Immunising for better future
VACCINES are the most cost-effective health care interventions. A dollar spent on a childhood vaccination not only helps save a life, but greatly reduces spending on future healthcare. Ezekiel Emanuel Importance of early childhood vaccination has become somewhat of a universal fact now but somehow Pakistan, a country with 14% of its total population being under-five, is oblivious to this fact.
According to UNICEF estimates, the neonatal (newborn) mortality rate for Pakistan in 2021 stood at 39 deaths per 1000 live births whereas under-5 year mortality rate was 63 deaths per 1000 births. Currently, Pakistan is far off the course from achieving the targets of Sustainable Development Goals i.e. reducing neonatal mortality rate to 12 per 1000 live births (SDG 3.2.2) and under-five mortality rate to 25 per 1000 live births (SDG 3.2.1).
The National Nutrition Survey 2018 shows Pakistan has the second-highest rate of malnutrition in South Asia, with 18 percent of children under five suffering from acute malnutrition, around 40 percent of the children in the same age group are stunted and 29 percent are underweight. Despite presence of Expanded Programme on Immunization (EPI) since 1978, Pakistan remains among the 10 most hit countries where children miss out on lifesaving vaccines.
Public’s hesitancy towards vaccines is a documented fact but the elephant in the room is the lack of political will and the resulting low spending on healthcare. The continuous political turmoil in Pakistan is a major reason for scattered and inadequate efforts towards child health and nutrition. Healthcare is a provincial subject in Pakistan but provinces also heavily rely on the Federation for financial and technical support. However, due to conflict between federal and provincial commands, the outreach and accountability of services, especially to remote areas, is reduced. This pegs Pakistan’s momentum towards child healthcare down but the biggest reason of current situation is inadequate spending on healthcare.
Pakistan’s current healthcare spending hovers around 3% of Gross Domestic Product (GDP), which is well below the World Health Organization (WHO) recommendation of at least 6% of GDP. Inadequate spending on health means less vaccines and medicine for children, untrained staff, unattended remote areas, and improper data management. As a result children suffer from poor health.
Pakistan has also failed to raise mass level awareness on polio and as a result drives are often postponed or fail to meet the desired results due to lack of security. As of December 2022, it remains to be among the only two polio ridden countries in the world (alongside Afghanistan) with over 20 cases reported in 2022. The political divide in Pakistan remains a major hurdle in increased attention on public healthcare. This problem is so intense that political parties discontinue healthcare schemes introduced by previous governments. Similarly provincial governments often go in opposite direction from the federal government.
The lack of unity also results in discontinuation or low coverage of vaccines during emergencies such as COVID-19 Pandemic and 2022 Floods. Following a gap of almost four years, latest nutrition survey was needed but it also couldn’t be carried out due to the floods. Pakistan needs to ensure that no matter what the situation, the regular immunization process is not halted because the diseases won’t wait.
There’s need for holistic efforts for following points: (1) Increasing federal budget dedicated to primary healthcare and immunization (2) Ensuring timely and transparent flow of funds at grassroots level (3) Using Sustainable Development Goal Indicators 3.2.1 and 3.2.2 as yardstick to monitor the efficiency of vaccine drives (4) increasing outreach of vaccination drives to reach out to children in remote areas (5) Practicing Sustainability and “Children as Collective Responsibility” mantras to ensure continuation and logical conclusion of PH schemes regardless of which political party is in-charge (6) Periodic progress sharing with media and civil society to exhibit accountability and transparency. These measure are required in order to safeguard Pakistan’s under-five population which will lead the country for next decades.
—The writer is Programme Manager, Society for the Protection of the Rights of the Child, SPARC, Islamabad.
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