Expanded Programme on Immunization (EPI)
Expanded Programme on Immunization (EPI) was launched in 1974 by WHO to ensure that all children, in all countries, benefited from life-saving vaccines. This programme has evolved into what is now commonly known as the Essential Programme on Immunization.
Today every country in the world has a national immunization programme and vaccines are viewed as one of the safest, most cost-effective, and successful public health interventions to prevent deaths and improve lives.
Since the initial focus on protection against six childhood vaccine-preventable diseases- BCG, diphtheria, pertussis, tetanus, polio, and measles) over four decades ago
There are now 13 vaccines (antigens) recommended by WHO for the EPI programme. They are: Bacillus Calmette-Guérin (BCG), diphtheria, pertussis, tetanus, Haemophilus influenzae type B (Hib), Hepatitis B (HepB), polio, measles, rubella, pneumococcal disease (PNC), rotavirus (Rota), human papillomavirus (HPV), and COVID-19 (for adults).
Committed to its goal of universal access to all relevant vaccines for all at risk, EPI continues to work in synergy with other public health programmes to control infectious diseases and achieve better health for all populations everywhere
In 2024, it will be 50 years since the Expanded Programme on Immunization (EPI) was initiated
Expanded Programme on Immunization in India
Expanded Programme on Immunization, in India was launched in 1978. It was renamed as Universal Immunization Programme in 1985 when its reach was expanded beyond urban areas.
To accelerate the coverage, Mission Indradhanush was envisaged and implemented since 2015 to rapidly increase the full immunization coverage to 90%.
Under UIP, immunization is providing free of cost against 12 vaccine preventable diseases:
Nationally against 9 diseases - Diphtheria, Pertussis, Tetanus, Polio, Measles, Rubella, severe form of Childhood Tuberculosis, Hepatitis B and Meningitis & Pneumonia caused by Hemophilus Influenza type B
Sub-nationally against 3 diseases - Rotavirus diarrhoea, Pneumococcal Pneumonia and Japanese Encephalitis; of which Rotavirus vaccine and Pneumococcal Conjugate vaccine are in process of expansion while JE vaccine is provided only in endemic districts
Progress in immunization
The EPI was introduced as the eradication of smallpox virus was on the horizon, and a need to leverage the then immunisation infrastructure and a trained workforce was recognised to expand the benefit of available vaccines. Following the announcement, nearly every country across the world initiated its national immunisation programme.
Globally, and in India, there has been significant progress in terms of the impact of immunisation and vaccines. While in 1974, there were vaccines to prevent six diseases, five decades later, there are vaccines against 13 diseases which are universally recommended; and vaccines against
17 additional diseases are recommended for a context-specific situation.
There is research in progress to develop vaccines against nearly 125 pathogens — many would prevent diseases prevalent in low- and middle-income countries.
The children with three doses of DPT, a tracer indicator of coverage, has been rising over these years.
In the early 1970s, around 5% of children in low- and middle-income countries had received three doses of DPT, which increased to 84% in 2022 at the global level.
Smallpox has been eradicated, polio eliminated from all but two countries and many vaccine
preventable diseases have nearly disappeared.
In India, the coverage has increased every passing year and in 2019-21, 76% of children received the recommended vaccines.
Since the launch of EPI, studies have shown that vaccines have saved millions of lives and prevented billions of hospital visits and hospitalisations.
Economic analyses have estimated that vaccines are highly cost-effective interventions, with every single dollar (or rupee) of expenditure on vaccination programmes ensuring a seven to 11-fold return.
In nearly all low- and middle-income countries, including India, the immunisation programme
remains a success among all government initiatives, nearly always with far greater coverage than any other health programme.
Moreover, in mixed health systems with both the public and private sector delivering services, immunisation often remains the only health intervention with greater utilisation from the government sector - in India, the share of the private sector in overall health services is nearly two thirds; however, nearly 85% to 90% of all vaccines are delivered from government facilities.
Challenges in immunization
In early 2023, the UNICEF’s ‘The State of the World’s Children’ report revealed a concerning
trend: for the first time in more than a decade, the childhood immunisation coverage had declined in 2021.
In 2022, globally, an estimated 14.3 million children were zero dose (did not receive any recommended vaccine) while another 6.2 million children were partially immunized
However, there are persisting inequities in coverage by geography, socio-economic strata and other parameters, which demand urgent interventions.
Recognition of persisting challenges despite overall progress
It is interesting that when it comes to vaccination, people often (and wrongly) believe that the
vaccines are only for children only - history clearly illustrates that vaccines have always been intended for individuals of all age groups –
first vaccine against smallpox in 1798, vaccines have always been available for individuals of all age groups, including adults,
first anti rabies vaccine, cholera, and typhoid vaccines developed between 1880s to mid 1890s were primarily for adults,
first vaccine ever developed in any part of the world against plague (in 1897) was from India and meant for individuals across all age groups,
BCG vaccine (against tuberculosis) was first introduced in a nationwide campaign in 1951 and was also administered to the adult population,
Influenza vaccines have always been administered to adults and children alike
Steps to be taken –
However, diseases that are preventable with vaccines are increasingly becoming common in the adult population. Therefore, it becomes imperative that government policies now focus on the vaccination of adults and the elderly, as well, as is happening in many countries. For better coverage of adult vaccines, we can learn from the past and five decades of the EPI.
First, there are some initial policy and technical discussions regarding expanding immunisation coverage in additional populations
Second, the NTAGI (National Technical Advisory Group on Immunization) in India, which provides recommendations on the use of vaccines should start providing recommendations on the use of vaccines in adults and the elderly
Third, the prevailing myths and misconceptions about vaccines must be proactively addressed to tackle vaccine hesitancy.
Fourth, various professional associations of doctors — community medicine experts, family physicians and paediatricians should work to increase awareness about vaccines among adults and the elderly.
Fifth, medical colleges and research institutions should generate evidence on the burden of diseases in the adult population in India.
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