Pakistan’s $350m annual expenditure on polio, routine immunisation at risk: ex-health ministers, advisers

ISLAMABAD: Pakistan is poised to spend over $186.45 million (approximately PKR 52.2 billion) this year on polio eradication alone, but former health ministers, advisors and experts warn that the country’s overall immunisation efforts, including the Expanded Programme on Immunisation (EPI), are faltering due to the lack of integration between the two programmes.

With an annual combined investment of around $350 million (PKR 98 billion) on both polio eradication and routine immunisation, health experts argue that the failure to merge these initiatives is wasting valuable resources and slowing progress in combating vaccine-preventable diseases, including polio, which remains endemic in Pakistan.

On World Polio Day 2024, former special assistant to Prime Minister on Health Dr. Faisal Sultan, former SAPM Dr. Zafar Mirza, caretaker Punjab Health Minister Prof. Javed Akram, caretaker health minister Dr. Nadeem Jan along with other national and international experts, called for the immediate integration of the polio programme with EPI to enhance efficiency and ensure that the substantial financial investment leads to tangible health outcomes.

Former health minister Dr. Faisal Sultan said integration is likely on help, while Dr. Zafar Mirza, a former Special Assistant to the Prime Minister on Health and a renowned public health expert, stressed that polio and routine immunisation must be integrated.

“Separately, they will not succeed. We must address inequity between provinces and even within provinces, particularly in areas like Balochistan and Khyber Pakhtunkhwa, where over 80 percent of children are not getting routine immunisation. These children will have weak immunity and will be vulnerable to polio. A holistic approach is needed to integrate both programmes,” Dr. Zafar Mirza Mirza, former SAPM on Health observed.

The $186.45 million spent annually on polio eradication primarily covers vaccine procurement from countries like China, Belgium, and Indonesia, as well as operational and communication costs managed by international partners like WHO and Unicef. However, Pakistan’s investment in routine immunisation against 12 other vaccine-preventable diseases through the EPI remains lower, with a projected budget of $164 million for 2024, including contributions from GAVI and the government of Pakistan.

Despite these significant investments, experts highlight that deaths and disabilities from both polio and other preventable diseases are still rising. Prof. Javed Akram, former caretaker health minister of Punjab, emphasised that duplication of resources in a resource-stricken country like Pakistan is unsustainable.

“Merging the polio and EPI programmes would prevent resource duplication and ensure better governance. Even flu shots, pneumococcal, and Hepatitis B vaccines should come under one umbrella. We need clear goals, set yearly targets, and put professionals in charge of managing these programmes,” he said. Prof. Akram also noted that polio is not only paralysing children but also impacting Pakistan’s economy. The urgency of integration is underscored by the current state of polio in Pakistan as of this year, 40 children have been affected by the poliovirus, with four fatalities reported due to complications from the disease.

According to Prime Minister’s Focal Person for Polio Eradication, Ayesha Raza Farooq, the virus has now spread to 71 districts, posing a severe threat to children across the country.

Farooq also highlighted challenges such as cross-border transmission, the repatriation of unregistered foreigners, and vaccine hesitancy, which is exacerbating the spread of the virus. “Communities in high-risk areas often refuse vaccination, demanding other government services, which complicates eradication efforts,” she said.

International health authorities echoed the call for integration. “Pakistan has the infrastructure, financial backing, and workforce to eliminate polio, but a more holistic approach is needed to address the root causes of both polio and other vaccine-preventable diseases,” said a representative from an international donor organisation, requesting anonymity.

The roadmap for polio eradication aims to interrupt virus transmission by mid-2025, but experts say this will only be possible if polio campaigns are integrated with stronger routine immunisation efforts and public awareness campaigns. Dr. Nadeem Jan reiterated that support from law enforcement agencies and the media is crucial in tackling vaccine hesitancy and ensuring the safety of polio workers in high-risk regions.

With World Polio Day 2024 serving as a reminder of global commitment to eradicating polio, Pakistan’s journey remains fraught with challenges. However, experts believe that with a renewed focus on integrating polio eradication with routine immunisation under a coordinated national strategy, Pakistan can overcome these hurdles and secure a healthier future for its children.