Jamali, Tanzil

Rizvi, Narjis

Tanzil, Sana

English

eCommons@AKU

eCommons@AKUCommunity Health Sciences Department of Community Health SciencesSeptember 2014Introduction of a new vaccine in EPI; what we canachieve from a programme in failureSana TanzilTanzil JamaliNarjis RizviAga Khan UniversityFollow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_chs_chsPart of the Public Health CommonsRecommended CitationTanzil, S., Jamali, T., Rizvi, N. (2014). Introduction of a new vaccine in EPI; what we can achieve from a programme in failure. Journalof the College of Physicians and Surgeons Pakistan, 24(9), 702.Available at: https://ecommons.aku.edu/pakistan_fhs_mc_chs_chs/499702 Journal of the College of Physicians and Surgeons Pakistan 2014, Vol. 24 (9): 702Sir,Under-Five Mortality Rate (U5MR) is unacceptably highin many countries of the world with pneumonia beingone of the major killers in this group.1 For preventingdeaths from pneumonia, WHO has been suggestingthese countries to introduce pneumococcal conjugatevaccine to reduce U5MR.1 Logically, Pakistan is one ofthe most appropriate countries for the introduction ofPCV into its Expanded Programme on Immunization(EPI) with high U5MR (89 deaths per thousand livebirths).2 Realizing the potential role that PCV can play toU5MR, the government of Pakistan integrated PCV 10within its EPI programme in October 2012 with anexpectation to reduce the pneumonia related U5MR.3It should be remembered that a well-functioning andefficiently performing immunization programme is one ofthe pre-requisite for the success of this new vaccine.4However, a quick review of the EPI programme inPakistan shows that the overall immunization coverageis currently only 54%; indicating low performance andsevere flaws in the existing immunization system.2Increased workload due to special campaigns toeradicate polio and frequent outbreaks of measles alsoindicate of the poor quality of immunization services.4The major factors responsible for the low immunizationcoverage of Pakistan's EPI programme are poorplanning resulting in inadequate number of fixedfacilities and increased workload on outreach services,inadequate monitoring and supervision, insufficienthuman resources and lack of cold chain integrity.4Another factor that has badly affected the EPIperformance is the flood in the past several years.5These floods have damaged the infrastructure of publichealth facilities which are the main source forvaccination. In addition, the floods also displaced thetrained vaccinators and interrupted the out-reachimmunization services by damaging the roads.5Within this context, where EPI has been already facingextensive service delivery challenges,  inception of PCV10 into routine immunization might fail to achieveexpected reduction in U5MR. However, serious effortsare required to improve the quality of EPI services,improved skills or capacity of existing human resourceand improved service utilization which are essential toachieve the desired outcomes. Moreover, adequateefforts must be directed towards awareness creation toenhance service utilization and enhanced uptake ofPCV10 vaccine. Once the existing gaps are filled andloose ends tied, PCV10 is likely to achieve the target ofreduced pneumonia related U5MR among children inPakistan.REFERENCES1. Madhi SA, Levine OS, Cherian T. Pneumococcal conjugatevaccine is efficacious and effective in reducing the burden ofpneumonia. Bull World Health Organ 2008; 86:365-8.2. National Institute of Population Studies (NIPS), Pakistan andICF International. Pakistan Demographic and Health Survey2012-13. Islamabad: NIPS and ICF International; 2013. 3. Government of Punjab, Pakistan. Expanded program onimmunization [Internet]. 2014. Available at URL: http://www.epi.punjab.gov.pk/Home.aspx4. Kostermans K, Presthus G, Clements CJ. Situation analysis:new vaccine introduction in an under-performing programme, adilemma for Pakistan. J Pak Med Assoc 2013; 63:1458-9.5. Kronstadt KA. Flooding in Pakistan: overview and issues forcongress. New Delhi: DIANE Publishing; 2010.LETTER TO THE EDITORIntroduction of a New Vaccinein EPI; What We can Achievefrom a Programme in FailureSana Tanzil, Tanzil Jamali and Narjis RizviDepartment of Community Health Sciences, The Aga KhanUniversity Hospital, Karachi.Correspondence: Dr. Sana Tanzil, Ibne-Ridwan Building,Department of Community Health Sciences, The Aga KhanUniversity Hospital, Stadium Road, P.O. Box. 3500, Karachi.E-mail: syeda.sana@aku.eduReceived: January 09, 2014;   Accepted: May 06, 2014.

Introduction of a new vaccine in EPI; what we can achieve from a programme in failure

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Introduction of a new vaccine in EPI; what we can achieve from a programme in failure

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