Aim & Objectives

of Expanded
Program on
Immunization.

Dr. Owais Raza

 Expanded Program on
Immunization
• 1974, WHO launched EPI against six
diseases
– Diphtheria
– Pertussis
– Polio
– Measles
– Tuberculosis
– Tetanus
• Other vaccines were added then
 Expanded Program on
Immunization
Expanded means…

“… adding more disease controlling

antigens of vaccination schedules, extending
to all corners of a country and spreading
services to reach the less privileged sector of
the country.
”
 Aim
… is to make immunisation complementary
to other Primary Health Care (PHC) services
in order to reduce morbidity, mortality and
disability from the vaccine preventable
diseases of childhood.
 Objectives
• Provide immunisation against the EPI targeted
diseases and Tetanus toxoid for pregnant
women or women of child – bearing age.

• Promote immunisation programmes, including

vaccine production and quality control.

• Intensify implementation of the immunization

activities and sustainability within the framework
of the maternal and child health services.
 Target (WHO - 1974)

To immunize 80% of the world’s children

with 6 vaccines by 1990.
 Strategy
• EPI should function through the integrated health service system.
• Immunization is a continuous program, that should continue
indefinitely once started.
• Program should be economically possible, socially acceptable,
operationally feasible and professionally rewarding.
• Program should have legislation. However, persuasion and
education should be the first choice.
• Surveillance, recording and reporting system should be an integral
part of the program
 Strategy
• Internal support will be processed and channeled
through National Coordinator of the program and the
Federal Ministry of Health.
• Efficient management and supervision in the activities.
• Provisional authorities may develop:
– Stationary Health Units
– Outreach Stations
– Mobile Services
• There should be community participation.
 EPI in Pakistan
• EPI was launched in Pakistan in 1978 with support from
WHO and UNICEF.
• Program currently targets 8 vaccines preventable
disease that is
– Polio
– Diphtheria
– Tetanus
– Pertussis
– Measles
– Tuberculosis
– Hepatitis B (2003)
– H. Influenza. (2008)
 Objectives (2008)
• Reduction of mortality & morbidity in age 0 – 11 months
and women of child – bearing age.
• 90% routine immunization coverage of all EPI antigens
with at least 80% coverage in every district by 2012.
• Interruption of polio virus transmission by 2010.
• Elimination of Neonatal Tetanus by 2015.
• Reduction of measles mortality by 90% by 2010.
• Reduction of diphtheria, pertussis and childhood
tuberculosis.
• Control of other diseases by introducing new vaccines
(e.g. HepB, Hib)
 EPI Strategies
• Developed in 1994…
– Eradication of poliomyelitis by the end of 2005
• NIDs
• Enhanced surveillance of AFP
• House – to – house immunization
• Cross border immunization
– Elimination of neonatal tetanus
• Campaign to immunize all women of child bearing age
– Supplementary dose of Vit. A (Immunization Plus)
• 6 – 59 months
• NIDs & SNIDs with OPV
 EPI service delivery
• Fixed centers
• Outreach clinics
• Mobiles teams
• NGOs / private practioners

Vertical program Vs. Horizontal program

 EPI-Partners
• International
– WHO
– UNICEF
– Rotary International
– DFID (Department for International Development)
– JICA (Japanese International Cooperation Agency)
– CDC Atlanta
– USAID (United States Agency for International Development)
– UNHCR
– Global Alliance for Vaccines and Immunization (GAVI)
• National
– Government of Pakistan
• Provisional government
• District government
– NGOs
Years % children fully Immunized
% Pregnant women
BCG DPT POLIO MEASLES immunized for tetanus

1996 78 66 66 65 30
% Pregnant women
BCG DPT1 DPT3 POLIO3 MEASLES HepB3
immunized for tetanus
2009 89 90 83 83 80 80 81
“Vaccine – preventable disease rates in the
United States are at very low levels. In 2007,
only 43 cases of measles, 12 cases of
rubella, no cases of diphtheria, 28 cases of
tetanus, and no wild-type polio were
reported to CDC.”

… then why continue?

“Given these immunization successes,
one might question the continued
interest in strategies to increase
immunization levels.”
“…although levels of vaccine-preventable
diseases are low, this should not breed
complacency regarding vaccination. For
several reasons — including possible
resurgence of disease, introduction of new
vaccines, suboptimal immunization levels,
cost-effectiveness, and gaps in sustainable
immunization efforts — the need to focus on
immunization rates remains crucial.”
 No child should be denied
immunisation without serious
thought as to the consequences,
both for the individual child and for
the community