Pakistan’s zero-dose children crisis has reached alarming levels, prompting the Pakistan Medical Association (PMA) to issue a national red alert and declare it a public health emergency.

The PMA said Pakistan has 651,000 infants who have not received the first dose of the diphtheria, tetanus and pertussis (DTP1) vaccine. The association warned that the growing immunity gap could trigger major outbreaks of vaccine-preventable diseases.

Zero-dose children are infants who have not received the first dose of the diphtheria-tetanus-pertussis (DTP1) vaccine through routine immunisation programmes.

The association said the current situation has weakened herd immunity and increased the risk of disease transmission across the country.

PMA Secretary-General Dr Abdul Ghafoor Shoro described the figures as evidence of a serious failure in Pakistan’s primary preventive healthcare system.

He said the presence of more than half a million zero-dose children reflected deep structural problems that had weakened the country’s healthcare framework.

According to the latest World Health Organisation (WHO) data for the Eastern Mediterranean Region, five countries account for 90% of all zero-dose children. These countries are Sudan, Yemen, Afghanistan, Pakistan and Somalia.

The PMA noted that Sudan, Yemen and Somalia face conflict or state collapse. It argued that Pakistan’s situation stems mainly from administrative failures and weak governance.

Dr Shoro said it was unacceptable for a country not affected by war to account for 14% of the region’s zero-dose children.

The association blamed the crisis on weak immunisation programmes, administrative negligence, poor governance, inadequate access to remote areas and limited efforts to address vaccine hesitancy.

The PMA also criticised decades of poor planning and a lack of political commitment to routine immunisation.

To address the crisis, the association called for an independent audit of funds allocated to provincial Expanded Programme on Immunisation (EPI) units and health departments. It urged authorities to strengthen financial transparency and hold negligent officials accountable.

The PMA also asked federal and provincial governments to treat routine immunisation as a national priority. It recommended using GIS-based demographic data to identify unvaccinated children, especially in high-risk districts.

The association further called for modern vaccine supply chains, timely payments for health workers, better clinical training and stronger security measures for frontline vaccination teams.