KARACHI: Although there are multiple factors responsible for low routine immunisation coverage in Pakistan — the biggest beneficiary of the Global Alliance for Vaccines and Immunisations (Gavi) funds — political interference in the appointment of district health officers and lack of accountability of relevant government officials is a major obstacle to improving vaccination coverage rates in Sindh.

This point came to light when health experts participating in a workshop at a local hotel on Wednesday were asked questions over the government’s failure in improving immunisation coverage in the province.

Supported by the International Vaccine Access Centre (IVAC) at Johns Hopkins Bloomberg School of Public Health in the US, the workshop was aimed at providing media personnel with the latest information on challenges related to low immunisation coverage in the country, with special focus on Sindh.

The data shared with journalists showed that despite Pakistan’s progress on immunisation and reduction in under-five mortality by 38 per cent from 1990 to 2012, more than 1,000 children under the age of five die every day in the country — many of them from diseases that could have been prevented by vaccines.

Every year more than one million children are missed out of a full course of the most basic vaccines. Poor coverage rates are one of the key reasons why Pakistan did not achieve the Millennium Development Goal 4 (reducing child mortality by two thirds from a 1990 baseline).

The most recent 2015 WHO data on under-five mortality shows that pneumonia (26.5pc of all under-five deaths) is the leading cause of death in Pakistan followed by diarrhoea (19.6pc), meningitis (2.8pc), measles (1.6pc), injury (11.9pc), malaria (0.1pc), AIDS (0.1pc) and others (37.3pc).

“Given the fact that the country is the biggest beneficiary of Gavi funds and has the resources (vaccines) to immunise all children, our overall vaccination coverage should be 95pc. However, it’s estimated to be 54pc with Punjab taking the lead (over 60pc) and Sindh (between 29 and 36pc),” said Dr Asad Ali, an expert on paediatric infectious diseases and associate professor at Aga Khan University while citing data of the Pakistan Demographic and Household Survey 2013-2014.

The same data showed that vaccination coverage rates had dropped in Sindh and Balochistan (16pc). It’s over 40pc in Khyber Pakhtunkhwa, he said, adding that the government officials claimed to have brought some improvement in the vaccination coverage in a recent survey.

He agreed with the point that there was a huge variation in the vaccination coverage data within the district as well as among the districts, giving example of Karachi having large slums.

A collective responsibility

He was of the opinion that bringing an improvement in the vaccination coverage was a collective responsibility and required concerted efforts. The media, he said, could play an important role in dispelling myths and misconceptions and creating public demand for vaccination.

Highlighting the gravity of the health situation in Sindh, Dr Khalid Shafi, an associate professor at the Dow University of Health Sciences and general secretary of the Pakistan Paediatrics Association said measles, a highly contagious disease that can be deadly in case of complications, had made a comeback and he was seeing its patients at his clinic in Karachi.

“Upon gathering information, we came to know that a family residing in Gulistan-i-Jauhar has recently lost a child [to] measles while three others suffered from the same disease,” he said while sharing details of a case. None of the children were ever vaccinated.

“This is happening under our nose despite the fact that vaccines are administered free-of-cost at government health facilities,” he continued.

Dr Shafi was of the opinion that the aim should be a society with healthy children and not just eradication of polio.

Citing some health statistics of Sindh, he said its infant mortality and under-five mortality rates were 82 and 104 respectively, which were very high.

“Instead of making big hospitals, we should focus on vaccinating children,” he said, adding that routine immunisation had to be increased to sustain the gains made in the fight against polio.

He admitted lapses on the part of his fellow paediatricians and said if they spared some time for parents’ counselling and briefed the parents about basic vaccines, the situation could improve.

One of the shared concerns during the discussion was the financial administrative powers the government had awarded to district health officers, whose appointments were often influenced by political concerns. The officers were provided separate funds by the health department as well as by the Sindh Expanded Programme on Immunisation for vaccination, but there was little accountability for the same, it was said.

Dr Agha Ashfaq, the project director of the EPI Sindh, spoke about government achievements and explained that the EPI coverage had been increased by 10pc in 2016. The government had improved its vaccine management and delivery system and enhanced its accountability process.

“The EPI centres are efficiently working and monitoring has been improved. The province has a vaccine logistics and information system, which exists only in Sindh,” he said, adding that lady health workers were being trained for routine immunisation coverage.

According to him, there were 19 deaths from measles last year and 51 outbreaks in the province. Total suspected cases were 2,248.

The government, he said, had allocated Rs6.2 billion for the EPI programme for five years.

Replying to a question, he said lack of data assessment and discrepancy in the data was a problem.

It was suggested that Pakistani journalists should take a cue from their Nigerian counterparts who ran a media campaign in the form of a series of articles to fight the negativity and change societal mindset towards vaccination.

The idea to create a journalists’ group for the cause of vaccination was also floated.

Zofeen T. Ebrahim and Huma Khawar, both seasoned journalists, conducted the workshop.

Published in Dawn, March 2nd, 2017