Situation analysis: new vaccine introduction in an under-performing programme — a dilemma for Pakistan

Objectives: to review the national immunisation programme as a means to providing the government of pakistan with strategic options for improving the service; to evaluate the impact of the eighteenth amendment to the constitution on immunisation services; and to assess the situation regarding the introduction of new vaccines. methods: the situation analysis of expanded programme on immunisation was conducted from january to may 2011 through a review of available data and literature. the official database and various financial documents of federal and provincial governments were analysed to estimate the programme costs. interviews were held with key informants, including staff of government immunisation services in all provinces and areas, as well as with united nations agencies, academics and development partners. workshops in three provinces were attended by immunisation staff from government and non-government organisations. views of all participants were recorded and used in to the overall review. results: the proportion of children who are fully immunised is around 43-62% (depending on the survey and year). but the proportion of children fully immunised within the national schedule by 12 months of age is more realistically as low as 40%. this implies that around 60% of pakistan's infants are not getting immunised, or are getting immunised late. the cost of introducing any new vaccines will place a huge burden on the resources of pakistan. conclusions: there is an opportunity to save thousands of lives by introducing pneumococcal and rotavirus vaccines, but it would be unwise to introduce new vaccines into a system that is not working properly. it makes more sense to invest in correcting the deficiencies in the routine immunisation service before adding the new vaccines.