When it comes to protecting the unborn and new-born, nothing can be more important and powerful than Routine Immunisation (RI), a global effort under Expanded Programme on Immunisation (EPI) to save children from deadly Vaccine Preventable Diseases (VPD) like Poliomyelitis, Measles, Childhood Tuberculosis, Diphtheria, Whooping Cough and Tetanus.
As a journalist, who has extensively interviewed people from lower income group, I have concluded that saving a child through scientific medical technique of planned immunisation is no meaningful effort unless there is a massive awakening about the cause accompanied by comprehensive financial coverage given to the people of lower income group.
In our part of the world where periodic examination of a pregnant woman or an expectant mother is considered a financial burden by her immediate family, undertaking routine immunisation plan sounds unrealistic.
It is, however true that one of the major reasons behind the death of an unborn or newborn is the curse of so called "code of ethics" of women's immediate family that restrict women from seeing a health professional to ascertain the well being of the baby thus killing them unborn or newborn. Most importantly, financial strength plays a vital role in attending to a child's needs before and after he or she is born.
Thirty five year old 'M' from Qasba Colony fixed her eyes aimlessly on the floor of her small shanty house as she confides the harrowing tale of the day she lost her four-month old unborn to the financial insufficiency three years ago. The wife of a motor mechanic, 'M' was very happy to conceive for the first time. In the fourth month of her pregnancy she wanted to consult a lady health professional to ensure the health and growth of her baby. Her husband declined her wish on financial grounds. It was not the end as her mother-in-law offered her free services to examine 'M' at home and pressed her lower abdomen so hard that she cried in pain. The pain did not go away and by the evening 'M' had a miscarriage. Since then she has never conceived.
She is not alone but obviously was fortunate to survive. There are enormous numbers of women who are losing their unborn and new-born every day in the absence of sufficient and pro-poor health cover to save their child. Many even die unreported.
Advocating the need of RI, the Project Director of Sindh EPI, Dr Agha Muhammad Ashfaq said that Expanded Programme on Immunisation was initiated in 1979-80 for Eradication, Elimination and Reduction in morbidity and mortality caused by VPDs including Poliomyelitis, Measles, Childhood Tuberculosis, Diphtheria, Whooping Cough and Tetanus. Initially there were five vaccines for the protection against these six diseases: DPT (Diphtheria + Pertussis+ Tetanus), Measles, OPV, BCG and TT.
Hepatitis-B vaccine was included in EPI Programme in 2002. Tetravalent combination vaccine was added in 2006, replacing DTP and Hep B. Tetravalent vaccine switched in 2008 to the pentavalent (DTP-Hep, B-Hib) vaccine with the addition of the new Hib vaccine while PCV10 vaccine was added in 2012-13. Injectable Polio vaccine was added in 2015 and plan has been made to add Rota Virus vaccine by April 2017. Dr Agha claimed that EPI is a cost effective public health regimen which reduces morbidity and mortality by giving 9 antigens for VPD while 10th will be Rota to be introduced in 2017. It covers children from 0 to 23 months of age and women of reproductive age 15 to 49 years, he added.
A similar view was expressed by Dr Asad Ali, Associate Professor, Pediatric Infectious Diseases, Aga Khan University. "Immunisation has a success record. Immunisation by vaccinations and shots has saved the lives of more babies and children than any other medical intervention in the last 50 years."
"When you immunise your baby you're protecting them against illness and serious harms such as meningitis, pneumonia, paralysis, deafness, seizures, brain damage or even death." He stressed upon the need increase vaccine coverage in Sindh, especially in the rural part of the province. No doubt vaccines are the greatest invention of modern medicine. But its practical application observed during recent anti-polio drives has been influenced by many factors including superstition, socio-economic condition and lately by terrorism.
Many people don't even want to understand the need of vaccinating their under five children against crippling polio virus and see the drive what they term it as an "unnecessary harassment" by polio workers. Millions of families are living in abject poverty and sometimes unknowingly compromise over polio vaccination to their children with the hope of a gain that could support their living. Mother of two Zakiyah while commenting on her experience with polio workers appeared to be totally disappointed. "I will not welcome them again. I allowed them to administer the drop to my child just because I thought they will be giving me something in return. They simply fooled us and did not give me even a 10kg flour bag, she said. Zakiyah is facing tremendous hardship to run her small household in Korangi after being separated from her husband as he failed to support the family without a job.
Dr Khalid Shafi of Pakistan Pediatric Association said that the association has a motto to reach every child in the province of Sindh for providing health coverage by consultation, advice and guidance. "However, we cannot provide with basic health cover which the government is responsible for."
Saving life in a remote area in the absence of medical facility can be challenging. But creating an environment to secure life is equally difficult and daunting. Globally, there has been significant progress in ending child deaths, or what is known as child mortality. In a country where superstition, lack of basic health facility and financial inabilities have forced people to believe that adapting the practice of natural remedy is the only way to immunise a child, generalising scientific cure is challenging task that Sindh needs to take up. There should be a plan to bring the poor in the sphere of medical solvency all over the province. There should be a health package designed for people indiscriminately to save a child. If one cannot think well, work well or sleep well if one has not dined well then how can the millions of people living at edge of starving level can think of better immunisation?
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