Global mission sees EPI accountability as

Islamabad
A high-level international mission on immunisation, which is currently visiting Pakistan, Thursday termed accountability of the Expanded Programme on Immunisation (EPI) as critical to increasing access to routine immunisation in the country.
The mission, which includes Dr. Seth Berkley, the chief executive officer of the Global Alliance for Vaccines and Immunisation (GAVI) , Dr. Ala Alwan, Regional Director for the Eastern Mediterranean Region at the World Health Organisation (WHO), and Dr. Geeta Rao Gupta, deputy executive director of Unicef, is currently holding meetings with leaders in Islamabad to set out their concerns about Pakistan’s poor immunisation coverage, while also offering their support for the country to move forwards.
While seeing accountability of EPI as a critical measure to move forward, the mission has also called for measures leading to the recruitment and training of qualified EPI personnel, coupled with improved reporting systems. Indeed, all cannot be well when such a high-profile mission visits Pakistan, and also has on its itinerary, a meeting with the country’s prime minister.
The mission has urged Pakistan to ensure stronger collaboration between the federal and provincial levels to tackle variations in vaccination. There are wide regional variations in coverage across the country’s four main provinces, with Punjab seeing 76% coverage rate and Balochistan just 27%. Almost 3 million children miss out on a full course of the most basic vaccines every year in Pakistan, leaving them vulnerable to life-threatening diseases. Some districts are seeing very few children protected against diseases such as diphtheria, pertussis, tetanus, measles and bacterial pneumonia.
Childhood immunisation in Pakistan is at a crossroads and strong political will is required to ensure that the lives of millions of children are not put at risk,” the three global health leaders warned Pakistan Thursday. Their meeting with the PM too is aimed at highlighting the importance of political will in ensuring immunisation coverage rises across all regions and districts in Pakistan.
“It is a tragedy when any child dies from a vaccine-preventable disease,” said Dr. Berkley. “The lives of millions of children across Pakistan are at risk because of limited access to vaccines. We have delivered a strong message to leaders that we are ready to work with them to drastically improve this situation and strengthen routine immunisation across Pakistan.”
Dr. Berkley believes Pakistan has a choice to make for its children. “Routine immunisation is the bedrock for access to vaccines against many illnesses, including polio, so by strengthening these systems, Pakistan will be making an investment of political will which will benefit many generations to come.
“Deaths among under-five years children attributable to vaccine preventable diseases constitute up to 25 per cent of the total deaths among this age group in developing countries, including Pakistan,” said Dr. Ala Alwan. “Pakistan is not on track for achieving MDG4 which aims at reducing child mortality by two-thirds by 2015. Increasing routine vaccination coverage will significantly contribute to decreasing infant and child deaths and achieving MDG4.”
“The need to improve routine immunisation coverage in Pakistan cannot be overemphasized,” said Geeta Rao Gupta. “We realise the challenge Pakistan faces regarding immunisation, and are determined to make 2015 a turning point for the country in terms of immunizing all children, especially those living in marginalised communities and hard to reach areas. The fact that nearly 400,000 children under the age of five die in Pakistan every year from diseases which can be prevented through vaccine is simply not acceptable. These precious lives can and must be saved.”
GAVI currently supports pentavalent vaccine which offers protection against five diseases (diphtheria-tetanus-pertussis (DTP), hepatitis B, and Haemophiliusinfluenzae type b) as well as pneumococcal vaccines as part of Pakistan’s routine schedule. GAVI also funds measles vaccination campaigns.
With Pakistan planning to introduce the inactivated polio vaccine (IPV) in the coming months, routine immunisation will be more important than ever as protection against polio is given to babies along with the antigens against other diseases. By the end of 2015, up to 73 GAVI-supported countries plan to have introduced IPV, which is seen as a key part of the Global Polio Eradication Initiative’s endgame strategic plan.
Earlier on, the delegation, which also included global and regional leaderships of Bill and Melinda Gates Foundation, USAID, Department for International Development (DFID), World Bank, and Islamic Development Bank, met minister of state and secretary of health Saira Afzal and Ayub Sheikh, respectively.
Dr. Berkeley stressed that Pakistan is the world’s largest recipient of support from GAVI as the organization has committed US $825 million support to strengthen immunisation services and health systems in Pakistan. This support will be available for the next five years period till the year 2020.
Pointing to the seriousness of the issue, Dr. Ala said, there is need to address issues of staffing, capacity, financing and management in delivery of immunisation services. The president of Global Development, Bill Gates Foundation Dr. Chris Elias said, his foundation is pleased to support to support Pakistan’s polio eradication effort. Dr. Geeta reiterated her organization’s support to protecting the health of children and mothers in Pakistan.
Speaking to the delegates, Saira shared that third party evaluation of the polio programme has been initiated, and that the same monitoring mechanism will be instituted for routine immunisation as well. She pledged a sea-change in Pakistan’s health indicators soon.