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Expanded Program on Immunization
open-in-new
<h2 id="introduction">Introduction</h2> <p>Vaccination has been one of the most impactful public health interventions of the past century. Since the foundation of the Expanded Programme on Immunization (EPI) by the World Health Organization (WHO) in 1974, vaccines have provided the single greatest contribution to improving health outcomes globally, particularly among children and infants. Widespread immunization has substantially reduced the morbidity and mortality rates from diseases such as <a href="/facts/Tuberculosis/ggPyovAl">tuberculosis</a>, <a href="/facts/Polio/6dYyXUhE">poliomyelitis</a>, <a href="/facts/Measles/tepQCUIG">measles</a>, <a href="/facts/Diphtheria/IKFXNjAV">diphtheria</a>, <a href="/facts/Tetanus/1vukLxUU">tetanus</a>, <a href="/facts/Whooping_cough/LyrTdSeh">pertussis</a>, <a href="/facts/Hepatitis_B/qqPTEY3p">hepatitis B</a>, <a href="/facts/Yellow_fever/feT3DIKu">yellow fever</a>, <a href="/facts/Meningitis/4m4STzJB">meningitis A</a> and many others. Recent innovations have expanded the impact of vaccines in addressing not only childhood diseases but also adult and emerging diseases, such as COVID-19. </p> <h2 id="history">History</h2> <h3>Milestones in Global vaccination</h3> <table><tbody><tr><th>Year</th><th>Milestone</th><th>Description</th></tr><tr><td>1974</td><td>EPI launch</td><td>WHO established EPI in 1974 to protect children worldwide against diseases such as smallpox, measles, poliomyelitis, tuberculosis, diphtheria, tetanus, and pertussis by 1990.<a class="footnote-ref" id="fnref:2" href="#fn:2"><sup>2</sup></a></td></tr><tr><td>1979</td><td>PAHO revolving fund</td><td>The Pan American Health Organization launched a fund to facilitate vaccine procurement<a class="footnote-ref" id="fnref:3" href="#fn:3"><sup>3</sup></a></td></tr><tr><td>1982</td><td>UNICEF child survival and development revolution</td><td>UNICEF launched GOBI strategy which focused on growth monitoring, oral rehydration therapy, breastfeeding, and immunization<a class="footnote-ref" id="fnref:4" href="#fn:4"><sup>4</sup></a></td></tr><tr><td>1984</td><td>EPI’s First standardized schedule</td><td>vaccination schedule was revised to include BCG, DTP, polio, and measles at specified ages <a class="footnote-ref" id="fnref:5" href="#fn:5"><sup>5</sup></a></td></tr><tr><td>1990</td><td>Declaration of Manhattan, Children’s Vaccine Initiative</td><td>This Initiative aimed to accelerate vaccines development to enhance EPI performance<a class="footnote-ref" id="fnref:6" href="#fn:6"><sup>6</sup></a></td></tr><tr><td>1999</td><td>Strategic Advisory Group of Experts (SAGE) on immunization</td><td>SAGE was established to advise WHO on global immunization policies, strategies, and research <a class="footnote-ref" id="fnref:7" href="#fn:7"><sup>7</sup></a></td></tr><tr><td>2000</td><td>Gavi, The Vaccine Alliance</td><td>Was established to address market failure in certain countries and increase access to vaccines <a class="footnote-ref" id="fnref:8" href="#fn:8"><sup>8</sup></a></td></tr><tr><td>2000-present</td><td>Ongoing Acceleration of New Vaccine Introduction</td><td>Included initiatives like pneumococcal conjugate vaccines (PCV), rotavirus vaccines, and meningococcal A conjugate vaccine, malaria vaccine to expedite introduction <a class="footnote-ref" id="fnref:9" href="#fn:9"><sup>9</sup></a> <a class="footnote-ref" id="fnref:10" href="#fn:10"><sup>10</sup></a><a class="footnote-ref" id="fnref:11" href="#fn:11"><sup>11</sup></a><a class="footnote-ref" id="fnref:12" href="#fn:12"><sup>12</sup></a></td></tr><tr><td>2017</td><td>Coalition for Epidemic Preparedness Innovations (CEPI)</td><td>CEPI was launched to as a response to Ebola, Zika, and SARS outbreaks to develop vaccines for emerging infectious diseases</td></tr><tr><td>2020</td><td>Immunization Agenda 2030 (IA2030)</td><td>IA2030 was setup to ensure universal access to vaccines, strengthen health care systems, and support universal health coverage.</td></tr><tr><td>2020-2023</td><td>COVID-19 Vaccines Global Access (COVAX)</td><td>Was established to accelerate the development, production, and equitable distribution of COVID-19 vaccines <a class="footnote-ref" id="fnref:13" href="#fn:13"><sup>13</sup></a></td></tr><tr><td>2023-2024</td><td>The Big Catch-Up</td><td>This Initiative focuses on restoring immunization coverage to pre-COVID-19 levels and strengthen routine immunization systems to achieve 2030 targets<a class="footnote-ref" id="fnref:14" href="#fn:14"><sup>14</sup></a></td></tr><tr><td>2024</td><td>EPI Expansion</td><td>EPI is expanded to cover vaccines against 13 global and 17 context-specific vaccine-preventable diseases <a class="footnote-ref" id="fnref:15" href="#fn:15"><sup>15</sup></a></td></tr></tbody></table> <h2 id="impact-of-vaccination-on-global-health">Impact of vaccination on global Health</h2> <p>Since the establishment of EPI in1974, vaccination has prevented 154 million deaths, among which 146 million are in children younger than 5 years of whom 101 million are in infants younger than 1 year. Measles vaccination is the single greatest contributor of lives saved by vaccination, preventing 93.7 million deaths out of total 154 million deaths prevented by vaccination globally. The vaccination has contributed for 40% of the decline in global infant mortality, 52% in the African region. In 2024, a child younger than 10 years is 40% more likely to survive to their next birthday relative to a hypothetical scenario of no vaccination. Increased survival probability is observed into adulthood as well, individuals aged 25 years are 35% more likely, and those aged 50 years are 16% more likely to survive to their next birthday <a class="footnote-ref" id="fnref:16" href="#fn:16"><sup>16</sup></a> </p> <h2 id="ongoing-disease-eradication-and-elimination-initiatives">Ongoing disease eradication and elimination initiatives</h2> <p>After eradication of smallpox in 1980, nine other eradication and elimination strategies have been established: </p><p>The Global Polio Eradication Initiative (1988) </p><p>Maternal and Neonatal Tetanus Elimination (1989) </p><p>The Measles & Rubella Initiative (2001) </p><p>The End TB strategy (2015) </p><p>The Global Health Sector Strategy on Viral Hepatitis (2016) </p><p>The Global Technical Strategy for Malaria (2016) </p><p>The Eliminate Yellow Fever Epidemics Strategy (2017) </p><p>The Global Strategy to Accelerate the Elimination of Cervical Cancer (2020) </p><p>The Global Roadmap to Defeat Meningitis (2020)<a class="footnote-ref" id="fnref:17" href="#fn:17"><sup>17</sup></a> </p> <h2 id="external-links">External links</h2> <ul><li><a href="https://web.archive.org/web/20131025022751/http://www.who.int/immunization_monitoring/Global_Immunization_Data_v2.pdf">Global Immunization Coverage</a></li> <li><a href="https://web.archive.org/web/20050707084438/http://www.who.int/immunization_monitoring/routine/immunization_coverage/en/index4.html">WHO UNICEF coverage estimates</a></li></ul> <h2 id="references">References</h2> <ol> <li id="fn:1"><p>"Essential Programme on Immunization". World Health Organization. Retrieved 6 November 2024. <a href="https://www.who.int/teams/immunization-vaccines-and-biologicals/essential-programme-on-immunization" target="_blank">https://www.who.int/teams/immunization-vaccines-and-biologicals/essential-programme-on-immunization</a> <a href="#fnref:1" class="footnote-back-ref">↩</a></p></li> <li id="fn:2"><p>Shattock, Andrew J; Johnson, Helen C; Sim, So Yoon; Carter, Austin; Lambach, Philipp; Hutubessy, Raymond C W; Thompson, Kimberly M; Badizadegan, Kamran; Lambert, Brian; Ferrari, Matthew J; Jit, Mark; Fu, Han; Silal, Sheetal P; Hounsell, Rachel A; White, Richard G; Mosser, Jonathan F; Gaythorpe, Katy A M; Trotter, Caroline L; Lindstrand, Ann; O’Brien, Katherine L; Bar-Zeev, Naor (May 2, 2024). "Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization". Lancet. 403: 2307–2316. doi:10.1016/S0140-6736(24)00850-X. PMC 11140691. 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"Vaccine coverage and the GAVI Alliance Immunization Services Support initiative". The Lancet. 373 (9659): 209. doi:10.1016/s0140-6736(08)61894-2. ISSN 0140-6736. <a href="https://dx.doi.org/10.1016/s0140-6736(08)61894-2" target="_blank">https://dx.doi.org/10.1016/s0140-6736(08)61894-2</a> <a href="#fnref:9" class="footnote-back-ref">↩</a></p></li> <li id="fn:10"><p>Light, Donald W. (February 2011). "Saving the pneumococcal AMC and GAVI". Human Vaccines. 7 (2): 138–141. doi:10.4161/hv.7.2.14919. ISSN 1554-8600. PMID 21937880. <a href="https://dx.doi.org/10.4161/hv.7.2.14919" target="_blank">https://dx.doi.org/10.4161/hv.7.2.14919</a> <a href="#fnref:10" class="footnote-back-ref">↩</a></p></li> <li id="fn:11"><p>Tang, Yuxiao; Plikaytis, Brian D.; Preziosi, Marie-Pierre; Borrow, Ray (2015-11-09). "Influence of Age on Antibody Response and Persistence Following Immunization With MenAfriVac". Clinical Infectious Diseases. 61 (suppl_5): S531 – S539. doi:10.1093/cid/civ601. ISSN 1537-6591. 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"Suitability of two WHO research and development initiatives for COVID-19 to promote equitable innovation: the Access to COVID-19 Tools Accelerator and COVID-19 Technology Access Pool". Revista Panamericana de Salud Pública. 46: 1. doi:10.26633/rpsp.2022.194. ISSN 1020-4989. PMC 9642827. PMID 36382255. <a href="https://dx.doi.org/10.26633/rpsp.2022.194" target="_blank">https://dx.doi.org/10.26633/rpsp.2022.194</a> <a href="#fnref:13" class="footnote-back-ref">↩</a></p></li> <li id="fn:14"><p>Nambiar, Devaki; Hosseinpoor, Ahmad Reza; Bergen, Nicole; Danovaro-Holliday, M. Carolina; Wallace, Aaron; Johnson, Hope L. (2023-04-28). "Inequality in Immunization: Holding on to Equity as We 'Catch Up'". Vaccines. 11 (5): 913. doi:10.3390/vaccines11050913. ISSN 2076-393X. PMC 10223221. PMID 37243017. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10223221" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10223221</a> <a href="#fnref:14" class="footnote-back-ref">↩</a></p></li> <li id="fn:15"><p>Samarasekera, Udani (May 2024). "50 years of the Expanded Programme on Immunization". The Lancet. 403 (10440): 1971–1972. doi:10.1016/s0140-6736(24)01016-x. ISSN 0140-6736. <a href="https://dx.doi.org/10.1016/s0140-6736(24)01016-x" target="_blank">https://dx.doi.org/10.1016/s0140-6736(24)01016-x</a> <a href="#fnref:15" class="footnote-back-ref">↩</a></p></li> <li id="fn:16"><p>Shattock, Andrew J; Johnson, Helen C; Sim, So Yoon; Carter, Austin; Lambach, Philipp; Hutubessy, Raymond C W; Thompson, Kimberly M; Badizadegan, Kamran; Lambert, Brian; Ferrari, Matthew J; Jit, Mark; Fu, Han; Silal, Sheetal P; Hounsell, Rachel A; White, Richard G (May 2024). "Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization". The Lancet. 403 (10441): 2307–2316. doi:10.1016/s0140-6736(24)00850-x. ISSN 0140-6736. PMC 11140691. PMID 38705159. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11140691" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11140691</a> <a href="#fnref:16" class="footnote-back-ref">↩</a></p></li> <li id="fn:17"><p>Samarasekera, Udani (May 2024). "50 years of the Expanded Programme on Immunization". The Lancet. 403 (10440): 1971–1972. doi:10.1016/s0140-6736(24)01016-x. ISSN 0140-6736. <a href="https://dx.doi.org/10.1016/s0140-6736(24)01016-x" target="_blank">https://dx.doi.org/10.1016/s0140-6736(24)01016-x</a> <a href="#fnref:17" class="footnote-back-ref">↩</a></p></li> </ol>