BARRIERS TO IMMUNIZATION IN PAKISTAN

Abstract

In May 1974, the 27th World Health Assembly initiated the Expanded Program on Immunization (EPI) to ensure that all children across the world should be benefited from life-saving vaccines. The EPI launched at that time recommended immunization to protect against six diseases: tuberculosis, diphtheria, tetanus, pertussis, measles, and poliomyelitis. Hepatitis and Haemophilus influenza type B vaccines were added to EPI in 2001 and 2008 respectively.

In 1978, the EPI was launched in Pakistan to immunize children against six childhood diseases. Later, with the support of development partners, several new vaccines e.g. hepatitis B, Haemophilus influenza type B (Hib) and pneumococcal vaccine (PCV10) were started in 2002, 2009 and 2012, and inactivated polio vaccine in 2015, respectively. Globally, millions of children are saved from illness and death by vaccine-preventable diseases due to routine immunization.  Despite of this successful public health initiative, Pakistan has not yet acquired this endeavor into its health system with the same level of proficiency.

In Pakistan, the immunization rate is not up to the mark, only about 2/3^rd of children get complete vaccination coverage. Many fatal diseases are preventable if EPI is made accessible for all. In Pakistan, in 2013, around 14 thousand cases of measles were reported that resulted in 306 deaths. Between January and August of 2019, 53 new polio cases were documented which was more than the past 3 years. World Health Assembly in 1988 passed the resolution of global polio eradication by 2000. WHO and UNICEF promoted it, the success of such immunization program depended on national policies and local realities. The country, Pakistan, is still facing the issue of polio along with Afghanistan and Nigeria for polio eradication and is a topic of concern.

Vaccine-preventable diseases are a major cause of mortalities amongst children, especially within developing countries, accounting for more than one million deaths annually. According to Global Polio Eradication Initiative, Pakistan has barriers against vaccination and this hinders the disease eradication. There is hesitation in a large number of the population either to vaccinate or not to vaccinate. This faltering is a big factor impeding polio vaccination. There are rumors found in the community regarding the mishandling of vaccines during transportation, storage, and its side effect.  In 2019 hundreds of school children were brought to the hospital with the complaint of vomiting, abdominal pain and fainting after polio vaccination in Khyber Pakhtunkhwa. This made a big fuss; people protested and damaged many healthcare centers. Barriers highlighted for low immunization rates in Pakistan include minimal support from the private sector; policy issues like public–private partnership decisions, program structure and management, governance and capacity, and the inability of addressing the community’s (especially of uneducated and low-income people) perceptions.

In Pakistan, of all the barriers in eradicating polio, the top-notch are workers being threatened and attacked, and vaccine refusal due to misconceptions of the vaccine. Some groups in the community assume and believe that the Polio vaccine is “haram” and may cause impotency. ¹¹

One of the issues is that vaccination teams lack motivational skills, and are not qualified, have no or limited knowledge of the disease and vaccine. This hinders the community to build trust in the vaccine. Local religious scholars take advantage of this and, by adding fuel to the fire, creates superstitions in the community. Laboratory under control of Drug Regulatory Authority of Pakistan (DRAP) has tested vaccine of polio and announced that it is “halal”.  “Fatwa” was issued by religious scholars that polio vaccine is halal and there is no problem with polio vaccine in light of religion and health. Refusal of vaccination is reduced by various community approaches including an announcement in the mosque, community meetings, fatwa in support of polio, Jirgas and household visits by influencers.  Media (Electronic and Print) should raise polio vaccine awareness and help in its safety concerns.

We need to achieve the globally standardized targets for immunization, and for the EPI to work to its full potential there should be an improvement in our existing health infrastructure. By paving the way to make the EPI program achievable and accessible for all, we can help in the improvement of our children’s health and support to the country economy.