Source: Hindu
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Context
- The 50th anniversary of the Expanded Programme on Immunization (EPI) prompts reflection and a call for expansion, transforming it into an Essential Programme on Immunisation.
Details
About EPI
Evolution of the EPI:
- Initiated by the WHO in May 1974 to extend vaccine access globally, the EPI laid the foundation for national immunisation programmes.
- Over the past five decades, there has been remarkable progress in immunisation globally, with significant impact seen in both developed and developing countries.
- In 1974, vaccines were available for six diseases, but today, there are vaccines against 13 universally recommended diseases and 17 additional diseases for specific contexts.
- Ongoing research aims to develop vaccines against nearly 125 pathogens, particularly targeting diseases prevalent in low- and middle-income countries.
- Successes include the eradication of smallpox, near elimination of polio, and significant reduction in vaccine-preventable diseases.
Evolution and Standardization:
- In 1984, the WHO established a standardized vaccination schedule for EPI vaccines, including BCG, DTP, oral polio, and measles.
- Over time, new vaccines such as Hepatitis B (HepB), yellow fever, and Haemophilus influenzae meningitis (Hib) conjugate vaccine were added to the list.
Role of GAVI:
- The Global Alliance for Vaccines and Immunization (GAVI) was created in 1999 with the aim of extending the reach of EPI vaccines, especially in the poorest countries.
- GAVI brought together various stakeholders, including UN agencies, public health institutes, donor organizations, and NGOs, to improve child health through immunization.
Goals of EPI:
- Ensure full immunization of children under one year of age in every district.
- Globally eradicate poliomyelitis.
- Reduce maternal and neonatal tetanus incidence.
- Cut measles-related deaths by half.
- Extend new vaccines and health interventions to children worldwide.
Implementation Strategies:
- National governments implement vaccination policies based on EPI guidelines.
- Implementation involves establishing a reliable cold chain system, vaccine delivery, training health workers, public education, and documentation.
Vaccination Strategies:
- Fixed vaccination sites in healthcare facilities.
- Mobile vaccination teams for remote areas.
- Pulse immunization campaigns in under-developed countries.
- Door-to-door canvassing in poor urban communities.
- National-level mass vaccination campaigns.
Monitoring and Evaluation:
- Monitoring through administrative data from clinics and community-based surveys.
- Community-based surveys validate reported vaccine coverage and estimate coverage within 10% accuracy.
- Questionnaires and home-based records help identify missed immunizations and improve delivery systems.
Results:
- EPI has significantly increased vaccination coverage, reaching 79%.
- Expansion of vaccines has led to a decrease in diseases like measles and polio.
- Measles deaths decreased by 60% worldwide between 1999 and 2005.
Successes of Immunisation Programs
Rising Coverage of Three Doses of DPT:
- The coverage of children receiving three doses of Diphtheria-Pertussis-Tetanus (DPT) vaccine, a key indicator of immunisation coverage, has shown a remarkable increase over the years.
- In the early 1970s, only around 5% of children in low- and middle-income countries had received three doses of DPT. By 2022, this figure had risen to an impressive 84% globally.
Eradication and Elimination of Diseases:
- The success of immunisation programs is evident in the eradication of smallpox and the near elimination of polio from all but two countries.
- Many vaccine-preventable diseases have significantly decreased, contributing to improved public health outcomes globally.
Improving Coverage in India:
- India launched its Expanded Programme on Immunization (EPI) in 1978, subsequently renamed as the Universal Immunization Programme (UIP) in 1985.
- This year marks two decades since India's last nationwide independent field evaluation of the UIP, conducted in collaboration with international experts.
- India has witnessed a steady increase in immunisation coverage over the years, with each passing year seeing improvements.
- In the period of 2019-2021, 76% of children in India received the recommended vaccines, indicating progress in reaching vaccination targets.
Impact on Lives and Healthcare System:
Saving Lives and Preventing Hospitalisations:
- Studies since the launch of the Expanded Programme on Immunisation (EPI) have demonstrated the life-saving impact of vaccines, with millions of lives saved and billions of hospital visits and hospitalisations prevented.
- Economic analyses have highlighted the highly cost-effective nature of vaccination programmes, with significant returns on investment.
Success of Immunisation Programs in Low- and Middle-Income Countries:
- Immunisation programs have emerged as a success story among government initiatives in low- and middle-income countries, including India.
- These programs often achieve far greater coverage compared to other health interventions, with immunisation being a key focus area for government healthcare delivery.
- In countries like India, where both public and private sectors deliver healthcare services, immunisation remains predominantly a government-led initiative, with government facilities accounting for the majority of vaccine delivery.
- Experts view immunisation coverage as a tracer indicator of the highest coverage possible for any government intervention in a given setting, underscoring its importance in public health.
Challenges and Shift in Focus
Decline in Childhood Immunisation Coverage:
- The UNICEF's 'The State of the World's Children' report in early 2023 revealed a concerning trend: for the first time in over a decade, childhood immunisation coverage declined in 2021.
- Globally in 2022, an estimated 14.3 million children were zero dose (received no recommended vaccine), with an additional 6.2 million partially immunised children.
Persisting Inequities and Misconceptions:
- Despite increasing vaccination coverage in India both nationally and at the state level, there are persistent inequities based on geography, socio-economic strata, and other parameters, necessitating urgent interventions.
- Misconceptions about vaccines contribute to vaccine hesitancy, highlighting the need for proactive efforts to address myths and misinformation.
Shift from Childhood to Life Course Immunisation:
- Vaccination perceptions historically focused on children, but vaccines have always been available for all age groups.
- Diseases preventable by vaccines are increasingly affecting the adult population, emphasizing the importance of adult vaccination.
Strategies for Expansion
Expanding Immunisation Coverage:
- Policy discussions are underway to expand immunisation coverage beyond children, including recent announcements on HPV vaccines for teenage girls.
- Recommended vaccines for adults and the elderly should be made available free of cost at government facilities to improve coverage.
Role of NTAGI:
- The National Technical Advisory Group on Immunization (NTAGI) in India should provide recommendations for vaccines in adults and the elderly, boosting coverage and public confidence.
Addressing Vaccine Hesitancy:
- Proactive measures, including leveraging professional communication agencies and social media, are essential to dispel myths and educate citizens about vaccines.
Physician Engagement:
- Medical associations and professionals should increase awareness about vaccines among adults and the elderly, utilizing patient interactions to promote vaccination.
Research and Evidence Generation:
- Medical colleges and research institutions should generate evidence on the burden of diseases in the adult population to inform vaccination strategies.
Must read articles:
Mission Indradhanush
Universal Immunisation Programme
Sources:
Hindu
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PRACTICE QUESTION
Q. The 50th anniversary of the Expanded Program on Immunization presents an ideal opportunity to make it an 'Essential Program on Immunization'. Critically analyse. (250 words)
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