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

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)