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Immunization in Pakistan

A recent survey conducted nationwide showed that six diseases namely, Diphtheria, Whooping Cough, Neonatal Tetanus, Poliomyelitis, Measles and Tuberculosis posed major health problems. A child should be immunized within the first year against these diseases; however, in most of the cases, several vaccinations are needed before a child is fully protected and many children are not brought for the full course. It is important that parents know why, when, where and how many times their infants should be immunized. Otherwise a child is likely to become undernourished, disabled and die.
Realizing the importance of immunization, the EPI was launched in 1979. The program aimed to reduce the morbidity and mortality rates of these diseases by 90 percent in children under-five years of age and immunize maximum number of women of child bearing age against neonatal tetanus.EPI’s achievements unfortunately are not satisfactory considering the amount of money and time spent on it. In order to better the program, the Government of Pakistan introduced an AHP (Accelerated Health Program). The AHP was framed to improve the health center system, especially the outreach segment; and control of diarrhoeal diseases and training of TBAs (Traditional Birth Attendants) were included in the program.
Measles account for nearly half of the three million preventable deaths each year in Pakistan. It is also one of the major causes of child malnutrition and vitamin A loss. Studies show that children are 10 times more likely to fall sick or die after the break out of measles.
Only one dose is needed to protect a child against measles. However, the timing of vaccination is significant; if vaccinated early the vaccine can prove to be useless because the mother’s antibodies suffice to protect the child against the disease. If vaccinated late, the child might already be exposed to measles. It is ideal to immunize the child against measles when the child is around nine months old.Polio is exterminated from most of the world, except for a few countries in the developing world. Unfortunately, Pakistan remains one of the few left where this disease continues to exist which results in paralysis, and an acute case can result in death. Polio immunization, unlike measles, requires three doses of the vaccine; and as result, many fail to complete all the three doses.
Pakistan has repeatedly been committing to the world to eradicate polio by a certain year but fails to achieve it and thus goal-post keeps moving. In the meantime, millions keep pouring into various international outfits to fight this menace and thousands are being sustained on hefty salaries to get rid of polio from the country. In this regard, an approach of NIDs (National Immunization Days) has been adopted. There are fixed vaccination centers along with thousands of EPI outreach teams and hundreds of mobile teams that are involved in achieving the targets.
Despite the drop in the number of polio cases, India has already eradicated it and Afghanistan is ahead of Pakistan and is likely to be polio free earlier. Polio eradication remains the top priority of public health program of the government, with 75,000 teams of health workers vaccinating 30 million children under five every year through a house to house strategy. According to health authorities, polio is now restricted to one third of the districts in the country. Peshawar, Khyber Agency, Bannu, Lakki, Waziristan, Quetta, Faisalabad, Jacobabad, Nasirabad, DG Khan, Rajanpur, Karachi, Thatta, Badin and Hyderabad are among the hotspots of polio transmission.
According to WHO, Pakistan can achieve the goal of polio eradication in view of drastic progressive reduction in the number of polio cases in Pakistan over the past three years. It is also maintained that there has been continuous improvement in polio surveillance and polio supplementary immunization activities. It however calls for continued campaign monitoring, attention to AFP (Acute Flaccid Paralysis) surveillance quality in Khyber Pakhtunkhwa and coordinated surveillance of immunization activities with Afghanistan.
There remains certain districts from where reports of campaign failure continue to come year after year.  It has also been reported in the past that pediatricians, who have regularly been reporting the number of polio cases, have been told by health authorities not to do so. There is no surveillance system to check polio cases reported to the private sector health facilities. Private health sector caters to 65 percent of the needs of the area. It is alleged that instead of medical officers being in charge of the drive, vaccinators in some areas run the campaign. The vaccinators are not provided with transport or funds which had been disbursed to the health department authorities. Instead they are asked to use bicycles. The vaccinators in some places are also not provided with ice to maintain the cold chain.
In 2002, Pakistan introduced the Hepatitis B vaccination in the national immunization campaign for children up to one year of age. Hepatitis B affects an estimated one out of every 10 Pakistanis, though some medical experts feel that its incidence is much higher. Due to a shortage of funds, the government has planned to target the youngest segment of the population. The program was launched with the material support of GAVI (the Global Alliance for Vaccines & Immunization). There are however reports of corruption coming in as well. Sale of government owned hepatitis B vials to private medical practitioners and medical stores have been reported in some districts.
According to one estimate, there are around 0.12 million cases of tuberculosis in Pakistan. It is dangerous not only for the person infected but for the whole community since one infected person is capable of infecting up to 10 people. It is also noted that 80 percent of the cases occur in people at their prime age which has a devastating effect on the economic and social situation of the country.
Another major cause of death of infants and mothers is due to neonatal tetanus. Newborns die every minute due to this infection, and mothers die every ten minutes. This can easily be avoided by giving two doses of tetanus toxoid during pregnancy and clean birth practices. It can protect both the mother and child until the birth; and can be independently vaccinated. This vaccine has been available for over 40 years.
The Provincial Vaccination Ordinance 1958 requires every parent of a child who has attained the age of six months and is under one year of age to get her or him vaccinated against small pox. It is also the parents’ responsibility to get the child inspected to verify the results of vaccination and to revaccinate the child after every three years. This vaccination provided under this law is free. Small pox has been eliminated from Pakistan, like the rest of the world and there is thus a need to upgrade this law.

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