Pakistan's expanded programme on immunization

An overview in the context of polio eradication and strategies for improving coverage

Aatekah Owais, Asif Raza Khowaja, Syed Asad Ali, Anita K M Zaidi

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Since its inception in 1978, Pakistan's Expanded Programme on Immunization (EPI) has contributed significantly towards child health and survival in Pakistan. However, the WHO-estimated immunization coverage of 88% for 3 doses of Diptheria-Tetanus-Pertussis vaccine in Pakistan is likely an over-estimate. Many goals, such as polio, measles and neonatal tetanus elimination have not been met. Pakistan reported more cases of poliomyelits in 2011 than any other country globally, threatening the Global Polio Eradication Initiative. Although the number of polio cases decreased to 58 in 2012 through better organized supplementary immunization campaigns, country-wide measles outbreaks with over 15,000 cases and several hundred deaths in 2012-13 underscore sub-optimal EPI performance in delivering routine immunizations. There are striking inequities in immunization coverage between different parts of the country. Barriers to universal immunization coverage include programmatic dysfunction at lower tiers of the program, socioeconomic inequities in access to services, low population demand, poor security, and social resistance to vaccines among population sub-groups. Recent conflicts and large-scale natural disasters have severely stressed the already constrained resources of the national EPI. Immunization programs remain low priority for provincial and many district governments in the country. The recent decision to devolve the national health ministry to the provinces has had immediate adverse consequences. Mitigation strategies aimed at rapidly improving routine immunization coverage should include improving the infrastructure and management capacity for vaccine delivery at district levels and increasing the demand for vaccines at the population level. Accurate vaccine coverage estimates at district/sub-district level and local accountability of district government officials are critical to improving performance and eradicating polio in Pakistan.

Original languageEnglish
Pages (from-to)3313-3319
Number of pages7
JournalVaccine
Volume31
Issue number33
DOIs
Publication statusPublished - Jul 18 2013
Externally publishedYes

Fingerprint

Immunization Programs
Pakistan
Poliomyelitis
Immunization
immunization
Vaccines
Measles
vaccines
Universal Coverage
tetanus
Pertussis Vaccine
Tetanus Toxoid
Social Security
Social Responsibility
Tetanus
Disasters
Population Groups
Population
Disease Outbreaks
whooping cough

Keywords

  • EPI
  • Overview
  • Pakistan
  • Polio eradication

ASJC Scopus subject areas

  • Immunology and Microbiology(all)
  • Infectious Diseases
  • Public Health, Environmental and Occupational Health
  • veterinary(all)
  • Molecular Medicine

Cite this

Pakistan's expanded programme on immunization : An overview in the context of polio eradication and strategies for improving coverage. / Owais, Aatekah; Khowaja, Asif Raza; Ali, Syed Asad; Zaidi, Anita K M.

In: Vaccine, Vol. 31, No. 33, 18.07.2013, p. 3313-3319.

Research output: Contribution to journalArticle

@article{b223279f6c6e464484c733991b6c3728,
title = "Pakistan's expanded programme on immunization: An overview in the context of polio eradication and strategies for improving coverage",
abstract = "Since its inception in 1978, Pakistan's Expanded Programme on Immunization (EPI) has contributed significantly towards child health and survival in Pakistan. However, the WHO-estimated immunization coverage of 88{\%} for 3 doses of Diptheria-Tetanus-Pertussis vaccine in Pakistan is likely an over-estimate. Many goals, such as polio, measles and neonatal tetanus elimination have not been met. Pakistan reported more cases of poliomyelits in 2011 than any other country globally, threatening the Global Polio Eradication Initiative. Although the number of polio cases decreased to 58 in 2012 through better organized supplementary immunization campaigns, country-wide measles outbreaks with over 15,000 cases and several hundred deaths in 2012-13 underscore sub-optimal EPI performance in delivering routine immunizations. There are striking inequities in immunization coverage between different parts of the country. Barriers to universal immunization coverage include programmatic dysfunction at lower tiers of the program, socioeconomic inequities in access to services, low population demand, poor security, and social resistance to vaccines among population sub-groups. Recent conflicts and large-scale natural disasters have severely stressed the already constrained resources of the national EPI. Immunization programs remain low priority for provincial and many district governments in the country. The recent decision to devolve the national health ministry to the provinces has had immediate adverse consequences. Mitigation strategies aimed at rapidly improving routine immunization coverage should include improving the infrastructure and management capacity for vaccine delivery at district levels and increasing the demand for vaccines at the population level. Accurate vaccine coverage estimates at district/sub-district level and local accountability of district government officials are critical to improving performance and eradicating polio in Pakistan.",
keywords = "EPI, Overview, Pakistan, Polio eradication",
author = "Aatekah Owais and Khowaja, {Asif Raza} and Ali, {Syed Asad} and Zaidi, {Anita K M}",
year = "2013",
month = "7",
day = "18",
doi = "10.1016/j.vaccine.2013.05.015",
language = "English",
volume = "31",
pages = "3313--3319",
journal = "Vaccine",
issn = "0264-410X",
publisher = "Elsevier",
number = "33",

}

TY - JOUR

T1 - Pakistan's expanded programme on immunization

T2 - An overview in the context of polio eradication and strategies for improving coverage

AU - Owais, Aatekah

AU - Khowaja, Asif Raza

AU - Ali, Syed Asad

AU - Zaidi, Anita K M

PY - 2013/7/18

Y1 - 2013/7/18

N2 - Since its inception in 1978, Pakistan's Expanded Programme on Immunization (EPI) has contributed significantly towards child health and survival in Pakistan. However, the WHO-estimated immunization coverage of 88% for 3 doses of Diptheria-Tetanus-Pertussis vaccine in Pakistan is likely an over-estimate. Many goals, such as polio, measles and neonatal tetanus elimination have not been met. Pakistan reported more cases of poliomyelits in 2011 than any other country globally, threatening the Global Polio Eradication Initiative. Although the number of polio cases decreased to 58 in 2012 through better organized supplementary immunization campaigns, country-wide measles outbreaks with over 15,000 cases and several hundred deaths in 2012-13 underscore sub-optimal EPI performance in delivering routine immunizations. There are striking inequities in immunization coverage between different parts of the country. Barriers to universal immunization coverage include programmatic dysfunction at lower tiers of the program, socioeconomic inequities in access to services, low population demand, poor security, and social resistance to vaccines among population sub-groups. Recent conflicts and large-scale natural disasters have severely stressed the already constrained resources of the national EPI. Immunization programs remain low priority for provincial and many district governments in the country. The recent decision to devolve the national health ministry to the provinces has had immediate adverse consequences. Mitigation strategies aimed at rapidly improving routine immunization coverage should include improving the infrastructure and management capacity for vaccine delivery at district levels and increasing the demand for vaccines at the population level. Accurate vaccine coverage estimates at district/sub-district level and local accountability of district government officials are critical to improving performance and eradicating polio in Pakistan.

AB - Since its inception in 1978, Pakistan's Expanded Programme on Immunization (EPI) has contributed significantly towards child health and survival in Pakistan. However, the WHO-estimated immunization coverage of 88% for 3 doses of Diptheria-Tetanus-Pertussis vaccine in Pakistan is likely an over-estimate. Many goals, such as polio, measles and neonatal tetanus elimination have not been met. Pakistan reported more cases of poliomyelits in 2011 than any other country globally, threatening the Global Polio Eradication Initiative. Although the number of polio cases decreased to 58 in 2012 through better organized supplementary immunization campaigns, country-wide measles outbreaks with over 15,000 cases and several hundred deaths in 2012-13 underscore sub-optimal EPI performance in delivering routine immunizations. There are striking inequities in immunization coverage between different parts of the country. Barriers to universal immunization coverage include programmatic dysfunction at lower tiers of the program, socioeconomic inequities in access to services, low population demand, poor security, and social resistance to vaccines among population sub-groups. Recent conflicts and large-scale natural disasters have severely stressed the already constrained resources of the national EPI. Immunization programs remain low priority for provincial and many district governments in the country. The recent decision to devolve the national health ministry to the provinces has had immediate adverse consequences. Mitigation strategies aimed at rapidly improving routine immunization coverage should include improving the infrastructure and management capacity for vaccine delivery at district levels and increasing the demand for vaccines at the population level. Accurate vaccine coverage estimates at district/sub-district level and local accountability of district government officials are critical to improving performance and eradicating polio in Pakistan.

KW - EPI

KW - Overview

KW - Pakistan

KW - Polio eradication

UR - http://www.scopus.com/inward/record.url?scp=84879883494&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84879883494&partnerID=8YFLogxK

U2 - 10.1016/j.vaccine.2013.05.015

DO - 10.1016/j.vaccine.2013.05.015

M3 - Article

VL - 31

SP - 3313

EP - 3319

JO - Vaccine

JF - Vaccine

SN - 0264-410X

IS - 33

ER -