Pakistan's routine immunisation system has bypassed 651,000 infants, prompting the Pakistan Medical Association to declare a National Public Health Emergency. The country now holds the second-highest number of zero-dose children in the World Health Organisation's Eastern Mediterranean Region, trailing only conflict-ridden nations. Main Developments Clinical and epidemiological data from the WHO reveals that Pakistan accounts for 14 percent of all zero-dose children across the Eastern Mediterranean Region. Zero-dose children are defined as those who have never received the first dose of the diphtheria-tetanus-pertussis-containing vaccine (DTP1). The PMA warns that the immunity gap has breached the threshold required for herd immunity. This exposes the entire region to uncontrolled outbreaks of preventable childhood diseases. Read also: Why Pakistan's AI alliance with China shifts global tech power According to WHO regional data, 90 percent of all zero-dose children in the region are concentrated in five countries: Sudan, Yemen, Afghanistan, Pakistan, and Somalia. While Sudan, Yemen, and Somalia face active wars or state collapse, Pakistan's inclusion stems from administrative negligence and governance failure. Background The Expanded Programme on Immunisation (EPI) in Pakistan has been weakened by structural corruption and nepotism in administrative appointments. The PMA points to decades of corrupt practices, administrative neglect, and a lack of political will from successive governments. Critical failures include the inability to establish secure vaccine delivery networks in remote territories and a failure to proactively counter vaccine hesitancy. Frontline health workers face delayed payments, inadequate training, and insufficient security protocols. PMA Secretary-General Dr Abdul Ghafoor Shoro described the situation as a systemic collapse of primary preventive healthcare. He stated that behind the devastating figures lies a deeper, systemic rot that has hollowed out the nation's healthcare framework. Why It Matters For a non-conflict nation to harbor 14 percent of the region's zero-dose children represents an unacceptable failure of governance, according to the PMA. The breach of herd immunity thresholds means the entire population faces increased risk of disease outbreaks. The crisis threatens to reverse decades of progress in reducing childhood mortality. Without immediate intervention, Pakistan could see a large-scale resurgence of preventable deaths among children under five. What's Next The PMA has demanded an immediate audit of all funds allocated to provincial EPI and health departments. This aims to ensure financial transparency, eliminate kickbacks in procurement, and hold negligent administrators accountable. The association calls on provincial and federal leadership to declare routine immunisation a non-negotiable national security priority. It recommends using GIS-mapped demographic data to track and inoculate missing children in high-risk districts. Additional demands include modernising vaccine supply chains to prevent thermal degradation, rectifying delayed payments for health workers, and providing competitive compensation with rigorous clinical training and robust security protocols.