Milestones, achievements, and future direction

Established by WHO in 1974, EPI's primary objective is to establish equal access to life-saving vaccinations for children of all geographic locations and socio-economic status.^1-4 This continually evolving effort has resulted in more children being immunized than at any time in recorded history, and national immunization programs now exist in every country. .^{2, 5, 6}

EPI began with a modest portfolio of vaccinations against six childhood diseases, including diphtheria, tetanus, and pertussis.^{2, 3} Build the foundations of the health system, including governance, service delivery, information systems, vaccine formulations, and financing;^Five The program will be expanded to a total of 13 vaccinations to include older children and adults.^{2, 3}

Over the past 50 years, the field of vaccination has seen many achievements worth celebrating during World Immunization Week, beginning with the remarkable success of the smallpox eradication program, which was most active from 1966 to 1977.^2,6 This success story innovation forms the basis of EPI and represents one of the greatest achievements in the history of immunization.^2,6

The next most successful eradication disease is polio.^2,4 This is partly due to collaboration between the WHO, the US Centers for Disease Control and Prevention (CDC), UNICEF and the Vaccine Alliance, but also due to national responses.² For example, the polio eradication program established in Nigeria has been highly successful, providing information that will help inform a rapid and effective response to future Ebola outbreaks.^Four Thanks to these efforts, polio infections have been reduced by more than 99%.²

In addition to polio, EPI has been demonstrated to have a significant positive impact on other diseases such as hepatitis B and diphtheria.^6,7 In Malaysia, efforts to expand HBV vaccination among school children have resulted in a vaccination rate of 93.7% under EPI.⁷ Similar success has been seen in the distribution of the DTP3 diphtheria vaccine, with coverage increasing from 20% in 1980 to more than 85% in 2010.⁶

One of the main challenges of large-scale immunization programs is the need for continued long-term investment.^Five Previous efforts have suffered from prioritizing coverage expansion over establishing sustainable health systems.^Five This can lead to the diversion of funds and concealment of low coverage in the region, negatively impacting overall program progress.^Five

This can be quantified by the stagnation of coverage in the 1990s, particularly in the African region.^Five More recently, Pakistan's national surveillance system overestimated vaccination rates, missing reports of delays in vaccinating young children.⁸

A further challenge is that the WHO does not set country-specific policies for large-scale vaccination programmes.^Five These governing bodies must establish their own policies and guidelines, which can lead to dissonance in national standards and expectations.^Five

To address this disharmony, efforts have been made over the past decade to establish coordinating bodies such as the National Immunization Technical Advisory Group (NITAG) and interagency coordination committees to improve stakeholder communication and resource allocation. has been carried out continuously.^Five

Image credit: Studio Romantic/Shutterstock.com

The unprecedented nature of the SARS-CoV-2 pandemic required a swift and effective vaccination response coordinated at the global level, with EPI playing a key role. In the face of one of the most challenging global vaccine initiatives in history, EPI helped nearly every country implement vaccinations within just 18 months.⁹

While impressive, such efforts have resulted in significant costs to health systems in many countries and jurisdictions, creating a need for continuous improvement. EPI has set out to do just that by publishing plans and recommendations for the global introduction of COVID-19 vaccination into standard immunization programs with an equity and people-focused approach.⁹

Plans to integrate COVID-19 vaccination into routine immunization, as outlined in a 2022 WHO publication, have the benefit of reducing missed vaccinations and helping to reduce burden on health systems. There is.⁹ These approaches can also pose logistical challenges in outreach to different target groups and supply chain logistics for different vaccines and products.⁹

The past 50 years of EPI operations have proven that flaws in the health care system can undermine the benefits of even the best vaccine. Addressing inequalities in vaccine access and strengthening the foundations of health systems, as seen in the aforementioned decline in vaccination rates in the 1990s, are critical to the continued success of EPI.^Five

At the Immunization and Vaccines-Related Implementation Research Advisory Committee (IVIR-AC) meeting in September 2023, WHO outlined ongoing campaigns and approaches, including measles elimination, HPV vaccination, and modeling-based policy implementation. did.^Ten This continued commitment, combined with the people-first approach outlined in the COVID-19 Integrated Plan for Immunization, will enable EPI to continue its impactful work saving millions of lives around the world. I'm starting to do that.^9,10

The arrival of EPI's 50th anniversary marks a pivotal moment as we reflect on some of the greatest victories in public health and immunization in recorded history. His EPI work over the past few decades has transformed the global landscape of public health, and this upward trend is set to continue.

As discussed in the previous paragraph and demonstrated by the rapid COVID-19 vaccination response, global cooperation and cooperation are essential for equitable and effective vaccine access. Organizations like EPI are expected to continue to play a central role in these efforts for the next 50 years.