IN the current backdrop of the killing of yet another polio worker, it makes perfect sense to talk about the importance of immunisation, especially during a week dedicated to it. Damage has been done, lives have been lost, and there has been a setback to the government’s efforts to make Pakistan polio-free. So it’s time to prevent this from recurring and move towards set objectives.

Of the seven million children born in Pakistan every year, more than 2m fail to be fully vaccinated by their first birthday.

Immunisation is a cost-effective public health intervention that reduces the risk of life-threatening illness by covering children under two years of age and women of reproductive age between 15 and 49 years. It works on eradication, elimination and reduction in mortality by providing 10 antigens for VPDs (vaccine-preventable disease) in Pakistan.

As the world observes World Immunisation Week, with the theme and hashtag ‘Protected Together, #VaccinesWork’, we will need to do some serious introspection before we can ensure that all children, including those in remote, marginalised communities, have access to vaccines and that the latter reach them via a reliable and efficient supply chain system. After all, immunisation can be the difference between life and death.

There are a series of interlinked reasons for the disparity in coverage.

Pakistan has taken impressive steps to improve vaccine access in recent years, taking the bar from a mere 54 per cent to 65pc (according to the Pakistan Demographic Health Survey 2017/18).

While the progress is encouraging, coverage is uneven and varies, based on geography, wealth and urban-rural disparity. In fact, geographic inequity in immunisation is evident between and within provinces. It is estimated that coverage in Punjab reaches 80pc while the latest survey in Balochistan gives 29pc as the provincial average. Within Punjab, coverage in the southern districts remains below 50pc while many other districts are at over 90pc in immunisation coverage.

There are a series of interlinked reasons for the disparity in coverage, resulting in children who have missed vaccinations. These include parents’ lack of trust in vaccinations, the remoteness of family homes, weak access to the country’s Expanded Programme on Immunisation, ignorance of the importance of immunisation, myths and biases against vaccination, and social as well as gender restrictions.

A recent threat and an emerging challenge is the continuous massive population movement from villages to cities and the mushrooming growth of slums in the heart of megacities all over Pakistan. Not recognised by public authorities as an integral part of the city (according to UN Habitat), these urban slums have grown significantly over the past years. The unplanned urban migration to slums and undocumented births leave huge gaps in immunisation coverage, since most families in these areas remain undocumented or under-documented.

A survey being conducted regarding the mapping of urban slums reveals there are approximately 4,000-5,000 slums in 10 megacities of the country. Interestingly, the number of slums is not important but the scale of the population residing in them is highly disproportionate to the population of the city. Faced with several inequities, communities living in slums are vulnerable because they have weak housing structures, no access to large, well-equipped hospitals, out-of -school children and no solid and liquid waste management systems. They live in extremely unhygienic surroundings. All these conditions make the residents highly vulnerable to infectious diseases.

The increase in the number of non-immunised or missed children living in these urban slums poses a big challenge for efforts to administer vaccines. The majority of these people have come from remote, hard-to-reach, uphill, or security-compromised areas and are mostly daily-wage workers or beggars, or even garbage pickers.

Obtaining detailed facts to create a profile would help the government learn about the bottlenecks and barriers in routine immunisation, and help in not only prioritising the interventions but also improving the ability to design integrated service-delivery programmes — the latter not only for health but also for other development interventions such as water, sanitation, education and low-cost, durable housing.

Luckily, all is not all gloom and doom. What slips through the net are the success stories, which may not be many, but are there nevertheless.

Just six months ago, the government was able to reach children who had never received any dose of vaccines, attaining above 93pc coverage through a massive anti-measles campaign. If we can do it for measles, we can put in every effort to increase routine coverage all over the country as well. Perseverance is the key to finding a solution.

The writer is a freelance journalist.

Published in Dawn, April 24th, 2019