Pakistan's immunisation success: now comes the last-mile push

Pakistan rarely gets credit for its quiet successes. One of the most important is unfolding in plain sight: routine immunisation has expanded steadily over the last decade, protecting more children even as the number of infants who need vaccines has grown.

The progress is real, measurable and sustained. Most importantly, it is saving lives.

In just one decade, Pakistan has reduced the number of zero-dose children, infants who had not received a single routine vaccine, by 65 per cent. From 2015 to 2024, this figure fell from 1.1 million to 397,000 children (WUENIC reports). Behind these numbers are hundreds of thousands of children who have now received their first vaccine dose and the protection that comes with it.

This is a key benchmark of immunisation programme success: reaching children who were previously unreached.

This is what real, system-wide progress looks like: steady, sustained and resilient. The COVID-19 pandemic - arguably the greatest disruption to global health services in a generation - only temporarily slowed the trajectory. Pakistan experienced a dip in coverage, but through strong government leadership and coordinated catch-up efforts, the programme rebounded quickly. Within three years of the pandemic's onset, the number of zero-dose children had fallen below 2019 levels.

Pakistan has now reached the hardest part of the journey.

The remaining ~400,000 zero-dose children are, by definition, the hardest to reach. Many live in informal urban settlements, remote geographies or communities shaped by poverty, mobility and exclusion. These are children who are often invisible to systems, and whose missed vaccinations may not be recorded until much later. This is where progress risks plateauing, unless there is an urgent, coordinated last-mile push.

Pakistan has moved from a problem of scale to a problem of equity.

Equity cannot be achieved by the immunisation programme alone. It requires coordinated action from provincial and district health leadership, frontline workers, local governments, development partners and community influencers - all focused on one shared goal: finding every missed child and ensuring they receive life-saving vaccines.

Reaching the last mile will require not only expanding coverage but changing how services are delivered. The Ministry of National Health Services Regulations and Coordination, together with UNICEF, its sister agencies, and the Global Polio Eradication Initiative are already working to make this shift. Efforts are underway to strengthen micro-planning, digitise records, and use polio campaign data to identify and refer missed children into routine immunisation services.

At the same time, service delivery is being adapted to meet families where they are. For many parents - especially daily wage workers, farmers and caregivers with multiple responsibilities - standard clinic hours are simply out of reach. Expanding vaccination services into evenings and weekends, extending health facility opening hours, and integrating routine immunisation with nutrition and primary healthcare services are practical, high-impact solutions.

For a mother of four like Shumaila in Islamabad, these changes make a real difference.

"It's very hard to step out during the day. There's always something keeping me busy at home. These evening hours make it so much easier for me to come to the centre without rushing or worrying," she shared after learning about the opening hours from polio vaccinators.

For Shumaila, flexibility can mean the difference between a child receiving timely protection or missing it altogether.

The next step is also about how systems think and respond. Data must be used not just for reporting, but as an operational tool to map missed settlements, track mobile populations, and ensure accountability down to the union council and facility level.

Financing and delivery choices will also shape what comes next. Pakistan's progress has been made possible through strong public investment and strategic partnerships that prioritise scale and efficiency. As policy choices evolve - whether through expanded domestic financing, strengthened delivery systems or blended models - the real test remains constant: which approach ensures that the hardest-to-reach children are consistently reached at scale?

Because the last mile is not forgiving. It demands precision, sustained effort and smart use of every available resource. It also demands shared responsibility: health systems cannot close this gap alone without predictable financing, strong local administration and sustained community trust.

Pakistan has already demonstrated that progress is possible even under pressure. The task now is not to slow down or celebrate prematurely, but to finish the job with urgency and focus.

That is why the next phase must be deliberately targeted, prioritising the districts, union councils, informal settlements and remote communities where zero-dose children are concentrated, and ensuring resources are focused where the need is greatest.

The remaining 400,000 children will not be reached by momentum alone. They will be reached by design, through targeted planning, flexible service delivery, integrated outreach and sustained leadership at every level.

When Pakistan completes this journey, it will not only mark a public health achievement. It will stand as a powerful example of what is possible when systems work, priorities are clear, and every institution commits to reaching every child - especially the hardest to reach.