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Dr. Akram on Reaching Every Child With Vaccines in Pakistan

Meet Dr. D.S. Akram. She’s a Professor of Pediatrics who holds a Master’s in Public Health in Epidemiology, and has remained Chairperson of the Pediatric Department of a renowned medical university in Pakistan. She has also received a national award for her work. Dr Akram is the founder and president of HELP – an NGO based in Karachi, Pakistan that provides primary health care in hard-to-reach areas  and is a member of the Gavi civil society steering committee.

Ahead of the January 27 global funding summit for Gavi, the Vaccine Alliance, I sat down to speak with Dr. Akram about her work and progress on immunizations in Pakistan. 

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How did immunization become a major focus of your life’s work?

Once I realized that so much illness and death among children is due to preventable causes, it was not enough for me to work in a hospital and just see the same problems coming back again and again. I saw these preventable illnesses cause the loss of so many lives that could have been saved, and cause so much emotional and financial trauma for families. I realized that all the treatments I had learned in my studies were not as important, to me, as being able to prevent diseases.

As a medical professional you have chosen to spend much of your career running a community service organization (CSO). Why is that?

If I start from the beginning of my career as a medical professional, my first entry into communities was through immunization. It was something that was needed. It was something that was tangible. It was something people could see. It produced results. For instance, we saw very quickly that diseases like diphtheria and pertussis were decreasing due to increasing immunization. And through immunization, we won the trust of the people we interacted with, which meant that immunization served as an entry into preventive health for many people.

Further, CSOs have the time to develop a close rapport with the communities, whereas the government has limited time and manpower. Government workers may come and go, and therefore lose the trust of  people – but CSOs meet people on multiple occasions. They know what complications to expect and help people to understand vaccines, helping to build more trust for further vaccination and other related care. 

What changes have you seen in Pakistan related to immunizations over the past two decades?

Pakistan’s expanded immunization program started in 1979, and the country did really well up to the early 1990s; immunization coverage rates were very high -- in the 80% range mostly, and even regions that were hard to reach were at 60%. After that, however, immunization rates began to fall due to a variety of challenges: Misinformation about polio expanded into misinformation about vaccines; insecurity increased in many areas; climactic changes brought about flooding, causing internal displacement; and, the large number of refugees from Afghanistan tested government manpower.

Gavi, however, has been a great motivating force for the government, impressing the importance of vaccines to protect children. The government has now widely introduced vaccines that were only available in the private sector for payment, such as pneumococcal and Hepatitis B, free of charge with Gavi assistance. We introduced these new vaccines before our neighboring countries did. So, we have come a long way and Gavi has been instrumental in leading us in the right direction.

What role can CSOs play to expand access to immunization in Pakistan?

A strategic goal for Gavi was to increase demand and improve access to vaccination in inaccessible areas. Gavi has therefore supported the creation of a national CSO platform in Pakistan, and these same CSOs received funding to initiate projects in different parts. By meeting with elders, forming village committees, and suggesting solutions, we have also been helping to produce reports and case studies for Gavi that have been helpful to understand the situation on immunization in various regions.

My CSO applied for, and received, a seat on the Gavi CSO steering committee two years ago. It has been a very rewarding experience, as I have been able to transfer information and motivation to other CSOs in Pakistan.

With support from Gavi, CSOs are therefore making themselves increasingly visible in Pakistan -- the government has started recognizing and calling on CSOs more. For instance, the CSO platform in Pakistan is being consulted and included in budget and strategic planning for the health systems strengthening funding application being made by Pakistan this year. With the support of Gavi and with our increasing numbers, there is an opportunity for CSOs to help reach where the government has been unable to reach with vaccines. This can go a long way in creating sustainability by demand creation and motivation in these areas.