Lacklustre immunisation efforts

The targeting of health workers trying to provide polio vaccination to children in Karachi and Khyber-Pakhtunkhwa (K-P) got much attention around the world. It disrupted UN vaccination campaigns and placed immense pressure on the government to provide security to public health workers. While the complete eradication of a debilitating disease like polio remains vital, the fact remains that multitudes of children across Pakistan die or suffer terribly due to a range of other debilitating diseases, which can be prevented through an efficiently administered immunisation programme.

Successful immunisation drives have helped eradicate small pox, lowered the global incidence of polio by 99 per cent and achieved dramatic reductions in other illnesses, which children are particularly susceptible to. The Expanded Programe for Immunisation (EPI) is a worldwide effort carried out with support of the World Health Organisation, UNICEF and other international donor agencies. In Pakistan, the EPI has also been trying to immunise children aged up to 23 months against eight vaccine preventable diseases.

During the last decade, however, EPI’s performance in Pakistan has been stagnant, with only between 40 to 60 per cent of children receiving vaccines at the age-appropriate time, when their use proves most effective. While the EPI was being implemented under the federal health ministry until mid-2011, the Eighteenth Amendment devolved health, including the EPI, to the provinces. Unfortunately, this has not helped improve the situation.

Dozens of children reportedly acquired measles this past month in Hyderabad and Mirpurkhas. While the provincial health department carried out a vaccination drive in eight districts of upper Sindh, it was not extended to the central and southern districts. Noticing the situation in Sindh, the health department in Punjab claims that it has deputed staff for vaccination at district hospitals, basic health units and rural health centres. The Sindh government should take note of these measures, as should the provincial health departments in K-P and Balochistan.

To encourage parents to get their children vaccinated, the city government in Lahore has gone a step further by directing relevant officials to deny requests for birth certificates and admissions to schools if parents do not submit a vaccination card. Child rights organisations have, however, pointed out that a policy of mandatory vaccination cards as a requirement for admission to schools will just become another obstacle in the way of poor children to receive education. Instead, it would be better for the government to focus on reviewing weaknesses in its immunisation programme and make its coverage more effective.

Immunisation workers lack motivation and their recruitment is frequently prone to political interference. Merit-based recruitments and performance-based incentives could help address such problems. Procurement of vaccines and other required items, and maintenance of vital equipment is also poorly managed.

The low priority given to public health issues in general also remains problematic. Hoping that our policymakers will shift their spending priorities may be asking for too much. One, however, does hope that they will realise that focusing on immunisation drives makes good sense, since such an effort offers an economical option for tackling vaccine-preventable diseases.

Published in The Express Tribune, February 4^th, 2013.