Zero-dose target

Covid-19 has been the greatest disruptor in a century filled with disruptions. For developing countries like Pakistan, the greatest disruption came in perhaps the most critical sector: the health and well-being of children. Despite notable progress in routine childhood immunisation over the past forty years, Pakistan remains among the eight countries accounting for over half of the world’s ‘zero-dose’ children — those who receive no vaccinations during their first year of life. Sadly, according to the Global Burden of Disease (GBD) Study 2023 published by the Lancet medical journal last month, the Covid-19 pandemic reversed the steady progress on this front, pushing thousands of Pakistani children into vaccine deprivation. The country now risks failing to meet its target of halving the number of zero-dose children from 2019 levels by 2030. The study analysed trends from 1980 to 2023 and projected coverage to 2030. It found that although the number of zero-dose children in Pakistan decreased significantly by 2019, the country remains among the top contributors globally, alongside Nigeria, India and Ethiopia. It also found that progress in reducing the number of zero-dose children has stalled across the world since 2019, the year Covid first emerged, due to ensuing disruptions to immunisation services, vaccine misinformation and resource diversion.

Globally, 15.6 million fewer children received DTP3, 15.6 million missed measles vaccines (MCV1), and 15.9 million missed polio vaccines between 2020 and 2023 compared to a scenario without Covid-19 disruptions. The polio numbers seem particularly relevant for Pakistan, given that the country recorded its 13th polio case of the year the same week the report was released. While the annual national polio tally is still not on track to meet last year’s total of 74, it shows that the virus still endures and that the country is struggling to eradicate it. The trends observed in the Lancet study would explain Pakistan’s post-Covid polio spike, particularly as it concerns the rise in vaccine misinformation. This has always been a challenge, but the Covid pandemic and new digital tools and access gave this misinformation unprecedented reach. This is among the main reasons thousands of parents continue to refuse polio vaccines for their children. And, given the millions that have missed polio vaccines around the world, it might just be the case that Pakistan and Afghanistan do not remain the only polio-endemic countries in the coming years.

This grim prognosis is only given credibility by the fact that the reversal in progress on childhood immunisation has also coincided with deep cuts to international aid among the wealthy Western countries. The head of Gavi, which vaccinates children in the world’s poorest countries, has expressed disappointment after the US announced it was pulling funding. Gavi is currently almost $3 billion short of the $11.9 billion it needs to keep to fund its operations over the next five years, when it hopes to protect up to 500 million children from preventable disease. The US, once the world’s leader in health, appears to have become victim to the same vaccine misinformation which it used to warn countries like Pakistan about. But, in this case, American children will not pay the heaviest price. While the Lancet says immediate action is needed for Pakistan to meet its childhood immunisation targets, the immediate term only points to more hurdles for those trying to improve the health of the world’s children.