In the current global scenario, COVID-19 shows that deaths from the Coronavirus were skewed towards the elderly and the fragile. The graph going viral on global social media considers children from birth to nine years as least vulnerable and at zero risk of mortality.

Well, this may not be the case in Pakistan and thus it is important that we do not get complacent by this message. A country where 74 out of 1000 children die before their fifth birthday and more than 60 percent deaths in children are caused by infectious diseases – we know our children need better protection to survive.

The key to survival of Pakistani babies is simple and costs nothing. By addressing malnutrition, ensuring exclusive breastfeeding up to at least six months, improving water and sanitation and last but not least, bringing routine immunisation rate up will not only prevent cases of vaccine preventable diseases but bring a dent to the high under five deaths in Pakistani children.

Immunisation is a cost-effective public health intervention which reduces the risk of life by covering children from 0 to 23 months of age. Pakistan’s Expanded Programme on Immunisation (EPI) works on eradication, elimination and reduction in mortality by giving protection against ten vaccine preventable disease in Pakistan.

Completing the schedule from birth to 15 months, children are protected against childhood tuberculosis, Polio, Diphtheria, Pertussis, Tetanus, Diarrhoea, Hepatitis B, Haemophilus Influenza Type B, Pneumonia and Measles. The year 2019 witnessed the introduction of an eleventh – Typhoid – (starting from Sindh) into this list.

According to the last Pakistan Demographic and Health Survey (PDHS) 2017/18, Pakistan’s childhood immunisation coverage rates stand at 66 percent with wide variations and huge disparities among provinces.

For instance, immunisation coverage of Balochistan stands at a dismal 29 percent whereas Punjab, the most populated province that hosts half of the country’s population, stands at 80 percent. The province has shown a significant increase taking the coverage up from 64 percent in 2013/14 to 80 percent in 2017/18.

The notable success of Punjab in increasing immunisation coverage is linked to the highest political commitment and leadership holding the provincial cabinet accountable to priority development indicators. The government not only included routine immunisation among its top priorities in health, but increased its domestic financing.

However, despite this progress, significant challenges and inequities remain. Coverage in the district of Rajanpur remains below 50 percent while many other mega cities in the province are faced with the challenge of covering populations residing in urban slums.

Although the effectiveness of immunisation programmes can be enhanced through human capabilities and commitment, to achieve and maintain the province’s immunisation objectives, we need to take some major steps to reach every child with life-saving vaccines.

The issue at hand is that the budget of the immunisation programme has always been treated as a project related expenditure and as part of development programme allocated for each fiscal year.

Launched in 1978 as the ongoing Public Sector Development Programme, the EPI programme at both the federal and provincial levels is financed through the development budget, which does not ensure timeliness or release and availability of funds according to demand.

As the programme is perpetual, continuing it on development project mode resulted in numerous obstacles in overall operation owing to delayed releases and inadequate allocation of funds for timely procurement of life saving vaccines. This led to intermittent interruptions in the immunisation delivery system.

Moreover, heavy dependence on international donors and fluctuation in donor funding would directly hamper the immunisation programme, which would directly trigger preventable diseases in children with higher child mortality rates.

Pakistan has surpassed Brazil to become the fifth-most populous country on Earth. Immunisation is not a onetime activity but a perpetual process. Countrywide, every year, the programme immunises eight million children under one year and the same number of pregnant women to prevent them from Neonatal Tetanus.

Recognising its perpetual function, it is critical that the government understands the serious risk of running this critical programme on project mode through the development budget.

Therefore, it is important that the province moves financing for immunisation from project mode (PC-1s) to recurrent budgeting. Otherwise the country would face major disruptions in getting its children the vaccines they need.

This year we celebrate the 30th anniversary of the adoption of the Convention on the Rights of the Child (CRC), the most widely endorsed human rights treaty in history. Pakistan was one of the countries that endorsed the CRC within a year of its adaption. As part of the recently developed Universal Immunisation Coverage vision (led by the State Minister of Health), the province has set a target of 90 percent fully immunised children by 2023.

However, the programme will continue to face serious challenges while the immunisation budget remains on the development side, waiting to be included in the fiscal budget every year, thus depriving children from receiving lifesaving vaccines on uninterrupted and sustainable basis.

There may not be a magic wand to overcome the plethora of problems that beset Pakistan’s immunisation, but if Punjab can take the lead, other provinces will follow.