By Dr. Masood Joegezi The coverage for the Measles-Containing Vaccine (MCV-I) among children aged 9–12 months reached 84% in 2023, leaving approximately 1,056,000 children unvaccinated. Similarly, the MCV-II coverage for children aged 18 months to 5 years has remained constant in 2023 at 80%. These figures are concerning, especially given the highly contagious nature of measles, with a basic reproduction model for measles (R₀) of 12–18. This means each person with measles can, on average, infect 12–18 others in a susceptible population. Despite the availability of vaccines, measles outbreaks have led to hundreds of preventable child deaths, as reported in print and electronic media. However, Pakistan's Expanded Program on Immunization (EPI) and the Department of Health (DoH) have shown reluctance to maintain a transparent record of measles-related mortality data. This lack of accountability hinders comprehensive policy-making and public health interventions. Vaccine-preventable disease deaths make up almost half of the deaths in children under five years in Pakistan, moreover, malnourished children are especially at risk of severe complications and deaths. Vaccine-preventable disease deaths remain a significant contributor to child mortality, accounting for nearly half of all deaths in children under five in Pakistan. Measles, in particular, is a deadly threat to malnourished children, who are at heightened risk of severe complications. Pneumonia, encephalitis, and croup (laryngotracheobronchitis) are the leading causes of measles-related mortality in children. Has the flood devastation of the year 2022 still shown an impact on the restoration of essential immunization services in the affected areas? However, few research papers have attributed to it. Furthermore, the staggering number of unvaccinated children, 40 million in 2020-raises critical questions about the Government of Pakistan and key stakeholders’ efforts to address these gaps. I am also certain that...

October 31, 2024 Organized by: The Center for Research and Security Studies (CRSS) Introduction The roundtable brought together senior policymakers, opinion leaders, researchers, analysts, and diplomats to discuss the evolving relationship between China, Afghanistan, and Pakistan. Led by Dr. Barnett Rubin, senior research fellow at the Stimson Center, the conversation focused on the strategic opportunities and persistent challenges within this trilateral relationship. The FGD aimed to analyze the trilateral dynamics of China, Pakistan, and Afghanistan in the context of regional stability, economic development, and counter-terrorism cooperation. Participants examined key issues, including China's shifting role in regional peace-building, security concerns linked to the Belt and Road Initiative, and the complex dynamics surrounding Afghanistan-Pakistan relations that require further understanding and engagement for lasting regional stability. Critical Analysis The trilateral relationship among China, Afghanistan, and Pakistan is marked by a combination of factors: economic ambitions, security concerns, and historical tensions. There is a need to explore these challenges and opportunities within the triangular dynamic, underscoring the necessity for regional and strategic alignment, cooperation, and integration. China’s role in particular, transitioning from a stance of non-intervention to one of active engagement, arises out of its pursuit of regional stability in alignment with its economic expansion through the Belt and Road Initiative (BRI). Meanwhile, Afghanistan and Pakistan navigate a historically fraught relationship where unresolved border issues, insurgent threats, and differing visions for governance create recurring friction. Afghanistan’s stability remains a linchpin for regional peace, with both Pakistan and China affected by the ongoing threat of terrorism from within its borders. Yet, the prospects for comprehensive cooperation are hindered by mutual...

By Dr. Masood Joegezi The alarming rise of Diphtheria-Corynebacterium cases in Karachi, which primarily affect the throat, releases toxin (formation of greyish white membrane also called throat distemper) and upper respiratory tract in humans, especially in children. It is a completely preventable disease with a vaccine (PENTA—a combination of antigens against diseases like diphtheria, tetanus, pertussis, hepatitis-B, and Haemophilus influenzae type b), which is administered I/M as the 1st dose given at 6 weeks of age, the 2nd dose at 10 weeks of age, and the 3rd dose at 14 weeks of age. If a child has not received the 1st dose by the age of 1 year, start vaccination as soon as possible according to the 0-1-6 schedule: 2 doses 4 weeks apart, then a 3rd dose 6 months after the 1st dose. Each year Pakistan has been reporting an increasing number of diphtheria cases, which correspond to the vaccination trends in the children despite having Federal & Provincial EPI Directorates and Districts and beyond field staffing, which is responsible for reaching every child during the special drive and delivering routine immunization to the children from the health facilities across the country. There is insecurity and saving skin from accountability in the health officials who are trying to prevent information to the public on the infectious disease outbreak, then things go bad to worse. In case someone in the system gives breaking news, they will face disciplinary action from the high officials, as the majority of the time our electronic and press media gives the news of a disease outbreak in Pakistan. In the beginning of this year 2024, the Ministry of National Health Islamabad conducted a global health security summit to be the most responsible state and shared data and information on infectious diseases with the world; however, insecurity and reservation still exist in the system. There was a huge outbreak of diphtheria in Karachi in October 2024. Regrettably,  health...

As a member of the Board of Governors at the Center for Research and Security Studies (CRSS), I have long been passionate about water security. I anticipated a strong, effective response to the Indian government’s misinterpretation of the need to revisit or renegotiate the Indus Water Treaty, particularly under the pretext of climate change. This narrative threatens peace in South Asia by overshadowing the stability essential for addressing poverty. I am reaching out to you as federal secretaries, given your roles as principal accounting officers for this vital matter, which is a lifeline for Pakistan. On January 25, 2023, India issued a notice requesting modifications to the treaty, followed by another on August 30, 2024, seeking further changes. The second notice stated that no further meetings of the Permanent Indus Commission would occur until both governments engage in renegotiation discussions, effectively pausing the treaty’s three-tiered dispute resolution process. You have the original documents, and it is critical to note that India’s justification revolves around climate change and environmental challenges in the watersheds of the Western and Eastern rivers. The vague, lackluster response from the Ministry of Foreign Affairs on September 19, 2024, suggests that both the Ministry of Water Resources and the Ministry of Foreign Affairs have failed to adequately address the issue. Decisive action could have mitigated the situation earlier. Revisiting the treaty threatens Pakistan’s water security, which is deeply tied to the nation’s energy, food, and economic stability. I firmly believe that DG (India), the Pakistani High Commissioner in New Delhi, and his staff must be aware of the press coverage of the proceedings of the 17th Lok Sabha Standing Committee on Water Resources (2021–22). In Recommendation No. 31 (Para No. 2.39), the committee directed the Government of India with the following words: “There is a need to renegotiate the Treaty to establish...

Pakistan, one of the last two endemic countries for wild polio, is closer than ever before to ending this devastating disease for good. However, many experts say Pakistan is among the countries most vulnerable to the climate crisis. As the world becomes hotter, more frequent and severe heatwaves, intense droughts, and devastating floods, threaten the incredible progress that has been made against polio. Just last year, from May to October 2022, a historic heat wave was followed by heavy monsoon rains and melting Himalayan glaciers, causing the worst floods in Pakistan’s history—almost one-third of the country was under water at its peak. One in seven people in the country were affected by these floods and close to eight million people were displaced, including thousands of polio workers themselves. Critical infrastructure across the country was also damaged, from roads and bridges to health and sanitation systems. Such devastation following floods and storms leads to wastewater overflow, compromising safe drinking water and spreading pathogens like cholera and polio. This increases the risk of people encountering these life-threatening diseases while making it even harder to reach every child with the necessary vaccines to protect them. In response to this climate emergency, the program activated extreme weather contingency plans to resume immunization activities for polio and other vaccine-preventable diseases as soon as possible. This included adjusting campaign schedules and strategies, such as conducting vaccinations at health camps, at transit points, and in settlements for displaced persons. In some cases, this meant wading through deep water to reach children with life-saving vaccines. Despite the extraordinary circumstances, the program managed to reach nearly 32 million children in the country during its August 2022 campaign. Health worker Shahida Saleem sits outside her house in Fatehpur, Rajanpur district during a polio campaign in September 2022. ©...