Abdul Wasay Khan  ( Medical Students, Dow Medical College, Dow University of Health Sciences, Karachi. )
Abdul Ghani  ( Medical Students, Dow Medical College, Dow University of Health Sciences, Karachi. )
Laraib Malik  ( Medical Students, Dow Medical College, Dow University of Health Sciences, Karachi. )

Madam, measles, a communicable disease prevented by vaccination, primarily affects children in the developing countries, health inequity being the main reason. Despite assurance of the government in the provision of vaccines, cold chain, and the launching of health promotion and education campaigns,¹ Pakistan has yet again witnessed recurrences of deadly diseases such as polio and measles.
WHO reported upsurge in the case reports and death toll in recent years, 3890 case reports in 2011 compared to 14,687 in 2012, and 64 deaths in 2011 against 306 in 2012. The situation is particularly alarming in Sindh, where the number of cases of measles rose from 1,643 in 2011 to 7,274 in 2012, and deaths mounted from 28 in 2011 to 210 in 2012. So far, 306 cases have been reported in Sindh at the start of 2013.²
During investigations, it was found that 18% of eligible children had received one dose of measles vaccine, 4% had received 2 doses, and an implausibly high 78% of the cases had remained unvaccinated for measles.² All the statistics point towards the inefficient EPI programmes and weak vaccines as the major contributors for resurgence. Apart from incompetent efforts on the part of government, various social and religious stigma attached to vaccination has further aggravated the issue. Rural population considers polio vaccination as a western plot to sterilize Muslims.³ Some claim that measles vaccines cause autism and bowel diseases. Lack of maternal education, health workers\\\' visit and transport facilities are also contributory to the problem.⁴ In poverty-stricken areas, where children are already malnourished and deprived of basic health facilities, flooding in the recent years has contributed as a lethal cause of the endemic.
Instead of making sincere efforts, blame game has started among the higher authorities, who are accusing each other for showing professional irresponsibility. The Sindh Health Minister stated, "District health officers and vaccinators in EPI programmes and Peoples Primary Healthcare Initiative are responsible for the outbreak, although they are accusing each other but they are responsible for this."⁵
Prevention is better than cure. To promise a healthier future for our children, free from infectious diseases, the EPI programme should be expanded, giving equal attention to all communicable diseases. The vaccines offered should be of international standards and be provided to children at their residence. Proper recording of the administration of the vaccine should be made compulsory. General practitioners and religious scholars should create awareness among the masses about the inevitability of immunization and defray the misconceptions.⁶

1. Ministry of Health, Expanded Programme on Immunization 2010. (Online) (Cited 2010 February 5). Available from URL: http://202.83.164.26/wps/portal/Moh/!ut/p/c0/04_SB8K8xLLM9MSSzPy8xBz 9CP0os3h_Nx9_SzcPIwP_MAsDA6MQL3NXtxBvIwNzA_ 2CbEdFAOW90 ZM! /?WCM_GLOBAL_CONTEXT=/wps/wcm/ connect/MohCL/ministry/ho me/sahomegeneral/sageneralright/ a_expanded+program+on+immunization.
2. Maqbool S. Pakistan closes 2012 with sharp rise in cases. The News. Jan 2 2013. (Online) (Cited 2013 January 2). Available from URL: http://www.thenews.com.pk/Todays-News-6-151953-Pakistan-closes-2012-with-sharp-rise-in-cases.
3. Hameed S. Infidel Vaccine: Polio vaccination controversy in Pakistan, 2007. (Online) (Cited 2010 Feb 17). Available from URL: http://sciencereligionnews.blogspot.com/2007/02/infidel-vaccine-poliovaccination.html.
4. Lorenz C, Khalid M. Influencing factors on vaccination uptake in Pakistan. J Pak Med Assoc 2012; 62: 59-61.
5. Ali Z. Measles epidemic: officials play blame game over outbreak. The Express Tribune. Jan 10, 2013. (Online) (Cited 2013 January 10). Available from URL: http://tribune.com.pk/ story/491932/measles-epidemic-officials-play-blame-game-over-outbreak/.
6. Peckham C, Bedford H, Senturia Y, Ades A. National immunization study: factors influencing immunization uptake in childhood. Horsham: Action Research, 1989.