Immunization crisis deepens as girl dies of diphtheria at PIMS

ISLAMABAD: A 14-year-old girl from Nankana district has died of diphtheria at the Pakistan Institute of Medical Sciences (PIMS), Islamabad, while two more children one from Buner, Khyber Pakhtunkhwa and another from Swabi remain critically ill in the isolation ward, highlighting Pakistan’s deepening immunization crisis, federal health officials confirmed on Saturday.

All three are lab-confirmed cases of diphtheria a vaccine-preventable disease virtually eradicated in most parts of the world, but now resurging in Pakistan due to dangerously low immunization coverage and widespread neglect in provincial vaccination programs.

The deceased girl was admitted to the PIMS on July 22 with high-grade fever, neck swelling, and respiratory distress. Despite aggressive treatment, including intravenous Diphtheria Antitoxin (DAT), she succumbed to myocarditis, acute kidney injury, and severe metabolic acidosis on July 26 at 5:30am. The second patient, an 8-year-old girl from Buner with Down syndrome and cerebral palsy, is currently on low-flow oxygen at the PIMS. Medical records reveal she was immunization-incomplete, and her condition deteriorated after seven days of sore throat and fever. Her father is deceased, and her illiterate mother was unaware of her vaccination history. The third patient, a 12-year-old boy from KP, was discharged from the PIMS on July 25 after a prolonged ICU stay. He was diagnosed with diphtheria complicated by neuropathy, myocarditis, and aspiration pneumonia and had presented with 105°F fever, grayish throat membrane, and breathing difficulty.

These alarming cases have reignited concern over the country’s immunization failures. Though Diphtheria Antitoxin is available in limited quantities, officials say the real issue is the rising number of zero-dose children those who have never received a single vaccine dose despite the availability of free vaccines under the Expanded Programme on Immunization (EPI).

“Pakistan’s EPI vaccines including three doses of the pentavalent vaccine administered on 6, 10, and 14 weeks are universally available and free of cost,” said a senior infectious diseases specialist at the PIMS. “Yet, due to chronic mismanagement, corruption, and the hiring of incompetent staff at provincial levels, large numbers of children remain unvaccinated and vulnerable to deadly but preventable diseases.”

According to an advisory issued on July 26 by the District Health Office (DHO) Islamabad, diphtheria poses a renewed public health threat, with many children still susceptible due to missed vaccinations. The advisory emphasizes urgent vaccination, rapid treatment initiation, and strict infection control measures. Despite its preventability, diphtheria continues to resurface. Experts warn that even with proper treatment, 1 in 10 patients with respiratory diphtheria may die, and without treatment, mortality can reach 50%. Younger children and immune-compromised patients are especially at risk. What further complicates the outbreak response is a lack of reliable national data. “Punjab, Sindh, KP, and Balochistan fail to share confirmed case data with the NIH,” a surveillance official said. “We only receive scattered suspected case reports, making it impossible to track real-time outbreaks.”

International organizations including WHO, Unicef, and Gavi have flagged Pakistan’s growing number of zero-dose children as a major global concern. Despite spending billions of rupees on immunization with significant foreign donor support, the vaccination system continues to miss hundreds of thousands of children each year.

“This is not a problem of funding. It’s a crisis of governance and accountability,” said a former Health Ministry official. “Without urgent reforms and enforcement, we are heading back to the pre-vaccine era where children die of diphtheria, measles, polio, and other diseases long defeated by the world.”

The Ministry of Health has again urged parents to ensure full vaccination of children, especially the pentavalent doses, while healthcare professionals are advised to initiate treatment without waiting for lab confirmation in suspected cases.

As more children fight for their lives and one has already lost hers, the resurgence of diphtheria serves as a damning indictment of Pakistan’s broken immunization system and a wake-up call that preventable diseases are back with deadly consequences.