Pakistan's COVID-19 fight threatens other vaccine programs

The decision of global health organizations to suspend mass vaccination campaigns amid the coronavirus pandemic could result in a new wave of polio and other highly infectious diseases in Pakistan, health experts have warned.

In an unprecedented move, the Geneva-based Global Polio Eradication Initiative (GPEI) recommended suspending polio vaccination campaigns worldwide to help stop the spread of the new coronavirus. As of Friday, Pakistan registered 25,837 coronavirus infections — one of the highest rates in the region after Iran — with 594 deaths.

However, the decision to suspend the inoculation campaigns was not without its criticism. "I fear the post-coronavirus situation in Pakistan will be worse due to the looming threats of other diseases that have been totally neglected," Qaisar Sajjad, the secretary-general of Pakistan Medical Association, told DW.

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Sajjad stressed that preventive measures such as vaccines are vital in a country with an already overburdened health system and a rapidly growing population. He said that preventative measures would avert a "huge burden" on Pakistan's health sector in the coming months.

Pakistan, along with neighboring Afghanistan, are the only remaining countries found with cases of the polio virus. The disease, which mainly affects children under the age of five, can infect the spinal cord, causing paralysis.

'Two terrible situations'

On March 24 — with the endorsement of WHO Director-General Tedros Adhanom Ghebreyesus and the approval of the Center for Global Health at the US Centers for Disease Control and Prevention (CDC) —  the GPEI called on all countries to postpone mass campaigns to boost immunity to the polio virus up until at least the second half of 2020.

The GPEI is a public-private partnership led by national governments with five partners — the World Health Organization (WHO), Rotary International, CDC, the United Nations Children's Fund (UNICEF), Bill & Melinda Gates Foundation and Gavi, the vaccine alliance.

"We are caught between two terrible situations," said GPEI chief Michel Zaffran of the WHO. "We have no choice … We did not want to have the program be responsible for worsening the situation with COVID-19."

On March 26, WHO's Strategic Advisory Group of Experts on Immunization (SAGE) also recommended all preventive mass vaccination campaigns for other diseases, including measles and yellow fever, to be temporarily put on hold. 

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Zaffran said suspending polio campaigns will enable GPEI to free up its resources and tens of thousands of frontline health workers to aid in the COVID-19 fight, adding that going door-to-door delivering oral polio vaccine would put both communities and health workers at risk of infection with the coronavirus.

Ahsan Ali, an official with the polio eradication program in the southern port city of Karachi, told DW that his vaccination work had not been well received amid the pandemic. "My role has been changed and people are not tolerating us out of fear that we are potential carriers of the coronavirus due to our door-to-door work," he said. Ali warned that it could take months before anti-polio vaccination programs resume in Pakistan.

In response to an enquiry regarding the suspension of vaccine campaigns in Pakistan, GPEI spokesperson Sona Bari told DW: "WHO has noted several times that services such as immunization are suffering from the impacts of COVID-19 on health systems." 

Hundreds of thousands of children at risk

Pakistan's polio numbers already drastically increased last year with 146 reported cases. This year, there have been 47 registered cases to date. Health experts warn that the side effects of the pandemic such as the disruption of regular life-saving immunization services could ultimately put hundreds of thousands of children at risk. 

Zaffran and his expert group had stressed that despite the suspension on vaccination campaigns, routine immunization at clinics and doctor's offices against polio and other vaccine-preventable diseases should continue.

Read more: COVID-19 in Pakistan: Why the government and doctors are at odds

However, an official with the Pakistan Emergency Operations Center for Polio Eradication (EOCPE), who spoke to DW on condition of anonymity, said that more than 40 million children missed routine polio vaccinations in April alone, including other routine vaccinations.

Pakistan has a long history of tackling infectious diseases, including polio, hepatitis and tuberculosis, under severe financial constraints. But Ashfaq Hassan Khan, an economist and adviser for various Pakistani government agencies, is worried that the coronavirus pandemic is pushing the country's already weakened and underfinanced health system over the brink.

"Pakistan is spending less than 1% of its GDP on the health sector, which is quite alarming. Pandemics such as COVID-19, polio and measles require reasonable financial means to handle it properly," Khan said, calling for greater public financing to serve Pakistan's poorer populations.

More than 1.5 million people worldwide die annually from diseases that could easily be prevented by vaccinations, according to figures from the United Nations Children's Fund (UNICEF).