EPI : a dream come true / by Harkishan Mehta

EPI: a dream come true by Or Harkishan Mehta Regional Adviser in Communicable Diseases, WPRO ]For more than a decade now, a quiet public health revolution has been going on throughout the Western Pacific Region. With techni- cal direction, coordination and support from WHO, this revolution has brought about a spectacular decline in sickness, death and disability among children. The credit for this is due to the Expanded Programme on Immuni- zation, well known throughout the region as EPI. It was launched by WHO in 1976 to control the depradations of diphtheria, pertussis, tetanus, measles, tuberculosis and polio by immunizing children against them. EPI set 1990 as the year to achieve immunization of all children. There were a few sceptics who thought the 1990 goal was too soon, was wishful thinking, was too ambitious, and so forth. These same sceptics have now joined the chorus of praise and support. The dream of EPI is coming true. At the outset, immunization services were virtually non-existent in many developing countries except against smallpox and tuberculosis. These services are now available to almost 90 per cent of the children born each year. Poliomyelitis has decreased rapidly, so much so that eradication of this disease has become a realistic goal. In 1982, a total of 9,142 cases were reported in the Region. Only 3,365 were reported in 1986, and 1,297 in 1988. In fact, only six of the 35 countries and areas of the region have reported poliomyelitis cases during the past three years. In view of this, WHO's Regional Committee for the Western "What the eye don't see, the heart don't grieve about." A baby gets his lifesaving jab in a Fiji clinic. Checking an incoming supply of vac- dnes at a township health centre in China. Pacific has set 1995 as the target year for the eradication of this disease in the region. In May 1989, the World Health Assembly approved detailed plans to eradicate poliomyelitis throughout the world by the year 2000. Diphtheria, pertussis and tetanus have also shown definitely decreasing trends. The region plans to eliminate neonatal tetanus by 1995. Only mea- sles, so far, has not shown any definite signs of decreasing. Epidemics conti- nue to occur in both developed and developing countries, indicating the need to increase immunization cover- age. It is estimated that over 90 per cent coverage is needed for effective measles control. The regional target is to achieve this by the year 1995. Between 1986 and 1988, coverage of BCG (immunization against tuber- culosis) rose from 68 to 83.3 per cent, diphtheria-pertussis-tetanus (OPT: three doses) from 61 to 78 per cent; oral polio vaccine (three doses) from 75 to 85 per cent, and measles vaccine from 60 to 70 per cent. Broad-based network EPI has now grown to be an operational programme of all WHO's member countries, working with a broad-based network of agencies of the United Nations system, multilateral and bilateral agencies, and non- governmental organizations. As the agency which has technical responsibility for EPI, WHO has developed operations manuals, simple and flexible immunization schedules, and prototype training materials for the programme. It has also provided leadership to introduce improved methods and equipment for the "cold chain," the system which ensures that vaccines are kept chilled and therefore viable all the way from the manufac- turer to the point of use. UNICEF and WHO have helped to strengthen national managerial capacities for immunization by sup- porting training activities and reviewing national programmes. EPI is now a high priority both for national governments and for the international community. Efforts will have to be sustained, particularly by the donor agencies, well beyond 1990, c: to ensure continued progress and to ~ maintain the high coverage already ~ achieved. EPI represents one of the major stepping-stones to the goal of Health for all by the year 2000. • W ORLD HEALTH. November 1989 13