Celebrating 50 Years of Cross-Cutting Impact: The Essential Programme on Immunization (EPI)

As public health advocates around the world commemorate the 50th anniversary of the Essential Programme on Immunization (EPI), established by the World Health Organization (WHO) in 1974, it's a fitting moment to reflect on the program's profound impact on global health. This groundbreaking initiative has been a cornerstone of global public health efforts for the past 50 years, not only saving countless lives but also delivering far-reaching economic benefits and fostering the integration of critical public health resources.

Since its inception, the EPI has been instrumental in preventing illness, bolstering healthcare systems worldwide, and providing invaluable lessons for future public health endeavors. Building on the momentum of smallpox eradication, EPI was initiated with the goal of providing universal access to life-saving vaccines for children worldwide.

Preventing Disease, Saving Lives

At its core, the EPI has focused on safeguarding children from preventable diseases such as measles, polio, diphtheria, pertussis, tetanus, and tuberculosis, among others. By providing access to life-saving vaccines for children worldwide, regardless of where they live or their socioeconomic status, the EPI has saved countless lives and alleviated the burden of preventable illnesses on communities and healthcare systems.

Maintaining progress in immunization from 2020 to 2030 could prevent millions of unnecessary deaths, especially in children under 5. A study conducted by the Vaccine Impact Modelling Consortium predicts that if pre-pandemic immunization progress is sustained over the next decade (2020 – 2030) we can save 32 million lives across all ages and 28 million children under age 5.

A new landmark study finds that immunization is the single greatest contribution of any health intervention to ensuring babies not only see their first birthdays but continue leading healthy lives into adulthood. The study, published by The Lancet, reveals that over the last 50 years, global immunization efforts have saved an estimated 154 million lives – or the equivalent of 6 lives every minute of every year. The vast majority of lives saved – 101 million – were those of infants.

The True Value of Vaccines

Beyond its direct health benefits, the EPI has created a life-saving public health infrastructure that also provides incredible economic value for both nations and families. By strengthening healthcare systems and preventing illness, vaccination programs provide one of the highest returns on investment of any public health interventions. Every US$1 invested in vaccine programs returns an estimated US$20 in healthcare cost savings, lost wages, and lost productivity, according to research from the Decade of Vaccine Economics (DoVE) Project. A child’s illness can impose significant financial burdens on families, including medical expenses, transportation for treatment, and lost wages. Preventing illness through vaccination doesn’t just save lives, it also keeps families out of poverty.

Bolstering Equity, Reducing Poverty

Central to the EPI's success is its commitment to global collaboration and equity in healthcare. Through partnerships with governments, international organizations, civil society organizations, and the private sector, the program ensures equitable access to vaccines for all, irrespective of socioeconomic status or geographical location. This emphasis on equity not only saves lives but also fosters a more inclusive and just world, where every individual has the opportunity to lead a healthy life.

Evidence has shown that vaccines have the greatest health and economic benefit amongst the poor. Globally, the poorest populations often experience the largest impacts of vaccine-preventable diseases, including the potentially catastrophic costs associated with medical care, missed work, and lasting disability that can be prevented with vaccination.

Research shows that vaccines are one tool that can help break the pernicious cycle of poverty and ill health, improving equity across both health and wealth. By preventing disease, vaccination also prevents the costs associated with medical treatment and thus helps to reduce the likelihood that households will fall into or remain in poverty.

The Lasting Impact of a Healthy Start

Vaccine-preventable diseases such as measles can delay or interrupt normal growth and development in early childhood, leading to long-lasting damage that can adversely impact children for the rest of their lives. Persistent or recurrent infections in early life can lead to poor growth and stunting, which in turn can adversely affect adult health. Moreover, healthier children are more likely to attend school, perform better in school, and obtain more education than a child who is often ill or who has suffered permanent disabilities as a result of illness.

Vaccinated children are far less likely to experience stunting compared to unimmunized children. Undernutrition and infectious diseases are tightly linked in a self-reinforcing cycle. Childhood episodes of diarrhea, pneumonia, and measles are exacerbated by undernutrition, which significantly contributes to the death toll from these infections. A study in Kenya revealed that immunization with polio, BCG, DPT, and measles had protective effects with respect to stunting. Among children under the age of 2, immunized children were 27% less likely to experience stunting when compared to unimmunized children. Additionally, children who suffered from cough or diarrhea in the two weeks prior to the study showed an 80-90% higher probability of being underweight or experiencing wasting.

Embracing the Future of EPI

As we celebrate the 50th anniversary of the Essential Program on Immunization, it's clear that the program's impact extends far beyond its inception. By continuing to invest in EPI, we can help build a world where every child is able to grow up healthy and live to their full potential. Investing in vaccines sets the stage for a healthier future, one where we can prevent antimicrobial resistance, create resilience against the impacts of climate change, and eliminate cervical cancer.