Poor quality and ailing vaccination programmes, beleaguered with corruption, have been blamed for Pakistan's recent surge in measles.
The epidemic, which started in October, 2012, has claimed more than 200 lives and has resulted in a large number of hospital admissions. Compared with the 64 deaths in 2011, measles witnessed a staggering upsurge in 2012 with a record 306 fatalities, according to WHO. The number of measles cases has also increased from 4000 in 2011 to 14 000 in 2012.
Zulfiqar Bhutta, Founding Chair of the Division of Women and Child Health at Aga Khan University, Karachi, Pakistan, tells The Lancet that the community demand for childhood vaccines is not being fulfilled in most areas of the Sindh province, where most of the deaths (210 of 306 in 2012) have occurred. He insists that the poor coverage is due to the lack of human and vaccination resources “to those who need it the most”.
“We have also confused people over the years by delivering some vaccines such as polio door to door and insisting that parents take their young infants and children many a mile for other vaccines”, he adds.
“This was a tragedy in waiting. We have been predicting for a while now that without adequate cover with routine immunisations in many parts of Pakistan, notably in rural populations, there was bound to be a situation where you would have an outbreak like this.”
Bhutta suggests that the problem has been compounded by several factors including devolution of health care to provinces and transition of services such as the extended programmes of immunisation without adequate preparation.
He adds: “One contributing factor to excess mortality could be the massive rates of malnutrition, particularly in Sindh, which probably would lead to reduced immunity and adverse consequences of disease. The fact that the disease [measles] is completely preventable and has been prevented in countries including Afghanistan with a much more meagre health-care system, puts the blame squarely and solely on the failure of routine immunisation systems.”
Bhutta denounces the reports suggesting a link between floods and the measles epidemic. “The floods of 2010 and 2011 could have contributed to the outbreak, but the distribution of the disease belies that. These are much more mainstream regions which have just witnessed a massive failure of public health preventive programmes.”