams to start door-to-door immunisation campaigns to curtail the diseases.

As per data obtained by The Express Tribune from the Pakistan Paediatric Association, cases of measles and diphtheria have been on the rise, with 2,747 children infected with measles in 2020 and 15,978 children identified in 2023. Conversely, 966 diphtheria cases were reported in the country in 2020, out of which the majority originated in K-P. The trend continues in K-P this year too, with over 300 cases of diphtheria reported in the province alone in 2024 so far, out of which 200 children have lost their lives, which is almost three times the number of children who died due to diphtheria across the country in 2020.

Dr Muhammad Arif Khan, director of the EPI in K-P, revealed that a shortage of beds in hospitals in the province was another major factor in the spread of diseases since many sick children are made to share beds. “In addition to this, protests organised by the EPI staff have halted the vaccination campaign. Furthermore, the Covid-19 pandemic had also thwarted the immunisation drive against several childhood diseases since the EPI vaccinators were busy administering coronavirus vaccines,” affirmed Dr Khan.

Miles away, in Punjab, the flood emergency of 2022 that displaced millions of people, has also amplified the spread of childhood diseases.

“An outbreak of measles and diphtheria has been reported in the border areas of Punjab. People who migrate from villages spread the diseases quickly since the vaccination rate in rural areas is low. Furthermore, malnutrition among children and a lack of household hygiene has further instigated the spread of the diseases,” highlighted Dr Mukhtar, provincial director of the EPI in Punjab.

General Secretary of the Pakistan Paediatric Association Dr Muhammad Khalid Shafi said three doses of the DPT vaccine given between the ages of two to five are required to protect a child against diphtheria. “Diphtheria did not exist in Pakistan eight years ago. An ineffective immunisation campaign has culminated in the current epidemic. For measles too, two-dosage vaccines administered immediately after birth are crucial for protecting a child against the illness. The government offers free immunisation till the age of two only. If this age limit can be increased to five years, more children can be vaccinated,” he opined.

Asif Iqbal, secretary of a local mosque in Karachi, believed that announcements from mosques on the importance of vaccinations could also help spread awareness on immunisation among parents. “Furthermore, a campaign should be started to inoculate children in schools and madrasas,” he said. “Until or unless 90 per cent of children are covered by the immunisation program, childhood diseases will continue to rise in Pakistan,” said Professor Jamal Raza, executive director of the Sindh Institute of Child Health.

“Unfortunately, the vaccination rate in Pakistan is less than 60 per cent,” said Dr Muhammad Hussain, President of the Paediatric Association of Pakistan K-P Chapter. Meanwhile Dr Zarfishan, head of the Public Institute of Health, maintained that immediate action had been taken in the districts of Punjab where cases of measles and diphtheria were reported and timely treatment was provided to the patients.

“In Sindh, 3,108,139 children were vaccinated against rubella and measles in 2023. After new cases showed up in 2024, the EPI launched its rubella and measles campaign on an emergency basis in 20 districts of Sindh and 118,935 children aged between six months and five years have been vaccinated,” said Dr Naeem, project director of the Expanded Program of Immunisation (EPI).