Pakistan’s Immunization Progress Hampered by Pandemic

Despite considerable advancements in routine childhood immunization over the last four decades, Pakistan is still among the eight nations that account for over half of the world’s “zero-dose” children—those who do not receive any vaccinations during their first year.

According to a significant global study released, the COVID-19 pandemic reversed years of consistent progress, leaving millions of children worldwide, and thousands in Pakistan, without vaccinations.

The Global Burden of Disease (GBD) Study 2023, which examined trends from 1980 to 2023 and projected coverage to 2030, revealed that while the number of zero-dose children in Pakistan decreased substantially by 2019, the country remains among the top contributors, along with Nigeria, India, and Ethiopia.

The study indicates that the number of zero-dose children globally decreased by nearly 75% between 1980 and 2019; however, this advancement has since come to a halt. As of 2023, Pakistan was still home to a significant proportion of the 15.7 million zero-dose children worldwide—those who had not even received the first dose of the diphtheria-tetanus-pertussis (DTP1) vaccine.

The COVID-19 pandemic caused a significant setback as Pakistan, like many other countries, faced disruptions to immunization services because of lockdowns, diversion of resources, and misinformation regarding vaccines. Globally, compared to a scenario without COVID-19 disruptions, 15.6 million fewer children received DTP3, 15.6 million missed measles vaccines (MCV1), and 15.9 million missed polio vaccines between 2020 and 2023.

Although Pakistan is recovering, the report points out that coverage has not yet returned to pre-pandemic levels. The Expanded Programme on Immunisation (EPI), which was established in 1974, has saved an estimated 154 million lives globally, the majority of whom are children under five. Despite ongoing governance and logistical obstacles, Pakistan has benefited from EPI and Gavi support, which has improved coverage of vaccinations like DTP3 and Bacillus Calmette–Guérin (BCG).

However, inequalities persist, both across provinces and between urban and rural communities. The study cautions that Pakistan is unlikely to achieve the 2030 target of halving its zero-dose children from 2019 levels unless immediate action is taken.

The Immunisation Agenda 2030 (IA2030), endorsed by the World Health Assembly, aims for 90% coverage of life-course vaccines, including DTP3, pneumococcal conjugate vaccine (PCV3), and the second measles dose (MCV2). The study predicts that, globally, only DTP3 has a plausible chance of meeting this objective, and only under ideal conditions.

Globally, while coverage for older vaccines like BCG and DTP1 almost doubled between 1980 and 2019, gains have stagnated or decreased in recent years. Even high-income countries saw stagnation or declines in uptake for certain vaccines. The COVID-19 pandemic caused the most significant disruption to immunization services in recent memory.

South Asia, which accounted for 12.5% of the world’s zero-dose children in 2023, needs to significantly accelerate its efforts. Although Pakistan has demonstrated some improvement since COVID, it will need to raise its immunization coverage by at least two percentage points per year to meet IA2030 targets—a rate that few countries have historically attained.