LAHORE: The federal health ministry has “turned down” the provinces’ requests to introduce Rotavirus vaccine in the country to fight diarrhea among infants due to nation-wide inadequate cold chain capacity and certain other challenges, saying it was not possible before 2017.

The Federal Expanded Programme on Immunization (EPI) Cell had received requests from Sindh, Balochistan and Khyber Pakhtunkhwa in 2013-14 to introduce the vaccine in the routine immunisation programme.

Now Punjab too has written to Ministry of National Health Services, Regulations and Coordination (NHSRC), saying it was ready to bear the provincial share of co-financing for introduction of Rotavirus vaccine in the province.

Punjab government apprised the ministry through its proposal that diarrhea was a leading cause of death among infants and the disease burden under five-year old segment was increasing enormously.

A senior official in the Federal EPI Cell told Dawn on Sunday the proposals to introduce Rotavirus were not practicable in the light of a “national assessment study” carried out in 2014, when the cell received requests from the three provinces in this regard.

He said the study had identified three major factors due to which the addition of new vaccine in the EPI index was not possible. The first and major problem was that the existing national level cold chain capacity was insufficient to bear the burden of new vaccines. Secondly, the one-third of total equipment installed at the federal, provincial, district and tehsil level to maintain the cold chain for preservation of the vaccine had completed its prescribed 10 year life span.

Thirdly, he said, the equipment and other logistic resources available at provincial and district health facilities were of various brands provided by more than one companies and the officials and other staff deputed there were not fully trained to operate them.

The study had strongly recommended that the addition of more vaccines without enhancing the existing infrastructure would risk health of the targeted children.

The official further said the federal government had already introduced new vaccines in the EPI programme, including pentavalent vaccine (combination of different vaccines in one injection to combat five diseases) and pneumococcal vaccine.

“Now we are going to introduce Injectable Polio Vaccine (IPV) in Pakistan in July this year”, he said, adding that the GAVI had given a node in this regard.

The addition of another new vaccine (Rotavirus) without upgrading the existing capacity of cold chain management might create serious troubles, he said.

The federal EPI cell had almost finalised a draft of the PC-I proposing that the capacity of the existing system should be enhanced first at all levels to maintain required temperature and safety of the vaccines. It was also proposed in the PC-I that the introduction of Rotavirus was not possible before 2017, he said.

Minister of State for NHSRC, Saira Afzal Tarar, told this reporter that the vaccine was much expensive and the process to introduce it through out the country required at least two year.

“Though it required at least two years, the ministry could take a decision in this regard if all the provinces were ready to share expenses by agreeing to fulfill their co-financing obligations”, the minister said.

She said the ministry was already battling some challenges, particularly the country-wide shortage of vaccines as complaints regarding shortage of BCG and pneumococcal vaccines were being received.

However, she said, the ministry’s decision came at a time when the provinces pointed out that the disease burden had increased enormously.

Many senior child physicians all over the country have been seeking Rotavirus vaccine addition to the EPI index without any delay to prevent children’s deaths by diarrhea and other such disorders. They had also given statistics to highlight the seriousness of the issue.

“About 30-40 per cent of the severe diarrhea that leads to hospitalisation among less than one-year old infants is caused by Rotavirus”, a senior physician of Sir Ganga Ram Hospital, Dr Masood Sheikh, said.

Given Pakistan’s annual birth cohort of 5.5 million, it was estimated that some 140,000 infants suffered from severe Rotavirus gastroenteritis every year with many dying from dehydration, he said, quoting a recent study.

Unfortunately, Dr Masood said the Rotavirus vaccine was available in the market only in Pakistan.

The Punjab government through a letter also tried to sensitise the federal authorities about the issue, seeking immediate introduction of Rotavirus vaccine in EPI index.

“The studies have revealed that more than one third of diarrhea cases are caused by Rotavirus”, the letter reads.

It also quoted experts who proposed Rotavirus vaccine introduction could reduce the diarrhea death toll significantly in children. “The Provincial EPI Steering Committee Punjab in its last meeting has recommended for introduction of this vaccine in provincial EPI programme”, the letter says.

It said the Punjab government supported the introduction of Rotavirus virus vaccine through GAVI funding.

“It is further assured that Punjab was ready to bear the provincial share of co-financing for introduction of Rotavirus vaccine in the province,” it adds.

Published in Dawn, April 20th, 2015

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