Ibrar Hayat, Saqlain Ahmed, Ahmad Ali, Naveed Ahmad,  Saeed Ahmad

Introduction

Vaccination and immunization awareness programs are public health initiatives designed to educate communities, dispel myths, and increase the uptake of vaccines. These programs act as a bridge between health science and public understanding.

These programs improve all the factors required for efficient vaccine delivery to the public, including easy accessibility, improved manufacturing and stock availability, myth dispelling, and enhancement of public awareness regarding vaccines. They also involve counselling sessions and vaccine scheduling to improve the vaccination process.

Vaccination is the physical act of administering a vaccine — a preparation containing weakened, inactivated, or fragmented microorganisms — into the body. Immunization is the biological process that occurs afterward, where the body’s immune system recognizes the vaccine and builds lasting, active resistance against a specific infectious disease.

It act as a road map to eradicate the diseases burden from the society

Objective

Is to determine the coverage rate of child hood and adult vaccination in rural area of lahore city
The majority of citizens of Pakistan live in rural areas about 61.2% so the vaccination awareness program and accessibility of the people and availability of vaccines in BHU must be an assurance to eliminate the disease burden in rural areas .

Fallowing a the vaccines available for child hood and adults in BHU 

For Child Hood 

For Adults

Background

In Pakistan, the Expanded Programme on Immunization (EPI) was initiated in 1978 in collaboration with the World Health Organization (WHO).

Additional vaccines were introduced over time, including:

• Hepatitis B Vaccine in 2002
• Haemophilus influenzae type b (Hib) Vaccine in 2009
• Pneumococcal Vaccine in 2012
• Inactivated Polio Vaccine (IPV) in 2015
• Rotavirus Vaccine in 2017
• Typhoid Conjugate Vaccine (TCV) in Sindh in 2019 and later in Punjab and Islamabad in 2021

The malaria vaccine has been developed and is being used in some developed countries but has not yet been introduced in Pakistan. The Ebola vaccine has also been developed.

WHO Contribution 

WHO have a great contribution through  EPI to eradicate or decrease diseases burden from the Pakistan  

Over 1 million children in Pakistan miss routine vaccines each year. Bridging this gap needs stronger outreach, better service delivery, and improved address. The Expanded Programme on Immunization (EPI)  runs through 9,000 sites with 15,000 vaccinators . WHO and partners have helped immunize over 7 million children and 5.5 million women against maternal and neonatal tetanus. Through the Big Catch-up, 1.4 million children were fully immunized .

A measles outbreak response reached 4.2 million children . To improve access, 808 motorbikes were provided for remote areas, 26 prefabricated EPI centres were set up for 750,000 people and 42 surveillance sites were strengthened for timely outbreak response . These efforts mark strong progress toward equitable and accessible immunization. 

Lady Health workers play a great role to deliver the vaccines at home to children to decrease infractions diseases rate form Pakistan.

Methods

It is a retrospective descriptive cross-sectional study. The study was conducted in rural areas of Lahore district served by three Union Council vaccination centers.

UC Barki
UC Hadyara 

UC Padhana 

These Union councils actively provide immunization services to 30 villages . The Study duration is April 2026 – May 2026 .. The data sources for the study are collected from monthly EPI reports , Vaccination Registers , UC Immunization records and conduct the survey in the villages to cloact  the data of adult vaccination . The Children included in study eligible for routine EPI Vaccination . The mean age of adults is  25.8 years and male is 62% and female 38% both male and female have the same mean age  .

Vaccination rate of children 

The total target population of children aged 12 to 23 months is 336 from the 3 union council centers having mean value 112 . The target population for barki Hadiara,  Padhana are 162 , 87 , 87 respectively. The following table provides coverage rate in ruler areas of Lahore city .

Dropout rate%

The dropout rate for the UC Barki is 21.38 and for UC Hadiara and UC Padhana is 5.81 and 3.57 respectively and the average dropout rate of 30 village  12.38

Coverage rate %

The coverage rate of UC Barki ,UC Hadiara and UC Padhana is 78.62 , 94.18 , 96.42 respectively. The fully vaccinated average coverage rate is 82.14 of three union councils .

Vaccination rate for adults

The survey of 300 individuals in these areas tell us they are not vaccinated yet .

The vaccination for the adults calculated is 6.73%b in 30 villages. That is a very low rate when we compare with the WHO references that have minimum vaccination coverage rate 80% is considered to be good . During the conducting of the survey, we noticed that the following reasons that have commonly tell us the individuals that they faces during the vaccinations.Reason number one is that vaccination is not available in BHUs and RHC in the hospitals, like hepatitis vaccines is available only in the Shabasi hospital and other vaccines like typhoid, malaria, and the tuberculosis vaccines available not in that area. 

We get the information from the vaccinators that take their duties in these areas. And the other major reason that we tell individuals is that the private sector is expensive. It means that privately, the vaccines that are required for the infectious disease are not available. In the public sector, these vaccines are available only in the private sectors like the Chughtai Lab vaccination center there jail road. The other reason for this is that it’s very, very distant from the villages and the people do not have public transport and other resources to get the vaccination from private centers.

The fifth reason is the lack of awareness. It means that people are not aware about the vaccination and immunization processes because these areas have the educational literacy rate is very low in these areas due to the fact that the public educational institutes are very less in these areas and that they are distant from the villages.

Result 

The mean age of the children was 17.5 months (range: 12–23 months). The Expanded Programme on Immunization (EPI) coverage rates by antigen were as follows: Bacillus Calmette–Guérin (BCG) (93.75%), Hepatitis B birth dose (HepB-BD) (13.65%), Bivalent Oral Polio Vaccine zero dose (bOPV-0) (69.64%), and Inactivated Polio Vaccine (IPV) (79.17%). Coverage for the first doses of bOPV/Pentavalent vaccine (Penta-1) was (18.37%). Coverage for the second doses of bOPV/Pentavalent vaccine and Pneumococcal Conjugate Vaccine (PCV-2) was (18.00%). Coverage for the third doses of bOPV/Pentavalent vaccine and Pneumococcal Conjugate Vaccine (PCV-3) was (79.17%). The coverage rates for Rotavirus vaccine dose 1 (Rota-1) and Rotavirus vaccine dose 2 (Rota-2) were (81.44%) and (18.36%), respectively. Coverage for Measles-Rubella vaccine dose 1 (MR-1) was (84.52%), while coverage for Measles vaccine dose 2 (Measles-2) was (18.82%). The overall fully vaccinated child (FVC) coverage rate was (82.14%) 

The average coverage rate of the monthly report of the EPI is 76.48%. That is very down to the WHO reference rate, that is the 80% that is considered to be the good. So initially, the vaccination coverage rate from the BGC is high, but when we move down, the vaccination coverage rate is low, and then at the end, the vaccination coverage rate again increases. 

In the mid of monthly EPI report the coverage rates decreased below 80% due to various reasons The reasons for the decrease in the EPI vaccination coverage rates are as follows. The mothers of the babies claimed that after vaccination, the babies suffered from fever and swelling at the injection site. These reasons were reported by the mothers as the main causes for not continuing the subsequent vaccinations. The injection-site swelling may be associated with improper vaccination techniques, as some vaccinators may not have inserted the needle at the appropriate site or angle. Another reason was the presence of socio-cultural myths and religious issues within the community. In these areas, social myths were common, and some people believed misconceptions regarding vaccination. These factors contributed to the decline in EPI vaccination coverage rates. 

The mean age of the individuals who participated in the research was 25.8 years. The results showed that adult vaccination coverage was very low, with a vaccination rate of only 6.73% in the rural areas. The vaccines mainly available in these areas were Hepatitis B, Tetanus, and COVID-19 vaccines. Other vaccines, such as those for tuberculosis, malaria, and typhoid, were not available in the rural health facilities. This lack of vaccine availability was a major concern, as outbreaks of typhoid and malaria continued to occur over time. The persistence of these diseases may also be associated with poor sanitary conditions and low levels of hygienic practices in the area. 

Discussion

The present study assessed childhood and adult vaccination coverage in rural areas of Lahore district, including UC Barki, UC Hadiara, and UC Padhana. The findings showed that childhood vaccination coverage was moderate, while adult vaccination coverage was very low. The fully vaccinated child coverage rate was 82.14%, which is close to the recommended minimum coverage level; however, some individual vaccine doses showed reduced coverage during the middle stages of the EPI schedule.

A major finding of this study was the decline in vaccination coverage after the initial doses. BCG coverage was high, which indicates that many children received vaccination at birth or during early infancy. However, coverage decreased for some subsequent vaccines. This decline may be due to fear among mothers regarding post-vaccination fever, swelling at the injection site, and pain. These concerns affected the continuation of later vaccine doses.

Another important factor was the presence of misconceptions, social myths, and religious concerns in the community. In rural areas, low literacy levels and limited health education may increase vaccine hesitancy. Some parents may delay or refuse vaccination because they do not fully understand the importance of completing the full immunization schedule.

The study also found that adult vaccination coverage was only 6.73%, which is very low. The main reasons were poor availability of adult vaccines in Basic Health Units and Rural Health Centers, lack of awareness, distance from private vaccination centers, and high cost of vaccines in the private sector. Hepatitis B, tetanus, and COVID-19 vaccines were mainly available, while other vaccines such as typhoid, malaria, and tuberculosis vaccines were not available in rural health facilities.

Poor sanitation and low hygienic practices may also contribute to the continued occurrence of infectious diseases such as typhoid and malaria in these areas. Therefore, vaccination programs should be combined with awareness campaigns, community counselling, improved vaccine supply, and better outreach services.

Overall, the study highlights that rural vaccination coverage can be improved by strengthening EPI services, training vaccinators, increasing the role of Lady Health Workers, ensuring vaccine availability, and educating communities about vaccine safety and benefits.

Conclusion

The study found that childhood vaccination coverage in rural areas of Lahore was moderate, with a fully vaccinated child coverage rate of 82.14%, while adult vaccination coverage was very low at 6.73%. Vaccine hesitancy, misconceptions, limited awareness, and poor availability of vaccines were the main factors affecting vaccination uptake. Strengthening immunization services, improving community awareness, ensuring vaccine availability, and enhancing outreach activities can help increase vaccination coverage and reduce the burden of vaccine-preventable diseases in rural communities.

References

1. Federal Directorate of Immunization, Pakistan. “Immunization Schedule.” Expanded

Programme on Immunization (EPI), Government of Pakistan.

2. World Health Organization (WHO). “Expanded Programme on Immunization Pakistan.”

WHO EMRO.

3. Telemedicine Clinics.
4. Pan American Health Organization (PAHO). “Immunization.” PAHO/WHO