OUT of a total of at least 64 polio cases that have surfaced in the country so far this year, more than 20 have been reported from Sindh. The polio eradication programme will launch its second sub-national campaign this week since the easing of the lockdown. It will cover 130 districts across the country aiming to reach more than 34 million children under the age of five.

Both routine and anti-polio immunisation services were affected due to Covid-19. Although essential immunisation resumed as lockdowns eased, Covid-19 fears prevented parents from accessing vaccine services, thus putting millions of children at risk of a resurgence of vaccine-preventable diseases.

The provincial healthcare system suffered a further blow when thousands of vaccinators, conducting routine immunisation went on strike.

Although it has been some weeks since vaccinators resumed work (after successful negotiations with the provincial government), the 39-day strike, which started on June 12 and continued for over a month, took a heavy toll with some 500,000 children under two years missing vaccinations.

Polio is a gateway disease to many other diseases.

The strike was observed in several districts of Sindh excluding Karachi. However, a large number of vaccinators from different cities of the province staged a sit-in outside the Karachi Press Club. Refusing to go back to work, they demanded the provincial government confirm them, review their pay scale and pay them their dues. More concerning is the fear of another strike if the protesters’ demands are not met.

The free Expanded Programme on Immunisation (EPI) was launched in Pakistan in 1978 to protect children against several childhood diseases and protect mothers and newborns against tetanus. Besides the three doses of oral polio vaccine, the essential immunisation schedule offers an injectable polio vaccine at 14 weeks. Pakistan plans to include a second dose at nine months in its routine immunisation schedule with support from Gavi, the Vaccine Alliance. The second dose, to be introduced by early next year, will increase protection against all polioviruses, including those causing disease through the vaccine itself.

As much as eradicating polio is a priority, it is important to understand that polio is a gateway disease to many other diseases. Strengthening routine immunisation is perhaps the most important pillar for the polio eradication strategy. Experts believe if routine immunisation is pushed through, it will offer a long-term solution which could see education and sanitation efforts implemented as well as a polio-free Pakistan.

There are some success stories. The discourse around something as vital to public health as immunisation needs to be incessant, realistic, and even-handed.

Last November, Sindh became the first province of the country to introduce the Typhoid Conjugate Vaccine, the eleventh in its routine immunisation programme. According to the latest Pakistan Demographic and Health Survey 2017-18, the Sindh EPI has shown a marked increase in coverage of routine immunisation to 49 per cent from 29pc as recorded in PDHS 2012-13.

Since 1985, the World Health Organisation has recommended oral polio vaccine at the time of birth as well as at six, 10 and 14 weeks as a safe and effective means of protection against polio.

The birth dose was initially not counted as part of the three-dose routine schedule. However, its administration at birth is especially important because this dose can create herd immunity and provide early protection to newborns and it may be the only vaccine received by children who later become lost to medical services.

An important milestone achieved by the Sindh EPI is its Zindagi Mehfooz (SafeLife) electronic immunisation registry (ZM-EIR) service operational in all 29 districts. The ZM-EIR utilises QR-based identification to record electronic immunisation records for each child, to identify children who are zero-dose, currently due for routine vaccinations and defaulters.

Most recently, an electronic birth registry feature has been added, designed to enrol pregnant women and newborns from 14 selected maternity hospitals in Karachi.

This feature ascertains provision of birth vaccines to newborns in target hospitals, linking child-level data with the government’s ZM-EIR as well as follow-up visits and further tracking of their immunisation status. Further, it will provide accurate target estimations to the EPI for the planning of polio campaigns and assisting health staff to address children in geographically inaccessible and marginalised communities.

A Karachi roadmap is also ready to be rolled out to cover the zero dose and partially immunised children of this megacity and find ways to cover populations half of which are living in urban slums and catchment areas. The improvement may be marked but for it to be sustained, efforts need to be consistent to ensure a healthier future for the children of Sindh.

The writer is a journalist.

Published in Dawn, August 18th, 2020