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Monday, December 9, 2013
- Medical practitioners at the National Institute of Child Health (NICH), a leading government-run children’s hospital in Karachi, hope that this will be the last winter they have to treat a stream of children suffering from pneumonia.
The disease is one of the leading killers of under-five children in the country, accounting for about 19 percent of child mortality.
Last month Pakistan became the first country in South Asia to introduce a free pneumonia vaccine, to immunise five million children against the deadly disease annually.
According to Dr. Mohsina Ibrahim at the NICH, the move will also help lower the incidence of other related diseases like meningitis, but only if “the vaccine is given the same importance as polio and taken door-to-door”, she told IPS.
The government was under considerable pressure to introduce the vaccine: with infant and under-five mortality rates of 78 and 94 per 1,000 children respectively, the country is unlikely to meet the target of reducing under-five mortality by two-thirds by 2015, as stipulated by the Millennium Development Goals (MDGs).
Considered to be the largest rollout of the vaccine after Africa and Central America, the new initiative will form part of the state’s routine child immunisation programme, a set of scheduled inoculations provided free of cost from birth to 15 months to protect against diseases like diphtheria, pertussis (whooping cough), measles, tetanus, meningitis, polio, tuberculosis, and hepatitis B.
The vaccine is being delivered through a partnership between the Pakistan government, the Global Alliance for Vaccines and Immunisation (GAVI), which supports and finances vaccines in the world’s poorest countries, the United Nations Children’s Fund (UNICEF) and the World Health Organisation (WHO).
GAVI plans to contribute 680 million dollars, and the government has donated 17 million rupees (175,000 dollars) to provide the vaccine until 2015.
“GAVI provides funds for countries to jump-start the introduction of newer vaccines, which they would otherwise never have the fiscal (capacity) to do,” Dr. Zulfiqar Bhutta, a leading paediatrician heading the women and child health unit at the Karachi-based Aga Khan University, told IPS.
This is done by procuring highly subsidised vaccines in bulk directly from manufacturers. ”After a negotiated period, countries (are expected) to pick up the vaccine tab,” he said.
Efficacy not guaranteed
According to Bhutta, the “critical task remains” of increasing routine vaccine coverage from 60 percent to 90 percent of all children, if the country hopes to stay on track for achieving the fourth MDG.In addition, Bhutta said, there remains the challenge of “ensuring that these vaccines reach the poor and are not leaked or sold in the open market”.
Dr. Ifra Sameen, another paediatrician at the NICH, is also sceptical about the vaccine “reaching those in need”.
Acknowledging that it is a “step in the right direction”, she told IPS that she fears “good intentions may be marred by the low coverage of immunisation in the state’s health system.
“We have not been able to eliminate polio, which has received enormous political commitment and was (taken) door-to-door. In addition, we already have a vaccine for measles, yet the disease still persists. Given this scenario, what are the chances of eliminating pneumonia, which requires the child to be brought to the health centre and given three doses at three different times?”
Huma Khawar, coordinator of GAVI CSO Support, believes awareness is vital. Unless all caregivers, whether mother, father or grandparent, are fully convinced of the importance and benefits of the vaccine and ensure their children are immunised against all nine childhood diseases, efforts made by the government, GAVI and other U.N. partners to reduce under-five mortality will not go far.
In addition to being cut off from children in conflict-riddled areas and those controlled by militants, the programme must also overcome the hurdles of poverty, uneducated mothers and poor governance within the state-run health systems to ensure widespread inoculation, according to Ibrahim.
And while she is happy that an otherwise cost-prohibitive vaccine – costing a little over 13,000 rupees (roughly 133 dollars) for the entire course of three injections – will be available to everyone, she believes “it would have been better to have strengthened the coverage of existing vaccines, instead of introducing new ones”.
“The government should have focused on diphtheria, pertussis (whooping cough), measles and tetanus. The measles vaccine, which boasts an efficacy of 95 percent, would reduce the incidence of not just measles… but also pneumonia, meningitis and diarrhoea.”
The government should also tackle issues like “malnutrition, low birth weight, and non-exclusive breastfeeding, which put children at greater risk of pneumococcal disease,” said Ibrahim, adding that babies who live in overcrowded places, where indoor pollution levels are high and sanitation is poor, are particularly susceptible.
Malnutrition is perhaps the leading cause of pneumonia, said Sameen. According to the last Pakistan Demographic and Health Survey (PDHS) for 2006-7 38 percent of children under five years are underweight.
Sameen, who specialises in child nutrition, carried out a study on severely malnourished children admitted to NICH between January and June this year and found some 20 percent suffered from pneumonia.
The Global Action Plan for Prevention and Control of Pneumonia (GAPP), issued by the WHO and UNICEF, recommends a three-pronged approach to fighting child pneumonia that includes protection (exclusive breastfeeding and improved nutrition), prevention (including the routine use of measles, DTP3, Hib, and pneumococcal vaccines), and treatment (with appropriate antibiotics and oxygen).