The road to zero

Part - I

As the global community observes the World Immunization Week, beginning April 24, for many it is time to reflect on the health of children and how far humanity has been able to ensure that children have access to health, education and an exploitation-free environment as a right.

In essence the magna carta for children, the Universal Declaration of the Rights of the Child gave voice to the most important and most vulnerable segment of any society – children. The declaration was passed by the League of Nations and later adopted by the United Nations in 1959 with an expanded scope.

The nations of the world agreed to ink the declaration, recognising that children were to be protected against all forms of exploitation and provided succour and care as a matter of right beyond the exclusive domain of parental responsibility.

The subsequent UN Convention on the Rights of the Child also further reinforced the notion of societal responsibility and role of the state in ensuring that children are given their right to an exploitation-free and healthy existence providing all means their development as useful and responsible individuals contributing to human progress.

Article 24 of the UN Convention of Rights of the Child, adopted in 1990, states that “States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States Parties shall strive to ensure that no child is deprived of his or her right of access to such health care services”. The same article calls upon states to take appropriate measures to ‘diminish infant and child mortality’ with emphasis on ‘developing primary health care services’.

It is proven beyond doubt that vaccination greatly reduces disease, disability, death and inequity worldwide. The pre-exposure vaccination of infants with several antigens is the cornerstone of successful immunisation programmes against a number of childhood diseases.

Efficacious vaccines not only protect the immunised, but can also reduce disease among unimmunised individuals in the community through ‘indirect effects’. The more children in a community are vaccinated, the less likelihood there is of any children getting sick.

In countries like Pakistan where pneumonia, diarrhoea, malaria, measles, and malnutrition are the major killers of children this cost- effective intervention plays a pivotal role.

Priority needs to be given to strengthening vaccination globally, especially in the countries that are home to the highest number of unvaccinated children. In Pakistan, around three million children miss out on vaccination annually with fully immunised children being only 54 percent of the targeted children. More than 1,000 Pakistani children under the age of five die every day, many of them from diseases that could have been prevented by vaccines.

The theme for World Immunization Week this year is ‘Close the Immunisation Gap’, reflecting the long-standing promise to increase immunisation coverage and save more children from preventable disease and disability. In Pakistan over 6.2 million children and 6 million pregnant mothers are targeted for vaccination against 9 vaccine preventable diseases every year. However, the percentage of coverage remains abysmally low in parts of the country even though the national average stands at 54 percent.

We need a stronger focus on reaching children missed by routine delivery systems. This week is also a reminder that poor routine immunisation is a major cause of the upsurge of polio cases. As part of the Polio Endgame strategy we must close the gap between immunisation services and target children.

With polio having been wiped out of almost the entire globe, Pakistan and Afghanistan represent the final frontier in defeating the disease. Both countries, due to their geopolitical situation and security environment, have confronted serious challenges in battling the disease.

Pakistan’s epic fight to reverse the odds in the face of a major polio epidemic is a story of courage, resilience and innovation. Major challenges like insecurity and inaccessibility were addressed with an unshakable resolve and a well thought-out and effectively executed strategy under the guidance of Prime Minister Nawaz Sharif.

From an outbreak-like situation and spate of violence against polio workers, coupled with inaccessibility and ban on polio campaigns in some areas, we have now a handful of cases with campaign quality and accessibility having significantly improved and teams working in a safe and protected environment. Together the nation surmounted the most daunting of challenges and we are now well poised to put an end to the transmission of the poliovirus with focus on maintaining the current momentum and micro-targeting areas of concern identified by independent monitoring.

The indomitable courage of our polio workers, who braved the odds in the face of often unfriendly and intimidating conditions in some areas and blatant hostility in others, finds no precedent elsewhere in the world. Nothing could dampen the spirit of these angels of hope who continue to spread light at every doorstep, unfazed and undeterred. These men and women represent the true spirit of Pakistan – a nation of the resilient, courageous and determined.

To be continued

The writer is the Prime Minister’s Focal Person for Polio Eradication.