Free Essay. Expanded Program on Immunization in Pakistan

Immunization is a health program that focuses on preventing infectious diseases. Immunization is provided through vaccinations where babies, children, and adults are protected against preventable and serious diseases. Pakistan has a robust health system that hears towards ensuring the well-being and health of the population. Pakistan has a dynamic national immunization program that commits to providing immunization management across the country. Pakistan's health ministry engages with key global stakeholders such as the World Health Organization to provide immunization services to its population. One of the key immunization programs adopted in Pakistan is the Expanded Program on Immunization (EPI). EPI was launched in 1978 in Pakistan with the aim of protecting children by immunizing them against diseases where Immunization is available. This paper covers the scope of Pakistan`s immunization program, the involvement of the World Health Organization in EPI, a comparison of Pakistan's immunization program with that of the U.S., and the emerging issues in Immunization especially the current outbreak of Corona Virus.

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Pakistan Immunization Program

Pakistan immunization program is guided by the Ministry Of Health, which creates and implements policies and platforms for vaccination programs (Government of Pakistan, 2020). The country`s immunization program is multidimensional and contains multiple components, all of which are geared towards ensuring proper management of the program. The components cover consistent cold chain system, delivery of vaccines, maintenance and storage of vaccine stocks, educational programs for public awareness, training of health personnel, documentation and monitoring of the entire program. The government engages with key stakeholders, including the WHO as part of enhancing the program and ensuring vaccination services reach all parts of the country. The engagement is in the form of resource mobilization, capacity and health infrastructure development (Government of Pakistan, 2020). Implementation of the immunization program varies in terms of set-up depending on health infrastructure across various areas in the country. Some regions are covered by fixed facilities for vaccination, and others are incorporated within healthcare facilities which include health posts and hospitals that incorporate vaccinations in addition to other healthcare services (Haq, Hafeez, Zafar & Ghaffar, 2017).

In some areas, the number of health facilities that have been set up is small. The program, in such cases, sets up mobile vaccination teams that consist of health personnel from health facilities to deliver vaccines to individual centers and villages. The program schedules these outreach services throughout the year. The program also incorporates a pulse immunization system where pulses of vaccine is given to individual children through annual vaccination campaigns (Haq, Shaikh, Tran, et al. 2019). This is critical, especially in areas with poor infrastructure and communication. The program also incorporates door-to-door canvassing, especially in poor urban communities which tend to have minimal uptake of vaccination (Faisal et al., 2008). The health ministry has increased periodic national-level mass campaigns on vaccination and included as part of the health ministry annual programs. The goal is to ensure every person gets the necessary healthcare, especially in the area of Immunization which enhances the health of the entire population and saves the country the cost of treatment of such diseases. Generally, Pakistan health ministry provides the necessary infrastructure and capacity to ensure the population is protected against diseases where Immunization is available.

Expanded Program on Immunization in Pakistan

The WHO is one of the key stakeholders in the management and implementation of the immunization program in Pakistan. WHO established its offices in Pakistan in 1960 and from then has continued to partner with the government of Pakistan through the ministry of health in providing technical support in health (Haq, Hafeez & Ghaffar, 2017). The support has been in strengthening health services, supporting and promoting health research, and addressing issues of public health such as the current Corona Virus. The partnership of WHO and the Pakistan government resulted to the establishment of the Expanded Program on Immunization - EPI.

The goal of EPI has been to reduce diseases, disability and death on vaccine-preventable diseases (VPDs) and support strengthening the national health systems with a focus on the realization of Millennium Development Goals. EPI program covers diseases such as tuberculosis, pertussis, measles, tetanus, poliomyelitis, and diphtheria. The program has grown over the years to include new vaccines such as the pneumococcal vaccine (PCV10), Haemophilus influenzae type b (Hib), and hepatitis B (Masud & Vinodhani, 2012).

The provision of EPI services is done through the public health delivery system where there are outreach and fixed centers (Haq, Hafeez & Ghaffar, 2017). Health workers and the Ministry of health in Pakistan manage and support the centers. The outreach and fixed centers are managed at province levels with the Federal Government acting as the coordinating, supervising and monitoring unit at province levels and ensure proper implementation of provincial immunization programs (Masud & Vinodhani, 2012).

The federal EPI unit provides technical and policy guidelines, surveillance and monitoring, and coordination for international support (Hasan, Bosan & Bile, 2010). In addition, the program facilitates provincial health departments through the procurement and delivery of vaccines, coordinating the availability of vaccines and general logistical support (Government of Pakistan, 2020).

The EPI program in Pakistan is coordinated by different stakeholders key among them being the federal government, provinces and health agencies. The federal government provides resources, especially the necessary finances. The resources are used to primarily procure and supply vaccines, safety boxes, syringes, and other logistical support needed by provincial entities (Hasan, Bosan & Bile, 2010). The provinces implement EPI programs and manage the operational cost of immunization initiatives at provincial and district levels.

Structurally, the EPI program is coordinated at the federal level by the Ministry of National Health Services and Regulation Coordination (NHSR&C) (Shaikh, Haq & Hafeez, 2018). The national EPI structure incorporates government technical and administrative personnel and development partners including WHO and UNICEF. The management of EPI at the provincial levels is managed by departments of health: At district levels, EPI is coordinated by personnel and Union council through outreach vaccination sites, fixed centers and mobile centers in certain areas (Haq, Hafeez & Ghaffar, 2017).

Program Objectives

The key objectives of the program include:

Affirmation and commitment of the government in providing safe, cost-effective, and safe vaccination against diseases that can be prevented.

Set national guidelines and standards for immunization program that aligns with evidence-based research and global goals and encourage and support the development of local evidence for safe and effective vaccination against diseases that can be prevented (Government of Pakistan, 2020).

EPI program has adopted objectives and strategies that align with priorities defined at both regional and global levels (Hasan, Bosan & Bile, 2010). The establishment of National Immunization Technical Advisory Group (NITAG) by the Ministry of Health in 2008 was part of aligning with WHO guidelines. The coordinated initiatives by NITAG provide evidence-based policy guideline on immunization-related issues (Haq, Hafeez & Ghaffar, 2017). This is a key area, especially with continued research in health. Research provides an avenue of changing immunization vaccines which then triggers policy changes.

Advancement in health research is a critical area as it facilitates the provision of better health services in the area of Immunization for the people (Masud & Vinodhani, 2012). NITAG therefore with collaboration with partners ensures vaccines provided are up to date with current research and facilitate development of policies that are evidence-based. NITAG in coordination with health partners through the national EPI program address emerging issues in the area of Immunization and provide updates to ensure the program meets the global standards and aligns with WHO transforming health guidelines (Masud & Vinodhani, 2012).

In 2015, a policy document was developed through a public-private initiative. The document provided policy guidelines for the involvement of health personnel in immunization service delivery and the role of the private sector in the immunization program. This immunization policy incorporates the country`s vision 2025 as it addresses the key objective: reduce infant mortality levels from 74 children to less than 40 per 1000 births; reduce maternal mortality levels from 276 to less than 140 adults per 1000 births; and reduce infant mortality levels through immunization initiatives and targets geared towards realizing the health goals for the country, region and global at large (Government of Pakistan, 2020).

Currently, EPI focuses on immunizing all children from ages 0 to 23 months against preventable diseases (Government of Pakistan, 2020). The supplemental immunization initiatives against measles, polio and tetanus are provided. This level targets children that are less than one year for routine Immunization, children with up to five years for polio eradication, and children from nine months to thirteen years for measles elimination: The program also covers women in childbearing and protects such against tetanus (Government of Pakistan, 2020).

Current Health Situation in the Area of Immunization

Pakistan has managed to develop a robust immunization program that can be able to address the issue of Immunization in the country. Through coordinated efforts by health partners, the country is in a position to realize its key goals of reducing maternal mortality rates and infant mortality rates (Hadler, Cochi, Bilous & Cutts, 2014). Immunization is a sensitive area as it facilitates the provision of vaccines against diseases that are preventable. The development of the EPI program is important in providing evidence-based guidelines on the implementation of the immunization program in Pakistan. The key, therefore, is on understanding whether the program has been able to realize its goals, barriers and areas in need of improvement.

Pakistan immunization indicators are yet to reach the expected levels. The country still lags behind in terms of ensuring 100 per cent implementation of health immunization program for the realization of health objectives. The core objectives of polio and measles eradication have not yet been achieved. The country records a significant percentage of infants who do not receive full vaccine dose (Faisal et al., 2008).

Pakistan is among countries that record the most under-vaccinated and unvaccinated children (Haq, Hafeez & Ghaffar, 2017). This is a negative trend that shows the interventions and measures adopted by EPI and other health agencies have not yet realized the goals. For instance, in 2018, about 40 per cent of children who did not receive a dose of DTP3 out of 3.8 million from the region were from Pakistan (Government of Pakistan, 2020). The government has not been able to reach to the poor and those in remote areas extensively and provide the necessary vaccines.