Expanded Programme on Immunization

Context:

• The year 2024 commemorates 50 years since the launch of the Expanded Programme on Immunization (EPI) by the World Health Organization (WHO) in 1974.

About Expanded Programme on Immunization (EPI):

• Launch: EPI was launched in 1974 to ensure that all children, in all countries, benefited from life-saving vaccines.
• Smallpox Eradication: EPI was introduced as the eradication of smallpox virus was on the horizon.

Global and National Immunization Progress:

• Expanded Vaccine Portfolio: 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.
• Increased Coverage: Significant rise in vaccination coverage rates globally, with DPT3 coverage increasing from 5% in the early 1970s to 84% by 2022.
• India’s Immunization Journey: Launch of EPI in 1978, renamed to Universal Immunization Programm (UIP) in 1985.
• Success of EPI: Smallpox has been eradicated, Polio eliminated from all but two countries and many vaccine preventable diseases have nearly disappeared. 

Impact of EPI:

• Lives Saved: Immunization programs credited with saving millions of lives, preventing billions of hospitalizations, and curbing diseases like smallpox and polio.
• Cost-Effectiveness: Economic analyses show vaccines to be highly cost-effective, with a seven to eleven-fold return on investment for every dollar spent.
• Success of Immunization Program: In nearly all low- and middle-income countries, including India, the immunization programme remains a success among all government initiatives.
• Immunization in Mixed Health Systems: In mixed health systems with both the public and private sector delivering services. Immunization remains the only health intervention with greater utilization from the government sector.
  • In India, the share of the private sector in overall health services is nearly two thirds; Nearly 85% to 90% of all vaccines are delivered from government facilities.

UNICEF’s ‘The State of the World’s Children’ report(2023):

• Childhood Immunization Decline:The childhood immunization coverage had declined in 2021.
  •  In 2022, globally, an estimated 3 million children were zero dose (did not receive any recommended vaccine). 
  • Another 6.2 million children were partially immunized.
• Improving Vaccination Coverage in India: Over the years, the vaccination coverage in India has increased, both nationally and State-wise. 
  • There are persisting inequities in coverage by geography, socio-economic strata and other parameters, which demand urgent interventions.

Background of Vaccine development:

• First Vaccine Development: The first available vaccine was against smallpox in 1798.
• Early Vaccine Development: The first anti rabies vaccine, cholera, and typhoid vaccines developed between 1880s to mid 1890s were primarily for adults.
• India’s First Plague Vaccine: The 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.
• Introduction of BCG Vaccine for Tuberculosis: The BCG vaccine (against tuberculosis) was first introduced in a nationwide campaign in 1951. It was administered to the adult population.
• Influenza Vaccines: Influenza vaccines have been administered to adults and children alike.

Strategies for Adult Immunization:

• Policy Expansion: Expanding immunization coverage in additional populations: The recent announcement on HPV vaccines for teenage girls is a good start.
  • The Indian government needs to consider providing recommended vaccines for a wider section of the adult and elderly population.
• Recommendation Framework: Considering that vaccines are highly cost effective, once recommended by the National Technical Advisory Group on Immunization (NTAGI). 
  • Vaccines for all age groups should be made available as free at the government facilities.
  • NTAGI should start providing recommendations on the use of vaccines in adults and the elderly.
  • Once a vaccine is recommended by the government body, the coverage is likely to be far greater than if the vaccines are not recommended by the government.
• Addressing Vaccine Hesitancy: Prevailing myths and misconceptions about vaccines must be proactively addressed to tackle vaccine hesitancy.
  • The government must consider the help of professional communication agencies to dispel myths (and in a layperson’s language and with the use of social media). 
  • This requires citizens to learn and educate themselves about these vaccines from reliable sources.
• Physician Engagement: Various professional associations of doctors — community medicine experts, family physicians and pediatricians should work to increase awareness about vaccines among adults and the elderly.
  • Physicians treating patients with any disease should use the opportunity to make them aware of vaccines.
• Research and Evidence Generation: Medical colleges and research institutions should generate evidence on the burden of diseases in the adult population in India.

Way Forward:

• Integration and Expansion: The introduction of new vaccines in national programmes contributes to increased coverage of all existing vaccines. 
  • Expanding coverage of vaccines for adults and the elderly may result in improved coverage with childhood vaccines and reduced vaccine inequities.
• Advancing EPI: India’s EPI has made major progress and it is time for another independent national level review of the UIP in India, engaging key partners and international experts.
  • In late 2023, India launched a pilot initiative of adult BCG vaccination as part of efforts to ‘end TB’ from India.
• Enhancing Awareness: The COVID-19 vaccination of the adult population has made the public sensitized to the need for and the benefits of adult vaccination.

Conclusion:

In the 50 years of the EPI, it is time for another expansion of the programme with focus on zero dose children, addressing inequities in vaccine coverage and offering vaccines to adults and the elderly. Make EPI an ‘Essential Program on Immunization’.