South Asia increased routine immunization coverage faster between 1990 and 2003 than any other region except Latin America/Caribbean, with an average annual rise of 0.9 percentage points in coverage against measles. Yet with measles immunization coverage of just 67 per cent in 2003, the region will have to step up the pace significantly if it is to meet the target of 90 per cent coverage by 2010.
The Maldives and Sri Lanka have both already achieved the goal and are predicted to sustain their levels of coverage. Coverage in Bhutan has slipped just below 90 per cent in recent years. All the other countries in the region will have to improve substantially if they are to have a chance of reaching the target, with Afghanistan and Pakistan requiring the biggest increases of all.
India's large population, together with its two-thirds immunization coverage, means that it contains over twice as many unimmunized children as any other country: about 7.8 million unprotected against measles.
Afghanistan still has a high under-five mortality rate - 257 child deaths per 1,000 live births, a rate exceeded only by Angola, Niger and Sierra Leone. Immunization of 11.2 million Afghan children between 6 months and 12 years of age - including a major campaign in 2002-2003 - has reduced the number of reported measles cases and has averted an estimated 35,000 measles deaths annually(17).
Despite its ongoing civil conflict, Nepal has achieved a relatively high average annual rate of increase in measles immunization coverage of 1.4 percentage points between 1990 and 2003.
Routine immunization coverage remains low in some areas of the region. In part this is because districts lack planning capacities, funds to conduct outreach and supervision and monitoring systems to track progress. But there are also weaknesses in the wider health systems in the region, with poor basic facilities and low salaries for health staff that give them little incentive to stay in the more remote areas.
In India, the National Rural Health Mission (2005-2010) has been launched to counter declining immunization coverage and reduce the number of disease outbreaks. It seeks to expand the base of current approaches, which focus primarily on polio, and make routine services more equitable. The mission was launched in response to recent outbreaks of measles, pertussis and diphtheria in the northern part of the country.