Considering the high disease burden due to pneumococcus, the government of Pakistan has decided to introduce pneumococcal vaccine in the routine immunisation schedule during 2011, depending on its availability and preparation at the country level.
The decision was endorsed here Friday during a meeting of the National Inter-agency Coordination Committee (NICC) and National Health Sector Coordination Committee. The meeting was convened to coordinate support from government and partner agencies to strengthen routine immunization and polio eradication activities on the one hand, and the health system, on the other.
The meeting was chaired by Secretary Health Nargis Sethi and attended by Director General Health Assad Hafeez, representatives of WHO, Unicef, JICA DFID, and World Bank; members of the joint mission of WHO EMRO, Unicef and the Global Alliance for Vaccines and Immunisation (GAVI); and representatives from civil society organizations.
According to information received from Unicef, PCV10 may be available for introduction in Pakistan in 2011 and PCV13 not before 2013. In these circumstances, the programme is willing to introduce PCV10 in 2011 and to switch over to PCV13 when that will be available. The cost of one vaccine comes to $7, of which only 15 cents per dose will have to be paid by Pakistan, with the remaining being catered by GAVI.
The NICC also endorsed the strengthening of the cold chain capacity down to the district level. Moreover, the NICC endorsed that the Expanded Programme on Immunisation (EPI) should submit an application to the GAVI Secretariat for introduction of rotavirus vaccine by 2013 under the co-financing scheme. Pakistan is eligible to apply for rotavirus vaccine. The deadline for submission of application is May 2011. NITAG has endorsed the introduction of this new vaccine and the programme is willing to introduce it from 2013.
The total cost of the rotavirus vaccine to cover 5 million children in Pakistan over a five-year period is $680 million, of which the country will bear only around $20 million. The total vaccine cost for immunising each child with this new vaccine is about $10. Pakistan will have to provide only $0.20 for each dose while the rest will be borne by GAVI. Addressing the meeting, Secretary Health, Nargis Sethi reaffirmed the commitment of the Ministry of Health to achieving the targets enshrined in the Millennium Development Goals by way of improved routine immunisation and strengthening of the health system in Pakistan.
“It is well-recognised that the health sector must involve other key stakeholders to improve the health system and to ensure our targets are met. Protecting the lives of the people of Pakistan cannot be the responsibility of one government, one organisation, one community, one sector, one partner or one individual,” Nargis remarked.
The representative of the GAVI mission shared that opportunities for allocation of funds for health systems strengthening and civil society organisations are now available and Pakistan must apply for assistance in these areas as well.
For the past several years, Pakistan has been receiving support through GAVI to strengthen routine immunization and to introduce new vaccines. The EPI introduced Hepatitis B vaccine in 2002 with the support of GAVI and switched over to combined vaccine against Diphtheria, Pertussis, Tetanus and Hepatitis B in 2006; later on in 2008, it was also converted into pentavalent vaccine under co-financing scheme of GAVI.
“The Ministry of Health appreciates the GAVI Board and Secretariat, who have approved our proposal for introduction of pneumococcal vaccine under the co-financing scheme and have conveyed us to make arrangement for its introduction in 2011. Our aim is to introduce this important vaccine as soon as possible to save the children from pneumonia and meningitis,” Nargis said.
The Ministry of Health has also received GAVI support to work towards strengthening overall health system through the EPI, LHWs and MNCH programmes. The GAVI partnership has a single, shared focus: to improve child health by extending the reach and quality of immunisation coverage within strengthened health services.
GAVI is an alliance that delivers long-term financial and material support to the low-income developing countries to increase access to new and underused vaccines and to help ensure the long-term sustainability of national efforts to control or eradicate diseases that cause high child mortality. The meeting was informed that the GAVI Board approved support for Pakistan in 2003; this support was initially for five years 2003-04 to 2007-08 (extended up to 2008-09) and was provided as an investment amount ($10,020,000) and then as reward as $20 for each additional child vaccinated for DPT3 from the baseline year/previous year’s coverage. So far, a total of $33,509,740 has been approved by GAVI as reward for Pakistan. The total amount of investment and reward approved by GAVI Board works out to $48,863,740, out of which a total of $34,201,500 has been disbursed to the country till date. GAVI still has $14,662,240 approved for Pakistan un-disbursed, which EPI plans to utilise during the next five years.