And now measles

For any immunisation drive that involves live vaccines, it is necessary to maintain what is known as a ‘cold chain’ — a network of refrigeration facilities that keeps the vaccine at optimum temperature. Perhaps unsurprisingly, the cold chain needed to deliver an effective anti-measles vaccination campaign is sorely lacking. According to a senior official of the World Health Organisation (WHO), one of the reasons behind the continuous outbreak of measles in Pakistan is the low coverage of routine immunisation coupled with a cold chain where the equipment is out of order or not properly maintained. The system is poorly managed he states, and delivering dead vaccine protects nobody. To a degree, measles has been taking a back seat in recent years as resources are concentrated on eliminating polio, but it is a false economy and deaths from measles are mounting.

This year there are reportedly 18 dead from this preventable disease, with Sindh and Khyber-Pakhtunkhwa reporting the majority of cases — and Punjab reporting none. Nationwide, in 2013, there were 8,749 cases reported and this year another effort is being made to vaccinate as many as possible. The campaign this year is the campaign that should have happened last year but stalled for lack of resources. The largest-ever vaccination drive is already going ahead in Sindh. Measles vaccination carries less cultural ‘luggage’ than polio and nobody is suggesting that vaccinating against it is somehow counter to religious sentiment. The problem with the failure to eradicate measles is systemic rather than cultural. The weaknesses in the cold chain are the result of failure to upkeep a vital part of the public health programme nationally. It is not just measles and polio vaccines that sit in the refrigerators; it is a range of other temperature-sensitive medications that are part of a spectrum of treatments that have to work in concert if they are to deliver immunity to a range of ailments. Holistic thinking across provincial and bureaucratic boundaries is often as deficient as the cold chain. We wish the new campaign every success.

Published in The Express Tribune, May 22^nd, 2014.

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