“An open vial of Pneumococcal Conjugate Vaccine (PCV 10) has to be discarded after six hours. It is given on the left thigh to a new born receiving Pentavalent. PCV 10 can safely be given along with other vaccines,” Dr Qamrul Hasan, Medical Officer, WHO, repeats the message to a group of medical officers.

In the next hall, another group of medical officers was laughing at the ‘exemplary behaviour’ in a role play where a vaccinator is greeting a mother and convincing her to ensure her new born completes the immunisation ‘by coming to the centre six time before she is 15 months old’.

The two groups are gathered at a local hotel in Lahore for a nationwide exercise organised by the Federal and Punjab, Expanded Programme on Immunisation (EPI) with support from WHO to introduce a new vaccine against Pneumonia in Pakistan which is to become a part of the country’s Expanded Immunisation Programme (EPI).

Pneumococcal Conjugate Vaccine (PCV 10) is a very expensive vaccine which has now been included in the routine immunisation free of cost. The first dose is to be given to babies six weeks after birth, followed with a second and third dose in the 10th and 14th weeks of life at the fixed EPI centres, explains Dr Hasan.

According to the 2006-07 Pakistan Demographic and Health Survey (PDHS) 13 per cent of the infant and under-five mortality rates of 78 and 94 per 1,000 children respectively, can be traced to pneumonia.

This is because Pakistan’s children are weak from malnutrition and cannot fight infection, and because many children do not receive life-saving vaccines that can prevent pneumonia. Prof Dr Anita Zaidi explains why pneumonia is the biggest killer of children in the country. Also, parents may not recognise that their child is suffering from severe pneumonia leading to delays in appropriate care, she adds.

The introduction of Pneumococcal vaccine is the second major milestone for Pakistan after the introduction of Pentavalent vaccine providing protection against five infections including Haemophilus influenza type B (Hib) infections. Together, these two vaccines are expected to protect against 50 per cent cases of severe pneumonia and 80 per cent of acute bacterial meningitis.

The Pakistan government has shown a lot of initiative in the introduction of these new vaccines in EPI. However, to realise the maximum potential of these vaccines, “we need to make sure that the vaccines reach our poorest children,” Dr Zaidi adds.

Interpersonal communication (IPC) therefore becomes very important for the success of the Immunisation Programme, especially when we are introducing a new vaccine like PCV10, said Dr Teresa Stuart, Unicef communications officer.

We have realised the effectiveness of health workers, such as vaccinator, lady health workers and community volunteers as frontline communicators and behaviour change agents on health issues. They can play a pivotal role in increasing immunisation by the way they communicate with the care givers, mothers, fathers or grandparents who bring their children, she adds.

However, the vaccinators have a different story. “Not to talk about the inflation and the cost of petrol these days, we are faced with multiple other problems such as the power break downs and non-functional cold chain equipment,” Tahir Shakoor, a vaccinator from Gujranwala shares his grief.

”Vaccinators need support. Inadequate resources for supervision and monitoring are a major concern for the programme. The new vaccine required the vaccinators to be trained before its introduction. This provided us an opportunity to refresh them on immunisation basics,” Qadir Abbasi, Director Monitoring, EPI, Islamabad, explains the reasons behind the extensive exercise.

Pakistan is currently among the eight countries that account for almost two-thirds of the world’s unimmunised children, according to the Global Alliance for Vaccines and Immunisation (GAVI), a public-private global health partnership providing the vaccine.

According to Dr Zaidi, to realise the full benefit of these vaccines it is vital to improve routine immunisation. We have to educate communities about the value of vaccines and we have to invest in improving vaccine delivery infrastructure at the union council and district levels. “Punjab has shown how it can be done. The other provinces need to put in much more effort.”

Moreover, health and health systems in Pakistan are very under-funded. Much more investment has to be made to strengthen the preventive health services for our population at the district and provincial levels. If we don’t do this, polio eradication objective will also be very hard to meet, she adds.

Pakistan has some of the highest rates of death among children in the world. One child in every 11 (87 per 1,000 live births) born in Pakistan dies before turning five years. Although the rates of child death have been falling steadily over the years, progress has been slow and Pakistan may miss meeting its Millennium Development Goal (MDG) target of reducing under-five deaths to 52/1000 live births, says a report by Research and Development Solutions (RDS).

“We are one of the three countries where polio transmission remains endemic. Around a third of these child deaths are due to vaccine preventable diseases. Since communicable diseases contribute so much to morbidity rates, prevention, particularly immunisation, is critical,” says Dr Ayesha Khan, CEO, RDS.