Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
Vaccine. 2013 Jul 18;31(33):3313-9. doi: 10.1016/j.vaccine.2013.05.015. Epub 2013 May 22.
Since its inception in 1978, Pakistan's Expanded Programme on Immunization (EPI) has contributed significantly towards child health and survival in Pakistan. However, the WHO-estimated immunization coverage of 88% for 3 doses of Diptheria-Tetanus-Pertussis vaccine in Pakistan is likely an over-estimate. Many goals, such as polio, measles and neonatal tetanus elimination have not been met. Pakistan reported more cases of poliomyelits in 2011 than any other country globally, threatening the Global Polio Eradication Initiative. Although the number of polio cases decreased to 58 in 2012 through better organized supplementary immunization campaigns, country-wide measles outbreaks with over 15,000 cases and several hundred deaths in 2012-13 underscore sub-optimal EPI performance in delivering routine immunizations. There are striking inequities in immunization coverage between different parts of the country. Barriers to universal immunization coverage include programmatic dysfunction at lower tiers of the program, socioeconomic inequities in access to services, low population demand, poor security, and social resistance to vaccines among population sub-groups. Recent conflicts and large-scale natural disasters have severely stressed the already constrained resources of the national EPI. Immunization programs remain low priority for provincial and many district governments in the country. The recent decision to devolve the national health ministry to the provinces has had immediate adverse consequences. Mitigation strategies aimed at rapidly improving routine immunization coverage should include improving the infrastructure and management capacity for vaccine delivery at district levels and increasing the demand for vaccines at the population level. Accurate vaccine coverage estimates at district/sub-district level and local accountability of district government officials are critical to improving performance and eradicating polio in Pakistan.
自 1978 年成立以来，巴基斯坦扩大免疫规划（EPI）为巴基斯坦儿童健康和生存做出了重大贡献。然而，世界卫生组织（WHO）估计巴基斯坦 3 剂白喉-破伤风-百日咳疫苗的免疫覆盖率为 88%，这可能是高估了。许多目标，如消灭脊髓灰质炎、麻疹和新生儿破伤风，尚未实现。2011 年，巴基斯坦报告的脊髓灰质炎病例数超过全球任何其他国家，威胁到全球消灭脊灰行动。尽管通过更好地组织补充免疫运动，2012 年脊髓灰质炎病例数减少到 58 例，但 2012-13 年全国暴发麻疹疫情，超过 15000 例病例和数百人死亡，突显了常规免疫接种方面的 EPI 表现并不理想。该国不同地区之间的免疫接种覆盖率存在显著不平等。实现普遍免疫覆盖的障碍包括项目在较低层次的运作失调、服务获取方面的社会经济不平等、人口需求低、安全状况差以及人口亚群对接种疫苗的抵制。最近的冲突和大规模自然灾害严重影响了国家 EPI 本已紧张的资源。免疫规划在该国的省级和许多地区政府中仍然是低优先级。最近将国家卫生部下放到各省的决定立即产生了不利影响。旨在迅速提高常规免疫接种覆盖率的缓解策略应包括改善区级疫苗接种的基础设施和管理能力，并增加人口对疫苗的需求。在地区/分区一级准确估计疫苗接种覆盖率和地方政府官员的责任追究对于改善巴基斯坦的表现和消灭脊灰病毒至关重要。
