At least 16 children under the age of five who have never been vaccinated have been identified in the Kathmandu Metropolitan City area.

Health workers deployed from the health division of the metropolis informed that they have identified 678 other children who have not completed their routine vaccine doses.

“Hundreds of children who have not taken even a single dose of vaccine have been identified across the country,” said Abhiyan Gautam, chief of the Immunisation Section at the Family Welfare Division under the Department of Health Services. “Health workers deployed in the ‘search and innoculate’ programme have found thousands of other children who have not completed all vaccine doses.”

Of late, Nepal has been witnessing a massive outbreak of measles. At least one death and more than 1,000 cases of measles have been reported in 16 districts, including Kathmandu since the start of 2023, the deadline set by authorities to eliminate the disease from the country. Of the 560 people (mostly students) residing in a hostel at ward 9 of Gokarneshwar Municipality run by a Buddhist school, none was found to have taken any of the routine vaccines.

The list of children who were never vaccinated or partially vaccinated in other local units is long, according to the officials. At least four percent of the children aged 12 to 23 months have received no vaccination, according to the Nepal Demographic and Health Survey-2022 carried out by the Ministry of Health and Population.

This figure was just one percent in 2016. The rapid surge in the number of unvaccinated children poses a serious threat to the country’s achievements over the years in immunisation through huge investments, warn child health experts.

They say a sudden spike in the number of unvaccinated children poses a serious risk for an outbreak of vaccine-preventable diseases.

“A massive outbreak of measles, which is vaccine preventable, is not a good sign,” said Dr Senendra Raj Upreti, former secretary for the Ministry of Health and Population. “Childhood vaccination is a priority programme in which the government has for years been investing huge amounts. This should be fixed at the earliest.”

A low vaccination coverage, floating population, lack of public awareness about the importance of vaccines and apathy of the government agencies concerned to plug the loopholes are some reasons behind regular outbreaks of measles in different parts of the country.

Doctors say people of all age groups are vulnerable. Underage children, pregnant women, elderly and those with weak immunity such as HIV-infected people are highly susceptible to measles.

Nepal had committed to eliminating measles by 2023 after missing the earlier deadline of 2019. To declare measles as eliminated, the number of cases should be less than five per 1,000,000 people throughout the year.

The Ministry of Health and Population has now extended the deadline for measles elimination to 2026.

The government provides 13 types of vaccines through the national immunisation programme. Earlier, only 11 antigens were included in the programme. Later, the Ministry of Health and Population added rotavirus and typhoid vaccines to the regular immunisation list. There are more than 16,000 immunisation clinics across the country.

Compared to far-flung villages in the remote districts, big cities like Kathmandu and Lalitpur, and emerging cities are more challenging in terms of implementing the health programmes, according to officials.

Experts say the federal system of governance under which there are three tiers of government—federal, provincial and local—could have created confusion and negatively impacted child vaccination.

“Earlier, there was a separate central body to promote vaccination, but now this duty has been delegated to various bodies under provincial and local governments,” said Dr Jhalak Gautam, an immunisation expert. “All stakeholder agencies should fulfil their responsibilities.”

Immunisation is the most cost-effective and efficient way to control and eliminate vaccine-preventable diseases that contribute to childhood illnesses and deaths, experts say.

Meanwhile, the World Health Organization, on Monday, called for focused efforts to provide life-saving childhood vaccines to the unvaccinated.

“The number of unvaccinated children more than doubled from 2 million in 2019 to 4.6 million in 2021 in the South-East Asia region despite efforts by countries to maintain or restore routine childhood immunisation. We need to urgently address the gaps and challenges aggravated by the Covid pandemic,” said Dr Poonam Khetrapal Singh, regional director, WHO, South-East Asia.

“We need to accurately identify high-risk areas with high numbers of zero-dose children, and rapidly improve access and uptake of routine immunisation.”

The WHO official was addressing representatives of the Ministry of Health, national immunisation advisory groups and partner agencies participating in a four-day regional workshop to strengthen routine immunisation capacities, post Covid.

“The catch-up immunisation activities and special campaigns being rolled out by countries must be reviewed and measures like increasing the age limit of target populations adopted, where needed, for filling the immunity gaps,” said a statement issued by the UN health agency.