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Immunisation: Agents of change

January 24, 2016


Senator Ayesha Raza Farooq
Senator Ayesha Raza Farooq

On Jan 12, Khyber Pakh­tunkhwa added another important tool to their inventory in the fight against polio and became the fourth province in the country to introduce the inactivated polio vaccine (IPV).

The vaccine has been included in the country’s routine immunisation schedule and will be administered to children at the age of 14 weeks along with the oral polio vaccine (OPV) given at birth. For Pakistan, with one of the world’s highest birth rates, this extra protection is aimed at strengthening children’s immunity against the crippling childhood ailment.

“No doubt eradication of polio is important; but so is the eradication of other childhood diseases. Unfortunately, over the last 15 years, ever since we have disregarded the routine immunisation, our immunisation coverage has worsened a great deal,” says Dr Meher Taj Roghani, deputy speaker, Khyber Pakhtunkhwa Assembly, speaking at an awareness session arranged by the assembly to draw the attention of parliamentarians and decision-makers to this challenge.

Gone are the days when women MPs complained of “not being taken seriously” by their male colleagues. Today, women parliamentarians have actually excelled in several areas of legislative functioning as compared to their male counterparts, especially in eradicating childhood diseases and changing the story of child survival by denting the high infant mortality rate in the country

A paediatrician working on immunisation for over three decades, Dr Roghani strongly feels that reduced focus on the EPI in relation to other specific campaigns accounts for the low coverage and constitutes a real challenge.

“With resources and political commitment directed towards the eradication of polio, with health workers (vaccinators, Lady Health Workers, Lady Health Visitors) focusing on polio campaigns, routine immunisation of children took a back seat. Moreover, the mothers have also started believing that by receiving the polio vaccine, routine immunisation is completed,” the paediatrician speaks from her experience.

Dr Meher Taj Roghani, deputy speaker, KP Assembly
Dr Meher Taj Roghani, deputy speaker, KP Assembly

Routine immunisation, or hifazti teekey, is a set of scheduled inoculations provided free of cost by the government from birth to 15 months that protects a child against nine vaccine-preventable diseases, including infant tuberculosis, polio, diphtheria, pertussis (whooping cough), neonatal tetanus, meningitis, Hepatitis B, pneumonia and measles.

The last Pakistan Demographic and Health Survey (PDHS) 2012-13 shows the proportion of immunised children in Pakistan has increased from 35pc in 1990-91 to 54pc in 2012.

However, there are marked variations in immunisation coverage in provinces and districts, and gender which is alarming. The 2012-13 PDHS shows that the proportion of fully immunised children in Sindh and Balochistan have dropped since 2006-07, from 37 to 29pc and 35 to 16pc, respectively.

It is startling to see that around one- fifth of infants and children in rural Balochistan did not receive any vaccination.

While Dr Roghani concluded requesting every member of the assembly to play their part in the process and re-direct focus on routine immunisation in the public arena, Shehla Reza, deputy speaker Sindh, chaired the advocacy session with the members of the Women Caucus of the Sindh Assembly to support immunisation activities within their mandates and in their constituencies.

In April 2015, Senator Ayesha Raza Farooq, prime minister’s focal person on polio, took an unprecedented step in Pakistan’s effort to eradicate vaccine preventable diseases by putting forward Mandatory Vaccination and Protection of Health Workers Bill 2015 in the Senate to mandate immunisation in the Islamabad Capital Territory (ICT).

“A disease knows no boundary. It is not limited to a district, union council, or a province. We need to start educating the constituents that it’s their responsibility to vaccinate and give a healthy life to their children. It will only prove beneficial if the bill is implemented across Pakistan,” Senator Farooq spoke to a group of parliamentarians and stake holders at the public hearing on the bill in Islamabad.

Routine immunisation, or hifazti teekey, is a set of scheduled inoculations provided free of cost by the government from birth to 15 months that protects a child against nine vaccine-preventable diseases.

“However, after the 18th Amendment, the bill’s application is only limited to the ICT, unless Article 144 of the Constitution is used. It states that if a resolution is passed by two provincial legislatures or assemblies, to the extent that the bill can be legislated by the federal government, then the bill shall be implemented nationwide,” she added commenting on the need for a uniform law across the country.

Women waiting in line to get their children vaccinated
Women waiting in line to get their children vaccinated

”Infant mortality will not be an alarming concern if 100pc of your child population is targeted to remain healthy and receive proper healthcare Our rankings in terms of children’s and maternal healthcare are not anywhere near satisfactory,” says Dr Zulfiqar Bhutta, founding director of the Centre of Excellence in Women and Child Health at the Aga Khan University, Karachi and co-director of the SickKids Centre for Global Child Health, putting the blame squarely on the abysmally low coverage of routine immunisation against childhood diseases.

A senior scientist at the Hospital for Sick Children’s Research Institute, Dr Bhutta believes that, for vaccines to prove effective, it is extremely important that they are provided to as many children as possible. Even if one child remains unvaccinated, he or she is vulnerable to risk.

“The system of vaccination or health certificates opens doors of opportunities for children,” he comments on the immunisation bill which says, avoiding routine immunisation will become a legal offence.

“In Pakistan, history shows that wherever health vaccines have been provided to children, the result has been favourable and shown nutritious growth in the child population.

A child receiving polio vaccine at the Rawalpindi HQ Hospital
A child receiving polio vaccine at the Rawalpindi HQ Hospital

”However, these practices need to be implemented in such a manner that the underprivileged do not feel discriminated against. The supply side needs to be taken care of. Going to an immunisation centre and not receiving a card or not finding a vaccinator to facilitate the process is discouraging and disappointing. So these practices need to be handled simultaneously. In short, if you are implementing such a system, measures need to be taken to give such people a sense of assurance and belonging, rather than to exploit them,” adds Dr Bhutta.

“Advocacy sessions in the country have generated an active debate and allowed the parliamentarians to participate in and learn, most of them for the very first time, about the extent of Pakistan’s performance on immunisation, its indicators and the contributing factors towards these results, which are not very encouraging,” says Shehryar Afridi, member of the National Assembly and an active parliamentarian on this front.

The sessions were also able to demonstrate how coverage and equity could be increased at the provincial level and revealed what role parliamentarians can play to catalyse immunisation seeking behaviours, added Afridi who has participated in a series of advocacy sessions and open-forums organised for parliamentarians in different provinces.

Published in Dawn, Sunday Magazine, January 24th, 2016