Expanded Program On Immunization
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The Expanded Program on Immunization is a
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
program with the goal to make
vaccine A vaccine is a biological Dosage form, preparation that provides active acquired immunity to a particular infectious disease, infectious or cancer, malignant disease. The safety and effectiveness of vaccines has been widely studied and verifie ...
s available to all children.


History

The
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
(WHO) initiated the Expanded Program on Immunization (EPI) in May 1974 with the objective to vaccinate children throughout the world. Ten years later, in 1984, the WHO established a standardized
vaccination schedule A vaccination schedule is a series of vaccinations, including the timing of all doses, which may be either recommended or compulsory, depending on the country of residence. A vaccine is an antigenic preparation used to produce active immunity to ...
for the EPI vaccines:
Bacillus Calmette-Guérin Bacillus Calmette–Guérin (BCG) vaccine is a vaccine primarily used against tuberculosis (TB). It is named after its inventors Albert Calmette and Camille Guérin. In countries where tuberculosis or leprosy is common, one dose is recommended ...
(BCG), diphtheria-tetanus-pertussis (DTP), oral
polio Poliomyelitis, commonly shortened to polio, is an infectious disease caused by the poliovirus. Approximately 70% of cases are asymptomatic; mild symptoms which can occur include sore throat and fever; in a proportion of cases more severe s ...
, and
measles Measles is a highly contagious 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 , cough, ...
. Increased knowledge of the immunologic factors of disease led to new vaccines being developed and added to the EPI’s list of recommended vaccines:
Hepatitis B Hepatitis B is an infectious disease caused by the ''Hepatitis B virus'' (HBV) that affects the liver; it is a type of viral hepatitis. It can cause both acute and chronic infection. Many people have no symptoms during an initial infection. Fo ...
(HepB),
yellow fever Yellow fever is a viral disease of typically short duration. In most cases, symptoms include fever, chills, loss of appetite, nausea, muscle pains – particularly in the back – and headaches. Symptoms typically improve within five days. In ...
in countries endemic for the disease, and
Haemophilus influenzae ''Haemophilus influenzae'' (formerly called Pfeiffer's bacillus or ''Bacillus influenzae'') is a Gram-negative, non-motile, coccobacillary, facultatively anaerobic, capnophilic pathogenic bacterium of the family Pasteurellaceae. The bacteria ...
meningitis (Hib) conjugate vaccine in countries with high burden of disease.Jamison D, Breman J, Measham A, Alleyne G, Claeson M, Evans D, Jha P, Mills A, Musgrove P. ''Disease Control Priorities in Developing Countries'', Second Edition. 2006, The World Bank Group
.
In 1999, the
Global Alliance for Vaccines and Immunization GAVI, officially Gavi, the Vaccine Alliance (previously the GAVI Alliance, and before that the Global Alliance for Vaccines and Immunization) is a public–private global health partnership with the goal of increasing access to immunization ...
(GAVI) was created with the sole purpose of improving child health in the poorest countries by extending the reach of the EPI. The GAVI brought together a grand coalition, including the UN agencies and institutions (WHO,
UNICEF UNICEF (), originally called the United Nations International Children's Emergency Fund in full, now officially United Nations Children's Fund, is an agency of the United Nations responsible for providing Humanitarianism, humanitarian and Devel ...
, the
World Bank The World Bank is an international financial institution that provides loans and grants to the governments of low- and middle-income countries for the purpose of pursuing capital projects. The World Bank is the collective name for the Interna ...
), public health institutes, donor and implementing countries, the
Bill and Melinda Gates Foundation The Bill & Melinda Gates Foundation (BMGF), a merging of the William H. Gates Foundation and the Gates Learning Foundation, is an American private foundation founded by Bill Gates and Melinda French Gates. Based in Seattle, Washington, it was ...
and
The Rockefeller Foundation The Rockefeller Foundation is an American private foundation and philanthropic medical research and arts funding organization based at 420 Fifth Avenue, New York City. The second-oldest major philanthropic institution in America, after the Carneg ...
, the vaccine industry,
non-governmental organizations A non-governmental organization (NGO) or non-governmental organisation (see spelling differences) is an organization that generally is formed independent from government. They are typically nonprofit entities, and many of them are active in h ...
(NGOs) and many more. The creation of the GAVI has helped to renew interest and maintain the importance of immunizations in battling the world’s large burden of infectious diseases. These are the goals: * to ensure full immunization of children under one year of age in every district, * to globally eradicate
poliomyelitis Poliomyelitis, commonly shortened to polio, is an infectious disease caused by the poliovirus. Approximately 70% of cases are asymptomatic; mild symptoms which can occur include sore throat and fever; in a proportion of cases more severe sym ...
, * to reduce maternal and
neonatal An infant or baby is the very young offspring of human beings. ''Infant'' (from the Latin word ''infans'', meaning 'unable to speak' or 'speechless') is a formal or specialised synonym for the common term ''baby''. The terms may also be used to ...
tetanus Tetanus, also known as lockjaw, is a bacterial infection caused by ''Clostridium tetani'', and is characterized by muscle spasms. In the most common type, the spasms begin in the jaw and then progress to the rest of the body. Each spasm usually ...
to an
incidence rate In epidemiology, incidence is a measure of the probability of occurrence of a given medical condition in a population within a specified period of time. Although sometimes loosely expressed simply as the number of new cases during some time peri ...
of less than one case per 1,000 births by 2005, * to cut in half the number of
measles Measles is a highly contagious 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 , cough, ...
-related deaths that occurred in 1999, and * to extend all new vaccine and preventative health interventions to children in all districts in the world. In addition, the GAVI has set up specific milestones to achieve the EPI goals: that by 2010 all countries have routine immunization coverage of 90% of their child population, that HepB be introduced in 80% of all countries by 2007, and that 50% of the poorest countries have Hib vaccine by 2005.Hadler S, Cochi S, Bilous J, Cutts F. “Vaccination Programs in Developing Countries.” Chapter 55: ''Vaccines'', 4th ed. 2004, Elsevier.
We can also mention the act of Guillaume Ngoie Mwamba, Director of the Expanded Program on Immunization in 2018, is the first person to receive the Ebola vaccine in Mbandaka, Democratic Republic of Congo on May 22, 2018.


Implementation

In each of the United Nations’ member states, the national governments create and implement their policies for vaccination programs following the guidelines set by the EPI. Setting up an immunization program is multifaceted and contains many complex components including a reliable
cold chain A cold chain is a low temperature-controlled supply chain network. An unbroken cold chain is an uninterrupted series of refrigerated production, storage and distribution activities, along with associated equipment and logistics, which maintain qu ...
system, transport for the delivery of the vaccines, maintenance of vaccine stocks, training and monitoring of health workers, outreach educational programs to inform the public, and a means of documenting and recording which child receives which vaccines. Each region has slightly varying ways of setting up and implementing their immunization programs based on their level of health infrastructure. Some areas will have fixed sites for vaccination: health care facilities such as hospitals or health posts that include vaccination with many other health care activities. But in areas where the number of structured health facilities is small, mobile vaccination teams consisting of staff members from a health facility can deliver vaccines straight to individual towns and villages. These ‘outreach’ services are often scheduled throughout the year. However, in especially under-developed countries where proper communication and infrastructure is absent, cancellation of the planned immunization visits leads to deterioration of the program. A better strategy in such countries is the ‘pulse immunization’ technique, where ‘pulses’ of vaccines are given to children in annual vaccination campaigns.Jamison D, Breman J, Measham A, Alleyne G, Claeson M, Evans D, Jha P, Mills A, Musgrove P. ''Disease Control Priorities in Developing Countries'', Second Edition. 2006, The World Bank Group
.
Additional strategies are needed if the area of the program consists of poor urban communities because such areas tend to have low uptake of vaccination programs. Door-to-door canvassing, also referred to as channeling, is used to increase uptake in such hard to reach groups. Finally, periodic national-level mass vaccination campaigns are being increasingly included in the programs.


Evaluation

In each country, immunization programs are monitored using two methods: an administrative method and through community-based surveys. The administrative method uses immunization data from public, private, and NGO clinics. Thus, the accuracy of the administrative method is limited by the availability and accuracy of reports from these facilities. This method is easily performed in areas where government services deliver the immunizations directly or where the government supplies the vaccines to the clinics. In countries without the infrastructure to do this, community-based surveys are used to estimate immunization coverage. Community-based surveys are applied using a modified
cluster sampling In statistics, cluster sampling is a sampling plan used when mutually homogeneous yet internally heterogeneous groupings are evident in a statistical population. It is often used in marketing research. In this sampling plan, the total populat ...
survey method developed by the World Health Organization. Vaccine coverage is evaluated using a two-stage sampling approach in which 30 clusters and seven children in each cluster are selected. Health care workers with no or limited background in statistics and sampling are able to carry out data collection with minimal training.“A simplified general method for cluster-sample surveys of health in developing countries.” ''World Health Statistics Quarterly''. 1991; 44(3):98-106. Such a survey implementation provides a way to get information from areas where there is no reliable data source. It is also used to validate reported vaccine coverage (for example, from administrative reports) and is expected to estimate vaccine coverage within 10 percent. Surveys or questionnaires, though frequently considered inaccurate due to self-reporting, can provide more detailed information than administrative reports alone. If home-based records are available, vaccination status be determined and dates of vaccination can be reviewed to determine if they were given at an ideal age and in appropriate intervals. Missed immunizations can be identified and further qualified. Importantly, systems of vaccine delivery besides clinics used for administrative evaluation can be identified and included in the analysis.


Results

Before the initiation of the EPI, child vaccination coverage for tuberculosis, diphtheria, pertussis, tetanus, polio and measles was estimated to be fewer than 5 percent. Now, not only has coverage increased to 79 percent, it has been expanded to include vaccinations for hepatitis B, Haemophilus influenzae type B,
rubella 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 ...
, tetanus, and yellow fever. The impact of increased vaccination is clear from the decreasing incidence of many diseases. For example, measles deaths decreased by 60% worldwide between 1999 and 2005, and polio, although missing the goal of eradication by 2005, has decreased significantly as there were fewer than 2,000 cases in 2006.


References

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External links


Global Immunization Coverage


World Health Organization