Is Pakistan losing the battle against measles?

Pakistan has seen a growing number of measles cases in recent years,
with more than 25,000 reported last year, including 321 deaths.

“It
is vital we bring the situation under control to save the lives of
children and offer people better health care,” said Anita Zaidi,
professor of paediatrics at the Aga Khan University Hospital in
Karachi.

In 2012 there were nearly 15,000 cases, and in 2011
4,380 cases. The steady rise comes despite a government measles
vaccination programme that has been running for more than 35 years.

Although
confirmed deaths so far this year stand at only 13 from 1,329 reported
cases, health officials are still concerned not enough is being done to
deal with the repeated outbreaks of measles.

“There have been at
least nine deaths from measles this year in the province
[Balochistan],” Ishaq Panezai, provincial deputy coordinator of the
Expanded Programme on Immunisation (EPI), told IRIN. The latest six
deaths came in Kalat District, where four children died in late April,
and in Pishin District where two others died around the same time. There
have also been deaths in the Zhob District and the provincial capital
Quetta.

“There should be a vaccination drive [in Kalat], but local authorities tell us it is too hazardous to visit,” said Panezai.

EPI
started work in 1978, initially covering six diseases, but it has since
grown to cover nine (poliomyelitis, tetanus, measles, diphtheria,
pertussis, hepatitis-B, pneumonia, meningitis and tuberculosis).

Impediments to vaccination

Insecurity is certainly
one factor that has limited some of the EPI’s vaccination campaigns;
others blame disruption caused by heavy monsoon flooding in recent
years. Yet others blame a decentralization of health services to the
provincial level.

“Funds, medicines, vaccines provided free of cost by the government are pilfered by people working here and sold to the private clinics or shops”

In a study published earlier this year,
researchers from the Quaid-e-Azam University in Islamabad said
corruption was the principal cause of the high number of measles
infections, notably in Sindh and Punjab provinces, something that was
leading to “ineffective healthcare system, shortage of vaccinators and
low immunization coverage.”

A
2010 report by Transparency International Pakistan found 48 percent of
patients surveyed faced corruption after admission to hospital. The two
most common complaints were: Having to pay money under the table to get a
bed (26 percent), and being asked to pay extra money to get allocated
medicine (18 percent).

“Mismanagement
and corruption go together, and these affect every sector including
health,” Sikander Lodhi, a Lahore-based economic analyst, told IRIN.

Health officials in public hospitals say vaccines, given for free, are often stolen.

“Funds,
medicines, vaccines provided free of cost by the government are
pilfered by people working here and sold to the private clinics or
shops,” said an employee at the health department in Quetta, who asked
not to be named. “The lack of proper supervision allows this to happen,
and also creates an environment of indifference, where no one is really
interested in providing health cover to people, except as a kind of
mechanical duty.”

The UK-based medical journal, The Lancet,
voiced similar concerns saying the “poor quality and ailing” vaccination
programmes, ridden with corruption, were a factor in the surge of
measles cases.

Measles in Pakistan
DEATHS CONFIRMED CASES
REPORTED CASES
2011 64 2,533 4,380
2012 310 2,676 14,687
2013 321 5,969 25,401
2014* 13 92 1,329
*January-May
Source: Pakistan Ministry of Health

The key impact of corruption, in the case of measles, is a reduced vaccination rate.

“The
low national EPI coverage [across all EPI vaccine programmes] of 54
percent of children, according to the Pakistan Demographic Health Survey
for 2012-13, with declining coverage trends over time in Sindh and
Balochistan, coupled with increasing number of polio cases in the low
transmission season, are the major challenges for Pakistan,” Saadia
Farrukh, an immunization specialist at the UN Children’s Fund (UNICEF)
Pakistan, told IRIN.

Most patients recover from measles without
treatment, but complications can develop, particularly where victims are
malnourished. Almost 40 percent of children in Pakistan are
underweight, according to the UN Food and Agriculture Organization.

Government efforts

At
a federal level, some steps are now being taken to strengthen routine
immunization, with a “Vaccine Management Assessment” under way across
the country.

Supplementary Immunization Activities, postponed
due to the unavailability of funds, are also now due to be launched
after the release of funds by the federal government, EPI National
Manager Ejaz Khan told the media in March. But he said the number of
measles cases reported this year was “worrisome” and indicated an
epidemic was possible.

Despite
official promises, health experts remain concerned. At a media briefing
in Karachi at the end of April, the Pakistan Paediatric Association
(PPA) said 53 percent of children in the country were not vaccinated
against any disease. PPA attributed this to misconceptions about
vaccines, including those linked to fertility, or the belief that
because vaccines caused fever at times, they were “not good” for
children’s health.

“Actually the government is more focused on donor-driven
polio campaigns, due to which, other diseases remain ignored,” said
Hasan Orooj, director of health services at the Capital Development
Authority (CDA).

Some families complain of a lack of
information. “I took my six-month-old infant for his shots at a
government hospital. He was given three or four jabs, but the doctor
refused to answer my questions about what they were for. He developed
high fever that night, so we will not be taking him again,” Rafiq Ahmed
told IRIN.

Experts agree there are major flaws in the system,
leading to deaths that could have been prevented. “We need a holistic
plan for vaccination cover. The focus on polio alone has not helped. The
EPI programme needs to be treated as a whole, and all vaccination given
importance,” said paediatrics professor Zaidi.

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