amina Bibi and her husband, Bashir Khan, were standing worried in the children’s ward of Tehsil Headquarters Hospital, Gujar Khan, where their eleven-month-old son, Ahmed Bashir, was admitted after being diagnosed with measles.

Ahmed was brought to the hospital in a serious clinical situation. The doctors gave him supportive treatment to save his life. He was diagnosed with measles after developing a high fever, cough and rash.

The doctors and staff were told that the child had never been vaccinated.

“I work as a labourer with minimum wage. I do not have time for vaccination,” said Bashir Khan.

Khan and his wife are uneducated. He says they had never thought that their son may have to struggle for his life because of their negligence.

The Rawalpindi district has recently seen a sharp increase in the spread of measles, which has claimed eight lives over thirty days. The district administration is investigating the epidemic.

When Ahmed fell sick, his parents took him to a nearby private healthcare clinic for examination, where he was diagnosed with measles. The clinic did not have the resources to provide specialised care including intravenous fluids to prevent dehydration and antibiotics to treat secondary infections.

The parents say they cannot afford private treatment.

Many families in rural Pakistan face similar challenges when dealing with the consequences of preventable diseases like measles.

The lack of access to healthcare and information about vaccinations puts these communities at risk and reinforces the need for urgent action to improve vaccination rates and increase awareness about the importance of vaccines.

A staff nurse at the Gujar Khan THQ says that measles vaccination falls under the Comprehensive Expanded Immunisation Programme where vaccines till nine months for children are mandatory.

She says it is a continuous process, and hundreds of children are vaccinated every week in accordance with the vaccination schedule.

“The measles vaccine is administered in the ninth month,” she says.

According to the healthcare worker, in the past two to three months, an increase has been observed in measles cases despite the vaccination being continued at government hospitals.

She says there is a need to raise awareness about vaccination among the masses, particularly among the poor. Many people, she says, do not believe that vaccines prevent diseases.

“There is a need for social awareness at the grassroots level about measles vaccination,” she says.

At the end of 2021, the government had launched a country-wide door-to-door anti-measles campaign. The target population included 15 million children in the Punjab (2.3 million in the Rawalpindi district).

According to the Federal Directorate of Immunisation, more than 300 Pakistani children died of measles in 2012. This was a staggering increase over 2011 when according to the World Health Organisation 64 children had died of measles in Pakistan, 28 of them in Sindh.

The WHO has ranked Pakistan among the top 10 countries in the world with a large pool of under-vaccinated children. It says the country is home to more than 600,000 zero-dose children.

The real challenge is the spread of misinformation about vaccines. This can fuel vaccine hesitancy and resistance. Some people in Pakistan believe that vaccines are unnecessary, unsafe or a Western conspiracy. “This misinformation can lead to lower vaccination rates and contribute to the spread of measles.” 

The recent floods have also caused a significant drop in routine immunisation services, especially in the flood-affected districts. Most of the major immunisation service delivery interruptions have been reported in Balochistan and Sindh provinces.

WHO statistics show that Pakistan has one of the highest rates of measles in the world, with an estimated 30,000 cases yearly. The recent outbreak, which began in early 2021, has seen a surge in cases, with over 5,000 confirmed cases and 80 deaths reported in the first few months of the year.

Dr Sana Malik, who works at the Paediatrics Department of the Pakistan Institute of Medical Sciences (PIMS), says measles is a highly contagious viral disease that can cause serious complications, including pneumonia, brain damage and death.

The doctor says the virus spreads through coughing and sneezing and can infect people of all ages but is most dangerous for children and infants.

According to the paediatrician, the measles vaccination, according to the EPI schedule, is given at nine months, but many cases reported at the hospital are between six and nine months old.

“This shows the disease is also infecting children before the scheduled vaccination age,” she says.

The doctor says measles patients are treated in isolation and given symptomatic clinical care, adding that pneumonia, severe diarrhoea and encephalitis are some of the complications in measles.

She says most parents, while giving the history of the patient or their child infected with the disease, confirm that their children were not vaccinated against measles.

“It is very difficult to save a child’s life if they have severe complications,” says Dr Malik.

Healthcare worker Ulfat Bibi says that poverty, and lack of healthcare infrastructure and resources in many parts of the country, particularly in rural areas, are among the reason behind the spread of the disease.

“Sometimes this makes it difficult for healthcare workers to reach vulnerable communities and provide vaccination and other essential services,” she says.

She says the real challenge is the spread of misinformation about vaccines. This can fuel vaccine hesitancy and resistance. Some people in Pakistan believe that vaccines are unnecessary, unsafe or a Western conspiracy.

“This misinformation can lead to low vaccination rates and contribute to the spread of measles.”

National Institute of Health (NIH) Advisor on Disease and Prevention Dr Rana Muhammad Safdar says keeping the two years of Covid-19 pandemic in view, the entire world and Pakistan need a leap to reach all unvaccinated children and vulnerable populations to get them vaccinated.

“It’s indeed a responsibility of the state that needs to be fulfilled,” he says.

He says healthcare workers also need to be encouraged and facilitated so that they can provide any vulnerable children with the vaccines they need.

The writer is a journalist and ICFJ fellow based in Islamabad