July 19, 2020
By Asra Haque
Pakistan will resume its routine immunization campaign under the Polio Eradication program on July 20, after nearly a five-month hiatus. Around 800,000 children will receive essential vaccines through a door-to-door campaign in South Waziristan, Attock, Faisalabad, and parts of Karachi and Quetta in the first phase. In Sindh, where 20 of Pakistan’s 58 polio cases emerged, the program aims to reach 260,000 children across several densely populated locations in Karachi. In the following month, the campaign will be extended to other affected and vulnerable regions.
Prior to the spread of the novel coronavirus, Pakistan’s anti-polio drive was able to reach 53-75% of its target vaccinations each year it was carried out. Upon the birth of a child, a total of four doses of oral polio vaccine (OPV) are given which is the preferred method of vaccine delivery by the Global Polio Eradication Initiative (GPEI) and the World Health Organization (WHO). Subsequently, the child is administered polio drops at six, ten, and fourteen weeks of age. Depending on hygiene conditions, additional doses may be required.
In Pakistan, a child receives up to seven doses of OPV over the course of several months. But swathes of missed populations threaten to reverse whatever strides Pakistan’s anti-polio drive makes every year. Currently, Pakistan and Afghanistan are the only two remaining countries in the world endemic for poliovirus. A myriad of factors hampers Pakistan’s progress in achieving complete eradication of the autoimmune disease. These include geographical limitations making it difficult for healthcare workers to reach far-flung and isolated populations, security concerns, poor literacy and education rates impeding awareness drives, and deplorable hygiene conditions,to list a few.
How has the pandemic affected routine immunization?
The current year however has proven to be the most difficult for Pakistan to carry out its vaccination drives due to several new hurdles encountered due to the COVID-19 pandemic.
Following the spread of the contagion in Pakistan, on 24 March, the Ministry of Health under guidelines and recommendations from the Global Polio Eradication Initiative and the Polio Oversight Board suspended its anti-polio drive which was to be initiated in April, leaving approximately 40 million children without essential vaccines according to the United Nations International Children’s Fund (UNICEF) and the Emergency Operation Centre for Polio Eradication.
A combination of lockdown measures impacting logistics and travel, diversion of crucial healthcare resources and personnel toward coronavirus funds, lack of protective equipment for healthcare workers, and pandemic fears prompting parents to forgo hospital visits and refuse door-to-door vaccinations, have severely jeopardized Pakistan’s immunization and vaccination efforts for not just polio, but also for other prevalent diseases among children.
Disruptions for treatment and vaccination of other childhood diseases
Pakistani children are at risk from diphtheria, pertussis (whooping cough), tetanus (lockjaw), Hepatitis B, pneumonia, childhood tuberculosis, meningitis, rubella, mumps, and measles, all of which are vaccine-preventable diseases. Some of these diseases, such as measles, rubella, mumps, and diphtheria have been eradicated from most of the developed world due to well-funded and executed immunization and treatment campaigns. Pakistan, with the exception of its anti-polio drive which receives plentiful international funding, does not have the resources or finances to quickly and efficiently exterminate most vaccine-preventable diseases.
With the ongoing pandemic, these troubles are now magnified as precious capital is diverted to the country’s coronavirus fund. For example, WHO data for the first four months of 2020 indicated a noticeable drop in the number of children worldwide receiving three complete doses of the vaccine for diphtheria, tetanus, and pertussis (DTP3) due to COVID-19 disruptions in healthcare. The WHO highlighted this development as the first in 28 years that the world has seen a marked reduction in DTP3 coverage. Pakistan is among those countries with high diphtheria, tetanus, and pertussis prevalence.
Pakistan’s vaccination drives are particularly hit hard by the restraints on medical aid, logistics, and access to healthcare by the ongoing lockdown. Diversion of human and financial resources away from different immunization and treatment programs to the coronavirus effort has not helped.
According to data from UNICEF, an estimated 2,700 children aged 19 and under, while a total of 5,600 adolescents and youths aged between 15 and 24 years of age were diagnosed with human immunodeficiency virus (HIV) in 2019. However, approximately 1,900 children aged 14 and under received antiretroviral treatment (ART, treatment for HIV) for the same year. The number of children receiving antiretroviral treatment is expected to decline, as reports emerge of critical shortages in essential drugs and equipment (such as syringes) for the treatment of HIV-positive children.
Are Pakistan’s prospects encouraging?
For the year 2020, Pakistan raised its annual expenditure for the healthcare sector in lieu of the contagion, however, there is no indication which programs will benefit from it. The impending re-launch of the country’s anti-polio drive hopes to address the five-month gap, however with 58 cases reported halfway into the year, there is a concern of whether Pakistan is capable of closing this gap. International organizations such as UNICEF and the WHO have issued dire warnings that the pandemic may have severely and perhaps irreversibly set back immunization efforts for a number of developing nations.
Pakistan seems to be no exception
Unless healthcare resources and funds are equitably allocated, and the myriad of obstacles to immunization and treatment for preventable diseases not addressed through effective policy, Pakistan may face a second healthcare crisis.