IN addition to Covid-19, many other infections are taking a toll on people in Pakistan, especially children, in 2021. A large increase in measles cases was recorded this year with up to 70 districts reporting outbreaks, and the numbers are increasing. According to the WHO’s measles risk assessment, reported cases in Pakistan until last month were thrice as many as those reported in 2020. The incidence of measles was found to be the highest in Balochistan where half the districts witnessed outbreaks.

Pakistan has planned to add the combined measles-rubella (MR) vaccine for children in its routine immunisation schedule. The introduction is marked by a nationwide campaign starting Nov 15. During the MR introduction campaign, spread over 12 days, every child between nine months and 15years will receive one dose of measles-rubella vaccine, regardless of their previous vaccination history. Children less than five years (0-59 months) will also receive two drops of the oral polio vaccine (OPV) during the campaign.

Despite the competing priorities of Covid-19 and the recent earthquake, Balochistan’s health authorities have expressed their commitment to the upcoming campaign. The province will vaccinate more than 5.6 million children against MR, while over 2.6m under-five children will receive two drops of OPV.

A nationwide vaccination drive aims to reach 90m children.

Measles and rubella (German measles) are highly infectious and are commonly found in populations in low- and middle-income countries. These infections are associated with morbidity and mortality in Pakistan and require immediate attention.

Rubella is a mild infection making children permanently immune to it. However, if a woman becomes infected with the rubella virus just before pregnancy and up to the first 10 weeks, it can cause multiple abnormalities in the baby or miscarriage or stillbirth.

Known to be one of the largest MR drives ever to be conducted, the campaign offers an opportunity to protect a generation by targeting up to 90m children in 12 days.

This time there is close collaboration between the Expanded Programme on Immunisation and the Polio Eradication Initiative teams to ensure that the maximum number of children are reached and that processes are in place to identify and record persistently missed children.

The scope, scale and opportunity of the MR campaign is ambitious as the aim is for the vaccine to reach every child in the country. This is an opportunity to identify children who have never received any vaccine and are known as ‘zero dose’ children. It will bring them into the system of routine immunisation so that they can receive all the vaccines they require, including two doses of the MR vaccine. Besides, the campaign will allow a stronger vaccination system to evolve.

Considerable human resource is required in the form of skilled persons who can give subcutaneous injections independently. The programme has to fill the gaps by hiring more nurses, Lady Health Visitors and trained Lady Health Workers to address any specific needs regarding gender and community access.

As almost half of the target children are school-going, EPI/PEI has developed a robust school strategy and is pursuing close coordination with the education ministry. However, what remains challenging is reaching out-of-school children, who mostly live in low-coverage areas such as urban slums and security-compromised regions or are a part of nomadic populations and displaced families, or live in juvenile prisons and orphanages, or attend informal education centres or those who work.

Balochistan EPI is striving to overcome systemic chal­­lenges, but given a difficult terrain, low population density and nomadic families the service delivery is more expensive and challenging than in other provinces. The programme is undertaking extensive efforts to identify human resource requirements. There is a need to recruit a sufficient number of skilled workers from hard-to-access communities before the start of the campaign. Female vaccinators should be especially identified, recruited and trained early to work in areas where gender sensitivities may impact vaccine uptake.

Besides ensuring active engagement and coordination with all key partners including polio, nutrition and Lady Health Workers programmes, civil society organisations and paediatric associations for a successful campaign, strong political commitment is needed. This is the first test for a new Balochistan leadership to take up the challenge of ensuring more than 95 per cent coverage in the province.

Vaccination against measles has proved to be an effective preventive intervention. There is a global momentum for measles and rubella prevention efforts, and in 2021, Pakistan is on the verge of stopping polio transmission. This campaign could make an important contribution.

The writer is a journalist.

Published in Dawn, November 11th, 2021