LAHORE: Two provinces have expressed their inability to procure vaccines due to a lack of expertise and logistics, asking the federal government to initiate this process under a uniformed and standardised policy to avoid any future crisis.

Under the 18th Amendment, the provinces were supposed to procure vaccines by themselves.

This is the second time the federal government has started receiving requests from Punjab and Balochistan about their inability to procure vaccines against nine preventable diseases due to a lack of experience and expertise, triggering a controversy as to who actually is responsible for procurement of vaccines under law.

Provinces remind govt of their limitations

Both the federal and provincial governments kept shifting responsibilities to each other for the procurement of vaccines since health was devolved after the 18th Amendment.

The international donor organisations/agencies and health partners had on some occasions expressed their serious concerns when both the federal and provincial governments showed their reluctance to attend them for the procurement of the vaccines.

Earlier, the four provinces had unanimously submitted a similar nature proposal in 2013 in the wake of countrywide measles outbreak in which some 413 children had died. At that time the provinces had declared that the devolution of EPI functions and specially procurement of vaccines was one of the key factors responsible for low coverage, which resulted in outbreak of the measles in 2012.

Also read: Punjab 35pc deficient in vaccines’ cold storage capacity

The federal government had promised to procure vaccines at central level till June 2015, categorically declaring that after that period the provinces would have to take this responsibility.

Recently, Punjab and Balochistan again wrote to the Ministry of National Health Services Regulations and Coordination that the procurement of vaccine and logistics was more feasible at the federal level due to certain issues, according to documents available with Dawn.

They cited many factors in the support of centralised procurement process and some of them included availability of bulk quantities to meet the entire country’s need and expertise at the Federal EPI Cell.

“As per decision of the Council of Common Interests (CCI) taken on April 28, 2011, the Federal EPI Cell was allowed to procure vaccines for the provinces till June 2015 and the provincial allocations were capped,” according to the Punjab government’s official correspondence with the federal ministry.

It said the Federal EPI Cell possessed the requisite experience and capacity for procurement of vaccines for the country.

Quoting Technical Advisory Group’s (TAG) decision, the Punjab government said the TAG had in its meeting held last year (2014) also advised that in order to avail the benefit of economy of scales, it was better to procure vaccine at federal level.

“The matter was discussed in the Provincial EPI Steering and Vaccine Management Committees on Jan 3, 2015 and it was decided that the Federal Ministry of National Health Services Coordination and Regulations would be approached for permission to allow Federal EPI Cell for procuring vaccines for Punjab,” the document said.

It said the Punjab government agreed to provide additional funds required for vaccine from provincial budget as these funds had been capped in 2011 allocations at the federal level. “You are therefore requested to allow Federal EPI Cell procurement of routine EPI vaccines for Punjab,” the provincial government asked the ministry.

National EPI Manager Dr Rana Safdar told Dawn that the federal government received last week requests from Punjab and Balochistan to centralise the vaccines procurement. He said the health sectors of many developed states like the USA and the UK had adopted centralised procurement system.

Even the Gulf states had the same scheme. So the federal government was also going to follow the same pattern in future in order to bring permanent solution to this issue, he said.

He said that according to the laid down rules, the federal government could initiate centralised procurement of the vaccines provided that the other two provinces also submitted their requests. He said the Ministry had rejected the application of the Balochistan government for not submitting it through proper channel (health department). It had asked Balochistan to follow the same procedure which was adopted by the Punjab government before submitting request to the federal ministry.

“Now we are awaiting similar requests from the two other provinces, KP and Sindh, in order to take final decision,” Safdar said.

He said the Federal EPI Cell would ensure from July 2015 provision of vaccines against all nine diseases.

Sharing format of the funding, he said the Federal EPI Cell would arrange two costly vaccines - Pentavalent and pneumococcal - through GAVI and Unicef to distribute them among provinces. Pentavalent is group of individual vaccines to actively protect infants from five potentially deadly diseases: Haemophilus Influenza type B, whooping cough, tetanus, hepatitis B and diphtheria.

He said GAVI would bear 90pc of the expenses on the total cost (approximately amounting to Rs10 billion annually) on the procurement of these two types of vaccines while the provinces would arrange funds for the rest 10pc cost.

The provinces, Safdar said, would be responsible for total funding on the procurement of four other conventional/traditional vaccines -- Oral Polio, BCG, Measles and Tetanus.

Published in Dawn, February 6th, 2015

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