GS Paper I

News Excerpt:

The year 2024 commemorates 50 years since the launch of the Expanded Programme on Immunization (EPI) by the World Health Organization (WHO) in 1974, a program focused on equity in childhood vaccine access.

Overview of the Essential Program on Immunization:

• Launched in 1974 by the WHO, the EPI’s primary objective is to establish equal access to life-saving vaccination in children across all geographical locations and socioeconomic statuses.
• The programme was introduced as the eradication of smallpox virus was on the horizon, and a need to leverage the then immunisation infrastructure and a trained workforce was recognised to expand the benefit of available vaccines. 
• In India, this year is also two decades since the country conducted the last nationwide independent field evaluation of the UIP, in collaboration with international experts.

Expansion of vaccine covered diseases in EPI:

• Globally, and in India, there has been significant progress in terms of the growth of immunisation and vaccines. 
• In 1974, there were vaccines to prevent six diseases.
• Today there are vaccines against 13 diseases which are universally recommended.
• Vaccines against 17 additional diseases are recommended for a context-specific situation. 
• There is research in progress to develop vaccines against nearly 125 pathogens — many would prevent diseases prevalent in low- and middle-income countries. 

Progress in coverage of vaccinations:

• The children with three doses of DPT (diphtheria-pertussis-tetanus), a tracer indicator of coverage, has been rising over these years. 
• In the early 1970s, around 5% of children in low- and middle-income countries had received three doses of DPT, which increased to 84% in 2022 at the global level. 
• Smallpox has been eradicated, polio eliminated from all but two countries (Pakistan and Afghanistan) and many vaccine preventable diseases have nearly disappeared.
• In India, the coverage has increased every passing year and in 2019-21, 76% of children received the recommended vaccines.

Impact of EPI:

• Since the launch of EPI, studies have shown that vaccines have saved millions of lives and prevented billions of hospital visits and hospitalisations. 
• Economic analyses have estimated that vaccines are highly cost-effective interventions, with every single dollar (or rupee) of expenditure on vaccination programmes ensuring a seven to 11-fold return.
• Moreover, in mixed health systems with both the public and private sector delivering services, immunisation often remains the only health intervention with greater utilisation from the government sector. 
• In India, the share of the private sector in overall health services is nearly two thirds; however, nearly 85% to 90% of all vaccines are delivered from government facilities. 

Challenges in universal immunisation:

• In early 2023, UNICEF's ‘The State of the World’s Children’ report revealed a concerning trend: 
• For the first time in more than a decade, the childhood immunisation coverage had declined in 2021. 
• In 2022, globally, an estimated 14.3 million children were zero dose (did not receive any recommended vaccine) while another 6.2 million children were partially immunised. 
• Over the years, the vaccination coverage in India has increased, both nationally and State-wise. 

Why children are preferred for vaccinations:

• Considering that children are most vulnerable from vaccine-preventable diseases, they have rightly been prioritised for vaccination. 
• A few decades ago, the supply of vaccines was limited, and the financial resources and trained workforce that governments had were scarce. 
• Thus, vaccines were aimed to be delivered to the population groups which would benefit from them the most — children.
• However, in the last five decades, things have changed for the better. With increased vaccine coverage, children are better protected.
  

Need for Universal vaccination:

• Diseases that are preventable with vaccines are increasingly becoming common in the adult population. Therefore, it becomes imperative that government policies now focus on the vaccination of adults and the elderly as well, as is happening in many countries. 
• For better coverage of adult vaccines, we can learn from the past and five decades of the EPI.
• First, there are some initial policy and technical discussions regarding expanding immunisation coverage in additional populations. 
• The recent announcement on HPV vaccines for teenage girls is a good start. Vaccines for all age groups should be made available as free at the government facilities.
• Second, the NTAGI in India, which provides recommendations on the use of vaccines should start providing recommendations on the use of vaccines in adults and the elderly. 
• Third, the prevailing myths and misconceptions about vaccines must be proactively addressed to tackle vaccine hesitancy. 
• Fourth, various professional associations of doctors — community medicine experts, family physicians and paediatricians should work to increase awareness about vaccines among adults and the elderly. 
• Fifth, medical colleges and research institutions should generate evidence on the burden of diseases in the adult population in India.
• India’s EPI has made major progress and it is arguably a time for another independent national level review of the UIP in India, engaging key partners and international experts.

Way Forward:

• In late 2023, India launched a pilot initiative of adult BCG vaccination as part of efforts to ‘end TB’ from India. 
• The COVID-19 vaccination of the adult population has made the public sensitised to the need for and the benefits of adult vaccination. 
• This is a right opportunity to start a new journey of adult vaccination in India. 
• In the 50 years of the EPI, it is time for another expansion of the programme with focus on zero dose children, addressing inequities in vaccine coverage and offering vaccines to adults and the elderly. 
• It is time to make EPI an ‘Essential Program on Immunization’.