Commemorating The 50th Anniversary Of The Expanded Programme On Immunization
World Immunization Week acknowledges the remarkable influence of vaccines in safeguarding children and communities. This year, we commemorate a significant achievement: the 50th anniversary of the Expanded Program on Immunization (EPI). Stemming from the success of eradicating smallpox, EPI was launched with the aim of ensuring global access to crucial vaccines for children. Its mission extends to protecting individuals of all ages through comprehensive immunization initiatives. Presently, every nation operates a national immunization program, affirming vaccines as universally acknowledged as one of the safest, most cost-efficient, and effective public health measures.
A Brief History of EPI
The Expanded Program on Immunization (EPI), an initiative launched by the World Health Organization in 1974, the history of EPI is a testament to the remarkable progress achieved in global health over the past five decades. The 50th anniversary of EPI in 2024 provides a pivotal occasion to celebrate the program’s achievements, highlight its impact on lives saved, and catalyze renewed efforts to strengthen routine immunization initiatives. EPI aimed to combat and prevent various communicable diseases through systematic immunization programs.
Remarkable Achievements
At its inception, EPI featured just six vaccines in its portfolio, but today, this number has grown to thirteen, encompassing a spectrum of diseases including the recent addition of COVID-19 vaccines. In less than a generation, the African Region has made tremendous gains in increasing access to immunization and driving down child deaths. For example, several diseases are on the brink of eradication and elimination (e.g., polio and maternal and neonatal tetanus, respectively), while the introduction of new vaccines is stamping out age-old diseases.
The timeline of EPI is marked by several key milestones. Among these accomplishments:
The eradication of smallpox in 1980s 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 percent. 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. Together with governments, we facilitated one of the greatest logistical mobilizations in peacetime history. By the early 1990s, global childhood immunization levels reached 80 per cent.
The creation of the Global Alliance for Vaccines and Immunization (Gavi) added another dimension to EPI’s success by supporting the introduction of a broader range of new vaccines. This period also 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. 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 program’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.
Vaccine Research and Development
Despite these challenges, improvements in scientific knowledge and development of new technologies as well as the support from the leadership of the African Vaccine Regulatory Forum (AVAREF) — have helped to accelerate vaccine development and clinical trials in the African Region. AVAREF works with national ethics committees and regulatory authorities to ensure timely regulatory evaluations and decision-making processes on clinical trial applications and to reduce the lengthy timelines for their review and approval. The forum has supported the development and/or review of multiple vaccines in the African Region, including vaccines against malaria, meningitis, rotavirus, pneumococcal pneumonia, cholera, HPV and Ebola.
Many clinical trials have been conducted and increasingly more are being planned in the African Region to evaluate the efficacy and safety of candidate vaccines. However, additional efforts are needed in this area to enhance regulatory oversight for the development and approval of new vaccines that meet quality, safety, and efficacy standards and build manufacturing capacity.
By Damilola Ilori
References
World Health Organization. (2024, January 01). 50th anniversary of the expanded programme on immunization (EPI). https://www.who.int/news-room/events/detail/2024/01/01/default-calendar/50th-anniversary-of-the-expanded-programme-on-immunization-(epi
World Health Organization. Regional Office for Africa. (n.d.). African Vaccination Week and 50th anniversary of the Expanded Programme on Immunization (EPI) : Speeches, messages. https://www.afro.who.int/regional-director/speeches-messages/african-vaccination-week-and-50th-anniversary-expanded
United States Agency for International Development. (2024, April 26). Commemorating World Immunization Week 2024. https://www.usaid.gov/news/apr-26-2024-commemorating-world-immunization-week-2024
