Immunization in Pakistan: Beyond Public Health

We all know that vaccines save lives. Yet their importance extends far beyond public health; vaccination is also one of the most cost-effective economic investments a country can make. A comprehensive analysis drawing on more than two decades of research in Pakistan reinforces this conclusion with remarkable clarity. The findings show that every rupee invested in routine childhood immunization yields substantial economic returns by reducing disease-related healthcare costs, improving educational outcomes, and strengthening long-term labor productivity. Healthier children are more likely to attend school consistently, achieve better cognitive development, and grow into adults capable of contributing productively to the economy.

The economic benefits also extend to households and the broader health system. By preventing avoidable illnesses, vaccination reduces out-of-pocket medical expenses that often push low-income families into debt or poverty. At the macro level, immunization lowers the fiscal burden on public hospitals, frees up scarce healthcare resources, and enhances national economic resilience. In this sense, vaccines function not only as a health intervention but also as a powerful tool for poverty reduction, human capital formation, and inclusive growth.

Despite these clear benefits, Pakistan’s immunization program stands at a critical juncture. As the country moves toward greater financial self-reliance and prepares to assume full responsibility for funding its vaccine programs, the stakes are higher than ever. Experts caution that sustaining and expanding immunization coverage will require more than purchasing vaccines and maintaining cold chains. It demands smarter economic planning, improved targeting of underserved populations, and stronger governance to ensure efficiency and equity.

Strategic investment in immunization delivery systems, data-driven planning, and community engagement will be essential to prevent coverage gaps and protect hard-won gains. Ultimately, treating vaccines as a core economic investment rather than a recurring expense can help Pakistan secure healthier generations, a more productive workforce, and a stronger, more equitable future where no child is left behind.

The Stakes: More Than Just Polio Drops

Pakistan’s immunization journey reflects a complex mix of persistent challenges and measurable achievements. Public attention often centers on the country’s long-running battle against polio, yet this focus can overshadow the far broader routine immunization system that quietly protects millions of children from measles, pneumonia, hepatitis, tetanus, and other life-threatening diseases. This routine system is the true backbone of public health and a critical pillar of long-term socioeconomic stability.

The data reveals dual reality. On one hand, Pakistan remains one of only two countries where wild poliovirus is still endemic, underscoring persistent gaps in coverage and trust. While approximately 84 percent of children receive their initial basic vaccines, only about 69 percent complete the second, crucial dose of the measles vaccine. These gaps are not merely statistical; they translate into real human costs. The measles outbreaks of 2022–23, which affected more than 30,000 children, highlighted how quickly preventable diseases can resurface when immunization coverage falters.

On the other hand, the opportunity cost of inaction is enormous. Global and country-specific evidence consistently shows that childhood immunization delivers exceptional economic returns. In low- and middle-income countries such as Pakistan, every dollar invested in routine immunization generates an estimated sixteen dollars in economic benefits. These gains arise from avoided hospitalizations, reduced pressure on overstretched health systems, and the protection of household incomes when parents are spared the need to miss work to care for sick children.

More importantly, vaccines protect future productivity. Children who avoid severe illness, disability, or cognitive impairment are more likely to attend school regularly, learn effectively, and grow into healthy, economically active adults. Seen through this lens, vaccines are not simply a health expense but a foundational investment in human capital. Preventing a single case of measles complications or polio-related disability can save families and the state from catastrophic, lifelong costs, reinforcing immunization as both a moral imperative and an economic necessity.

By the Numbers: What Research Tells Us About Specific Vaccines

A closer examination of individual vaccines reveals why immunization is repeatedly ranked among the most cost-effective public health interventions available to Pakistan. The economic logic becomes particularly clear when the long-term costs of disease are compared with the relatively modest costs of prevention.

Polio provides the most striking example. While the eradication campaign requires sustained and visible financial commitment, the alternative is far more expensive and socially damaging. Managing recurrent outbreaks, providing rehabilitation, and supporting lifelong care for a single child living with polio-induced paralysis can exceed USD 50,000 over a lifetime. Beyond direct medical costs, there are indirect losses through reduced educational attainment, limited labor market participation, and long-term dependency, all of which impose a heavy burden on families and public resources.

Measles offers a similarly compelling case. Reaching the hardest-to-vaccinate “zero-dose” children often those living in remote, insecure, or marginalized communities costs an estimated USD 27 per child. While this figure may appear high relative to routine service delivery, it is negligible compared to the economic and health costs of a measles outbreak, which includes hospitalization, emergency response expenditures, and productivity losses for caregivers.

Vaccines targeting pneumonia and Haemophilus influenzae type b (Hib), two leading causes of child mortality, are consistently classified as highly cost-effective. By preventing severe infections, these vaccines avert expensive hospital admissions, reduce the need for antibiotics, and save thousands of young lives each year, producing substantial economic and social returns.

Even COVID-19 vaccination demonstrated strong economic value. Despite higher initial prices, prioritizing high-risk populations in Pakistan proved cost-effective by preventing severe disease, reducing mortality, and protecting the health system from collapse. Collectively, these findings reinforce a clear conclusion: targeted investment in vaccines delivers exceptional value for money while safeguarding both public health and economic stability.

Navigating the Post-Donor Era: Evidence Gaps at a Critical Turning Point

Pakistan’s immunization program is approaching a decisive transition. For decades, international partners most notably Gavi have played a central role in co-financing vaccine procurement and system strengthening. By 2028, Pakistan is expected to fully assume financial responsibility for its immunization program, marking a significant test of fiscal sustainability and policy commitment. Recent estimates suggest that maintaining current coverage levels while closing existing gaps could require a 150 percent increase in domestic immunization spending by 2030. In this context, efficient, evidence-based allocation of resources is no longer optional; it is essential.

Despite the growing body of research on vaccine cost-effectiveness, critical knowledge gaps persist. Much of the existing literature focuses narrowly on short-term healthcare savings, such as avoided treatment costs and reduced hospital admissions. Far less is known about the long-term macroeconomic gains associated with a healthier and more cognitively capable population, including impacts on labor productivity, human capital formation, and national economic growth.

Equity considerations are another blind spot. There is limited empirical evidence assessing whether immunization spending delivers comparable economic benefits across provinces, rural and urban areas, or income groups. Without such analysis, it remains unclear whether current investments are reducing disparities or inadvertently reinforcing them.

Evidence gaps are particularly pronounced for newer vaccines targeting adolescents and adults, such as HPV vaccines for cervical cancer prevention or typhoid vaccines in high-burden settings. Similarly, the economic value of innovative delivery mechanisms digital immunization registries, mobile outreach, or drone-based supply chain remains insufficiently documented.

As Pakistan enters this post-donor phase, filling these gaps is vital. Robust economic evidence can guide smarter investments, protect equity, and ensure that the immunization program remains both financially sustainable and socially inclusive in the years ahead.

From External Support to National Stewardship

The evidence sends an unmistakable signal: Pakistan must now reframe immunization as a long-term national investment rather than a time-bound, donor-supported intervention. As external financing declines, the sustainability of the immunization program will depend on the country’s ability to embed vaccines firmly within its core development and fiscal planning frameworks. This shift requires moving beyond short-term coverage targets toward a strategic vision that recognizes immunization as foundational to human capital formation, economic productivity, and social protection.

For government institutions, this means institutionalizing economic evaluation in decision-making. Budget impact and cost–benefit analyses should become mandatory prerequisites for the introduction of new vaccines, ensuring that financial commitments are realistic and aligned with long-term fiscal capacity. Early planning for domestic financing is essential to avoid coverage disruptions during the transition to full self-financing.

The research community also has a critical role to play. Future studies must go beyond aggregate cost-effectiveness to examine equity, efficiency, and sustainability. Understanding how immunization investments affect different population groups and how resources can be allocated more intelligently will help policymakers achieve greater impact without disproportionate increases in spending.

Development partners, meanwhile, can contribute most effectively by strengthening local capacity. Investing in Pakistani expertise in health economics, data analysis, and policy evaluation will enable evidence generation from within the system, reducing reliance on external assessments.

Ultimately, vaccines are not only among the most powerful life-saving interventions, but also among the most reliable economic investments a country can make. Using this evidence wisely will allow Pakistan to secure a healthier, more productive, and more resilient future for generations to come.

Conclusion

This review makes a compelling case that immunization in Pakistan is far more than a public health obligation; it is a strategic economic investment with profound and lasting returns. The accumulated evidence demonstrates that vaccines consistently generate benefits that extend well beyond disease prevention reducing household poverty risks, easing fiscal pressure on the health system, strengthening human capital, and supporting inclusive economic growth. By preventing avoidable illness, disability, and premature death, immunization protects both present livelihoods and future productivity, reinforcing its role as a cornerstone of national development.

Yet the article also highlights a moment of significant vulnerability. As Pakistan transitions toward full domestic financing of its immunization program, maintaining coverage and equity will require deliberate, evidence-informed policy choices. Reliance on short-term, donor-driven models must give way to long-term national stewardship grounded in economic evaluation, fiscal planning, and accountability. Addressing persistent data gaps particularly around equity, long-term macroeconomic impacts, and innovative delivery mechanisms will be essential for spending smarter rather than simply spending more.

Ultimately, the choice facing Pakistan is clear. Treating vaccines as a recurrent expense risks underinvestment and renewed disease outbreaks; treating them as a national investment secures healthier children, a more productive workforce, and greater economic resilience. Anchored in robust evidence and sustained political commitment, immunization can remain one of Pakistan’s most powerful tools for building a healthier, more prosperous, and more equitable future.

Please note that the views expressed in this article are of the author and do not necessarily reflect the views or policies of any organization.

The writer is affiliated with the Department of Epidemiology and Public Health, University of Agriculture, Faisalabad Pakistan and can be reached at Mishagillani786@gmail.com

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