KARACHI, March 19: Health indicators and some measles cases show, rather strongly, that the nationwide Expanded Programme on Immunization (EPI) is likely to fail to bring about the desired results.

According to three paediatric specialists, one of whom talked to Dawn on condition of anonymity, many of the children who were struck recently by measles had been vaccinated under the much publicized EPI.

Dr S M Afaq of the National Institute of Child Health told Dawn on Wednesday that up to 14 per cent of the children in Sindh recently hit by measles, had been immunized. Seventy-four per cent of the children had not been vaccinated against the disease at all, while the immunization status of some 12 per cent of the children remained unknown.

The above data showed, firstly, that a large number of children were not covered by the immunization programme. “The other side of the coin is that many children who had been vaccinated against it, had developed the ailment.

“This shows that either the strain we face is a new one or our immunization programme is utterly ineffective,” he said. “I don’t think that there can be a third explanation for this.”

Speaking at a press conference, Dr Anita Zaidi of the Aga Khan University Hospital expressed similar views. She said many of the measles cases handled at the city hospitals involved children who had been vaccinated against the disease for which there was no treatment.

In response to a question she said that efficacy of the vaccines that were administered was a very important issue. “This is one area which needs urgent attention,” she said.

Another doctor, on the condition of anonymity, said that the EPI was being run by well-meaning people, “However, how much say do these people have over the entire chain through which every vaccine passes before being administered, is another matter,” he said.

The child specialist pointed out that the vaccines for the said programme was imported from well-known suppliers. “So there’s no problem until that stage.

“However, what happens from the port of disembarkation to the individual EPI centres is not known. It seems, in many cases, the vaccines become ineffective after being placed in unfavourable conditions at one or another stage.

“There are several ways in which the vaccines may become ineffective. In some cases it’s the frequent power breakdowns which result in the vaccines being kept in temperatures above the allowable limits. And in other cases it’s mishandling, pure and simple,” he said.

The specialist pointed out that not very long ago the health indictors in Pakistan were better than those of both India and Bangladesh. “But today they compare poorly with indicators of the two countries mentioned.”

He said in 2002 the mortality rate among under-fives stood at 92 per 1,000 live births. “But in Bangladesh the same indicator stood at 80, which is very surprising indeed.” Dr Afaq claimed that during the last 14 years mortality rate among children of less than five years of age had bee reduced by just 18 per 1,000 live births. “this is despite the much vaunted immunnization programme,” he said.

Meanwhile, the annual report of the director-general of the Health Services acknowledges, indirectly of course, that the EPI is facing tough problems.

The latest report, under the caption of “Constraints” says there’s a lack of adequate and timely release of operating funds by the provincial and/or local health offices.

It also suggests that the old equipment and transport vehicles need to be replaced, pointing out the problems related to inadequate and irregular power supply, especially in the remote areas.

The report also mentions political interference for frequent transfers of vaccinators.