ASSOSA UNIVERSITY

COLLEGE OF HEALTH SCIENCE

DEPARTMENT OF PUBLIC HEALTH
TERM PAPER
ON
EXPANDED PROGRAMME ON IMMUNIZATION (EPI)
SUBMITTED TO-MULUAS A (PhD)
SUBMITTED BY
Group Members:-

1) NEGALGN AGONAFER-------ID---WM0202/15
2) HABTAMU BIRHANU---------ID---WM0200/15
3) YORDANOS TEZERA-----------ID---WM195/15

September-2023

Assosa Ethiopia

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 ACKNOWLEDGEMENT
At the outset, we wish to acknowledge the immeasurable grace and kindness of “Almighty God”
who enable me to complete the EPI term paper assignment successfully.

We extend our heartfelt appreciation to Muluas Amente (PhD) for his unwavering commitment
to our education and for his significant contributions to my accomplishments in this EPI term
paper assignment and the overall Introduction to Reproductive Health.

We wish to express our appreciation and gratitude to the various authors and publishers for using
their books for collecting and arranging this term paper assignment.

Group Members

September-2023

ASSOSA, Ethiopia

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 Table Of Contents
ACKNOWLEDGEMENT .................................................................................................................................................... i
1. Introduction and Background Justification on EPI ................................................................................................3
1.1 Importance of immunization in public health: .............................................................................................3
1.2 Introduction to the Expanded Program on Immunization (EPI):..................................................................3
1.3 Significance of the EPI in improving vaccine coverage and reducing disease burden: ................................3
1.4 Historical context and evolution of the EPI: .................................................................................................4
1.5 Rationale behind the establishment of the EPI: ...........................................................................................4
2. Objectives of EPI ...................................................................................................................................................5
3. Methods and Strategies’ to achieve EPI objectives ..............................................................................................7
4. Impacts and achievements of EPI .........................................................................................................................9
4.1 Global EPI ...................................................................................................................................................10
4.1.1 Global Trends EPI: .............................................................................................................................10
4.1.2 Global Coverage EPI: .........................................................................................................................11
4.2 EPI in Ethiopia ............................................................................................................................................12
4.2.1 Ethiopia Overview of EPI: ..................................................................................................................12
4.2.2 Ethiopia Routine immunization schedule ..........................................................................................13
4.2.3 Ethiopia Trends of EPI: ......................................................................................................................14
4.2.4 Ethiopia Coverage of EPI: ..................................................................................................................14
4.2.5 Ethiopia HSTP II on EPI by 2025 .........................................................................................................15
4.2.6 EPI Challenges and gaps in Ethiopia ..................................................................................................16
5. Strength & Weakness/Barriers to Immunization ................................................................................................17
5.1 Strengths of the EPI: ...................................................................................................................................17
5.2 Weaknesses of the EPI: ..............................................................................................................................18
5.3 How to overcome barriers and achieve universal immunization coverage ...............................................21
6. Global Public Health Impact of EPI .....................................................................................................................21
6.1 Role of International Collaboration in the EPI ...........................................................................................24
7. Conclusion ...........................................................................................................................................................27
8. Future direction & Recommendation .................................................................................................................28
References: ..................................................................................................................................................................29

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 1. Introduction and Background Justification on EPI
1.1 Importance of immunization in public health:
Immunization plays a crucial role in public health by preventing the spread of infectious diseases
and reducing the burden of vaccine-preventable illnesses. Vaccines stimulate the immune system
to produce an immune response, providing protection against specific diseases. By immunizing
individuals, not only are they safeguarded from potential infections, but they also contribute to
the overall health of communities.

Immunization has had a profound impact on global health outcomes. Vaccines have eradicated or
significantly reduced the incidence of diseases such as smallpox and polio. They have also led to
a decline in morbidity and mortality rates associated with diseases like measles, tetanus,
diphtheria, and pertussis.

1.2 Introduction to the Expanded Program on Immunization (EPI):

The Expanded Program on Immunization (EPI) is a global initiative launched by the World
Health Organization (WHO) in 1974. It aims to ensure that all individuals, regardless of their
socioeconomic status, have access to life-saving vaccines. The EPI focuses on providing routine
immunization services to vulnerable populations, particularly in low-income countries.

The EPI operates through national immunization programs, working closely with governments,
healthcare providers, and international partners. It supports the procurement, distribution, and
administration of vaccines, as well as the development of immunization policies and strategies
tailored to local contexts.

1.3 Significance of the EPI in improving vaccine coverage and

reducing disease burden:
The EPI has played a critical role in improving vaccine coverage rates worldwide. Through its
efforts, the program has increased access to vaccines and expanded vaccination services to
remote and underserved areas. By strengthening health systems and infrastructure, the EPI has
helped ensure the availability and affordability of vaccines.

As a result of the EPI's initiatives, there has been a significant reduction in the burden of

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vaccine-preventable diseases. Vaccination campaigns and routine immunization services have
led to a decline in the incidence of diseases such as measles, polio, and tetanus. The EPI's focus
on reaching marginalized populations has helped address disparities in vaccine coverage,
ensuring that vulnerable communities have equal access to immunization services.

In conclusion, immunization is a vital aspect of public health, preventing the spread of infectious
diseases and reducing associated morbidity and mortality rates. The Expanded Program on
Immunization (EPI) is a global initiative that plays a crucial role in improving vaccine coverage
and reducing the burden of vaccine-preventable diseases. Through its efforts, the EPI aims to
ensure equitable access to immunization services, ultimately contributing to improved health
outcomes for communities worldwide.

1.4 Historical context and evolution of the EPI:

The Expanded Program on Immunization (EPI) was launched by the World Health Organization
(WHO) in 1974. It emerged in response to the global need for increased access to immunization
services and the prevention of vaccine-preventable diseases.

Prior to the establishment of the EPI, immunization efforts were primarily focused on individual
vaccines such as smallpox and polio. However, there was a recognized need for a comprehensive
and coordinated approach to immunization on a global scale. The EPI was developed to address
this need and expand immunization services to vulnerable populations.

Over the years, the EPI has evolved to adapt to changing public health priorities. Initially, the
program focused on immunizing children against six diseases: tuberculosis, diphtheria, pertussis,
tetanus, polio, and measles. However, the EPI has expanded its scope to include additional
vaccines, such as those for hepatitis B, Haemophilus influenzae type b (Hib), and pneumococcal
diseases. This expansion reflects advancements in vaccine development and the recognition of
the importance of protecting against a wider range of vaccine-preventable diseases.

1.5 Rationale behind the establishment of the EPI:

The establishment of the EPI was driven by several key rationales, including the need to address
disparities in access to immunization services and the goal of reducing the burden of vaccine-

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preventable diseases globally.

1. Disparities in access: Prior to the EPI, there were significant disparities in access to
immunization services, particularly in low-income countries. The program aimed to address
these inequities by providing routine immunization services to all individuals, regardless of their
socioeconomic status or geographic location.

2. Disease burden reduction: Vaccine-preventable diseases were a significant cause of

morbidity and mortality, particularly among children in developing countries. The EPI aimed to
reduce the burden of these diseases by ensuring the availability and affordability of vaccines, as
well as by strengthening immunization systems and infrastructure.

3. International collaboration: The EPI was established as a global initiative, emphasizing the
importance of international collaboration and partnership. The program worked closely with
governments, healthcare providers, and international organizations to support countries in
implementing effective immunization programs.

The establishment of the EPI marked a significant milestone in global public health, providing a
framework for countries to strengthen their immunization systems and expand access to life-
saving vaccines. By addressing disparities in access and reducing the burden of vaccine-
preventable diseases, the EPI has played a crucial role in improving health outcomes and saving
countless lives worldwide.

2. Objectives of EPI
The objectives of the Expanded Program on Immunization (EPI) are:

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1. To Improve vaccine coverage rates:

 One of the primary goals of the EPI is to increase the proportion of the target population that
receives the recommended vaccines.

 This is aims to ensure that a high percentage of individuals, especially children, are
immunized against vaccine-preventable diseases.

2. To Reduce vaccine-preventable diseases:

 The EPI aims to significantly decrease the incidence and burden of vaccine-preventable
diseases worldwide.

 By increasing vaccine coverage and implementing effective immunization strategies, the

program seeks to minimize the occurrence of diseases such as measles, polio, diphtheria,
pertussis, and tetanus.

3. To Ensure equitable access to immunization services:

 The EPI recognizes the importance of addressing disparities in access to immunization

services.

 It aims to provide equal access to vaccines and immunization services for all individuals,
regardless of their socioeconomic status or geographic location.

 This is seeks to eliminate barriers that may hinder certain populations from receiving the
benefits of immunization.

4. To Strengthen immunization systems:

 The EPI focuses on building and strengthening immunization systems at the national and
local levels.

 This is involves enhancing vaccine supply chains, improving cold chain management,
establishing robust surveillance systems, and developing effective communication strategies
to support immunization programs.

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5. To Enhance immunization program performance:

 The EPI aims to continually improve the performance of immunization programs.

 This is involves monitoring and evaluating immunization coverage, vaccine safety, and
program effectiveness.

 By identifying areas for improvement and implementing evidence-based strategies, the

program seeks to optimize the impact of immunization efforts.

3. Methods and Strategies’ to achieve EPI objectives

 The Expanded Program on Immunization (EPI) employs various strategies and methods to
achieve its objectives.

 This Key components of the EPI include:

1. Vaccine procurement and delivery:

 The EPI works to ensure the availability and accessibility of vaccines.

 This involves coordinating with vaccine manufacturers, negotiating prices, and facilitating
the procurement and distribution of vaccines to countries.

 The program emphasizes the importance of establishing reliable supply chains to deliver
vaccines to health facilities and communities efficiently.

2. Cold chain management:

 The EPI places significant emphasis on maintaining the integrity of vaccines through proper
cold chain management.

 This involves the storage, transportation, and monitoring of vaccines at recommended

temperatures to maintain their potency.

 The program provides guidance on cold chain equipment, training healthcare workers on
cold chain management, and implementing monitoring systems to ensure vaccine quality.

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3. Surveillance systems:

 The EPI relies on robust surveillance systems to monitor vaccine-preventable diseases and
immunization coverage.

 This involves collecting and analyzing data on disease incidence, vaccine coverage rates, and
adverse events following immunization.

 Surveillance systems help identify disease outbreaks, assess the impact of immunization
programs, and inform evidence-based decision-making.

4. Community engagement:

 The EPI recognizes the importance of engaging communities to increase vaccine acceptance
and coverage.

 The program employs various strategies to build trust, raise awareness, and address vaccine
hesitancy.

 This includes conducting community outreach activities, involving community leaders,

leveraging social and mass media, and addressing misconceptions and concerns related to
vaccines.

5. Training and capacity-building:

 The EPI invests in training healthcare workers to ensure they have the knowledge and skills
required for effective immunization delivery.

 This includes training on vaccine administration, cold chain management, surveillance, and
communication.

 The program also supports the development of national immunization plans and policies,
strengthening the capacity of countries to implement and manage immunization programs
effectively.

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 4. Impacts and achievements of EPI
 The Expanded Program on Immunization (EPI) has had a significant impact on global public
health, leading to numerous achievements.

 Some of the key impacts and achievements of the EPI include:

1. Improvement in vaccine coverage rates:

 The EPI has played a crucial role in increasing vaccine coverage rates worldwide.

 Through its efforts, the program has expanded access to vaccines, particularly in low-income
countries.

 As a result, more individuals, especially children, have been reached with life-saving
vaccines.

 This has led to higher immunization coverage rates and a greater proportion of the population
protected against vaccine-preventable diseases.

2. Reduction in vaccine-preventable diseases:

 The EPI has contributed to a significant decline in the incidence and burden of vaccine-
preventable diseases.

 Vaccination campaigns and routine immunization services have been instrumental in

reducing the transmission of diseases such as measles, polio, diphtheria, pertussis, and
tetanus.

 This has resulted in fewer cases, hospitalizations, and deaths associated with these diseases,
particularly among vulnerable populations.

3. Eradication and elimination of diseases:

 The EPI has played a vital role in achieving the eradication of smallpox, one of the deadliest
diseases in history.

 This milestone, accomplished in 1980, stands as a testament to the success of global

immunization efforts.

 The EPI has also contributed to the elimination of diseases such as polio in many parts of the
world, with only a few remaining endemic countries.

4. Improved overall public health outcomes:

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 The impact of the EPI extends beyond the prevention of specific diseases.

 By reducing the burden of vaccine-preventable illnesses, the program has improved overall
public health outcomes.

 Fewer cases of these diseases mean fewer hospitalizations, reduced healthcare costs, and
improved quality of life for individuals and communities.

 The EPI has also indirectly contributed to the reduction of poverty, as immunized individuals
are less likely to face the financial burden of medical expenses associated with vaccine-
preventable diseases.

5. Equity in access to immunization services:

 The EPI has made significant strides in addressing disparities in access to immunization
services.

 By focusing on reaching marginalized populations and underserved areas, the program has
helped ensure equitable access to vaccines and immunization services.

 This has reduced health inequalities and improved health outcomes among vulnerable
communities.

 The impact and achievements of the EPI are supported by numerous studies, data, and
evidence.

 Global immunization coverage rates have steadily increased over the years, and the incidence
of vaccine-preventable diseases has significantly declined.

 These positive trends demonstrate the effectiveness of the EPI in improving public health
outcomes and saving lives worldwide.

 The specific impact and achievements may vary across countries and regions, as the EPI
operates within different contexts and health systems.

4.1 Global EPI

4.1.1 Global Trends EPI:

 The EPI has achieved significant progress in improving global immunization coverage over
the years.

 Vaccination rates have increased, and many vaccine-preventable diseases have been greatly

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 reduced or eliminated in several countries.

 For example, smallpox was eradicated globally through the efforts of the EPI.

 The EPI has also been successful in reducing the burden of diseases like polio and measles.

 Polio cases have decreased by over 99% since the launch of the Global Polio Eradication
Initiative, and measles deaths have declined by 73% between 2000 and 2018.

 However, challenges remain, including disparities in coverage between and within countries,
vaccine hesitancy, weak health systems, and outbreaks of vaccine-preventable diseases in
some regions.

 Ongoing efforts are required to sustain and further improve immunization coverage globally.

4.1.2 Global Coverage EPI:

 Immunization coverage varies across countries and regions, but the EPI has made significant
strides in increasing coverage rates worldwide.

 According to WHO, as of 2019, global coverage for the first dose of diphtheria-tetanus-
pertussis (DTP1) vaccine was 86%, and coverage for the third dose (DTP3) was 85%.

 Measles-containing vaccine coverage has also improved, with 86% of children worldwide
receiving the first dose of measles vaccine by their second birthday in 2019.

 However, measles outbreaks in recent years have highlighted the need for sustained efforts to
achieve and maintain high coverage rates.

 The EPI has expanded its scope to include new vaccines, such as those against human
papillomavirus (HPV), rotavirus, and pneumococcal infections.

 Efforts are ongoing to increase access to these vaccines and improve coverage rates.

 The EPI's goal is to achieve at least 90% vaccination coverage at the national level and 80%
coverage in every district or administrative unit by 2020.

 While progress has been made towards these goals, some countries and regions still face

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 challenges in achieving and maintaining high coverage rates.

 To improve coverage, the EPI and its partners focus on strengthening health systems,
addressing barriers to access, enhancing surveillance and monitoring systems, and promoting
community engagement and vaccine acceptance.

4.2 EPI in Ethiopia

 The Expanded Programme on Immunization (EPI) in Ethiopia is a national immunization
program that aims to provide vaccines to prevent vaccine-preventable diseases to all eligible
individuals across the country.

4.2.1 Ethiopia Overview of EPI:

 The EPI in Ethiopia was established in 1980 and is implemented by the Federal Ministry of
Health in collaboration with regional health bureaus.

 It follows the guidelines and recommendations of the World Health Organization (WHO) and
the Global Vaccine Action Plan (GVAP).

 The program focuses on delivering a set of vaccines against diseases like

1) tuberculosis, 4) diphtheria,

2) polio, 5) pertussis,

3) measles, 6) tetanus,

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7) hepatitis B, 10) Rota virus

8) Haemophilus influenzae type b (Hib), 11) It also includes targeted immunization

campaigns for disease like measles and
9) Pneumococcal infections.
polio

4.2.2 Ethiopia Routine immunization schedule

NO VACCINE TARGETED DISEASES AGE ROUTE/SITE OF
ADMINISTRATION
1 BCG Severe forms of Tuberculosis At Birth or soon after Intradermal (ID), Rt
deltoid
2 PCV Meningitis and pneumonia Weeks 6,10 & 14 Intramuscular (IM),
(streptococcal and pneumococcal)
3 OPV Poliomyelitis Birth (OPV0), weeks 6, 10 & 14 Oral

4 IPV Poliomyelitis Week 14 IM, Rt thigh 2.5 cm below

5 DPT-Hib- Diphtheria, Pertussis, Meningitis &
HepB pneumonia associated with
Haemophilus influenza and Liver
disease due to Hepatitis B virus.
6 TT/Td Tetanus/diphtheria
Weeks 6, 10 & 14 IM, Lt anterolateral thigh
At 0, 1 & 6 months, 1st & 2nd year IM, Lt Deltoid
for TT 1st dose early as possible 2nd
dose 4 week after 1st dose 3rd dose
6 months after 2nd dose 4th dose 1
year after 3rd dose 5th dose 1 year
after 4th dose

7 MCV Measles 9 and 15 months Subcutaneous (SC), Rt

deltoid
8 Rotavirus Rotavirus-associated Weeks 6 & 10 Oral
vaccine gastroenteritis
9 HPV Human papillomavirus, associated Age - 0, 6 months for Quadrivalent IM, Deltoid muscle of
with cervical cancer and upper arm
anogenital wart

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 4.2.3 Ethiopia Trends of EPI:
 Over the years, Ethiopia has made significant progress in expanding its immunization
coverage and improving the EPI.

 The country has experienced an upward trend in immunization coverage rates, with efforts to
reach underserved populations and remote areas.

 Ethiopia has shown commitment to achieving the GVAP targets, which include achieving at
least 90% national immunization coverage and reducing inequalities in coverage between
and within regions.

 The country has also been actively involved in the global polio eradication initiative.

Soure:EDHS Mini 2019

4.2.4 Ethiopia Coverage of EPI:

 Immunization coverage in Ethiopia has improved steadily, although there are still variations
across regions and communities.

 The country has made efforts to increase coverage rates and reach underserved populations,
including those in rural areas and remote communities.

 According to the Ethiopian Demographic and Health Survey (EDHS) conducted in 2019, the

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national immunization coverage for children aged 12-23 months for selected antigens and
dropout by region was as follows:

4.2.5 Ethiopia HSTP II on EPI by 2025

 Penta3 61% to 85%

 MCV2 measles 50% to 80%

 full vaccination 44% to 75%

 Penta1 100%

 MCV1 98%

 Reduce number of unimmunized children by 75% by 2025 from the 2020 baseline

 Reduce DTP-HepB-Hib1 (Penta 1) - DTP-HepBHib3 (Penta 3) dropout rate to 2%

 Reduce DTP-HepB-Hib1 (Penta 1) - MCV1 dropout rate dropout rate to 2%

 Reduce MCV1- MCV2 dropout rate dropout rate to 5%

 Ensure availability of immunization service in all HF (Hospitals, Health centres and

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 Health posts)

 Introduce COVID 19 Vaccine, nOPV2 and piloting of Hepatitis B birth dose by 2021,
scale introduction Hepatitis B birth, and introduce MR, IPV2, Yellow fever, Men A
vaccines by 2022

 All polioviruses are laboratory-contained nationally by 2023

 Achieve and maintain the function and polio free status mistermed in to national
immunization and surveillance system

4.2.6 EPI Challenges and gaps in Ethiopia

 Lack of focus on generating demand for immunization at national and regional levels.

 Insufficient attention from regional and lower-level leadership on immunization

communication.

 Absence of immunization communication officers at regional, zonal, and woreda levels.

 Weak integration of communication activities with Health Extension Workers (HEWs) in

some areas.

 Limited budget for demand generation, communication, and social mobilization

interventions.

 Limited research on social and behavioral aspects of immunization practices.

 Inconsistent functionality of the Women Development Army structure in some areas.

 Increasing vaccine hesitancy among parents, leading to lower immunization rates.

 Disruptions in pregnant women conferences, affecting immunization efforts.

 Decreasing commitment and increasing burnout among healthcare providers, including

Health Extension Workers.

 Lack of dedicated teams for risk communication and mitigation.

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  Absence of risk communication guidelines/strategies at the national and regional levels.

 Limited development and implementation of tailored demand generation interventions in

communities with high numbers of under-immunized children.

 Limited engagement with Civil Society Organizations in addressing vaccine hesitancy

and related issues.

These challenges highlight the need for improved communication, research, and targeted
interventions to enhance immunization coverage and address vaccine hesitancy.

5. Strength & Weakness/Barriers to Immunization

Despite the achievements of the Expanded Programme on Immunization (EPI), several
challenges and barriers persist, hindering the achievement of universal immunization coverage.
These challenges vary across countries and regions but share common themes. Understanding
and addressing these challenges is crucial for ensuring equitable access to vaccines and
maximizing the impact of immunization efforts. The following are some key challenges and
barriers to immunization:

5.1 Strengths of the EPI:

1. Global coordination: The EPI benefits from strong global coordination and collaboration
among countries, international organizations, and stakeholders. This allows for the sharing of
best practices, resources, and technical expertise, promoting a unified approach to immunization.

2. Comprehensive approach: The EPI takes a comprehensive approach to immunization,

addressing multiple diseases and vaccines. This ensures a broad impact on public health and
reduces the burden of a wide range of vaccine-preventable diseases.

3. Strong evidence-based approach: The EPI relies on scientific evidence and data to guide its
strategies and decision-making. This evidence-based approach helps ensure that immunization
programs are effective and targeted towards areas of greatest need.

4. Support for health system strengthening: The EPI recognizes the importance of strong
health systems in delivering immunization services. The program supports capacity-building

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efforts, including training healthcare workers, strengthening supply chains, and improving
surveillance systems, which contribute to overall health system strengthening.

5.2 Weaknesses of the EPI:

1. Vaccine Hesitancy:

 Vaccine hesitancy refers to the reluctance or refusal to vaccinate despite the availability of
vaccines.

 It is influenced by various factors, including

Misinformation,

misconceptions about vaccine safety and efficacy,

religious or cultural beliefs, and

Lack of trust in healthcare systems.

 Vaccine hesitancy can lead to suboptimal immunization coverage and increased vulnerability
to vaccine-preventable diseases.

2. Access and Geographical Barriers:

 Limited access to vaccines remains a significant barrier, particularly in remote and

underserved areas. Factors such as

Inadequate healthcare infrastructure,

transportation challenges, and

Geographical barriers (e.g., conflict zones or hard-to-reach regions) can impede the
delivery of vaccines and immunization services to vulnerable populations.

3. Socioeconomic Inequalities:

 Socioeconomic disparities can affect immunization coverage rates.

 Financial barriers, including the cost of vaccines and transportation to healthcare facilities,

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 can prevent individuals from accessing immunization services.

 Additionally, marginalized populations, such as those living in poverty or in rural areas, may
face additional barriers related to education, awareness, and healthcare infrastructure.

4. Weak Health Systems:

 Weak health systems can hinder immunization efforts, including

Inadequate healthcare infrastructure,

limited human resources, and

Poor supply chain management,

 Insufficient resources can impact vaccine delivery, cold chain maintenance, and monitoring
systems, leading to suboptimal immunization coverage, including

Funding,

equipment, and

Trained personnel,

5. Vaccine Supply and Logistics:

 Ensuring a consistent and reliable supply of vaccines is essential for successful immunization
programs.

 Challenges related to vaccine procurement, storage, transportation, and distribution can

compromise immunization efforts.

 Issues such as stock outs, expired vaccines, and inadequate cold chain management can lead
to gaps in vaccine availability and hinder immunization coverage.

6. Outbreaks and Emergencies:

 Outbreaks of infectious diseases and humanitarian emergencies pose challenges to

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 immunization efforts.

 Disruptions in healthcare services, population displacement, and weakened health systems

during emergencies can lead to decreased immunization coverage and increased
vulnerability to vaccine-preventable diseases.

7. Vaccine-Related Challenges:

 Some vaccines pose unique challenges due to factors such as the need for multiple doses,
cold chain requirements, and vaccine administration techniques.

 Vaccines with complex storage and administration requirements may be more difficult to
deliver in resource-limited settings, impacting their accessibility and effectiveness.

8. Vaccine Mismanagement and Waste:

 Inadequate vaccine management, including improper storage, handling, and administration,

can lead to vaccine wastage.

 Vaccine wastage not only represents a loss of valuable resources but also contributes to
supply shortages and compromises immunization coverage.

9. Cultural and Religious Beliefs:

 Cultural and religious beliefs can influence perceptions of vaccines and immunization
practices.

 Misunderstandings, misinformation, and religious objections may contribute to vaccine

hesitancy and resistance to immunization, particularly in certain communities or
populations.

10. Lack of Data and Surveillance Systems:

 Inadequate data collection, monitoring, and surveillance systems can hinder the
assessment of immunization coverage and the identification of underserved populations.

 Without accurate and timely data, it becomes challenging to target interventions, track

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 progress, and address immunization gaps effectively.

5.3 How to overcome barriers and achieve universal immunization

coverage
 Addressing these challenges requires a multifaceted approach that involves

targeted communication and Ensuring equitable access to

education, immunization services.

community engagement,  Collaboration among

strengthening health systems, governments,

improving vaccine supply chains, international organizations,

addressing vaccine hesitancy, and healthcare providers, and

communities

6. Global Public Health Impact of EPI

 The Expanded Programme on Immunization (EPI) has had a significant impact on global
health since its establishment.

 By increasing access to vaccines and reducing the burden of vaccine-preventable diseases,

the EPI has contributed to improved health outcomes, reduced mortality rates, and enhanced
public health systems.

 The following are some key impacts of the EPI on global health:

1. Reduction in Vaccine-Preventable Diseases:

 The EPI has played a crucial role in reducing the incidence and mortality rates associated
with vaccine-preventable diseases.

 Vaccines provided through the EPI, have significantly decreased the burden of these diseases
worldwide. such as those against

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1) measles, 5) tetanus,

2) polio, 6) hepatitis B, and

3) diphtheria, 7) Haemophilus influenzae type b (Hib

4) pertussis,

2. Childhood Mortality Reduction:

 Immunization has been instrumental in reducing childhood mortality rates.

 Vaccines provided through the EPI have prevented millions of deaths among children under
the age of five.

 Diseases such as measles and pertussis, which were major causes of child mortality in the
past, have seen significant declines in mortality rates due to vaccination.

3. Eradication and Elimination of Diseases:

 The EPI has contributed to the eradication of smallpox, making it the first disease to be
eradicated globally.

 Additionally, the EPI has made progress towards the elimination of polio, with only a few
remaining endemic countries.

 These achievements highlight the program's impact on disease control and the potential for
global disease eradication efforts.

4. Improved Immunization Coverage:

 The EPI has worked towards improving immunization coverage rates, particularly in low-
income countries.

 Through targeted interventions, outreach programs, and strengthening of health systems,

the EPI has increased access to vaccines and reached underserved populations.

 This has led to improved immunization coverage and reduced disparities in vaccine

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 uptake.

5. Health System Strengthening:

 The EPI has contributed to the strengthening of health systems, particularly in low-
resource settings.

 Efforts to improve vaccine supply chains, cold chain management, surveillance systems,
and training of healthcare workers have enhanced the overall capacity of health systems to
deliver immunization services effectively.

 This strengthening has had broader benefits for the overall healthcare infrastructure.

6. Reduction in Outbreaks and Disease Transmission:

 High immunization coverage rates achieved through the EPI have led to a reduction in
outbreaks and the transmission of vaccine-preventable diseases.

 By achieving herd immunity, where a significant proportion of the population is immune

to a disease, the EPI has helped protect vulnerable populations, including infants, the
elderly, and those with weakened immune systems.

7. Economic Benefits:

 Immunization has significant economic benefits.

 By preventing illness, disability, and premature deaths, vaccines provided through the
EPI have reduced healthcare costs, productivity losses, and the economic burden of
vaccine-preventable diseases.

 Immunization has been recognized as a cost-effective public health intervention with a

high return on investment.

8. Equity in Access to Vaccines:

 The EPI has prioritized equity in access to vaccines, aiming to reach marginalized
populations and underserved areas.

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  Efforts to reduce disparities in immunization coverage have contributed to improved
health equity, ensuring that all children, regardless of their socioeconomic background or
geographic location, have access to lifesaving vaccines.

9. Global Collaboration and Partnerships:

 The EPI has fostered global collaboration and partnerships among countries, international
organizations, and stakeholders.

 This collaboration has facilitated the sharing of best practices, knowledge transfer, and
resource mobilization to support immunization efforts worldwide.

 The EPI has served as a platform for international cooperation in addressing global health
challenges.

6.1 Role of International Collaboration in the EPI

 The role of international collaboration is crucial in the success of the Expanded Programme
on Immunization (EPI).

 Immunization efforts require coordinated action and cooperation among countries,

international organizations, donors, researchers, and other stakeholders.

 International collaboration plays a significant role in several key aspects of the EPI:

1. Knowledge Sharing and Best Practices:

 International collaboration facilitates the sharing of knowledge, experiences, and best

practices in immunization.

 Countries can learn from each other's successes and challenges, enabling the adoption of
effective strategies and approaches to improve immunization coverage and outcomes.

 Platforms such as the World Health Organization (WHO), United Nations Children's Fund
(UNICEF), and global immunization partnerships provide opportunities for knowledge
exchange and learning.

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2. Technical Support and Capacity Building:

 International collaboration supports countries in building their technical capacity and

expertise in immunization.

 Technical agencies, such as the WHO and UNICEF, provide guidance, training, and
technical assistance to countries, helping them strengthen their immunization programs.

 Collaborative initiatives focus on improving vaccine supply chains, cold chain management,
surveillance systems, data management, and program evaluation.

3. Funding and Resource Mobilization:

 International collaboration plays a critical role in mobilizing financial resources to support

immunization programs.

 Donor countries, international organizations, and public-private partnerships contribute

funding to support vaccine procurement, delivery systems, training programs, research, and
surveillance activities.

 Through collaborative efforts, resources are pooled and allocated to countries with the
greatest need, ensuring equitable access to vaccines and immunization services.

4. Vaccine Procurement and Supply:

 International collaboration facilitates vaccine procurement and supply chain management.

 Organizations such as Gavi, the Vaccine Alliance, negotiate vaccine prices, support vaccine
manufacturers, and ensure the availability of affordable and quality vaccines.

 Collaborative efforts help address supply chain challenges, improve forecasting, and
strengthen vaccine distribution systems to ensure a steady supply of vaccines to countries.

5. Disease Surveillance and Outbreak Response:

 International collaboration is crucial for disease surveillance and outbreak response.

 Timely sharing of surveillance data and information on disease outbreaks enables early

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 detection, rapid response, and containment of vaccine-preventable diseases.

 Global networks, such as the Global Polio Eradication Initiative and the Global Measles and
Rubella Laboratory Network, facilitate collaboration in disease surveillance, laboratory
testing, and emergency response.

6. Research and Development:

 International collaboration supports research and development efforts to improve existing

vaccines, develop new vaccines, and address emerging challenges in immunization.

 Collaborative research initiatives focus on vaccine efficacy, safety, delivery methods, and
vaccine-preventable disease epidemiology.

 Partnerships between researchers, governments, and industry contribute to scientific

advancements and innovation in immunization.

7. Advocacy and Policy Development:

 International collaboration strengthens advocacy efforts to promote immunization as a public

health priority.

 Collaborative initiatives raise awareness about the benefits of immunization, address vaccine
hesitancy, and advocate for policies that support immunization programs.

 By working together, countries can amplify their voices and influence global policies and
strategies related to immunization.

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 7. Conclusion
The Expanded Program on Immunization (EPI) is a critical global health initiative that has made
significant strides in improving vaccine coverage rates, reducing vaccine-preventable diseases,
and ensuring equitable access to immunization services. The term paper highlights the
objectives, strategies, and achievements of the EPI, emphasizing its impact on public health and
the importance of continued investment and support.

Key findings and conclusions of the term paper include:

1. The EPI has been successful in improving vaccine coverage rates, expanding access to
vaccines, and reaching vulnerable populations worldwide. This has led to a significant reduction
in the incidence and burden of vaccine-preventable diseases.

2. The program's comprehensive approach, global coordination, and evidence-based strategies

have contributed to its success. Vaccine procurement and delivery, cold chain management,
surveillance systems, and community engagement are key components that have been
instrumental in achieving the EPI's objectives.

3. Despite its achievements, the EPI faces challenges such as vaccine hesitancy, inadequate
resources, and reaching marginalized populations. These challenges require targeted
interventions, increased funding, and strengthened health systems to ensure the program's
continued effectiveness.

4. The EPI's impact extends beyond the prevention of specific diseases, leading to improved
overall public health outcomes, reduced healthcare costs, and poverty reduction.

5. Continued investment and support for the EPI are crucial to sustain its achievements and
address ongoing challenges. This includes financial resources, technical assistance, capacity-
building efforts, and research to strengthen immunization programs and address emerging issues.

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 8. Future direction & Recommendation
Based on the findings and conclusions of the term paper, we would recommend the following for
the Expanded Program on Immunization (EPI):

1. Strengthen vaccine communication and combat vaccine hesitancy: Develop targeted

communication strategies to address vaccine hesitancy and misinformation. Engage with
communities, healthcare providers, and influential leaders to build trust, address concerns, and
promote the importance of vaccines.

2. Increase funding and resources: Advocate for increased funding and resources for the EPI at
national and international levels. Adequate financial support is crucial for vaccine procurement,
cold chain management, surveillance systems, healthcare worker training, and community
engagement activities.

3. Improve health system capacity: Strengthen health systems to support immunization

programs. This includes investing in healthcare infrastructure, training and retaining healthcare
workers, and improving supply chain management to ensure the availability and accessibility of
vaccines.

4. Enhance surveillance systems: Continuously improve surveillance systems for vaccine-

preventable diseases and adverse events following immunization. This will help identify disease
outbreaks, monitor vaccine coverage rates, and inform evidence-based decision-making.

5. Address disparities and reach marginalized populations: Implement targeted strategies to

reach underserved populations, including those in remote areas, conflict-affected regions, and
urban slums. This may involve mobile vaccination clinics, community outreach programs, and
tailored approaches to address cultural and social barriers.

6. Foster global collaboration and knowledge-sharing: Strengthen collaboration among

countries, international organizations, and stakeholders to share best practices, experiences, and
resources. This will help accelerate progress, improve program effectiveness, and address
common challenges.

7. Invest in research and innovation: Allocate resources for research and innovation in
immunization, including the development of new vaccines, vaccine delivery technologies, and
strategies to improve vaccine coverage and acceptance.

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