Weeks of missed immunizations can encourage new outbreaks of preventable diseases such as measles, according to doctors in Pakistan, who warn of other health emergencies looming even as the country battles the coronavirus pandemic.
Routine immunization has stopped since the end of March, when the government enacted it corona virus locking action that closes schools and public transportation. Full of COVID-19 patients, many public and private hospitals also close outpatient departments where newborns and mothers usually receive immunizations.
There are already early signs of an increase in vaccine-preventable diseases, doctors say.
“The government has diverted all of its resources and staff to deal with the corona virus,” said Dr. Afzal Khan Khattak, a pediatrician and provincial president for the Pakistan Pediatric Association in the northwestern Khyber Pakhtunkhwa Province, which has a large refugee population and poor health access. “We have received an increase in measles cases.”
Closing public transportation also makes it difficult to reach open facilities, including the government-run immunization clinic known as the EPI center. The fear of contracting the corona virus also keeps many parents away, even though the World Health Organization says older people generally suffer from it highest risk.
“There is a perception among parents that children are more susceptible to viruses,” said Dr. Anjum Qadeer, immunization coordinator in Chakwal district in eastern Punjab, a province that has recorded more than a third of total state cases.
To reduce the risk of corona virus spread, accidentally WHO and global vaccine supporters have recommended that countries postpone mass vaccination campaigns, such as door to door polio program, in areas without active outbreaks.
“The government has transferred all its resources and staff to deal with the corona virus.”
But they also urged routine immunization programs in clinics and hospitals to continue. However, in Pakistan and many parts of South Asia, this routine immunization has “very disturbed“, According to UNICEF.
Global health advocates have warned it more than 117 million children all over the world might only miss the measles vaccine when routine campaigns and immunizations are stopped. The risk is magnified in countries with already low immunization rates. Pakistan’s routine immunization coverage reaches 66 percent in 2018, according to a government health survey published last year – far from 95 percent Target health experts say it is needed to prevent outbreaks.
A new study by researchers from Johns Hopkins University, published at Lancet on May 13, projects that between 42,000 and 192,000 more children worldwide could die each month due to the indirect impact of COVID-19 on access to health and food – with more than one in 20 additional deaths related to vaccine-preventable diseases . Pakistan’s project data can face the third highest total of additional child deaths from 118 countries measured, behind India and Nigeria.
The national health authority said more outpatient departments and immunization clinics had reopened on May 9, when Pakistan began to reduce some of its locking measures. The Coordinator of the Pakistan Expansion Program on Immunization (EPI), Dr. Rana Muhammad Safdar, said that missed vaccinations were triggered by parental fears and closed public transportation.
“There is no problem in providing government services,” he said.
But some doctors told The New Humanitarian that many hospital outpatient departments, or OPDs, were still closed.
“We have not received the government’s order that OPD must be opened,” Dr. Muhammad Zubair, medical officer at Sir Ganga Ram Hospital, one of the largest public sector hospitals in Lahore, the capital of Punjab.
Parents fear the risk of a hospital outbreak
Pakistan faces a two-pronged problem in increasing routine immunization coverage: keeping hospitals and clinics open and accessible, and convincing parents to use them in the midst of a pandemic.
“We have to increase demand and supply to ensure maximum coverage,” Dr. DS Akram, a Karachi-based pediatrician and founder of the Health Education and Literacy Program, or HELP, a non-governmental organization engaged in maternal and child health. .
But increasing hospital worker infections – there were more than 900 cases of the corona virus among Pakistani health workers on May 12, according to government data – has prompted several large hospitals to reduce services or close down, and to encourage parental fears.
On May 5, for example, the government sealed a maternal hospital and operating room at a children’s hospital at the Pakistan Institute of Medical Sciences – the largest medical university in Islamabad – after 15 staff contracted the corona virus. Separate hospital in Peshawar also closed the gynecology unit.
“I cannot risk visiting public sector hospitals to vaccinate my child, when hundreds of doctors and health workers themselves have contracted the virus,” said Madiha Naz, a 27-year-old mother in Islamabad whose newborn child missed the scheduled vaccination. .
He said a private hospital in a high-class area of the Pakistani capital had suspended vaccinations and closed the outpatient department to prevent large crowds. Now, he plans to buy the needed vaccines himself and find health workers to manage them.
“I can’t risk visiting public sector hospitals to vaccinate my child, when hundreds of doctors and health care workers themselves contracted the virus.”
“My child is at risk of contracting a preventable disease,” he said. “I don’t know whether coronavirus, or no vaccination, is more dangerous for my child.”
It is unclear how many children have missed immunizations since the coronavirus outbreak in Pakistan began. The EPI program targets 7.9 million children this year, as well as the same number of pregnant women. It offers free essential vaccinations covering 10 diseases, including tuberculosis, polio, diarrhea, pneumonia, whooping cough, tetanus, hepatitis-B, meningitis, diphtheria, and measles.
Safdar, program coordinator, said it was “difficult to ascertain” the exact numbers.
But Akram from HELP says between 12,000 and 15,000 children are born every day in Pakistan according to government statistics, showing that the number of newborn babies has the potential to lose their first immunization for tuberculosis and polio to reach hundreds of thousands.
Older children who need vaccination against measles, tetanus and other diseases will also go without, he warned, adding that more cases of measles have been reported at Karachi hospitals. Pakistan, one of only three countries where polio is still endemic, already recorded 47 cases of wild polio virus this year in mid-May – more than double the amount recorded at the same point last year. The country has suspended door-to-door polio vaccination campaigns nationally until at least the end of May.
“All of this points to the threat that vaccine-preventable cases among children are likely to increase,” Akram said.
How to restart immunization
Although the reopening of hospital outpatient departments and government EPI centers varies across the country, health workers say they are trying to start vaccinations as soon as possible.
“Our vaccination services are affected by the closure of major hospital OPD but now we are trying to continue our services in all EPI centers,” said Qadeer, immunization coordinator in the Chakwal Punjab district, adding that many families still had not arrived due to fear of coronavirus and mobility problems.
Khattak, a pediatrician at Khyber Pakhtunkhwa, said the government could improve the situation by reducing fear among parents – marking a separate room for immunization in public hospitals, for example.
Asher Pervaiz, an immunization program officer with the Pakistan Red Crescent Society, said the organization’s regular 15-day vaccination program at EPI centers has been postponed since the outbreak began in March. But the Red Cross vaccination now runs a shorter, seven-day program, including targeting villages in the two southwest Balochistan districts, which have experienced instability for years and are one of the country. poorest province.
Akram said he hoped the normal immunization schedule could get back on track within a month. But even so it can still take two months or longer for routine immunizations to catch up with the number of children who have missed vaccinations, he said.
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