Government to Strengthen Immunisation Through the National Immunization Support Project

The Government of Pakistan moved to strengthen the country's routine immunisation system through the National Immunization Support Project (NISP), a major investment in the Expanded Programme on Immunization delivered with support from international partners including the World Bank and Gavi.

Why routine immunisation, not more campaigns

Pakistan runs some of the largest vaccination campaigns in the world — national rounds reaching around 45 million children under five. Yet the districts with the most persistent poliovirus transmission remain the districts with the weakest routine immunisation coverage.

That relationship is causal, not incidental. Campaigns raise population immunity quickly but temporarily; routine immunisation builds durable individual protection through a complete schedule. Where the routine platform is weak, the susceptible child population refills continuously as newborns arrive, and campaigns have to run harder each year just to hold position.

Investing in the routine system is therefore the only route to an exit from permanent campaigning.

What the project addresses

• Cold chain. Equipment, storage and transport, without which a vaccine delivered is not a vaccine that works.
• Health workforce. Vaccinator recruitment, training, supervision and retention, particularly in underserved districts.
• Service reach. Extending outreach to populations that fixed facilities do not serve — remote settlements, mobile families, informal urban settlements.
• Data systems. Electronic immunisation registries that track individual children rather than aggregate counts, so a child who misses a dose can actually be identified and followed up.
• Demand generation. Community engagement so families bring children for the full schedule rather than only accepting what arrives at the door.

The connection to polio

Inactivated polio vaccine (IPV) is delivered through the routine schedule, and has been essential since trivalent oral vaccine was withdrawn worldwide in 2016 following the eradication of wild type 2. Type 2 immunity in Pakistani children now depends on the routine platform functioning.

More broadly, polio eradication cannot be sustained on campaigns alone. A country that interrupts transmission but retains a weak routine system remains permanently vulnerable to reintroduction.

What it means for families

A stronger routine system means fixed vaccination points that are actually open and stocked, staff who are present, and a record of what your child has received. Campaign drops are still necessary — but the EPI card is what shows whether a child is genuinely protected.

Related: low routine immunisation · partners and donors · eradication strategy