• Polio national coordinator says use of expired vaccine is harmless • Health dept storekeeper who issued the stock suspended

RAWALPINDI: At least 50 children were administered an expired polio vaccine in the Dhoke Budhal village in Rawalpindi on Monday, the first day of an ongoing nationwide vaccination campaign.

Local health department teams are monitoring the affected children, none of whom have reacted adversely to the vaccine. The polio programme has also clarified that the use of the expired vaccine was limited to one basic health unit (BHU) and that while the expired vaccine loses efficacy, it is harmless and cannot cause the disease.

Rawalpindi Deputy Commissioner Saifullah Dogar has suspended the storekeeper of the Rawalpindi district health department and constituted a three-member committee to look into the issue.

Reports spread on Monday that an expired polio vaccine was administered in an area near Gujar Khan. After local residents found that the vaccine had expired, parents refused to have their children vaccinated. The vaccination campaign was immediately halted in the area in response.

As the news spread across the country, mainly through social media, people in areas where unexpired vaccines were used also began to question polio vaccination teams.

Soon after the incident came to light, the deputy commissioner and executive district officer (EDO) health visited the Dudhal BHU and began investigating what had happened.

EDO Health Dr Sohail Ahmed Chaudhry told Dawn that a vaccine that expired on Nov 30 this year was used in the Narali union council. He said that the process was stopped soon after the vaccination team discovered the vaccine was expired and informed the authorities concerned, and the expired vaccine was withheld.

“A few vials of the expired vaccine were used in the Potohar area, but vaccines with a 2020 expiration date were used in other parts of Rawalpindi district,” he said, adding that according to the vials used, between 50 and 60 children below the age of five were orally administered the expired vaccine.

The exact number of children who received the expired vaccine would only be known once the preliminary inquiry report has been received, he added.

Mr Chaudhry said the expired vaccine was used by a health team working in the field in Narali, 22 kilometres from Rawat police station. He said the polio vaccination drive began at 8am but was halted at 9:30am. It was restarted once the expired vaccine had been seized.

In a video message, Deputy Commissioner Dogar confirmed that an expired vaccine was administered in Dhoke Budhal, adding that the vaccine was recovered immediately and replaced with an unexpired one.

Both officials said Zafarul Haq, the health department storekeeper who issued the stock of expired vaccine, had been suspended. A three-member committee led by Additional Deputy Commissioner General (Finance and Planning) Maleha Jamal has been constituted to investigate the incident.

The ongoing vaccination campaign began on Monday. It is targeting 39.6 million children under five over three days, with a two-day catch-up period in core reservoirs. Vaccination teams have been provided security cover by police.

Emergency Operation Centre on Polio National Coordinator Dr Rana Safdar told Dawn that the vaccine supplied to Punjab in April 2018 had an expiration date of Nov 30, 2019.

“Although the vaccine was consumed across the province, some vials were available at a BHU near Gujar Khan,” he said, adding that since it is the norm for teams to try and use up leftover stock first “the team tried to use the leftover stock without looking into whether the vaccine had expired”.

“We halted the vaccination campaign just after getting the information and sent an unexpired vaccine to the area, due to which the campaign later resumed,” he said.

Dr Safdar also said that the expired vaccine was not harmful if administered, as it cannot cause the disease.

“Expired vaccines lose efficacy but remain harmless. So there was no need to panic. Moreover, there was no issue with the cold chain management, [it was just that] the expiration date had passed,” he said.

Refrigerators lined with ice are used to maintain temperatures between 2°C and 8°C. If the temperature rises above 8°C, the vaccine is spoiled. This is also known as disturbing the cold chain, and it changes the colour of the vaccine as well as a strip on the vials.

Dr Safdar said that Additional Deputy Commissioner Saima Younus visited the area and looked into the matter after learning of the incident.

“I spoke to the [additional deputy commissioner] and she told me everything was under control and the polio campaign had also resumed in the area. Moreover, we have not received any other complaints from across the country,” he said.

Although it is correct that an expired polio vaccine cannot cause the disease, it should not be administered at all, University of Health Sciences Vice Chancellor Dr Javed Akram said.

“Vaccines are basically proteins, and everything can have side effects,” he said, adding: “Moreover, parents are suspicious of the vaccine and so these sorts of things can increase refusals because the confidence of parents is shattered.”

It is standard operating procedure around the world not to provide facilities with more vaccines than required and to destroy them before they expire, he added.

“The polio programme should have destroyed it much earlier. The incident raises questions about the performance of the programme. Accountability is needed so such things are not repeated in the future,” Dr Akram said.

A total of 104 polio cases have been reported in Pakistan this year, compared to 12 in 2018 and eight in 2017. Provincial data shows that 75 cases were reported from Khyber Pakhtunkhwa, 16 from Sindh, seven from Balochistan and six from Punjab.

Pakistan and Afghanistan are the only two countries in the world where polio cases are being reported. Pakistan is under a polio-linked travel restriction imposed by the World Health Organisation, due to which since 2014 everyone travelling abroad has to carry a polio vaccination certificate.

Published in Dawn, December 17th, 2019