Immunization in Pakistan


It is World Immunization Week and the global health community can celebrate the fact that a large share of the world’s children no longer suffer illness and death due to vaccine preventable diseases. However, the families of Pakistan still suffer greatly; children in Pakistan are less likely to have benefitted from the cost-effective intervention of childhood vaccines than children in neighboring countries, and additionally than children in most of the rest of the world. 84% of children globally have been protected against measles and polio, but in Pakistan, far too many children still die of measles and suffer the effects of becoming ill from measles, and the nation remains one of only three countries endemic for polio. Full immunization coverage in Pakistan remains between 43 and 62% (depending upon the source of information), even though the Expanded Program on Immunization was established in Pakistan more than 35 years ago, and even though many partners have supported Pakistan’s efforts to increase coverage for many years.

The World Bank became engaged in Pakistan’s polio initiative in 2003, with an expectation that polio would soon be eliminated. After many years of collaboration, the results have not been as hoped, nor as the families of Pakistan deserve. So, how can this change? At the World Bank we are optimistic that it can, and we are working together with the Ministry of National Health Services, Regulation and Cooperation, each of the Provinces, the World Health Organization, UNICEF, the United Kingdom’s Department for International Development, Australia’s Department of Foreign Affairs and Trade, the Gates Foundation and the GAVI Alliance to agree upon a joint program of support which aims to increase coverage and quality of services for immunization against vaccine preventable diseases for children under two. Now is the opportunity to make a difference. An effective program will demand efforts to (i) strengthen management, governance and stewardship functions (monitoring, evaluation and surveillance systems), (ii) improve service delivery performance (planning, human resources, supervisory systems, linkage to communities; (iii) demand generation (empowering and educating communities) and (iv) technical leadership. The joint program which is emerging will address exactly these issues.

This is an exciting opportunity, and the Government’s leadership in bringing these partners technical and financial resources together leads us to believe this is the moment in time when we can really make a difference. Over the next two years, we expect to see gains in immunization coverage, reductions in deaths and disability from vaccine preventable illness and to ensure that Pakistan’s children and families obtain the same benefits available to other children and families around the world.


Julie McLaughlin
Sector Manager for Health, Nutrition and Population, South Asia
World Bank



  1. says

    Salam ,

    Routine immunization is become very serious issue now a days because all EPI vaccinaters are busy in Polio campaigns so no focus on immunization, because Many international organization working on Strengthen Routine Immunization but they facing much problem to launch this project because KPK govt Health director and secretaries they are not serious as they need because they are not serious for monitoring unit because Many organization funding a huge amount of money but they want monitoring and KPK govt are not agree on that because they know if monitoring unit build then they cant do corruption. I hope in KPK govt take this project seriously because international organization are ready to invest on this project but they want a Monitoring , surveillance system better and working excellent……..

  2. Fouzia Rahman, Independent Public Health Consultant, Msc, MPH (Johns Hopkins School of Public Health, Baltimore, MD, USA says

    The Pakistan Demographic Health Survey (PDHS) 2012-13 showed 48.4% and 65.8% fully immunized children in rural and urban Pakistan respectively. Theoretically, in addition to polio immunization campaigns the routine immunization services also deliver polio vaccinations, it is serious situation that currently Pakistan is the only country on the surface of earth spreading wild polio virus !!!

  3. Fouzia Rahman says

    When I am writing this (November 14, 2014) Pakistan has a build- up of 235 polio cases (almost all wild polio virus 1(WPV1). … typically difficult to eradicate in high population density and low/squalid living conditions and poor human hygiene and sanitation. IT IS A TEST OF PATIENCE for Global Polio Eradication Initiative (GPEI) especially when India and 11 other South Asian countries have been certified polio free March this year. It is huge challenge for Pakistani public health system run under the provincial governments is not adequately equipped to meet this challenge. Pakistan Army should come forward for “operation polio” in FATA, KP and Pusthun settlements in Gadap Area of Karachi.

  4. says

    By reviewing studies that assessed causes of low immunization specifically in Pakistan it was found that socio economic characteristic, awareness, access, and managerial issues have connection to low immunization coverage in the country.
    To improve the primary health care services utilization through Community service model routine immunization,options include ensuring that vaccines and vaccinators are available at all times through a well-laid network of fixed centers. Further communities implementation should be made aware of these services at the fixed centers to achieve optimum utilization on immunization services. Leadership and good management should be nurtured through proper training. The Country should look creatively at expanding the role of primary health care workers to assist in immunization coverage. Completeness and timeliness of reported routine data needs to be improved.

    Low literacy rates especially among women, their lack of empowerment and involvement in decision making, early marriages, and high fertility rates with lack of birth spacing and poor access to health care facilities are all important proximal determinants of low immunization in children in Pakistan.

    Addressing low immunization requires a clear, comprehensive strategy that includes governments, nongovernmental and community organizations, and the communities themselves. Maternal and paternal education came out clearly as a significant determinant shows that both male and female education is important to increase immunization rate in children.

    In Pakistan the Health care services has delivered through all tires of health care with a well-established infrastructure. Before 18th amendment health services were delivered under the umbrella of federal government and implantation remained responsibility of provincial health departments. Health policies in Pakistan are aimed to address the basic problems in health sector by strengthening the health care system.

    However due to reasons of improper implementation and gaps in supervision these policies did not meet their objectives. Baluchistan is the largest province in Pakistan and especially suffering from under utilization of health services in the rural area.
    Before 18th amendment health care system in Baluchistan has not been able to provide needed health care to people. The present health care delivery has not been able to cater the health care needs of majority of the people and leading to low confidence of the communities in the public health system. Instead they prefer to visit selective facilitation of their choice or go to private physicians’ traditional healers and quacks. One of the main reasons of low health services system utilization in Baluchistan is unavailability of health care providers in the rural communities, although BHUs are staffed with medical officers and representative of vertical programs like lady health visitors midwives, vaccinator in the community providing preventive health services. Although health workers are providing preventive health services but not integrated health promotion activities, every vertical program is providing service separately through provincial representative.

    Medical officers are one of the key well educated health personnel and can be used properly to administer preventive health services in the rural area and primary health care level through integrated health care services and community mobilization to strengthen the health care system at primary care level in rural areas, another reason for the low utilization and low performance is because of deficient supervision and monitoring of the supporting staff of vertical programs. Medical officer can supervise and mange integration of health services and community.

    Barriers to universal immunization coverage include poor performance at primary health care level of the EPI, socioeconomic inequity in access to services, decreased demand from population, reduced security, and resistance to vaccines among population sub-groups. Recent conflicts and large-scale natural disasters have severely stressed the already constrained resources of the national EPI. Immunization programs remain least priority for provincial and many district governments in the country

    International and national studies have recommended different strategies to handle the worsening situation in the country which include Improving EPI service delivery, Integration of maternal-neonatal-child health and immunization programs and services under one directorate, Improving district level management capacity and accountability, Independent district level monitoring and evaluation, Increasing vaccine demand in the population through targeted education, Mass communication for vaccine promotion, Involvement of Civil Society Organizations (CSOs) and other stakeholders

    I have proposed a study will use Community Service model under the leadership of medical officer /in charge BHU in the rural area, which intends to improve EPI services delivery, integration of maternal-neonatal-child health and immunization programs and services at BHU level, monitoring and evaluation at BHU level, increasing vaccine demand in the communities through targeted education on male, and involving local social networks and other stakeholders. The main objective of this study is to assess the effectiveness of Community Service model to improve health care services utilization at BHU level District Panjgur Balochistan.

  5. dr. farrukh seir says

    1. All but approximately 3% immunization is conducted by public sector, more than half funding is going to polio campaign.
    2 .KPK in spite of security threat showed better coverage than Sind, Baluchistan is the province of concern..
    3. Routine immunization programme need improvement in service delivery, reporting, and monitoring,
    with going in to 3G and 4G technologies era electronic modes should be used.
    4. . Attitude of physians,education of parents and awareness regarding general immunization need more focus..
    5.Provinces must accept challenges in post devaluation era. it is an opportunity to reduce their costs on diseases, IMMUNIZATION is the most effective health intervention

  6. dr. farrukh seir says

    1.All but approximately 3% immunization is conducted by public sector, more than half funding is going to polio campaign.
    2.KPK in spite of security threat showed better coverage than Sind, Baluchistan is the province of concern..
    Routine immunization programme need improvement, service delivery, reporting, and monitoring,
    with going in to 3G and 4G technologies era electronic modes should be used.
    . Attitude of physians,education of parents and awareness regarding general immunization need more focus..
    Provinces must accept challenges in post devaluation era. it is an opportunity to reduce their costs on diseases, IMMUNIZATION is the most effective health intervention

  7. Mindy Aftab says

    Immunization is directly linked with education. You increase education coverage among the citizens of the country and you will be surprised by the results these immunization derives can accomplish.

  8. Naseem Jalil says

    Thank you world Bank and other development organizations for making the many efforts to protect the people of Pakistan from such dire diseases. What makes me sad is that our own people continue to resist these live-saving efforts! I think we need to come up with mass awareness programs to really make this more effective.

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