The Expanded Programme on Immunization (EPI): 50 years and counting

In the last week of April each year, the world comes together to celebrate World Immunization Week (WIW) (or European Immunization Week, as it is called in the WHO/Europe region). Each year’s theme highlights a critical call to action of a central achievement of vaccination programmes. The 2024 WIW theme is particularly special as it marks the 50th anniversary of the Expanded Programme on Immunization (EPI), showcasing the long-term impact of our collaborative efforts against infectious diseases. The outcome is remarkable: vaccines have saved 6 lives a minute, every minute, for half a century.

At RIVER-EU, we aim to protect children and adolescents in underserved communities across Europe by reducing vaccine inequalities, specifically for human papillomavirus (HPV) and measles, mumps, and rubella (MMR) vaccine. Our efforts not only protect these current generations but also ensure that future generations live in a world where vaccine-preventable diseases such as measles and cervical cancer are non-existent.

The outcome is remarkable: vaccines have saved 6 lives a minute, every minute, for half a century.

What is the Expanded Programme on Immunization?

The journey of the EPI traces back to 1967 when the World Health Organization (WHO) initiated mass vaccinations as part of the Smallpox Eradication Programme. Smallpox, a devastating disease that claimed millions of lives, was successfully eradicated by 1980 through unprecedented global collaboration. This monumental achievement served as a catalyst for the expansion of immunisation efforts, leading to the introduction of additional vaccines into national immunisation programmes worldwide.

The initial EPI was launched in 1974 and included six vaccines, marking the beginning of a transformative era in public health. Measles, one of the most contagious diseases known to humans, was among the first diseases targeted by the programme. Between just 2000 and 2020, measles vaccination successfully prevented an estimated 31.7 million deaths worldwide.

The expansion of the EPI to encompass 13 vaccines demonstrates the remarkable advancements made possible by science, technology, and the dedication of healthcare professionals worldwide. Notably, HPV vaccine stands out as a prime example of human progress, being one of two current vaccines that can prevent cancers in both men and women. (The other is hepatitis B vaccine, as chronic hepatitis B infection is a leading cause of liver cancer.)

Protecting generations

While the WIW commemorates global immunisation efforts, it’s essential to recognise the significance of regional immunisation weeks organised by WHO’s regional offices. These campaigns, tailored to address local health needs and realities, respond to diverse contexts, to ensure that everyone, everywhere, at every age, can fully benefit from the life-saving potential of vaccines.

In Europe, the European Immunization Week, from April 21st to 27th, centres on the theme of “Protecting Generations.” This theme not only pays homage to the legacy of the EPI but also reflects the commitment to protecting the health of present and future generations. Efforts to vaccinate past generations have already protected millions of lives in Europe.

The HPV vaccine, alongside the MMR vaccine, exemplifies the concept of life course immunisation, which aims to protect individuals within generations and across generations. By harnessing the power of mass vaccinations and herd immunity, we have the potential to eradicate diseases like measles and cervical cancer, just as we did with smallpox.

However, due to measles’ easy spread, maintaining a minimum of 95% population immunity is critical to prevent outbreaks. When vaccination rates decline, as seen in Europe with 58,000 cases in 2023, controlling measles becomes more challenging. This emphasises the urgent need to boost immunisation rates to prevent outbreaks effectively.

RIVER-EU: embracing health equity

As we reflect on the profound impact of immunisation during the World Immunization Week and European Immunization Week, it becomes clear that prioritising vaccination is not just a matter of public health; it’s a win-win strategy that addresses multiple societal needs.

Immunisation aligns perfectly with the arguments that frame health as a matter of security. By protecting against infectious diseases, vaccination ensures both individual and collective well-being. Moreover, it resonates strongly with the rights-based approach to health, as access to healthcare is enshrined as the 16th principle on the European Pillar of Social Rights, agreed upon by EU Member States. Furthermore, vaccination stands as a testament to the economic argument for investing in public health. It is one of the most cost-effective interventions available, as prevention is always preferable to treatment.

To fully realise the advantages offered by immunisation, it is imperative to shift to a health equity mindset: ensure equitable access to vaccination services for all members of society, especially underserved communities. At RIVER-EU, we advocate tirelessly for vaccine equity by engaging underserved communities, recognising that equitable access to vaccines is not only a moral imperative but also a strategic necessity for building healthier and more resilient societies.

Humanly Possible

Looking at the achievements of the past 50 years, we should not forget the vital role played by individuals at every level. Each and every scientist, healthcare professional, and ordinary citizen who has embraced immunisation to protect themselves and future generations, is a lifesaver. Together, we have demonstrated the boundless potential of humanity when faced with daunting challenges; we have made the impossible, #HumanlyPossible.