EXPANDED PROGRAM ON IMMUNIZATION
The year 2024 marks a significant milestone for immunisation programmes, both globally and in India.
It commemorates 50 years since the launch of the Expanded Programme on Immunization (EPI) by the World Health Organization (WHO) in 1974.
The EPI was introduced as the eradication of smallpox virus was on the horizon, and a need to leverage the then immunisation infrastructure and a trained workforce was recognised to expand the benefit of available vaccines.
THE AFTERMATH OF EPI
Following the announcement, nearly every country across the world initiated its national immunisation programme.
WHEN DID INDIA LAUNCH EPI?
India launched the EPI in 1978, which was later renamed as the Universal Immunization Programme (UIP) in 1985.
THE IMPACT OF EPI
Globally, and in India, there has been significant progress in terms of the impact of immunisation and vaccines.
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.
There is research in progress to develop vaccines against nearly 125 pathogens — many would prevent diseases prevalent in low- and middle-income countries.
THE SUCCESS STORY
- The children with three doses of DPT, a tracer indicator of coverage, has been rising over these years.
- 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, polio eliminated from all but two countries and many vaccine preventable diseases have nearly disappeared.
- In India, the coverage has increased every passing year and in 2019-21, 76% of children received the recommended vaccines.
- Since the launch of EPI, studies have shown that vaccines have saved millions of lives and prevented billions of hospital visits and hospitalisations.
- Economic analyses have estimated that vaccines are highly cost-effective interventions, with every single dollar (or rupee) of expenditure on vaccination programmes ensuring a 7 to 11-fold return.
- In nearly all low- and middle-income countries, including India, the immunisation programme remains a success among all government initiatives, nearly always with far greater coverage than any other health programme.
PRIVATE V/S PUBLIC IN IMMUNIZATION
Moreover, in mixed health systems with both the public and private sector delivering services, immunisation often remains the only health intervention with greater utilisation from the government sector.
For instance, in India, the share of the private sector in overall health services is nearly two thirds; however, nearly 85% to 90% of all vaccines are delivered from government facilities.
CHALLENGES
- In early 2023, the UNICEF’s ‘The State of the World’s Children’ report revealed a concerning trend: for the first time in more than a decade, the childhood immunisation coverage had declined in 2021.
- In 2022, globally, an estimated 3 million children were zero dose (did not receive any recommended vaccine) while another 6.2 million children were partially immunised.
- Over the years, the vaccination coverage in India has increased, both nationally and State-wise. However, there are persisting inequities in coverage by geography, socio-economic strata and other parameters, which demand urgent interventions.
- People often (and wrongly) believe that the vaccines are only for children only. The truth is that in nearly 225 years since the availability of the first vaccine against smallpox in 1798, vaccines have always been available for individuals of all age groups, including adults.
- The first anti rabies vaccine, cholera, and typhoid vaccines developed between 1880s to mid 1890s were primarily for adults.
- 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.
- The BCG vaccine (against tuberculosis) was first introduced in a nationwide campaign in 1951 and was also administered to the adult population.
- Influenza vaccines have always been administered to adults and children.
Therefore, it becomes imperative that government policies now focus on the vaccination of adults and the elderly, as well, as is happening in many countries.
WHAT CAN WE DO?
- Expanding immunisation coverage in additional populations.
- The recent announcement on HPV vaccines for teenage girls.
- The National Technical Advisory Group on Immunization (NTAGI) in India, which provides recommendations on the use of vaccines should start providing recommendations on the use of vaccines in adults and the elderly.
- The prevailing myths and misconceptions about vaccines must be proactively addressed to tackle vaccine hesitancy.
- Various professional associations of doctors — community medicine experts, family physicians and paediatricians should work to increase awareness.
- Medical colleges and research institutions should generate evidence on the burden of diseases in the adult population in India.
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