Low vaccination coverage, parental hesitancy cause of surge in VPDs

ISLAMABAD: A large number of vaccine-preventable disease (VPDs) cases are being reported across Pakistan, including the capital Islamabad, where cases of measles, mumps, diphtheria, pertussis, tetanus, and pneumonia are being reported daily due to low and uneven immunisation coverage in the country, officials said.

Paediatricians and infectious disease experts have confirmed that numerous cases of measles, mumps, diphtheria, pertussis, and tetanus are being brought to public and private health facilities. The vaccination history indicates that almost half of the children were not vaccinated against one or more vaccine-preventable diseases.

There are 12 vaccines in the Expanded Programme on Immunisation (EPI) of Pakistan to prevent childhood tuberculosis (TB), diphtheria, diarrhoea, hepatitis B, measles, meningitis, pertussis (whooping cough), pneumonia, polio, tetanus, typhoid, and rubella. However, due to challenges in the immunisation system, a considerable number of children remain unvaccinated across Pakistan.

Officials at the National Institute of Health (NIH) in Islamabad confirmed that they were receiving reports of sporadic and scattered outbreaks of vaccine-preventable diseases across Pakistan, especially outbreaks of measles, as well as cases of mumps, tetanus, diphtheria, and pertussis. They deplored that some provincial health authorities and the private sector were not sharing data with the NIH.

“Our surveillance teams are getting reports of vaccine-preventable disease outbreaks from across Pakistan, and we are receiving some data on suspected cases. However, unfortunately, some provincial authorities and the private sector, even in the capital Islamabad, are not sharing data with the NIH,” an official claimed.

Blaming the Punjab health authorities for their reluctance to share data with the NIH Islamabad, the official said there was some improvement in data sharing by Punjab, but a large amount of data about diseases, especially vaccine-preventable diseases, was still not being shared.

“How can the NIH prepare policies for disease control and issue advisories when we don’t get credible data from district health officers across Pakistan?” the NIH official questioned. They urged the provincial health authorities to regularly share disease data with the NIH so that effective measures could be taken and policy guidelines could be issued.

“Another issue is that the NIH reference laboratories in the provinces are not fully functional because the provincial authorities are not providing recurrent budgets to run these labs. The NIH Islamabad has provided equipment and training for the establishment of these provincial labs, but due to the non-provision of recurrent budgets and the absence of staff, these labs are not fully functional,” the NIH official claimed.

Officials in the Islamabad health department also confirmed that cases of measles and other vaccine-preventable diseases were being reported from different areas of the capital but claimed that there was no ‘clustering or outbreak’ of vaccine-preventable diseases in the federal capital.

“Whenever we learn about cases of measles or any other vaccine-preventable disease, we conduct a mop-up activity in that area. We urge parents to get their children vaccinated at EPI centres, as vaccines against 12 vaccine-preventable diseases are free and they save lives,” said Dr. Zaeem Zia, District Health Officer (DHO) of Islamabad.

Paediatricians at three leading tertiary-care hospitals in Islamabad, including PIMS, Polyclinic, and FGH Chak Shahzad, and some private health facilities also confirmed that they were seeing a rise in cases of measles and other vaccine-preventable diseases, including mumps, pertussis, tetanus, and diphtheria. They urged parents to get their children vaccinated as per the EPI schedule.

Health officials in Sindh also confirmed that measles outbreaks in the province have been severe, particularly in Karachi and other regions, leading to the deaths of several children. Efforts to control the spread have included mass immunisation campaigns and heightened surveillance, but the situation is far from controlled.

In Punjab, the situation is equally dire, according to the local health authorities. A recent outbreak claimed the lives of 14 children across various districts, including Pattoki, Khanewal, and Sharqpur. Many more children are hospitalised with severe symptoms.

Commenting on the sudden rise in measles cases, a senior epidemiologist with the Ministry of National Health Services, Regulations, and Coordination (NHS, R&C) claimed that measles is a highly infectious disease and its elimination requires over 95% coverage with two doses of the vaccine.

“As per a third-party assessment conducted last year, the current national coverage stands at around 75% with wide interprovincial and inter-district variations, leaving significant pockets of under-immunised children that continue to favour transmission and outbreaks all across the country. Another factor favouring infection and serious complications is malnutrition, which is simultaneously prevalent across provinces and concentrated among the most vulnerable populations,” the expert added.

According to him, the solution is equitable vaccination coverage with measles plus vitamin A, as well as effective measures for improving nutrition overall. “Comprehensive disease control always requires an integrated approach, which is the sole reason behind the creation of the Centre for Disease Control (CDC) at NIH. After Pak CDC operationalisation, it was supposed to bring all required elements together for effective disease prevention and control, but it never happened,” he deplored.