NEWS of a study claiming a correlation between the BCG vaccine and Covid-19 recently went viral on social media. It was suggested that countries that do not have a BCG vaccination policy saw a far greater incidence of and mortality from Covid-19 compared to those that do. However, the World Health Organisation, while once again recommending the neonatal vaccine in countries with a high rate of tuberculosis, has not advised its use as a preventive against Covid-19; it says that more evidence is needed.

But the study mentioned above also indicates that BCG boosts immunity against ailments other than tuberculosis. In Pakistan, as in many other countries, the BCG vaccine is administered to children shortly after birth to protect them from childhood tuberculosis. In the next 15 months, the children are given shots to protect them from nine other vaccine-preventable illnesses including polio, diphtheria, pertussis, tetanus, hepatitis B, haemophilus influenza type B, diarrhoea, pneumonia and measles.

Domestic funding for immunisation programmes is critical.

Pakistan is the fifth most populous country in the world. Through the Expanded Programme on Immunisation (EPI), the government ensures the provision and availability of vaccines against these diseases free of cost. Sadly, it is able to protect just 66 per cent of the country’s newborns, according to the Pakistan Demographic Health Survey (PDHS) 2017-18, with more than one-third of Pakistani children not fully vaccinated by their first birthday.

While Sindh has been at the forefront of the response to the Covid-19 pandemic, more than half its children are not fully immunised. The PDHS 2017-18 shows some improvement in immunisation coverage, but it continues to fall below the required levels. Karachi, Pakistan’s most populous city, suffers from frequent outbreaks of measles. In addition, it has not fared too well on the polio front. The Pakistan Polio Eradication Programme states that eight out of 40 extremely high-risk union councils are in Karachi alone. According to one survey, the city has almost 1,000 slums and underserved areas. The increasing number of un-immunised or ‘missed’ children in urban slums poses a big challenge.

Across the country, immunisation activities have been disrupted due to Covid-19. The rise in the number of children missing out on routine immunisation will have a huge impact on the coming generations. The provinces need to make sure that once the crisis is over, immunisations both essential as well as campaign-specific continue at full pace.

However, Pakistan’s immunisation programme is heavily dependent on foreign funding. Globally, donors have already started shifting and reallocating resources towards the new health emergency. Therefore, it is critical to ensure that domestic financing for the vaccines increases.

The EPI at both the federal and provincial levels is financed through the development budget, because it began as a public-sector development programme. This, however, does not ensure timeliness in the release and availability of funds according to demand. Immunisation is not a one-time activity but a continuous process. Countrywide, every year, the EPI immunises 7.8 million children under 12 months and the same number of pregnant women with the TT vaccine. But the budget for the immunisation programme has always been treated as a project-related expenditure, and as part of the development budget allocated for each fiscal year.

In order to ensure uninterrupted procurement and supply of vaccines including delivery and services, it is vital that the Sindh government moves its vaccine budget from the development to the recurrent budget. Without sustainable and continuous financing, children will remain at risk. The EPI cannot continue to run in project mode. Child immunisation must be a permanent part of the regular health system, or else the country may face major disruptions in getting its children the vaccines they need.

Pakistan is already facing a difficult time with the resurgence of polio. With a not-so-strong routine immunisation system, polio eradication will continue to be a major challenge in the years ahead. Vaccines need to get to all children, wherever they are. An interruption or break in the immunisation and supply of vaccines may lead to the re-emergence of many diseases. It is hoped the routine immunisation programme remains unaffected and continues to be robust and accessible to those that most need inoculations.

While the BCG-Covid-19 link is not definitive and any claims to the contrary may be premature, studies on the subject still bring into focus the importance of the vaccine as part of children’s essential immunisation schedule. Parents must ensure

their children complete their essential immunisation, and all future health sector budgeting should reflect a priority for regular vaccinations.

The writer is a journalist.

Published in Dawn, April 25th, 2020