Children Remain at Risk Due to Low Routine Immunisation

Children across Pakistan remain at risk of polio and other vaccine-preventable diseases because routine immunisation coverage is too low — a problem that repeated polio campaigns can mask but cannot solve.

The distinction that matters

Two systems deliver vaccines to Pakistani children, and they do different jobs.

Routine immunisation — the Expanded Programme on Immunization (EPI) — delivers the full childhood schedule at fixed health facilities: polio (both oral and inactivated), measles, pentavalent, pneumococcal, rotavirus, BCG and others, at defined ages. This is what gives a child durable, complete protection.

Polio campaigns deliver two drops of oral polio vaccine to every child under five, door to door, several times a year. This raises population immunity quickly and across a wide area, which is what interrupts transmission.

Campaigns are a supplement. A child who receives campaign drops but never completes the EPI schedule is protected against polio to a degree, and against nothing else at all.

Why weak routine coverage keeps polio alive

Where routine immunisation is weak, the susceptible child population refills continuously. Every newborn enters unprotected, and campaigns have to work harder each round simply to hold position. The districts with Pakistan's most persistent poliovirus transmission — the Quetta block, southern Khyber Pakhtunkhwa, parts of urban Sindh — are also those with the weakest routine coverage. That is not a coincidence.

It also explains a pattern in the case data: children who are paralysed are typically not only missing polio doses but missing the routine schedule entirely, which points to households that the health system has not reached at all rather than to a single missed campaign.

What is being done

• Integrated health camps delivering routine immunisation alongside polio drops, so a single visit does more than one job.
• Cross-referral — polio teams identifying children who are behind on the routine schedule and connecting them to EPI services.
• Strengthening the EPI platform through initiatives such as the National Immunization Support Project — see the immunisation support project.
• Using the polio workforce, one of the largest health delivery networks in the country, to support broader immunisation.

What parents should do

Accept the polio drops every round — and separately, take your child to a health facility for the full routine schedule. They are not alternatives. The EPI card is the record that shows whether your child is actually protected.

Related: polio FAQs · eradication strategy · parental refusals