With more than 25,000 cases and 321 deaths last year in Pakistan, measles infections are becoming a growing concern for doctors and citizens alike. This was an increase on previous years and, worryingly, 1,329 new cases have already been confirmed this year. These repeated outbreaks not only raise concerns about measles, but also that the government is not doing enough to combat preventable diseases in general.
Measles is included in the Expanded Programme of Immunisation (EPI), which has been running since 1978 and which also vaccinates against polio, tetanus and meningitis. This programme should ensure that all children are immune to the most common preventable diseases, but it is failing to reach many. Ishaq Panezai, provincial deputy coordinator for the EPI, tells IRIN news that in Kalat district, where the six people recently died of measles, they are being told by local authorities that it is too dangerous to work there.
The challenge to vaccination
The unstable security situation certainly hampers efforts to vaccinate the population, as does the severe flooding caused by monsoon rains. However, many people believe that corruption is at the heart of the problem and this is borne out by a number of studies. Chief amongst them is a recent piece of research done by Quaid-e-Azam University in Islamabad, which cited corruption as the main cause of the high rates of measles infections.
The Lancet, a British medical journal, agrees, calling the Pakistani vaccination programmes “poor quality and ailing”. According to a health employee in Quetta, medicines from government clinics are often stolen by employees and then sold to private clinics or shops, damaging the overall EPI mission. As Sikander Lodhi, a Pakistani economist, tells Irin, this corruption extends to every sector in society, so tackling it will present a major challenge for those hoping to improve public health.
The road ahead
The national government has already moved to free up additional funds for the EPI and they are carrying out a Vaccine Management Assessment. This step has been welcomed by experts, but they remain cautious about the true impact it will have, given the scale of the problems faced. Not least amongst them are the generally low immunisation rates. At the moment 53% of children are not vaccinated against anything, a shockingly high number.
There is some concern that the current approach is not broad enough and that the focus on polio is obscuring the challenges presented by other diseases, including measles. Most suggest that a holistic approach, similar to the original mission of the EPI, is the only way to safe guard Pakistan's children. However, to achieve this people will need to educated on the benefits of immunisations, since misconceptions are currently hampering vaccination programmes. Overcoming these challenges will be important for combating all disease, not just measles or polio.
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