News Desk
In the paediatric wards of Pakistan’s Karachi, diseases that vaccines have prevented for decades are again taking children’s lives.
At least 144 children died from measles and diphtheria at four major hospitals in the city during the first seven months of 2026, according to hospital data reported in August.
The figure is a stark measure of what happens when children enter a vaccination programme but fail to complete it, or never enter it at all.
The four hospitals recorded 1,915 measles cases and 125 deaths during the period. They also recorded 89 diphtheria cases, with 19 deaths.
The data came from Indus Hospital, Sindh Infectious Diseases Hospital and Research Centre, the National Institute of Child Health and the Sindh Institute of Child Health and Neonatology.
These are not diseases for which medical science lacks an answer. Both measles and diphtheria are vaccine-preventable. Their return in severe form points towards gaps in routine immunisation, incomplete vaccination schedules and weaknesses in reaching children who remain outside the health system.
The Karachi figures represent more than an outbreak statistic. They expose the consequences of an immunisation system that can reach a child once, but does not always keep that child protected.
Dangerous drop after first dose
Pakistan’s vaccination figures reveal the shape of the problem.
The latest UNICEF country data put coverage of the third dose of a diphtheria-tetanus-pertussis-containing vaccine at 86 percent, while coverage for the second measles-containing vaccine dose stands at 83 percent.
Earlier national data cited by UNICEF and Pakistan’s National Commission on the Rights of the Child showed a similar pattern. DTP1 coverage stood at 94 percent, but DTP3 fell to 86 percent.
Measles-containing vaccine coverage declined from 84 percent for the first dose to 80 percent for the second.
The report identified difficulties retaining children in vaccination schedules, cold-chain disruptions, shortages of trained personnel and inadequate community mobilisation among the factors affecting delivery.
That difference between the first and later doses is crucial.
A child who receives an initial vaccine but misses subsequent doses may remain inadequately protected. When enough children occupy that gap, diseases capable of spreading rapidly can find susceptible communities.
Measles is particularly unforgiving because of its extreme transmissibility.
WHO and UNICEF say global measles vaccination coverage remains well below the 95 percent level required to prevent outbreaks.
In 2025, 84 percent of children received the first measles dose and 77 percent received the second, while 57 countries experienced large or disruptive measles outbreaks.
Pakistan’s own experience has demonstrated the same vulnerability.
Karachi exposes the immunity gap
The 144 deaths recorded in Karachi occurred despite the existence of an established national immunisation programme and repeated supplementary vaccination campaigns.
Hospital data show that measles accounted for the overwhelming majority of deaths. Of the 1,915 measles cases recorded at the four hospitals during the first seven months, 125 children died. Diphtheria accounted for another 19 deaths.
Doctors and health officials have pointed to missed vaccination doses and delayed treatment among the factors associated with severe cases.
Officials have also said reported cases declined compared with the previous year, but the continuing deaths recorded by major hospitals demonstrate that transmission and vulnerability remain significant concerns.
The figures also represent only patients who reached the four hospitals included in the reported dataset. They do not provide a complete picture of every child affected across Karachi or Sindh.
That makes the hospital numbers a measure of the visible burden rather than necessarily the entire burden.
Zero-dose children remain a major concern
Pakistan remains among the countries with large numbers of children who receive no routine vaccines.
UNICEF said in March 2026 that Pakistan remained among the top ten countries globally with the highest number of zero-dose children.
The organisation also highlighted social and geographic barriers that can prevent timely vaccination, including practices that keep mothers and newborns indoors after childbirth and consequently delay birth-dose vaccination.
WHO has identified Pakistan as one of the ten countries containing more than half of the world’s nearly 20 million unvaccinated or under-vaccinated children in 2025.
The distinction between zero-dose and partially vaccinated children matters.
A child who has never received a vaccine represents a failure to establish contact with the immunisation system, while a child who receives the first dose but disappears before subsequent doses represents a different weakness: the system established contact but failed to retain it.
Both groups enlarge the pool of children susceptible to vaccine-preventable diseases.
Campaigns cannot replace routine immunisation
Pakistan has repeatedly turned to mass campaigns to close immunity gaps.
In November 2025, the government launched a nationwide measles-rubella campaign targeting 34.6 million children aged six months to 59 months.
UNICEF and WHO reported that more than 17,000 measles cases had been recorded in Pakistan by the time of the campaign, with more than half involving zero-dose children.
The campaign reached millions. WHO later reported that the measles-rubella operation protected 34 million children nationwide, while oral polio vaccine was also administered to 19 million children in 88 high-risk districts.
But large campaigns cannot substitute indefinitely for routine vaccination.
WHO, UNICEF and Gavi explicitly warned in April 2026 that catch-up campaigns are important for closing immunity gaps, but expanding routine immunisation remains the most sustainable way of protecting children and preventing outbreaks.
Their Big Catch-Up initiative had delivered more than 100 million vaccine doses to an estimated 18.3 million children across 36 countries before concluding in March 2026.
The warning is particularly relevant to Pakistan, where children can still disappear between scheduled doses.
The problem is also one of access
Immunisation gaps do not arise from a single cause.
Pakistan has large differences in healthcare access between provinces, districts, rural and urban communities and income groups.
UNICEF says its routine immunisation support specifically targets urban slums, hard-to-reach areas and disadvantaged communities where children are more likely to remain unvaccinated or miss doses.
In January 2026, WHO provided 20 four-wheel-drive vehicles to Pakistan’s Expanded Programme on Immunisation for work in 20 priority districts with high concentrations of zero-dose children.
The distribution covered provinces and territories including Sindh, Punjab, Khyber Pakhtunkhwa, Balochistan, Pakistan-occupied Kashmir and Gilgit-Baltistan.
The deployment itself reflects the geographic challenge facing the programme.
In some communities, the difficulty is reaching a vaccination point. In others, it is returning for a later dose. Elsewhere, misinformation, distrust, inadequate counselling or a shortage of trained personnel can interfere with uptake.
The result is the same: children remain vulnerable despite vaccines being available.
The health system carries part of the burden
The responsibility does not end with parents.
Every interaction between a child and the healthcare system represents an opportunity to identify missed vaccines. Yet children presenting at hospitals or clinics may be treated for an immediate illness without their wider immunisation status being addressed.
The consequences become especially serious when vaccine-preventable diseases are diagnosed only after severe symptoms develop.
Diphtheria, for example, can cause respiratory obstruction, heart complications and neurological problems. Measles can produce pneumonia, encephalitis and other severe complications, particularly among malnourished or otherwise vulnerable children.
Once a child reaches that stage, the public health system is dealing with the consequences of an earlier protection gap.
Pakistan’s immunisation infrastructure faces a retention problem as much as an access problem.
The cost is measured in preventable deaths
The scale of the national immunisation challenge has to be viewed alongside what vaccines have already prevented.
WHO reported in April 2026 that Pakistan had protected more than 160 million children and 130 million mothers with life-saving vaccines over five decades of the Expanded Programme on Immunisation.
The organisation estimated that vaccination had averted 2.6 million child deaths from preventable diseases in Pakistan.
That record makes the continuing mortality from measles and diphtheria particularly stark.
A vaccine-preventable death is rarely the result of a single missed appointment.
It can emerge from a chain of failures: a child never registered, a vaccination session missed, a subsequent dose forgotten, a health worker unable to reach a neighbourhood, a vaccine stock problem, misinformation, delayed recognition of symptoms or late referral.
The longer that chain remains unbroken, the greater the possibility that a preventable infection will become fatal.
Karachi is a warning written in numbers
The 144 deaths reported in Karachi during the first seven months of 2026 provide a concrete measure of that failure.
They show that national vaccination programmes can coexist with significant pockets of vulnerability. They show that reported declines in cases do not necessarily translate into adequate protection for every community. And they demonstrate how quickly immunity gaps can become hospital burdens when highly contagious diseases circulate among under-vaccinated children.
Pakistan’s immunisation challenge is not simply about whether vaccines exist. It is about whether children receive the right doses at the right time and remain connected to the system until their schedules are completed.
The continuing deaths from measles and diphtheria suggest that too many children are falling through that gap.
