Expanded Program on Immunization

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The Expanded Programme on Immunization is a global health initiative launched by the World Health Organization in May 1974, with the aim to make vaccines available to all globally [1]

Contents


Introduction

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 tuberculosis, poliomyelitis, measles, diphtheria, tetanus, pertussis, hepatitis B, yellow fever, meningitis 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.

History

Milestones in Global vaccination

YearMilestoneDescription
1974EPI launchWHO established EPI in 1974 to protect children worldwide against diseases such as smallpox, measles, poliomyelitis, tuberculosis, diphtheria, tetanus, and pertussis by 1990. [2]
1979PAHO revolving fundThe Pan American Health Organization launched a fund to facilitate vaccine procurement [3]
1982UNICEF child survival and development revolutionUNICEF launched GOBI strategy which focused on growth monitoring, oral rehydration therapy, breastfeeding, and immunization [4]
1984EPI’s First standardized schedulevaccination schedule was revised to include BCG, DTP, polio, and measles at specified ages [5]
1990Declaration of Manhattan, Children’s Vaccine InitiativeThis Initiative aimed to accelerate vaccines development to enhance EPI performance [6]
1999Strategic Advisory Group of Experts (SAGE) on immunizationSAGE was established to advise WHO on global immunization policies, strategies, and research [7]
2000Gavi, The Vaccine AllianceWas established to address market failure in certain countries and increase access to vaccines [8]
2000-presentOngoing Acceleration of New Vaccine IntroductionIncluded initiatives like pneumococcal conjugate vaccines (PCV), rotavirus vaccines, and meningococcal A conjugate vaccine, malaria vaccine to expedite introduction [9] [10] [11] [12]
2017Coalition for Epidemic Preparedness Innovations (CEPI)CEPI was launched to as a response to Ebola, Zika, and SARS outbreaks to develop vaccines for emerging infectious diseases
2020Immunization Agenda 2030 (IA2030)IA2030 was setup to ensure universal access to vaccines, strengthen health care systems, and support universal health coverage.
2020-2023COVID-19 Vaccines Global Access (COVAX)Was established to accelerate the development, production, and equitable distribution of COVID-19 vaccines [13]
2023-2024The Big Catch-UpThis Initiative focuses on restoring immunization coverage to pre-COVID-19 levels and strengthen routine immunization systems to achieve 2030 targets [14]
2024EPI ExpansionEPI is expanded to cover vaccines against 13 global and 17 context-specific vaccine-preventable diseases [15]

Impact of vaccination on global Health

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 [16]

Ongoing disease eradication and elimination initiatives

After eradication of smallpox in 1980, nine other eradication and elimination strategies have been established:

The Global Polio Eradication Initiative (1988)

Maternal and Neonatal Tetanus Elimination (1989)

The Measles & Rubella Initiative (2001)

The End TB strategy (2015)

The Global Health Sector Strategy on Viral Hepatitis (2016)

The Global Technical Strategy for Malaria (2016)

The Eliminate Yellow Fever Epidemics Strategy (2017)

The Global Strategy to Accelerate the Elimination of Cervical Cancer (2020)

The Global Roadmap to Defeat Meningitis (2020) [15]

Related Research Articles

<span class="mw-page-title-main">Vaccination</span> Administration of a vaccine to protect against disease

Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism. In stimulating the body's adaptive immunity, they help prevent sickness from an infectious disease. When a sufficiently large percentage of a population has been vaccinated, herd immunity results. Herd immunity protects those who may be immunocompromised and cannot get a vaccine because even a weakened version would harm them. The effectiveness of vaccination has been widely studied and verified. Vaccination is the most effective method of preventing infectious diseases; widespread immunity due to vaccination is largely responsible for the worldwide eradication of smallpox and the elimination of diseases such as polio and tetanus from much of the world. However, some diseases, such as measles outbreaks in America, have seen rising cases due to relatively low vaccination rates in the 2010s – attributed, in part, to vaccine hesitancy. According to the World Health Organization, vaccination prevents 3.5–5 million deaths per year.

<span class="mw-page-title-main">Measles</span> Viral disease affecting humans

Measles is a highly contagious, vaccine-preventable infectious disease caused by measles virus. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Initial symptoms typically include fever, often greater than 40 °C (104 °F), cough, runny nose, and inflamed eyes. Small white spots known as Koplik's spots may form inside the mouth two or three days after the start of symptoms. A red, flat rash which usually starts on the face and then spreads to the rest of the body typically begins three to five days after the start of symptoms. Common complications include diarrhea, middle ear infection (7%), and pneumonia (6%). These occur in part due to measles-induced immunosuppression. Less commonly seizures, blindness, or inflammation of the brain may occur. Other names include morbilli, rubeola, red measles, and English measles. Both rubella, also known as German measles, and roseola are different diseases caused by unrelated viruses.

<span class="mw-page-title-main">MMR vaccine</span> Combined vaccine against measles, mumps, and rubella

The MMR vaccine is a vaccine against measles, mumps, and rubella, abbreviated as MMR. The first dose is generally given to children around 9 months to 15 months of age, with a second dose at 15 months to 6 years of age, with at least four weeks between the doses. After two doses, 97% of people are protected against measles, 88% against mumps, and at least 97% against rubella. The vaccine is also recommended for those who do not have evidence of immunity, those with well-controlled HIV/AIDS, and within 72 hours of exposure to measles among those who are incompletely immunized. It is given by injection.

<span class="mw-page-title-main">Rubella</span> Human viral disease

Rubella, also known as German measles or three-day measles, is an infection caused by the rubella virus. This disease is often mild, with half of people not realizing that they are infected. A rash may start around two weeks after exposure and last for three days. It usually starts on the face and spreads to the rest of the body. The rash is sometimes itchy and is not as bright as that of measles. Swollen lymph nodes are common and may last a few weeks. A fever, sore throat, and fatigue may also occur. Joint pain is common in adults. Complications may include bleeding problems, testicular swelling, encephalitis, and inflammation of nerves. Infection during early pregnancy may result in a miscarriage or a child born with congenital rubella syndrome (CRS). Symptoms of CRS manifest as problems with the eyes such as cataracts, deafness, as well as affecting the heart and brain. Problems are rare after the 20th week of pregnancy.

An advance market commitment (AMC) is a promise to buy or subsidise a product if it is successfully developed. AMCs are typically offered by governments or private foundations to encourage the development of vaccines or treatments. In exchange, pharmaceutical companies commit to providing doses at a fixed price. This funding mechanism is used when the cost of research and development is too high to be worthwhile for the private sector without a guarantee of a certain quantity of purchases.

<span class="mw-page-title-main">Vaccine hesitancy</span> Reluctance or refusal to be vaccinated or have ones children vaccinated

Vaccine hesitancy is a delay in acceptance, or refusal, of vaccines despite the availability of vaccine services and supporting evidence. The term covers refusals to vaccinate, delaying vaccines, accepting vaccines but remaining uncertain about their use, or using certain vaccines but not others. Although adverse effects associated with vaccines are occasionally observed, the scientific consensus that vaccines are generally safe and effective is overwhelming. Vaccine hesitancy often results in disease outbreaks and deaths from vaccine-preventable diseases. Therefore, the World Health Organization characterizes vaccine hesitancy as one of the top ten global health threats.

Viral pneumonia is a pneumonia caused by a virus. Pneumonia is an infection that causes inflammation in one or both of the lungs. The pulmonary alveoli fill with fluid or pus making it difficult to breathe. Pneumonia can be caused by bacteria, viruses, fungi or parasites. Viruses are the most common cause of pneumonia in children, while in adults bacteria are a more common cause.

<span class="mw-page-title-main">Bandim Health Project</span> West African healh research organization

The Bandim Health Project works with population based health research in one of the world's poorest countries, Guinea-Bissau in West Africa.

Claims of a link between the MMR vaccine and autism have been extensively investigated and found to be false. The link was first suggested in the early 1990s and came to public notice largely as a result of the 1998 Lancet MMR autism fraud, characterised as "perhaps the most damaging medical hoax of the last 100 years". The fraudulent research paper, authored by Andrew Wakefield and published in The Lancet, falsely claimed the vaccine was linked to colitis and autism spectrum disorders. The paper was retracted in 2010 but is still cited by anti-vaccine activists.

A vaccination policy is a health policy adopted in order to prevent the spread of infectious disease. These policies are generally put into place by state or local governments, but may also be set by private facilities, such as workplaces or schools. Many policies have been developed and implemented since vaccines were first made widely available.

Jean Marie Okwo-Bele is a Congolese physician, public health expert and former Director of the Department of Immunization, Vaccines and Biologicals of the World Health Organization (WHO).

<span class="mw-page-title-main">Christopher J.L. Murray</span> American global health researcher (born 1962)

Christopher J.L. Murray is an American physician, health economist, and global health researcher. He is a professor at the University of Washington in Seattle, where he is Chair of Health Metrics Science and the director of the Institute for Health Metrics and Evaluation (IHME).

Pakistan is one of the two remaining countries in the world where poliomyelitis (polio) is still categorized as an endemic viral infection, the other one being Afghanistan. While it has yet to fully eradicate Polio, there has been a major downwards trend in the number of reported cases per year; the total count of wild poliovirus cases in Pakistan in 2019 was down to 147, compared to 84 in 2020, 1 in 2021, 20 in 2022, 6 in 2023 and 41 as of October 2024.

Robert Michael Hecht is an American global health policy and financing expert. Hecht is currently Founder and President of Pharos Global Health Advisors. He has previously held positions with the World Bank, UNAIDS, the International AIDS Vaccine Initiative, and Results for Development Institute. He serves as a lecturer at Yale University’s Jackson Institute for Global Affairs and is a clinical professor at the Yale School of Public Health. He has published on a range of topics in global health and development, with a special focus on the economics, financing, and policies for infectious diseases, nutrition, and broader health system reform. He has been an advisor to the President's Emergency Plan for AIDS Relief (PEPFAR), the World Health Organization, and UNITAID. Hecht holds a BA from Yale and a PhD from Cambridge University.

Mathuram Santosham is an Indian American physician who is Professor and Chair at the Johns Hopkins Bloomberg School of Public Health. Santosham is best known for his work on oral rehydration therapy and childhood vaccines, with a focus on supporting people from indigenous communities.

<span class="mw-page-title-main">Vaccine Confidence Project</span> International vaccination information project

The Vaccine Confidence Project (VCP) founded in 2010 by Heidi Larson, was developed in response to hesitancy and misinformation on vaccination programmes such as those that caused a boycott of polio eradication efforts in Northern Nigeria in 2003–04. It is an early warning system to identify and evaluate public confidence in vaccines, with the purpose of tackling the problem early, when it is likely to be manageable.

<span class="mw-page-title-main">Shabir Madhi</span> South African physician and professor

Shabir Ahmed Madhi, is a South African physician who is professor of vaccinology and director of the South African Medical Research Council Respiratory and Meningeal Pathogens Research Unit at the University of the Witwatersrand, and National Research Foundation/Department of Science and Technology Research Chair in Vaccine Preventable Diseases. In January 2021, he was appointed Dean of the Faculty of Health Sciences at the University of the Witwatersrand.

Vaccine equity means ensuring that everyone in the world has equal access to vaccines. The importance of vaccine equity has been emphasized by researchers and public health experts during the COVID-19 pandemic but is relevant to other illnesses and vaccines as well. Historically, world-wide immunization campaigns have led to the eradication of smallpox and significantly reduced polio, measles, tuberculosis, diphtheria, whooping cough, and tetanus.

<span class="mw-page-title-main">Nina Schwalbe</span> American public health researcher

Nina Schwalbe is an American public health researcher who is the founder of Spark Street Advisors, a public health think tank based in New York City. Schwalbe specializes in vaccines. She has previously worked at Gavi, UNICEF and USAID.

Elizabeth Miller is a British epidemiologist and professor at the London School of Hygiene and Tropical Medicine. She worked at the Public Health Laboratory Service and Public Health England, researching the safety and effectiveness of new and existing vaccination programmes. Prominent work included investigating the link between MMR vaccine and autism, finding no evidence to support a causal association between these.

References

  1. ↑ "Essential Programme on Immunization". World Health Organization. Retrieved 6 November 2024.
  2. ↑ 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 . Retrieved 6 November 2024.{{cite journal}}: CS1 maint: date and year (link)
  3. ↑ Horst, Myrza M. L. de L.; Soler, Orenzio (January 2010). "Fundo Estratégico da Organização Pan-Americana da Saúde: mecanismo facilitador para melhorar o acesso aos medicamentos". Revista Panamericana de Salud Pública. 27 (1): 43–48. doi:10.1590/s1020-49892010000100007. ISSN   1020-4989.
  4. ↑ Srbinoski, Bojan; Petreski, Blagica; Petreski, Marjan (2022-09-24). "Measurement of Multidimensional Child Poverty: Evidence from North Macedonia". Child Indicators Research. 16 (1): 247–271. doi:10.1007/s12187-022-09967-9. ISSN   1874-897X.
  5. ↑ 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.
  6. ↑ Gracia, Diego (2013-06-11). "Institute of Medicine (IOM). The Learning Healthcare System: Workshop Summary. Washington, DC: The National Academies Press, 2007". Eidon Nº 39. doi:10.13184/eidon.39.2013.89-91. ISSN   2174-8292.
  7. ↑ "Recommendation of Who Strategic Advisory Group of Experts (Sage) on Immunization", Pediatric Clinical Practice Guidelines & Policies, American Academy of Pediatrics, p. 1102, 2014-04-30, doi:10.1542/9781581108613-part06-recommendation, ISBN   978-1-58110-861-3 , retrieved 2024-09-18
  8. ↑ Gavi, the Vaccine Alliance (2023-05-08). A History of Gavi, the Vaccine Alliance . Retrieved 2024-09-18– via YouTube.
  9. ↑ Lob-Levyt, Julian (January 2009). "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.
  10. ↑ 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.
  11. ↑ 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. PMID   26553685.
  12. ↑ Ho, Mei Mei; Baca-Estrada, Maria; Conrad, Christoph; Karikari-Boateng, Eric; Kang, Hye-Na (August 2015). "Implementation workshop of WHO guidelines on evaluation of malaria vaccines: Current regulatory concepts and issues related to vaccine quality, Pretoria, South Africa 07 Nov 2014". Vaccine. 33 (36): 4359–4364. doi:10.1016/j.vaccine.2015.06.107. ISSN   0264-410X. PMID   26165916.
  13. ↑ Silva, Luiza Pinheiro Alves da; Rapini, Márcia Siqueira (2022-11-08). "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. PMID   36382255.
  14. ↑ 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.
  15. 1 2 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.
  16. ↑ 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.
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