Celebrating 50 Years of the Essential Programme on Immunization: Achievements and Future Directions for the Eastern Mediterranean Region

PDF version

Editorial

Hanan Balkhy¹

¹Regional Director, WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt.

Citation: Balkhy H. Celebrating 50 years of Essential Programme on Immunization: What’s achieved and what’s next for the Eastern Mediterranean Region. East Mediterr Health J. 2024;30(8):537–538. https://doi.org/10.26719/2024.30.8.537.

Copyright: © Authors 2024; Licensee: World Health Organization. EMHJ is an open access journal. All papers published in EMHJ are available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

The year 2024 marks a pivotal moment in global health: it is the 50th anniversary of the Expanded Programme on Immunization (EPI) (1,2). This extraordinary achievement is a testament to the power of collective action, scientific innovation and unwavering commitment to child health.

Since its inception in 1974, EPI has been a cornerstone of public health, saving millions of lives and preventing countless cases of vaccine-preventable diseases (VPDs). The programme has been instrumental in eradicating smallpox (3,4) globally and making substantial progress towards polio eradication, and elimination of measles and rubella in the Eastern Mediterranean Region (EMR) (2,5). Introduction of vaccines by EPI against hepatitis B, Haemophilus influenzae type b (Hib), pneumococcal disease, rotavirus, and human papillomavirus (HPV) has expanded the scope of control of vaccine-preventable diseases, leading to substantial improvements in child health.

The impact of EPI on healthcare in the EMR is undeniable; more than 25 million lives have been saved over the past 50 years, with measles vaccination alone accounting for 12.89 million lives saved (6). For each prevented death, on average, 58 years of life and 66 years of full health were gained (6). Notably, vaccination has contributed to 33% reduction in infant mortality in the EMR since 1974 (6). These achievements underscore the transformative power of immunization in improving public health outcomes. Immunization significantly contributes to several Sustainable Development Goals (SDGs) directly (SDG 3) and indirectly (SDGs 4, 5 and 10).

Beyond the lives saved, EPI has had a profound economic impact. By preventing disease, immunization programmes have saved hundreds of billions of US dollars in healthcare costs and contributed significantly to lifelong productivity. Healthy children are more likely to attend school, join the workforce and become productive members of society, fostering long-term economic growth and development (7).

EPI has played a pivotal role in strengthening primary health care systems, serving as a platform for delivering essential health services and building community trust in health providers.

Despite these remarkable achievements, certain challenges persist. The COVID-19 pandemic exposed vulnerabilities in immunization systems, underscoring the need for resilient and equitable immunization programmes. Global vaccination coverage, including in our region, regressed during the COVID-19 pandemic (8). Disruptions to routine immunisation services have resulted in large immunity gaps, threatening to reverse decades of progress achieved through EPI. Vaccine hesitancy, misinformation and disinformation pose additional risks to achieving high vaccination coverage (9). Conflicts and humanitarian crises leading to dysfunctional health systems and population displacement continue to impede progress in our region (10). Of particular concern is the increasing number of zero-dose children – those who have never received a single vaccine (11). These children represent the most vulnerable populations and are at heightened risk of vaccine-preventable diseases (12). Finding, reaching and protecting these children with complete vaccination is crucial to achieving Universal Health Coverage and preventing outbreaks.

The future of vaccination and EPI hold tremendous promise if these challenges can be overcome. New vaccines against numerous diseases, which may have substantial impact on reducing morbidity and mortality are already available or will be available soon. HPV vaccine (13) and typhoid conjugate vaccine (TCV) (14) are already available and rolled out in many low-income and middle-income countries; new vaccines against respiratory syncytial virus (RSV) have been approved for use in the USA and Europe (15); and the long-awaited vaccines against malaria are currently being deployed (16). Building an improved delivery system through which the benefits of these vaccines can reach individuals of all ages, everywhere, will be the uphill challenge for the near future.

To sustain the gains made and accelerate progress towards immunization goals, several key actions are imperative. Firstly, countries in the EMR must prioritize immunization in their national health agendas and allocate adequate resources for immunization programmes. Secondly, strengthening immunization systems through the development of robust surveillance systems, effective vaccine logistics and supply chains, and well-trained healthcare workforce is crucial. Thirdly, fostering partnerships between governments, civil society organizations and the private sector is essential for achieving immunization goals. Fourthly, investing in research and development for new vaccines and innovative delivery strategies is vital to address emerging challenges. Furthermore, integrating immunization services into primary health care is crucial for achieving Universal Health Coverage and ensuring long-term sustainability of immunization programmes.

By building upon the solid foundation laid by EPI, we can create a healthier and more resilient future for the people of the Eastern Mediterranean Region.

References

1. World Health Organization. Essential Programme on Immunization. Geneva: World Health Organization, n.d. https://www.who.int/teams/immunization-vaccines-and-biologicals/essential-programme-on-immunization.
2. Zahraei SM, Izadi S, Gouya MM, Shahri SMH, Mohammadi M. Immunization coverage of children aged 24–35 months in the Islamic Republic of Iran: a national cluster coverage survey. East Mediterr Health J. 2022;28(2):121–129. https://doi.org/10.26719/emhj.21.059
3. Fenner F. A successful eradication campaign. Global eradication of smallpox. Rev Infect Dis 1982; 4: 916–930. DOI: 10.1093/clinids/4.5.916.
4. Sultan MA. Emerging challenges to realizing global polio eradication and their solutions. East Mediterr Health J. 2022;28(7):515–520. https://doi.org/10.26719/emhj.22.045.
5. Musa N, Ghoniem A, Hsu CH, Mubarak S, Sume G, Sharifuzzaman M, etc. Progress toward measles elimination – World Health Organization Eastern Mediterranean Region, 2019-2022. MMWR Morb Mortal Wkly Rep. 2024;73(7):139-144. doi: 10.15585/mmwr.mm7307a1.
6. Shattock AJ, Johnson HC, Sim SY, Carter A, Lambach P, Hutubessy RCW, et al. Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization. Lancet 2024;403(10441):2307-2316. doi: 10.1016/S0140-6736(24)00850-X.
7. Wahl B, Pitzer VE. Expanded Programme on Immunization at 50 years: its legacy and future. Lancet 2024;403(10441):2265-2267. doi: 10.1016/S0140-6736(24)00982-6.
8. Shet A, Carr K, Danovaro-Holliday MC, Sodha SV, Prosperi C, Wunderlich J, et al. Impact of the SARS-CoV-2 pandemic on routine immunisation services: evidence of disruption and recovery from 170 countries and territories. Lancet Glob Health 2022;10(2):e186-e194. doi: 10.1016/S2214-109X(21)00512-X.
9. Pertwee E, Simas C, Larson HJ. An epidemic of uncertainty: rumors, conspiracy theories and vaccine hesitancy. Nat Med. 2022 Mar;28(3):456-459. doi: 10.1038/s41591-022-01728-z.
10. Nnadi C, Etsano A, Uba B, Ohuabunwo C, Melton M, Wa Nganda G, et al. Approaches to vaccination among populations in areas of conflict. J Infect Dis. 2017;216(suppl_1):S368-S372. doi: 10.1093/infdis/jix175.
11. Hasan Q, Hutin YF, Hajjeh R. Immunization in the Eastern Mediterranean Region: some signs of post-COVID-19 recovery, but more work ahead. East Mediterr Health J. 2023;29(9):681–683. https://doi.org/10.26719/2023.29.9.681.
12. Cata-Preta BO, Santos TM, Mengistu T, Hogan DR, Barros AJD, Victora CG. Zero-dose children and the immunisation cascade: Understanding immunisation pathways in low and middle-income countries. Vaccine 2021;39(32):4564-4570. doi: 10.1016/j.vaccine.2021.02.072.
13. Murillo R, Ordóñez-Reyes C. Human papillomavirus (HPV) vaccination: from clinical studies to immunization programs. Int J Gynecol Cancer 2019;29(8):1317-1326. doi: 10.1136/ijgc-2019-000582.
14. Batool R, Qamar ZH, Salam RA, Yousafzai MT, Ashorn P, Qamar FN. Efficacy of typhoid vaccines against culture-confirmed Salmonella Typhi in typhoid endemic countries: a systematic review and meta-analysis. Lancet Glob Health 2024;12(4):e589-e598. doi: 10.1016/S2214-109X(23)00606-X.
15. Venkatesan P. First RSV vaccine approvals. Lancet Microbe 2023;4(8):e577. doi: 10.1016/S2666-5247(23)00195-7.
16. RTS,S Clinical Trials Partnership. Efficacy and safety of RTS,S/AS01 malaria vaccine with or without a booster dose in infants and children in Africa: final results of a phase 3, individually randomised, controlled trial. Lancet 2015;386(9988):31-45. doi: 10.1016/S0140-6736(15)60721-8.