AS the Covid-19 outbreak continues to impact the lives of people across the globe, Pak­istan is no exception. The country has wit­nessed significant increase in confirmed cases. In addition to the risk imposed by the virus to human lives, it has also adversely imp­acted essential public health services, especially immunisation of children and women against vaccine-preventable diseases.

Children and young people are severely affected by the pandemic. An increasing number have missed routine immunisation due to interruption of services. In April 2020, two-thirds of children missed out on routine immunisation as compared to January, increasing the risk of disease outbreak. Immunisation needs to resume as early as it can safely be done with protection in fixed, extended outreach and mobile services prioritising the most vulnerable children and those who were missed.

Almost 40 million children missed out on their polio drops as the nationwide polio campaign in April, had to be postponed. While polio surveillance, communication and community engagement structures have immensely contributed to the current Covid-19 response, the immunity gap is widening.

As per the Ministry of National Health Services, Regulations and Coordination (MNHSRC), disruption in health services due to Covid-19 has caused full immunisation coverage in children to decline from 240,000 in January to 190,000 in April 2020. Antenatal care services for pregnant women declined from 537,000 in January to 345,000 in April 2020.

Covid-19 has interrupted regular immunisations.

From January to June 2020, there has be­en a 25 per cent decline in Penta 3 coverage and 6pc decline in measles coverage containing vaccine (MCV1) immunisation. Bet­ween March and April 2020, around 700,000 children missed Penta 3 vaccination and similarly 500,000 children missed MCV1 immunisation.

Response to the pandemic has stretched the health system in the country. Outreach services are affected more than in fixed centres. Restrictions on movement and concerns around Covid-19 transmission have prevented caregivers from accessing immunisation services. Lockdowns of certain areas due to high prevalence of infection, is exacerbating inequities in immunisation services. An overburdened system could lead to a total collapse resulting in increased outbreaks, not only from Covid-19, but also from other diseases like measles and polio.

To avoid this, sustained access to essential health services is imperative. A catch-up campaign to reach children missed due to suspension of immunisation during the lockdown period is being planned. Currently, the Provincial Expanded Programme for Immunisation has started outreach services on immunisation with support from partners.

The government’s development partners including Unicef are supporting continuity of immunisation services for children and wom­en. All provinces have shifted the imm­uni­sation budget from development to recurrent ensuring sustainability of funding for immunisation programmes. This is a commendable step for sustained public financing for immunisation which will reduce reliance on donor funding. It would also contribute to­w­ards achieving the target for essential immunisation ultimately reducing morbidity and mortality from vaccine-preventable diseases.

Increased investments in health and nutrition besides education, child protection and water and sanitation are needed more than ever before to help reduce the impact of Covid-19. The government’s commitment and leadership are essential to put national programmes for public health back on track.

Capacity building of health workers, provision of PPE, closer cooperation between the Expanded Programme for Immunisation and the Polio Eradication Initiative, better micro planning, stronger partnerships with CSOs and use of latest technology in data collection could go a long way in mitigating the effects of Covid-19 and full resumption of routine immunisation.

Unicef has supported the MNHSRC to procure PPE worth $1.5 million with funding from World Bank, and $500,000 from the Asian Development Bank. It is facilitating the procurement of additional PPE, testing kits and medicines worth $7m with support from other partners. Gavi, the Vaccine Alliance has approved procurement of PPE worth $5.5m. Surgical gloves, masks, and caps worth $854,121.69 are being procured by Unicef from its own resources.

The MNHSRC and Unicef are jointly leading the Risk Communication and Community Engagement Task Force for raising public awareness around the transmission of Covid-19 and its prevention.

Since vaccines are one of the most powerful tools in public health, their safe delivery during the pandemic must be ensured and essential life-saving programmes must continue to avoid a situation where suffering and death caused by children missing out on routine immunisation exceeds that caused by Covid-19.

The writer is Unicef representative in Pakistan.

Published in Dawn, July 27th, 2020