HE findings of a landmark study in The Lancer offer a nuanced verdict on half a century of childhood immunisation.

Bet ween 1980 and 2019, global vaccine coverage for key preventable diseases such as measles, polio, diphtheria, tetanus and TB rose sharply, with the number of children who received no vaccines at all -`zero-dose children`falling by 75pc. However, this progress began to stall from 2010 onwards, with coverage plateauing or even declining in many countries. Covid-19 then disrupted health systems, leaving millions of children unprotected and eroding years of hard-won gains. By 2023, the global tally of zero-dose children stood at 15.7m, concentrated in just eight states, including Pakistan. Progress towards the WHO Immunisation Agenda 2030 halving zero-dose numbers and attaining 90pc coverage for `life-course` vaccines is now off track, with forecasts showing that only DTP3 might scrape the 90pc mark, while most countries remain far from halving their zero-dose burden. This means more frequent and deadly outbreaks of preventable diseases, with malnutrition and conflict worsening matters.

The implications for Pakistan are grave. Despite periodic success, our Expanded Programme on Immunisation remains hostage to underfunded primary healthcare, a fragile cold chain and online disinformation. Polio eradication has been delayed year after year because of mistrust and bureaucratic delays.

Unless these problems are fixed, more and more children will keep missing out on essential vaccines. We must no longer delay what needs to be done. To begin with, both the federal and provincial governments must recommit to routine vaccination as a standing public health priority, not a reactive exercise when outbreaks loom. Clear budget lines, realistic targets and transparent progress dashboards will help. Secondly, field workers need reliable pay, security in volatile districts and digital tools to register and follow every child. Most importantly, policymakers should enlist the right influencers to counter vaccine rumours with plain language and credible data trust, not coercion, is of the essence. Finally, equity must guide every initiative. The study shows that the poorest, most remote communities shoulder the heaviest burden of missed doses. Reaching them demands political will and creative logistics, from solar-powered cold boxes to conditional cash transfers for parents. The cost of failure lies not only in preventable deaths, but in squandered human potential. Pakistan and the world cannot afford to waste another decade.