WE all know that diarrhoea is among the leading causes of death among children under five years of age. In Pakistan, over 50,000 children die annually from diarrhoeal diseases. What is less known is that rotavirus is one of the most common causes of moderate to severe diarrhoea in low-income countries. The World Health Organisation (WHO) estimated that in 2013, India, Nigeria, Pakistan and D.R. Congo together accounted for about half of all rotavirus deaths among under-fives.

Starting in Punjab, Pakistan finally introduced the rotavirus vaccine in its national immunisation programme last year. The vaccine was introduced in Balochistan on April 25. Administered in two oral doses among six-10-weeks-old infants, the rotavirus vaccine is the 10th vaccine to be introduced in the provincial Expanded Prog­ramme on Immunisation (EPI). The other nine vaccines are intended to prevent tuberculosis, polio, diphtheria, whooping cough, tetanus, hepatitis B, influenza type B, pneumonia and measles.

The government’s free-of-cost vaccination schedule (which would otherwise be Rs36,400 per child) is completed in six visits to an EPI centre for all infants under 23 months of age. But only when it is available to every child will the full potential of vaccination be realised. According to the Pakistan Demographic and Health Survey, 2012-13, our routine immunisation coverage stands at 54 per cent, with substantial coverage and equity challenges between and within regions and provinces.

Balochistan’s children need universal immunisation coverage.

Balochistan has the weakest infrastructure, and the highest gender, education and literacy disparities in the country. Provincial adult literacy is 38pc compared to 57pc nationally; female literacy is 18pc compared to 45pc nationally. Its infant mortality rate is 97 (per 1,000 live births) compared to the national average of 74; under-fives mortality rate 111 compared to 89. Although immunisation coverage has improved since 2012-13 (reported in the health survey at 16pc), it still lags behind the other provinces.

There are several reasons for Balochistan’s alarming situation, including lack of human resources for its EPI; political inference; lack of accountability and weak programme supervision at the district level; urban-rural disparity in service delivery; issues of coverage, access and equity; population growth and lack of reliable data; lack of vaccine availability and poor storage and handling and; above all, little awareness and willingness among the masses to have their children vaccinated.

Balochistan’s EPI targets 0.31 million children compared to 3.5m in Punjab, but its low population density, nomadic families and difficult terrain means that service delivery is costlier and more challenging than in other provinces. Despite this, historically, it has had less access to financing than the rest of the country.

However, there has been significant improvement in recent years due to high-level support from the provincial government. It is making significant investments to strengthen routine immunisation, improve service delivery (including the cold chain system), provide motorbikes (to enable vaccinators’ reach), and launch a mobile phone monitoring system (to track vaccinators’ performance). Expanding immunisation access is crucial for achieving the UN’s Sustainable Development Goals. Not only do vaccinations prevent the suffering and death associated with infectious diseases, they also help enable national priorities such as education and economic development to take hold.

The last week of April each year is marked by WHO and its partners as World Immunisation Week, the aim of which is to promote vaccine use to protect people of all ages against preventable diseases. The goal of the 2018 campaign— ‘Pro­tected Together, #VaccinesWork’ — is to urge greater action on immunisation around the world and plug remaining gaps in coverage.

In Pakistan, such a gap exists significantly in Balochistan. The introduction of the rotavirus vaccine in its EPI has the potential to save thousands of lives. In a country where safe drinking water, hygiene and sanitation are not ensured, preventing illness through vaccination is crucial. There is arguably no single preventive health intervention that is more cost-effective. While the EPI is focused on strengthening supply, there are significant gaps in creating demand, despite the fact that the otherwise cost-prohibitive rotavirus vaccine is being offered for free. This requires developing trust in vaccines.

Balochistan’s EPI is striving to overcome systemic challenges. The last polio case in the province was from Duki, a district that has shown persistently low coverage. Time and again, experts have argued that polio can only be eradicated — and stay eradicated — in places where the routine immunisation system functions sufficiently and efficiently to consistently raise overall population immunity levels.

The writer is a freelance journalist.

Published in Dawn, April 29th, 2018