Article · Wikipedia archive · Last revised Jun 15, 2026

Expanded Program on Immunization

The Essential Programme on Immunization (EPI) is a global health initiative led by the World Health Organization agency. It aims to make vaccines available to all globally. It was launched in May 1974 under the old name of Expanded Programme on Immunization.

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The Essential Programme on Immunization (EPI) is a global health initiative led by the World Health Organization agency. It aims to make vaccines available to all globally. It was launched in May 1974 under the old name of Expanded Programme on Immunization.1

Vaccination has been one of the most impactful public health interventions of the past century. Vaccines have provided the single greatest contribution to improving health outcomes globally, particularly among children and infants. Over its first 50 years, the EPI has prevented 154 million deaths, among which 146 million are in children younger than 5 years of whom 101 million are in infants younger than 1 year. Measles vaccination is the single greatest contributor of lives saved by vaccination, preventing 93.7 million deaths out of total 154 million deaths prevented by vaccination globally. The vaccination has contributed for 40% of the decline in global infant mortality, 52% in the African region. In 2024, a child younger than 10 years is 40% more likely to survive to their next birthday relative to a hypothetical scenario of no vaccination. Increased survival probability is observed into adulthood as well, individuals aged 25 years are 35% more likely, and those aged 50 years are 16% more likely to survive to their next birthday.2

When the EPI was founded, it focused on childhood vaccination to protect the youngest and most vulnerable. It focused on seven vaccine-preventable severe illnesses, tuberculosis, polio, measles, smallpox, diphtheria, tetanus, pertussis, and made recommendations to governments and other organizations in terms of the vaccination schedule. The EPI has since expanded its scope to include older children, adolescents and adults. As of 2026, the WHO/EPI recommends universal vaccination against 12 vaccine diseases (and 2 more for high-risk groups).1

Recommendation

As of 2026, the WHO/EPI recommends universal vaccination against diphtheria, Haemophilus influenzae type B (Hib), Hepatitis B (HepB), human papillomavirus (HPV), measles, pertussis, pneumococcal disease, polio, Respiratory Syncytial Virus (RSV), rotavirus, rubella, and tetanus. High risk groups should also be given COVID-19 and seasonal influenza vaccines. There is also a list of more than 20 context-specific vaccine-preventable diseases for specific geographic areas and populations.1

Disease eradication

Smallpox was certified as eradiated in 1980, showing to the world that a deadly disease can be wiped out by well-coordinated vaccination. This provided fuel for the growth of EPI and spawned strategies to eliminate other diseases:3

Polio is very close to being eradicated as of 2026.3

History

The first 15 years of the EIP focused on establishing vaccination schedules and ensuring that poorer countries had a supply of vaccines. In 1974, only 5% of children in low-income countries and 21% of all children received basic vaccines. DTP3 coverage increased from 20% in 1982 to 76% in 1990. (DTP3 refers to the third shot of the DTP vaccine. DTP3 completion rates in one-year-olds is used as a proxy for infant vaccination completion rates.) The growth was fueled by Child Survival and Development Revolution initiated by Jim Grant in UNICEF.3

After the sharp increase in vaccination rates, the growth has slowed to a halt because the most of the remaining infants live in places where the cold chain for vaccine storage is unreliable. In response the EPI broadened its scope and introduced more vaccines (HepB, Hib, PCV) into schedules. This expands the spectrum of protection for kids with access to vaccines. The GAVI was founded in 2000, providing funding for expanding vaccine access in poorer countries. The DTP3 completion rate was 83% by 2010. Technical innovations such as the solar-powered refrigerator and the vaccine vial monitor played a large role in gaining the 7 percentage points.3

In the one-and-a-half decades after 2010, the EPI saw major achievements including the appearance and endorsement of rotavirus, HPV, and malaria vaccines. The rotavirus vaccine greatly reduced women and child mortality due to diahhrea; the HPV vaccine had already made a dent in the number of cervical cancer cases; and the malaria vaccine too has saved lives. The under-five mortality rates plunged due to immunization against pneumonia, diarrhea, and measles. The EPI moved its focus onto integration of vaccination into broader primary health care system (specifically, maternal and child health services), continuing the theme of improving healthcare for those who already get some. However, global DTP3 coverage stagnated around 85%.3

The EPI also had to navigate obstacles such as supply chain disruptions caused by many disease outbreaks and vaccine hesitancy. The COVID-19 pandemic had greatly disrupted regular immunization services, with a severe decrease in DTP3 rates during 2020–2023. Outbreaks of new diseases such as COVID-19 and Zika also showed that the EPI needs to be able to deliver not only well-established vaccines, but also new vaccines for new diseases before too many are infected.3

Milestones in global vaccination
Year Milestone Description
1974 EPI launch WHO established EPI in 1974 to protect children worldwide against diseases such as smallpox, measles, poliomyelitis, tuberculosis, diphtheria, tetanus, and pertussis by 1990.5
1979 PAHO revolving fund The Pan American Health Organization launched a fund to facilitate vaccine procurement6
1982 UNICEF child survival and development revolution UNICEF launched GOBI strategy which focused on growth monitoring, oral rehydration therapy, breastfeeding, and immunization7
1984 EPI’s First standardized schedule vaccination schedule was revised to include BCG, DTP, polio, and measles at specified ages 8
1990 Declaration of Manhattan, Children’s Vaccine Initiative This Initiative aimed to accelerate vaccines development to enhance EPI performance9
1999 Strategic Advisory Group of Experts (SAGE) on immunization SAGE was established to advise WHO on global immunization policies, strategies, and research 10
2000 Gavi, The Vaccine Alliance Was established to address market failure in certain countries and increase access to vaccines 11
2000-present Ongoing Acceleration of New Vaccine Introduction Included initiatives like pneumococcal conjugate vaccines (PCV), rotavirus vaccines, and meningococcal A conjugate vaccine, malaria vaccine to expedite introduction 12131415
2017 Coalition for Epidemic Preparedness Innovations (CEPI) CEPI was launched to as a response to Ebola, Zika, and SARS outbreaks to develop vaccines for emerging infectious diseases
2020 Immunization Agenda 2030 (IA2030) IA2030 was setup to ensure universal access to vaccines, strengthen health care systems, and support universal health coverage.
2020-2023 COVID-19 Vaccines Global Access (COVAX) Was established to accelerate the development, production, and equitable distribution of COVID-19 vaccines 16
2023-2024 The Big Catch-Up This Initiative focuses on restoring immunization coverage to pre-COVID-19 levels and strengthen routine immunization systems to achieve 2030 targets17
2024 EPI Expansion EPI is expanded to cover vaccines against 13 global and 17 context-specific vaccine-preventable diseases 4


References

References

  1. "Essential Programme on Immunization". World Health Organization. Retrieved 6 November 2024.
  2. Shattock, Andrew J; Johnson, Helen C; Sim, So Yoon; Carter, Austin; Lambach, Philipp; Hutubessy, Raymond C W; Thompson, Kimberly M; Badizadegan, Kamran; Lambert, Brian; Ferrari, Matthew J; Jit, Mark; Fu, Han; Silal, Sheetal P; Hounsell, Rachel A; White, Richard G (May 2024). "Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization". The Lancet. 403 (10441): 2307–2316. doi:10.1016/s0140-6736(24)00850-x. ISSN 0140-6736. PMC 11140691. PMID 38705159.
  3. Mirza, I; Lemango, ET; Lindstrand, A (17 June 2025). "Expanded Programme on Immunization (EPI): A Legacy of 50 Years and the Road Ahead". Vaccines. 13 (6): 649. doi:10.3390/vaccines13060649. PMC 12197319. PMID 40573980.
  4. Samarasekera, Udani (May 2024). "50 years of the Expanded Programme on Immunization". The Lancet. 403 (10440): 1971–1972. doi:10.1016/s0140-6736(24)01016-x. ISSN 0140-6736. PMID 38763146.
  5. Shattock, Andrew J; Johnson, Helen C; Sim, So Yoon; Carter, Austin; Lambach, Philipp; Hutubessy, Raymond C W; Thompson, Kimberly M; Badizadegan, Kamran; Lambert, Brian; Ferrari, Matthew J; Jit, Mark; Fu, Han; Silal, Sheetal P; Hounsell, Rachel A; White, Richard G; Mosser, Jonathan F; Gaythorpe, Katy A M; Trotter, Caroline L; Lindstrand, Ann; O’Brien, Katherine L; Bar-Zeev, Naor (May 2, 2024). "Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization". Lancet. 403 (10441): 2307–2316. doi:10.1016/S0140-6736(24)00850-X. PMC 11140691. PMID 38705159. Retrieved 6 November 2024.
  6. Horst, Myrza M. L. de L.; Soler, Orenzio (January 2010). "Fundo Estratégico da Organização Pan-Americana da Saúde: mecanismo facilitador para melhorar o acesso aos medicamentos". Revista Panamericana de Salud Pública. 27 (1): 43–48. doi:10.1590/s1020-49892010000100007. ISSN 1020-4989. PMID 20209231.
  7. Srbinoski, Bojan; Petreski, Blagica; Petreski, Marjan (2022-09-24). "Measurement of Multidimensional Child Poverty: Evidence from North Macedonia". Child Indicators Research. 16 (1): 247–271. doi:10.1007/s12187-022-09967-9. ISSN 1874-897X.
  8. Samarasekera, Udani (May 2024). "50 years of the Expanded Programme on Immunization". The Lancet. 403 (10440): 1971–1972. doi:10.1016/s0140-6736(24)01016-x. ISSN 0140-6736. PMID 38763146.
  9. Gracia, Diego (2013-06-11). "Institute of Medicine (IOM). The Learning Healthcare System: Workshop Summary. Washington, DC: The National Academies Press, 2007". Eidon Nº 39. doi:10.13184/eidon.39.2013.89-91. ISSN 2174-8292.
  10. "Recommendation of Who Strategic Advisory Group of Experts (Sage) on Immunization", Pediatric Clinical Practice Guidelines & Policies, American Academy of Pediatrics, p. 1102, 2014-04-30, doi:10.1542/9781581108613-part06-recommendation, ISBN 978-1-58110-861-3, retrieved 2024-09-18{{citation}}: CS1 maint: work parameter with ISBN (link)
  11. Gavi, the Vaccine Alliance (2023-05-08). A History of Gavi, the Vaccine Alliance. Retrieved 2024-09-18 – via YouTube.
  12. Lob-Levyt, Julian (January 2009). "Vaccine coverage and the GAVI Alliance Immunization Services Support initiative". The Lancet. 373 (9659): 209. doi:10.1016/s0140-6736(08)61894-2. ISSN 0140-6736. PMID 19108881.
  13. Light, Donald W. (February 2011). "Saving the pneumococcal AMC and GAVI". Human Vaccines. 7 (2): 138–141. doi:10.4161/hv.7.2.14919. ISSN 1554-8600. PMID 21937880.
  14. Tang, Yuxiao; Plikaytis, Brian D.; Preziosi, Marie-Pierre; Borrow, Ray (2015-11-09). "Influence of Age on Antibody Response and Persistence Following Immunization With MenAfriVac". Clinical Infectious Diseases. 61 (suppl_5): S531–S539. doi:10.1093/cid/civ601. ISSN 1537-6591. PMC 4639503. PMID 26553685.
  15. Ho, Mei Mei; Baca-Estrada, Maria; Conrad, Christoph; Karikari-Boateng, Eric; Kang, Hye-Na (August 2015). "Implementation workshop of WHO guidelines on evaluation of malaria vaccines: Current regulatory concepts and issues related to vaccine quality, Pretoria, South Africa 07 Nov 2014". Vaccine. 33 (36): 4359–4364. doi:10.1016/j.vaccine.2015.06.107. ISSN 0264-410X. PMID 26165916.
  16. Silva, Luiza Pinheiro Alves da; Rapini, Márcia Siqueira (2022-11-08). "Suitability of two WHO research and development initiatives for COVID-19 to promote equitable innovation: the Access to COVID-19 Tools Accelerator and COVID-19 Technology Access Pool". Revista Panamericana de Salud Pública. 46: e194. doi:10.26633/rpsp.2022.194. ISSN 1020-4989. PMC 9642827. PMID 36382255.
  17. Nambiar, Devaki; Hosseinpoor, Ahmad Reza; Bergen, Nicole; Danovaro-Holliday, M. Carolina; Wallace, Aaron; Johnson, Hope L. (2023-04-28). "Inequality in Immunization: Holding on to Equity as We 'Catch Up'". Vaccines. 11 (5): 913. doi:10.3390/vaccines11050913. ISSN 2076-393X. PMC 10223221. PMID 37243017.
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