A Circle of Care from Birth to Immunity

Karachi, Sindh: Muhammad Ismail, 39, beams with joy as he cradles his newborn daughter—his third child, and his first girl—just hours after her birth at Sindh Government Qatar Hospital in western Karachi. The hospital holds a special place in his heart; it’s where he welcomed all three of his children, starting with his firstborn eight years ago, and now, once again, today.

His gentle affection for his daughter is a heartwarming sight, especially as he waits patiently at the birth-dose vaccination centre—one of the hospital’s busiest corners. The day has only just begun, yet his daughter is already the 13th newborn to receive lifesaving vaccines this morning.

“We call them ‘baby’ and ‘baba’,” says Mahjabeen Mazhar, a seasoned vaccinator at the centre. She explains that most newborns haven’t been given names by the time they arrive for their first vaccines. “Each child is special,” she adds with a smile, “and each vaccine is a gift.”

Karachi, Pakistan’s largest city, faces the country’s highest burden of under-immunized children. Sindh Qatar Hospital alone delivers an average of 400 to 500 babies each month and vaccinates even more.

“We also vaccinate babies born in nearby hospitals or brought from home deliveries,” says Mahjabeen. “No vaccine dose should go to waste, and no child should be left behind.” This is a general policy among vaccination sites to ensure vaccines such as the BCG are fully used instead of becoming medical waste. A BCG vial, for example, can vaccinate nearly 15-20 newborns on average.

The surrounding area is home to many mobile and migrant families, often living in poverty, with large households and limited access to reliable healthcare. Many rely on unskilled birth attendants at home and often do not prioritize timely vaccination.

“For many, traditional rituals are seen as enough protection,” Mahjabeen explains. “But if a child misses the birth dose, it is almost impossible to bring them back into the system.”

To close this gap, the birth dose vaccination centre is a mandatory checkpoint before hospital discharge. Every newborn must receive their initial vaccines and a certificate from the centre before leaving. This strategy ensures that critical vaccines are delivered when caregivers are most accessible and motivated: at birth.

Thanks to funding from the King Salman Humanitarian Aid and Relief Centre (KSrelief), UNICEF has established round-the-clock birth dose vaccination sites in selected public hospitals across in four major cities including Karachi. Since the launch in October 2023, the results have been transformative: nine out of ten newborns in participating hospitals receive their vaccines on time, and one in every ten babies vaccinated at these sites are from outside the immediate hospital coverage area, showing that the intervention is helping expand vaccine access.

“The only babies missed are those who are ill,” Mahjabeen adds, “and even then, we work closely with doctors to follow up as soon as the child stabilizes.”

“Bringing children into the coverage loop is only the beginning,” says Dr Kamal Asghar, Health Specialist with UNICEF’s Sindh Field Office. “The bigger challenge is making sure they complete the full schedule.”

UNICEF continues to work with federal and provincial governments to strengthen health systems, improve infrastructure, and support frontline workers. With support from partners like KSrelief, sustainable progress is being made, one child at a time.

As Muhammad Ismail watches his daughter receive her first vaccine, he represents hundreds of families who are now stepping into the circle of care. With continued support and local partnerships, Pakistan is turning a new page in ensuring every child gets a healthy start to life, right from birth.