KARACHI, Nov 2: Participants in an advocacy seminar on Friday urged the government to devise an independent monitoring system with non-governmental organisations and civil society on board to ensure proper use of the expensive pneumococcal conjugate vaccine (PCV), which will become part of the Sindh government’s routine immunization programme for infants by mid November.

The seminar was organised by an NGO, Health Education and Literacy Programme (Help), in collaboration with Global Alliance for Vaccine and Immunisation (Gavi), to mark the recent introduction of PCV in the national immunisation programme and advocate its free administration to children below one year to prevent them from developing severe pneumococcal diseases like meningitis, pneumonia and bacteraemia.

During group discussion and question-answer session, the audience talked about the lack of using routine vaccines already part of the national and provincial immunisation programmes and the lax monitoring and audit systems. They stressed the need for making government health officers and workers more vigilant and responsible.

The participants said that there was a fair chance that the expensive vaccine, which costs around Rs4,600 per dose in the market, would go waste unless the government arranged for stringent checks to prevent its pilferage, recycling and illegal sale to private health facilities or vaccinators.

Earlier in the seminar, a WHO official in Sindh, Dr Soomar Khuso, also called for improving the maintenance of vaccine cold chains at the district level. “Our children are vaccinated but they still catch preventable diseases,” he said, adding that immunisation would be ineffective if the supply chains were not maintained properly.

The special secretary of the provincial health department, Dr Suresh Kumar, said that after the launch of PCV in Punjab, Sindh too was ready to launch the vaccine in its routine immunisation programme from the second week of November. He thanked Gavi, Unicef, WHO and other partners on behalf of the health department for working together to help lower the mortality rate in children, one of the targets set by millenium development goals.

Talking about the general apprehension about misuse of the vaccine and the possibility of increasing demand by parents, Dr Kumar said that Unicef can address such issues under its social mobilisation programmes.

The national programme manager of Pakistan government’s expanded programme for immunisation (EPI), Dr Zahid Larik, said that administration of the vaccine to around 5.5 million children born every year in the country already began last month. He said that after imparting some necessary training to field workers in three districts, Larkana, Sukkur and Dadu, the vaccine would be introduced simultaneously in all districts across Sindh in about a week. He said that eight new cold rooms have also been set up across the province with the support of Gavi to store the vaccines properly. Dr Larik said that Gavi has agreed to contribute up to $680 million for the vaccine till 2015, with the Pakistani government bearing five per cent of the total cost of the programme, and after this period the programme would be handed over to the Pakistani government. He said that the Gavi-sponsored PCVs were two-dosed intramuscular vaccines, as compared to single doses available in the market. This way, he explained, the chances of wastage would be minimised. The name of the vaccine provided by Gavi is also different, he added.

Dr Larik said that the government was also finalising measures to have an independent evaluation of the coverage of routine immunisation. “This would help us know the exact number of target population and the overall coverage rate as well,” he said.

“The vaccines would be provided to the provinces on a quarterly basis so that they are in supply throughout the year.”

After pneumonia, said Dr Larik, diarrhoea was the second most-prevalent cause of death in children. “It is also a major source of concern for the government. Around 23 per cent children die because of preventable diseases,” he said, adding that the government was making arrangements for introducing the rotavirus vaccine next year to prevent diarrhoea in children.

The chairman of Help, Prof Dr D.S. Akram, said that community-based organisations working under evidence-based policies were in a position to play an important role in the promotion and monitoring of routine immunisation and primary health care activities in the province.

Dr Fehmina Arif of Dow University of Health Sciences said that pneumonia killed around 1.8 million children below five years every year across the world and 98 per cent deaths took place in developing countries. Pakistan was among the top ten countries with highest mortality rates related to pneumonia, she added.

Dr Arif said that malnutrition, low birth weight, non-exclusive breastfeeding, lack of measles immunisation, indoor pollution and crowded households were among the leading risk factors for pneumonia. It can be prevented by timely immunisation, adequate nutrition and by addressing environmental factors, she said.

Dr Asif Aslam of Unicef reminded the audience about the MDG targets and observed that Pakistan would not be able to meet them by 2015. However, he said, the process of identifying and addressing the hurdles in meeting those targets should not be stopped.

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