Expanded Programme on Immunization (EPI)

• Context (TH): The Expanded Programme on Immunization (EPI) has completed 50 years.
• EPI was launched by the World Health Organization (WHO) in 1974.
• India launched the EPI in 1978, and 1985, it was renamed the Universal Immunization Programme (UIP).

EPI: A success story

• From vaccines for the prevention of six diseases in 1974, it now includes universally recommended vaccines against 13 diseases and 17 additional vaccines for context-specific diseases.

• 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, and polio has been eliminated from all except Afghanistan & Pakistan.
• In India, the coverage has increased every passing year, and in 2019-21, 76% of children received the recommended vaccines.
• It is estimated that every dollar (or rupee) spent on vaccination programmes ensures a seven- to eleven-fold return.
• Immunisation often remains the only intervention with greater utilisation from the government sector. For instance, in India, the private sector’s share of overall health services is nearly two-thirds; however, nearly 85% to 90% of all vaccines are delivered from government facilities.

Decline trend and disparieites in immunisation

• According to UNICEF’s ‘The State of the World’s Children’ report (2023), Childhood immunisation coverage declined in 2021.
• In 2022, globally, an estimated 14.3 million children were given zero doses (did not receive any recommended vaccine), while another 6.2 million children were partially immunised.
• Moreover, persisting inequities in coverage by geography, socio-economic strata, and other parameters demand urgent interventions.
• It is often believed that the vaccines are only for children, leading to lower coverage among adults.

Vaccination coverage among adults

• Vaccines have been available to all age groups since the first vaccine against smallpox.
• Vaccines for Rabies, cholera, and typhoid developed between the 1880s-90s were primarily for adults.
• The first vaccine plague (in 1897) was from India and meant for individuals across all age groups.
• The BCG vaccine (against tuberculosis) was first introduced in a nationwide campaign in 1951 and was also administered to the adult population.
• However, the limited supply and scarcity of resources led to vaccination programmes prioritising children, who were most vulnerable.

Suggestions to improve adult vaccine coverage

• Essential Program on Immunization: EPI should be extended to a programme focusing on zero-dose children, addressing inequities in vaccine coverage, and offering vaccines to adults and the elderly. The recent announcement on HPV vaccines for teenage girls is a good start.
• The National Technical Advisory Group on Immunization (NTAGI) should start providing recommendations on the use of vaccines in adults and the elderly.
• Medical colleges and research institutions should generate evidence on the burden of diseases in the adult population in India.
• The prevailing myths and misconceptions must be proactively addressed to tackle vaccine hesitancy.