ISLAMABAD: Pakistan may be facing a serious interruption in vaccine supply as provinces are showing unwillingness to pay for vaccine imports, following the expiration of the current National Finance Commission (NFC) award next month.

According to a report of the Global Alliance for Vaccine and Immunisation (GAVI), the risk recommends that the National EPI managers and technical staff ensure effective management of the existing vaccine supplies worth millions of dollars.

Pakistan has been the largest recipient of GAVI’s support, with $842 million worth of vaccine committed up to 2019, but lags far behind in the immunisation targets set by MDGs (millennium development goals). Since 1990, Pakistan has seen a mere 26 per cent reduction in mortality rate of children under five.

GAVI reports that Pakistan’s immunisation programme continues to face serious challenges as shown by an ongoing transmission of measles, polio and other vaccine-preventable diseases. With the NFC award on provinces’ share in federal funds ending in June, GAVI sees “vaccine procurement for 2015-16 and beyond unclear”.

National Health Services Secretary Ayub Sheikh, however, told Dawn that “arrangements for vaccine procurement are being made and capacity issues in the EPI will be resolved.”

Because of perceived lack of capacity, both financial and technical, the provinces asked the federal government to continue vaccine procurement on their behalf.

GAVI has suggested that the federal and provincial governments rapidly establish a National Task Force on Nutrition, Sanitation and Immunisation, which may include representatives of the ministries of National Health Services, Finance and Planning and Development to address immunisation bottlenecks.

An official of ministry of NHS agreed with GAVI’s assessment of the situation and the solution suggested.

“Although there is a buffer stock for various vaccines ranging from three to six months, the vaccines will start disappearing from September 2015 onwards, unless necessary measures are expedited,” he said talking to Dawn on condition of anonymity.

Pakistan requires 400 million doses of vaccines annually and the procurement process takes four to six months before delivery starts, according to him.

“Our other worry is whether donors will continue assisting an incapable EPI management. If Islamabad fails to meet its co-financing obligations, GAVI will stop assisting in the procurement of Pentavalent and Pneumococcal vaccines worth almost Rs15 billion per year,” he said.

It is some consolation that GAVI has agreed to provide free of cost IPV (for 6.2 million infants annually) until 2018 with plans to introduce Routine Immunisation from July 2015.

“However, the required preparations have not been put in place as yet, which will definitely delay IPV launch in Pakistan and pose a serious blow to our polio eradication plan,” said the official.

NHS Secretary Ayub Sheikh told Dawn it has been decided that all the provinces will allocate funds and the federal government will purchase the vaccines.

“Five PC-I are being made for the purchase of vaccines at the moment, four by the provinces and fifth by the federal government for Islamabad, Fata and Azad Jammu and Kashmir territories. The World Bank has provided consultants for the task,” he said.

Acknowledging that capacity issues haunt the EPI, he said: “Posts have been advertised and soon a head and competent staff will be appointed. Moreover, the WHO has been requested to replace some technical staff.”

When asked about the IPV programme, the secretary said it had started in some areas of the country and efforts were being made to expand the activity to other areas.

Published in Dawn, May 11th, 2015

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