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The long haul: Getting vaccines to all children in Pakistan

© UNICEF Pakistan/2004
UNICEF immunization teams reach children in remote areas of Pakistan

ISLAMABAD, Pakistan, 6 December 2004 – In Pakistan’s remote western province of Balochistan, which borders Iran and Afghanistan, children of Balochi nomads are being immunized against polio during UNICEF’s National Immunization Days (NIDs).  Nomadic families are difficult to reach, but UNICEF immunization teams are dedicated to vaccinating every one of the 33 million Pakistani children under the age of five – no matter where they live. 

Getting vaccinations to children in remote areas is just part of the work UNICEF does to ensure all children are immunized against polio. The vaccines are sent a long way via planes, trucks, cars, bicycles and on foot to reach all of the children in need, and to reach them quickly.

“From the ocean to the Himalayan mountains, from the big cities to the most isolated desert settlement, we have the task of getting everything needed for the NIDs there in the right quantities - and never a day too late,” says UNICEF Pakistan Supply Officer Atif Dar.

The immunization campaigns operate under the slogan, ‘Two drops of polio vaccine, Every Child, Every Time’. In 2004 there have been six National Immunization Days (NIDs), plus additional rounds in January and June.  As a result, the supply deadline for delivery had to be met eight times during the year.

This is procurement on a massive scale. An astonishing 258,000,000 doses of the oral polio vaccine (OPV) have been brought into the country for consignment to the National Institutes of Health, at a cost of US $24.5 million.

Vitamin A capsules have also been administered during the polio campaigns. Twenty-six million children received these capsules along with their vaccination. 


© UNICEF Pakistan/2004
Workers unload UNICEF supplies for an immunization campaign

Getting vaccines to the children on time 

“Such huge quantities of vaccine mean we need to charter a special aircraft,” explains Chief Supply Officer Zahfrul Hannan. “Our vaccine this year has come in from Europe and so may have been on the move for up to 36 hours before reaching Islamabad. In the hold of the plane everything is kept stable, packed in dry ice at optimum temperature - but once the freight is on the ground, keeping the cold chain maintained is crucial if the live oral vaccine’s efficacy is to be preserved.

 “The ideal is for the cartons to be pre-cleared by the customs authorities before arrival, so that there is no delay in on-shipping, even if the plane touches down in the middle of the night.”

Another air journey and then long distance road transport takes the vaccine on to its next destination, a hub city from where trans-shipment to the country’s 120 administrative districts is coordinated. At this point a UNICEF EPI officer (Expanded Programme on Immunization) works alongside the government health officer to monitor movement of the supplies to the ‘tehsil’ (sub-district) level.

Once the cartons are unloaded from the tarpaulin-covered refrigerated truck, many forms of transport come into play, according to the demands of Pakistan’s varied topography, and the resources and ingenuity of the local government-led distribution effort.

On rugged terrain, such as in Balochistan, sturdy jeeps are used by the vaccination team. In the cities a vaccinator can hop on the local bus, take a taxi or a ‘chinchi’, a bicycle rickshaw, to complete his or her allocated round, vaccine carrier casually slung over the shoulder.

Even where there are no marked roads, ways are found to get vaccines to the children. For example, in the high passes in the far north of Pakistan, where flights are often cancelled due to poor weather, the vaccines are distributed on foot. Workers carry the vaccines down narrow mountainside tracks to get to children in the area. Often this means walking rooftop to rooftop to get reach everyone living on the side of precipitious mountain slopes.

Zeba Bukhari is UNICEF’s Chief of Office for Azad Jammu Kashmir, FATA and FANA, possibly Pakistan’s most inaccessible areas. He describes the urgency of vaccine delivery in these areas: “The further distance the vaccine has travelled from the capital, the greater is the effort needed to get it to each individual beneficiary child – and as every hour passes there’s a continual worry whether it’s still at the right temperature.”

The fact that there has been no polio case reported from remote areas in the last few years is a tribute to the perseverance of the vaccination teams against all difficulties. And the concerted national and community effort will soon result in Pakistan being taken off the list of the world’s countries still plagued by polio.




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