Pakistan cannot succeed in immunisation programmes in the absence of developing Vaccine Inventory Management System (VIMS), which includes proper storage and handling of vaccines, World Bank latest assessment report points out.
A fiduciary systems assessment (FSA) carried out by the World Bank—in order to evaluate the fiduciary systems pertaining to the immunisation programme for determining whether they provide reasonable assurance that the programme funds—will be used for their intended purpose.
The report, available with Pakistan Today, mentions that failure to adhere to cold chain requirements is reducing vaccines’ efficacy, resulting in a lack of protection against VPDs, despite inoculation. “The loss of vaccine effectiveness due to non-functional cold chain is cumulative, permanent, and irreversible,” the report says, adding that a proposed intervention will prove to be a cost-saving strategy since vaccines may be wasted if they are exposed to extremely low or high temperature, resulting in increased costs to replace the wasted vaccines, human services, and specialised transportation.
As per specifications, all health facilities require at least 95 per cent of functional cold chain equipment at all levels, which will have to increase the benefits of vaccination.
Indirectly, the report mentions, this intervention is also expected to bring net positive economic returns through improvement in system efficiency. Efficiency gains are possible through awareness campaigns on electronic media, disaggregated by provinces. The low coverage ratio in Pakistan pertains not only to supply side problems, but also serious demand side issues as well. For instance, a significant number of parents—especially in rural and tribal areas—are non-literate or uneducated about health issues, particularly the importance of vaccination.
The report revealing the data among non-immunised children says that 45 per cent were not immunised due to misconceptions about the efficacy of immunisation, fear of side effects, and a lack of knowledge about immunisation. Parents ignore the importance of vaccination against VPDs and are generally unaware of the consequences of not immunising their children. As such, many children are vaccinated only if the facility is provided at their doorstep, as parents do not assume responsibility to immunise their children. Some parents reject the immunisation of their children, even if the government provides the service.
It says that childhood immunisation against vaccine-preventable diseases presents a highly cost-effective intervention—delivering significant reductions in morbidity and mortality from inexpensive and standardised interventions. It remains one of the most fundamental competencies of public health programmes.
Referring to the challenges in Pakistan, it says that the country has been facing a formidable challenge in achieving the national elimination of polio virus. Ensuring strong national routine immunisation is the first essential pillar in polio eradication—which has been the key to rapid control of polio in many countries.
The report mentions that current political context presents both challenges and opportunities for improving EPI performance. Addressing the challenges requires strong leadership, good governance, and effective management, particularly at the provincial and district levels to implement fundamental reforms, restructure institutions, and strengthen systems in the context of the 18th Amendment to the constitution which was passed by the Parliament in April 2010.
