National Vaccination Programmes

The Expanded Programme on Immunisations (EPI) was established by the World Health Organisation (WHO) in the 1970’s, following the success of polio vaccination. The aim of the EPI was to ensure that immunisations were available for every child in the world.

At its conception, the EPI recommended just 6 universal vaccines. As more vaccines have become available, the WHO has added to its list of universal vaccines for children and now includes recommendations for adults and healthcare workers.

Many countries around the world now have vaccination programmes that incorporate the EPI goals. For example, in 2017, the WHO estimated that 85% of children under the age of one received at least three doses of diphtheria, tetanus and polio (DTP) vaccine.

An independent advisory group, the Strategic Advisory Group of Experts (SAGE), made up of experts from around the world, meet twice a year to review available evidence on immunisation and vaccine-related topics. The recommendations made by SAGE inform WHO global vaccine policies.

Pathways for WHO policy recommendations on vaccine use

Although WHO make recommendations, individual countries decide on which vaccines they will they use and design their own vaccine schedules. Ideally, vaccine schedules are decided by national committees that consist of members who have expertise in different vaccine-related areas. The role of national committees is to provide oversight of vaccine schedules and make recommendations for vaccine uses, doses, timings and any changes or additions to the schedule. In addition, the committee may identify areas for which vaccines are needed and review new vaccines that are due to be licensed. It is important these committees are not influenced by pharmaceutical companies or other lobby groups with narrow scopes of interest.

The video below explains why MenAfriVac, which protects against Meningococcal A infection, was added to the African EPI and highlights some of the factors that need to be considered when introducing a vaccine

Different vaccines may be used in different parts of the world. The reasons for this include:

• Disease epidemiology – this relates to the type of infections that are prevalent in a particular country and the impact of those infections on society.
• Clinical characteristics of a particular infection – such as severity and long-term complications.
• Economic considerations – including the affordability of a vaccine and the costs of adding it to an EPI schedule.
• Type of vaccines available, and storage and transport requirements.
• Political and public health considerations – these may be related to global recommendations, the potential for international spread of a particular infection and how a particular country makes decisions.

In some countries, other vaccines are used in addition to those recommended by WHO. Some examples of vaccination schedules in different countries can be found in the reference section below.

In the next section we will consider how vaccines are no longer just used in children.