Pakistan's Khyber Pakhtunkhwa (KP) province has unveiled an ambitious plan to increase routine immunization coverage for children under two years old to 90% by 2027, a significant 35% jump from the current 55% rate. This target represents a monumental stride towards safeguarding child health and is crucial in a province known as the epicenter of Pakistan's polio challenge. The initiative aims to vaccinate approximately 1.42 million children annually against preventable diseases, including polio, diphtheria, tetanus, mumps, hepatitis B, pertussis, rotavirus, rubella, meningitis, pneumonia, typhoid, and measles. This effort is particularly critical given the security challenges in the province's southern districts bordering Afghanistan, where vaccinators frequently face threats and targeted attacks, leaving large populations vulnerable to diseases like polio. Global vaccination efforts have narrowed the prevalence of the wild poliovirus, which once paralyzed children worldwide, to only Pakistan and Afghanistan. KP is considered the epicenter of Pakistan's ongoing polio crisis, with 11 of the 18 confirmed poliomyelitis cases reported nationwide this year originating from the province. Since 2019, Pakistan has registered a total of 350 polio cases, with 172 of them being children from KP.

The province's Chief Minister, Ali Amin Gandapur, hailed the initiative as a "turning point" in the province's public health efforts during its unveiling last month. He lauded the strategy as a comprehensive approach encompassing digital data registration, community engagement, and field-level monitoring. "Although achieving the targets of the action plan is challenging, it’s not impossible," Gandapur remarked at the inaugural ceremony. "With better teamwork, determination and hard work, those targets could be accomplished." The "team" includes international partners Gavi, UNICEF, and the World Health Organization, whose "generous support and continued collaboration" the Chief Minister applauded.

The Chief Secretary of Khyber Pakhtunkhwa, Shahab Ali Shah, stated, "The initiative outlines an eight-point strategy to ensure no child is left behind, with a special focus on underserved and hard-to-reach areas." Dr. Asghar Khan, Director of the provincial Expanded Programme for Immunization (EPI), further elaborated, "This immunization plan emphasizes improved surveillance, increased vaccine uptake, and community-driven solutions to reach every child." He added, "To ensure effective implementation of the immunization plan, the government will enhance the capacity of vaccination teams and increase the transport budget." In the current fiscal year, the KP government has earmarked 8 billion Pakistani rupees (US$2,826,855) for immunization, including 5 billion Pakistani rupees (US$1,766,780) for vaccine procurement. Dr. Khan further detailed, "Over 1,800 vaccination centers will be fully operationalized, each equipped with trained staff, cold chain facilities, and a steady supply of vaccines."

Regional Perspective

The province of Khyber Pakhtunkhwa demonstrates a strong commitment to tackling chronic health challenges, particularly in its fight against polio. The goal of vaccinating 90% of children under two by 2027, requiring a substantial increase from current immunization rates, is a direct response to the alarming polio situation in the region. The focus on hard-to-reach and conflict-affected areas reflects a deep understanding of local impediments and indicates a proactive approach to addressing the root causes of low immunization coverage. The engagement of community organizations and reliance on frontline health workers, such as Lady Health Workers, enhances the potential for long-term success of this initiative by building trust and fostering community acceptance.

Analysis

Khyber Pakhtunkhwa's plan to boost immunization coverage is a crucial step towards polio eradication and represents a model of ambition in a challenging environment. The government's commitment to allocating significant financial resources, coupled with international support, underscores the seriousness of the efforts. However, success hinges significantly on the ability to overcome ongoing security challenges and reach the most marginalized populations. The "Big Catch-up" strategy, aimed at catching up on missed vaccinations, requires meticulous logistical planning and effective execution. In the long term, the success of this campaign could not only contribute to polio eradication in the province but also improve overall child health outcomes, potentially leading to positive economic and social impacts through reduced disease burden.