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.

The first vaccine was invented against smallpox in 1798 by Dr Edward Jenner.

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.

According to WHO, Vaccine hesitancy is the delay in acceptance or refusal of vaccines despite the availability of vaccination services.