Submission ID 131494
| Issue/Objective | Pakistan faces a significant burden of diarrheal diseases, with Shigella identified as one of the leading bacterial causes, especially among young children. The increasing prevalence of antimicrobial resistance further underscores the public health importance of Shigella. As Shigella vaccine candidates progress through late-stage development, evaluating national preparedness for their integration into the routine immunization program is increasingly relevant. |
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| Methodology/Approach | A qualitative exploratory study was conducted to examine stakeholder perspectives on the Shigella disease and vaccine introduction in Pakistan. Data collection involved focus group discussions with parents and caregivers of children with diarrhea, as well as in-depth interviews with key stakeholders, including Expanded Program on Immunization (EPI) officials, policymakers, and healthcare providers at both national and subnational levels. Interviews were conducted in Urdu, audio-recorded with consent, transcribed, translated, and verified for accuracy. Thematic analysis was used to identify key perceptions, facilitators, and challenges related to vaccine introduction. |
| Results | Participants consistently identified diarrheal diseases as a significant child health issue, while Shigella was regarded as an important yet underrecognized pathogen due to limited diagnostic capacity and gaps in routine surveillance. Policymakers noted that robust local evidence on disease burden, antimicrobial resistance, and vaccine impact is essential for informed decision-making. Key considerations included vaccine formulation, dosing schedule, compatibility with existing immunization programs, and potential competition with other vaccines. Caregivers demonstrated cautious acceptance, shaped by perceptions of disease severity, trust in the immunization system, and concerns regarding multiple injections and service accessibility. Stakeholders also cited health system limitations, such as cold chain capacity, human resources, and service delivery in remote areas. The economic sustainability of the EPI program was a major concern, given ongoing reliance on external funding sources, including Gavi. Decision-making was characterized as a multi-layered process involving national data, government commitment, and input from global and national advisory bodies. |
| Discussion/Conclusion | Stakeholders demonstrated awareness of the diarrheal disease burden and expressed conditional interest in a future Shigella vaccine. However, enhanced surveillance, robust evidence generation, community engagement, and long-term financial planning are necessary to support informed decision-making. These findings provide practical insights to inform policy discussions and preparedness for potential Shigella vaccine introduction in Pakistan. |
| Presenters and Affiliations | Naveed Ahmed Aga Khan University Mohammad Tahir Aga Khan University Farah Qamar Aga Khan University |
