Intended for healthcare professionals


Measles epidemic exposes inadequate vaccination coverage in Pakistan

BMJ 2013; 346 doi: (Published 14 January 2013) Cite this as: BMJ 2013;346:f245
  1. Abdul Nafey Kazi
  1. 1Karachi

The sudden rise of measles in the province of Sindh, Pakistan, has further exposed the inadequacy of the expanded programme of immunisation in the country, which has already been demonstrated by the persistence of poliomyelitis.

With several thousand reported cases of measles and a death toll of at least 210 in 2012 compared with 28 deaths in 2011, the health authorities in Sindh have been unsuccessful in curbing this epidemic, which has surged since October 2012. Cases of the disease rose from 4000 in 2011 to 14 000 in 2012. On 10 January, 218 new cases were reported.

Health authorities have cited massive flooding and continuous rains over the past five years as the chief reason for the epidemic because health workers could not access remote areas to administer the vaccine. Several child health experts have also suggested that malnutrition could have complicated the matter further.

However, non-governmental organisations and public health experts have blamed the weak immunisation programme as the main cause of this outbreak.

Dr Abdul Momin Kazi of the Aga Khan University stated: “The vaccination coverage of EPI [the expanded programme of immunisation] is far from complete. Religious scholars should be encouraged to create awareness regarding the necessity of immunisation.

“Furthermore, a stringent use of technology, for instance through an SMS based intervention, can be used to expedite the process.”

This is not the first time that the health authorities in Pakistan have come under great criticism for the lack of coverage of immunisation of children. Last year witnessed an increase in the number of polio cases reported from Pakistan as well as assassinations of several vaccination workers. More than 55% of the population of Pakistan live in rural areas, and non-official figures state that EPI coverage is less than 70%.

Health authorities have declared an emergency in all parts of Sindh.


Cite this as: BMJ 2013;346:f245

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