Sir: The state of public health is becoming very serious in Pakistan. The death ratio due to counterfeit medicines is increasing due to lack of basic check and balance system. The primary health necessities, for instance, immunization and polio vaccinations which are the preservers of life are leading to the death of children and patients. As previous day in local hospital in Karachi a number of children lost their precious lives. There should be check in balance in medical department before vaccination. So, the concerns departments should take measures to improve the public health condition. TILYAN ASLAM Turbat, Kech