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

Living in the heart of Islamabad, across the posh F-7 sector on the fringes of one of the most affluent areas, is 64-year-old RaziaBano. A widow, she is an old resident of this KatchiAbadi living in a make shift house in what can be described as nothing but subhuman conditions. Her son, Ismail, is the only bread earner for a family of five.

Razia has two grandchildren, three-year old Maheen and a year-old Maria. Both, Bano and her daughter-in-law, unaware of the advantages of immunization have never felt the importance to get the two girls vaccinated. “It never dawned on me that it is something important,” is all she has to say.

“When you ask parents if their children have been immunized they respond in the affirmative, saying ‘qatreypilaiey thee’ (oral drops have been administered). Prod some more and ask ‘teekalagahai?’ ( ifthey have been jabbed), the response is in the negative,” says GhulamSummia, 34, Social Mobilizer working for the civil society. “Parents did not know the children had to be taken to health centre for routine immunization and the door-to-door vaccinations are only carried out for anti-polio vaccines.”

Government’s Expanded Programme on Immunization (EPI) offers a set of scheduled inoculations provided free of cost from birth to 15 months to protect all children against 10 vaccine preventable diseases like Tuberculosis, polio, diphtheria, whooping cough, tetanus, hepatitis B, haemophilusinfluenza type B, pneumonia, diarrhoea and measles, and pregnant women from tetanus.

The Pakistan Demographic and Health Survey 2017/18 sheds light on some facts regarding the state of essential vaccination in Pakistan. Although the national immunization coverage of a fully immunized child is 66 per cent, coverage in Islamabad stands at 68 percent.

However, Dr HasanOrooj, Director General Health, Islamabad says, that by addressing the equity gap, in the past one year, Islamabad has been able to achieve 100 percent immunization coverage. “We are doing all we can, to reach the last child and meet the goal of universal immunization coverage, a vision of the government that no child will be left unvaccinated.”

Rapid urban growth, he agrees has resulted in sprawling new settlements in the form of urban slums. These slums are an increasing focus of coverage and equity work as data reveals large numbers of under immunized children living here, says Dr HasanOrooj, Director General, Health, Islamabad. However, the programme, he says had to face many challenges due to dearth of financial and human resources to cater to the needs of current population and target children.

Based on growing urban population in the country, dedicated urban immunization strategies need to be developed for sustainable quality immunization service provision to the urban population in the country.

In this regard, “UNICEF is supporting the Immunization Programme for evidence generation regarding slums communities, providing support regarding integration of immunization services with basic primary health care services in slums of mega cities,” says Dr Hari Krishna Banskota, Chief of Health. The data on profiling, barriers and bottlenecks, has been utilized for preparing immunization plans integrated with basic primary health care services, for targeting these communities during mass vaccination campaign to prevent these high risk communities from vaccine preventable diseases.

“About 20 years ago, there were only 12 slums in Islamabad. Today the number has gone up to 45 slums and 24 underserved areas in Islamabad, faced with both supply and demand issues,” reveals LubnaHashmat, heading a civil society organization in Islamabad. Her organization has been working with UNICEF for profiling the slums.

“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. The deployment of Lady Health Workers is also very weak for slum areas hence there is hardly any initiative on demand generation for routine immunization for slums of Islamabad. “

As the world observes World Immunisation Week, we will need to do some serious introspection before we can ensure that all children, including those in remote, marginalized communities, have access to vaccines and that the latter reach them via a reliable and efficient supply system. The increase in the number of unimmunized or missed children living in these urban slums poses a big challenge.