Objectives: To review the national immunisation programme as a means to providing the government of Pakistan
with strategic options for improving the service; to evaluate the impact of the Eighteenth Amendment to the
Constitution on immunisation services; and to assess the situation regarding the introduction of new vaccines.
Methods: The situation analysis of Expanded Programme on immunisation was conducted from January to May
2011 through a review of available data and literature. The official database and various financial documents of
federal and provincial governments were analysed to estimate the programme costs. Interviews were held with key
informants, including staff of government immunisation services in all provinces and areas, as well as with United
Nations agencies, academics and development partners. Workshops in three provinces were attended by
immunisation staff from government and non-government organisations. Views of all participants were recorded
and used in to the overall review.
Results: The proportion of children who are fully immunised is around 43-62% (depending on the survey and year).
But the proportion of children fully immunised within the national schedule by 12 months of age is more realistically
as low as 40%. This implies that around 60% of Pakistan's infants are not getting immunised, or are getting
immunised late. The cost of introducing any new vaccines will place a huge burden on the resources of Pakistan.
Conclusions: There is an opportunity to save thousands of lives by introducing pneumococcal and rotavirus
vaccines, but it would be unwise to introduce new vaccines into a system that is not working properly. It makes more
sense to invest in correcting the deficiencies in the routine immunisation service before adding the new