Expanded Program on
Immunization
In 1974, World Health Organization (WHO) initiated the Expanded Program on
Immunization (EPI). It was formulated with the purpose of vaccinating children
throughout the world. Today, its main objective is to provide full immunization to
children across the globe having an age of less than one year.
Expanded Program on Immunization (EPI) was launched in Pakistan in 1976 as a
pilot project. It started in Peshawar and Nowshera. Later in 1978, it thoroughly
became a part of the Annual Development Program (ADP).
Need for Expanded Program on Immunization (EPI)
Immunization can be expressed as the process by which an individual is made
immune to infectious diseases by the help of vaccines. The increased incidence of
mortality and morbidity among young children and the ever growing costs of
treatment have made it clear that immunization is the need of the day.
Immunization, being a preventive measure, is considered as one of the most
effective health intervention.
In a country like Pakistan, thousands of children die each year. Such a high mortality
rate among children is mainly because of the infectious diseases prevailing in the
region. Currently 15% deaths of children under 5 years of age contribute to 50%
overall mortality in Pakistan as compared to (8-10) % in developed world. A study
conducted in North West Frontier province of Pakistan reported only 65% of fewer
than three year olds as fully immunized.
The vaccines used for Immunization save millions of children every year around the
globe. Being cheap, easy-to-use technology vaccines can have tremendous health
impacts even in Pakistan. Compared to drug treatments, vaccines require little
training or expensive equipment for delivery, do not require diagnosis, can be taken
in a few doses instead of needing longer-term regimens, and rarely have major side
effects.
EPI in Pakistan is formulated with an objective of reduction in morbidity and
mortality caused by 8 vaccine preventable diseases. These diseases are
Poliomyelitis
Diphtheria
Pertussis (Whooping cough)
Tuberculosis
Tetanus
Measles
Hepatitis-B
Hip Meningitis & Pneumonia
Not only children but pregnant women are also on the target of the Programme for
vaccination against the targeted vaccine preventable diseases.
Market Failures
For an immunization program to be initiated in the private market, production and
allocation of vaccines need to be taken care of. For new vaccines to be formulated,
Research and Development (R&D) is required. In Pakistan, two key market failures
can be analyzed that limit R&D on vaccines needed primarily for Immunization
purposes.
1. First, governments and other purchasers of vaccines face time-inconsistent
incentives. Before a vaccine is developed, governments want vaccine
producers to invest in R&D and to establish large-scale production facilities.
But once a vaccine has been developed, governments want the vaccine to be
sold at the lowest possible price, to allow limited budgets to purchase the
vaccine for as many individuals as possible. Governments are the main
purchasers of vaccines, and vaccines used in poor countries are purchased
through a small number of international agencies (such as UNICEF). These
institutions can use their dominant purchasing power and regulatory control
(as well as the power of public opinion) to drive prices down, once vaccines
have been developedthus making it difficult for firms to recoup their R&D
investments. Private firms anticipate this time-inconsistent behavior, which
thus reduces incentives for firms to make the necessary R&D investments in
the first place.
2. Second, R&D in new medicines is a global public good. Because the benefits
of scientific advances on (for example) an HIV vaccine would spill over to
many countries, none of the many small countries that would benefit from
such a vaccine has an incentive to unilaterally encourage the development of
a vaccine. While intellectual property rights create incentives for innovation,
granting private firms temporary market exclusivity increases dynamic
benefits (that is, creates incentives for innovation) at the cost of static
welfare (in the form of reduced access to medicines).
