Vaccines have emerged as a cornerstone of public health, preventing the spread of deadly diseases and saving countless lives.
The Expanded Programme on Immunization (EPI), an initiative launched by the World Health Organization in 1974, stands as a global endeavor to ensure equitable access to life-saving vaccines for every child, regardless of their geographic location or socioeconomic status. Over the past five decades, EPI has evolved and achieved remarkable milestones that reshaped the global health landscape.
The 50th anniversary of EPI in 2024 provides a pivotal occasion to celebrate the programme's achievements, highlight its impact on lives saved, and catalyze renewed efforts to strengthen routine immunization initiatives.
What is EPI?
Building on the momentum of the smallpox eradication effort, EPI was initiated with the goal of providing universal access to life-saving vaccines for children worldwide. This programme, which is now commonly referred to as the Essential Programme on Immunization, seeks to safeguard individuals of all ages through comprehensive immunization efforts.
Today, every country has a national immunization programme, and vaccines are universally recognized as among the safest, most cost-effective, and successful public health interventions to prevent fatalities and enhance the quality of life.
A brief history of EPI
At its inception, EPI focused on protecting all children against six childhood illnesses, including tuberculosis, diphtheria, tetanus, pertussis, polio, and measles. Today, today, this number has grown to 13 universally recommended vaccines across the life course, and 17 additional vaccines with context dependent recommendations.
EPI has marked several key milestones over the years, including the eradication of smallpox in 1980, which stands as a monumental triumph in the history of immunization. The global expansion of childhood vaccination programmes and the establishment of a robust vaccine supply chain were equally critical, allowing vaccines to reach even the most remote areas and endure extreme temperature conditions.
Thanks to a unique public-private partnership between WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC), UNICEF, the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance, polio has been reduced by more than 99%. The world stands on the threshold of eradicating a human pathogen globally for only the second time in history, after the eradication of smallpox.
In the 1980s, UNICEF and partners embarked on a bold mission – to immunize every child against preventable diseases. Governments and partners facilitated one of the greatest logistical mobilizations in peacetime history. By the early 1990s, global childhood immunization levels reached 80%.
The creation of Gavi, the Vaccine Alliance, added another dimension to EPI's success by providing international support to countries to enable the broader introduction of a range of new vaccines. Over the 50 years, we have witnessed the development and introduction of vaccines targeting diseases like Hib, Pneumococcal infections, rotavirus, HPV, meningitis A, Japanese encephalitis, and malaria.
Notably, EPI innovations, such as injection safety practices and solar power integration in health facilities, extended their influence beyond immunization to benefit other health programmes. The role of EPI in building systems that facilitated the rapid global rollout of COVID-19 vaccines demonstrated its capacity to respond to emerging health crises.
EPI's evolving Impact
The EPI's journey began with a focus on protection against 6 childhood vaccine-preventable diseases (Bacillus Calmette-Guérin (BCG), diphtheria, pertussis, tetanus, polio, and measles).
Over the course of 5 decades, its impact has grown. The vaccines available in the programme now encompass older children, adolescents, and adults. The incorporation of new vaccines has significantly amplified the scope of immunity offered by immunization, rendering defense against a wider spectrum of diseases.
There are now 13 vaccines (antigens) recommended by WHO for the EPI programme. They are: Bacillus Calmette-Guérin (BCG), diphtheria, pertussis, tetanus, Haemophilus influenzae type B (Hib), Hepatitis B (HepB), polio, measles, rubella, pneumococcal disease (PNC), rotavirus (Rota), human papillomavirus (HPV), and COVID-19 (for adults).
There are also vaccines recommended for particular settings, including Yellow fever, Meningitis, Japanese encephalitis (JE), Cholera.
This comprehensive array of vaccines underscores the EPI's commitment to safeguarding individuals from infancy through adulthood, embodying a holistic approach to health and well-being.
Global synergy for better health
Central to its mission of ensuring universal access to relevant vaccines for those at risk, the EPI operates in tandem with other public health programmes to achieve disease control and enhance health outcomes. Through collaborative efforts, the EPI contributes to improving the health and resilience of populations across the globe.
Immunization is one of the most efficient and cost-effective healthcare interventions, bringing the most marginalized communities into contact with primary health care.
EPI's 50th anniversary is an opportunity to both honor its achievements and set new ambitions for the future. The programme's success in preventing numerous diseases, improving child and maternal health, and advancing equity in healthcare access underscores the significance of immunization as a cornerstone of public health.