Context: 2024 marks the 50th anniversary of the World Health Organization's Expanded Programme on Immunization (EPI), launched in 1974. This initiative, pivotal in the post-smallpox eradication era, spurred countries globally to set up national immunization programs.
India launched its program in 1978, renaming it the Universal Immunization Programme (UIP) in 1985. This year is also significant as it marks twenty years since India's last comprehensive review of the UIP, highlighting a crucial period for evaluating past progress and shaping future strategies.
About Vaccines
Vaccination effectively protects against diseases by safely using your body's natural defenses to build resistance. Vaccines train the immune system to produce antibodies, similar to natural exposure to a disease, but without causing the disease or its complications, as they contain only killed or weakened germs.
All the ingredients of a vaccine play an important role in ensuring a vaccine is safe and effective. Some of these include:
- The antigen. This is a killed or weakened form of a virus or bacteria, which trains our bodies to recognize and fight the disease if we encounter it in the future.
- Adjuvants, which help to boost our immune response. This means they help vaccines to work better.
- Preservatives, which ensure a vaccine stays effective.
- Stabilisers, which protect the vaccine during storage and transportation.
Global and National Vaccine Impact
- Over the past five decades, vaccine development and coverage have dramatically improved. From vaccines for six diseases in 1974, today there are universally recommended vaccines for 13 diseases and additional vaccines for 17 more based on regional needs.
- The coverage for the DPT vaccine, a key indicator of immunization reach, has increased from 5% in the early 1970s to 84% globally by 2022.
- Smallpox has been eradicated, and polio nearly eliminated, showcasing significant progress in disease control through vaccination.
Economic and Health Benefits
- Vaccination programs are not only medically beneficial but also economically viable.
- Studies indicate that every dollar spent on vaccination can yield a return of seven to 11 times the investment, underscoring their cost-effectiveness.
- These programs are typically more successful in government settings, especially in countries like India where the government administers 85% to 90% of all vaccines despite a substantial private healthcare sector.
Challenges and Declines in Coverage
- There is Persistent inequities in vaccine access by geography and socioeconomic status.
- In early 2023, the 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.
From childhood focus to life course
- Historically, vaccines have targeted not only children but also adults, dating back to the first smallpox vaccine in 1798. With the growing burden of vaccine-preventable diseases in adults, there is a pressing need to extend immunization to older populations.
- Recent policies, such as the introduction of the HPV vaccine for teenage girls and pilot adult BCG vaccination campaigns, are steps toward broader immunization coverage.
Steps to be taken in this regard:
- As 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 the government facilities.
- Second, the NTAGI in India, 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. 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).
- 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.
Conclusion:
In late 2023, India launched a pilot adult BCG vaccination program to combat tuberculosis, expanding immunization efforts beyond the previous 50-year focus on children, inspired by the acceptance of COVID-19 vaccines.
The goal now is to also address vaccine inequities, target zero-dose children, and extend vaccination coverage to adults and the elderly, thereby transforming the Expanded Programme on Immunization (EPI) into ‘Essential Program on Immunization (EPI)’ that encompasses all age groups.