Note4Students: 

Prelims: Government Schemes and Policies;

Mains: Health Care System in India; Immunization Programme;

Mentor comments: The Expanded Programme on Immunization (EPI) initiative by WHO was crucial as it coincided with the near eradication of smallpox, prompting the need to expand immunization efforts globally. Following this, most countries, including India, established their national immunization programs. India’s EPI was later renamed the Universal Immunization Programme (UIP) in 1985.  Universal health coverage means that all people can benefit from quality health services, where and when they need them, without suffering financial hardship.

Let’s learn

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Why in the News?

Year 2024 marks the completion of 50 years of the Global and Indian Immunization Programs since the launch of the Expanded Programme on Immunization (EPI) by the World Health Organization in 1974. 

• This year also marks the completion of 20 years since India’s last nationwide independent field evaluation of the  Universal Immunization Programme (UIP), highlighting the need to assess progress and plan for the future.

Initiatives and Success stories by governments:

• Low and Middle-Income countries: 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. 
• Disease Eradication: Smallpox has been eradicated, polio eliminated from all but two countries and many vaccine-preventable diseases have nearly disappeared.
  • India launched a pilot initiative of adult BCG vaccination as part of efforts to ‘end TB’ in India.
• Vaccination Coverage: In India, the coverage has increased every passing year, and in 2019-21, 76% of children received the recommended vaccines.
  • Vaccines have been instrumental in saving lives and reducing hospitalizations, with a high cost-effectiveness ratio. 
• Built Health Infrastructure: In Public-private health systems, immunization often remains the only health intervention with greater utilization from the government sector.
  • For instance, in India, the share of the private sector in overall health services is nearly two-thirds; however, almost 85% to 90% of all vaccines are delivered from government facilities. 

Challenges faced by Immunization Programs:

• Issue with Coverage: 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, childhood immunization coverage had declined in 2021. 
• Issue with Recommendations: In 2022, globally, an estimated 14.3 million children were zero doses (did not receive any recommended vaccine) while another 6.2 million children were partially immunized.
• Issue of Inequities: Over the years, vaccination coverage in India has increased, both nationally and State-wise. However, there are persisting inequities in coverage by geography, socio-economic strata, and other parameters, which demand urgent interventions.

Need to shift focus from Child vaccination to Adult Vaccination:

• Vaccines have historically been available for all age groups, not just children. While children were prioritized due to limited resources, adult vaccination is now crucial as vaccine-preventable diseases are becoming more common in the adult population. 
• Governments should focus on expanding adult vaccination coverage, learning from the success of childhood immunization programs

What can be done?

• Need for Better Policies: Considering that vaccines are highly cost-effective, once recommended by the National Technical Advisory Group on Immunization (NTAGI), vaccines for all age groups should be made available as free at government facilities.
• Technical expansion of the Program: The recent announcement on HPV vaccines for teenage girls is a good start. However, we need to remember that once a vaccine is recommended by the government body, the coverage is likely to be far greater than if the vaccines are not recommended by the government.
• Generating Awareness: The government must consider the help of professional communication agencies to dispel myths (and in a layperson’s language and with the use of social media).
  • Medical colleges and research institutions should generate evidence on the burden of diseases in the adult population in India.

Conclusion: In the 50 years of the EPI, it is time for another expansion of the program with a 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’.