Pakistan is the fifth most populous country of the world and an importing one when it comes to immunisation. Punjab, which comprises half the country, is the blue-eyed province with the highest immunisation coverage.

With a population around 119.6 million, it is known for its comparative prosperity and the lowest rate of poverty among all other provinces of Pakistan. As per global statistics, Punjab is South Asia’s most urbanised region with more than 37 percent people residing in urban slums. The Third-Party Verification Immunisation Coverage Survey ‘20 (TPVICS) by Aga Khan University reveals a 10 percent increase in fully immunised children coverage in Punjab (from 80 percent to 90 percent) compared to previous years. However, despite the encouraging figures, there are still challenges related to equitable Immunisation coverage and it is this last 10 percent that becomes the hardest to reach.

A recent threat and an emerging challenge faced by the province is the continuous massive population movement resulting in rapid urban growth in the form of urban slums. Not recognised by public authorities as an integral part of the city (according to UN Habitat), these urban slums have grown significantly over the past years.

A comparative analysis between the sources revealed that Lahore is amongst the five districts of Punjab that contain the highest number of zero dose children in the province. The 2017 census data identifies 100 percent Lahore as an urban area. However, the provincial capital is home to an estimated population of more than 12.5 million people alone and has more than 30 percent of its settlements in urban slums. A deep dive into the issue signals that there are both demand and supply issues that contribute towards low uptake of immunisation services.

To identify and understand the issues, there is a need to identify and empathise with zero-dose children, the most underserved and under-immunised as for most caregivers living in urban slums, vaccination not a priority amongst food, shelter, daily earnings.

The number and locations of slums are not recorded and updated as part of the government system, hence regular micro plans of EPI teams do not include outreach vaccination in slums in a systematic manner. Accessing health sites is also a challenge on the service delivery side due to transportation fees as the EPI centre is too far, requiring the parents, mostly daily wagers, to take a day off work. Flexibility of timings of EPI fixed sites can help resolve this challenge by ensuring EPI centres are open after working hours and at weekends for this population.

Demand-related barriers are emerging in many countries as a major reason for zero dose or under immunised children. There is a growing recognition of the role that demand generation interventions can play in helping countries increase the coverage and equity of immunisation, as well as making progress towards the universal health coverage targets in Sustainable Development Goals.

Engaging with the community cannot be over emphasised to reach the missed children in such high-risk communities. The deployment of Lady Health Workers is also very weak for slum areas hence there is hardly any initiative on demand generation for routine immunisation for slums. By analysing the current reach of social mobilisers, Lady Health Workers, we may understand who is being missed. This is possible by focusing on people, families and communities, their stories and experiences.

Civil society organisations need to be engaged on a more regular basis and ensure that social mobilisation and community engagement activities are tailored to community needs and develop better linkages with communities to understand their cultures; For example, at a time when decision makers are at home; spoken in a local language; using pictures for low literacy populations; engaging with influential individuals at the community level, etc.

In a world where numbers are seen as proof of success, the positive thing with immunisation is that its success is quantifiable and the results are tangible. As we observe World Immunisation Week, we will need to do some serious introspection before we can ensure that all children, including those living in slums, have access to vaccines and that the latter reach them via a reliable and efficient supply system. Therefore, it is a dire need to capitalise on World Immunisation Week (WIW) 2022, and spread awareness about vaccines as one of the best tools to improve health. In the current globalised world, as we have witnessed in the case of COVID-19, an outbreak anywhere is a threat everywhere. Let us collectively work to make those numbers climb. That would mean as many lives of children saved. By addressing the equity gap, Punjab can achieve 100 percent Immunisation coverage. #Vaccines4Life

The writer is a freelance journalist.

Despite the encouraging figures, there are still challenges related to equitable immunisation coverage.