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The Expanded Program on Immunization in the Americas: a review.


 The basis for the Pan America Health Organization/World Health Organization Expanded Program on Immunization (EPI) is provided by a resolution (WHA27.57) adopted by the World Health Assembly in May 1974. The program's longterm objectives include: to reduce morbidity and mortality from diphtheria, whooping cough, tetanus, measles, tuberculosis, and poliomyelitis by providing immunization services directed against those disease for every child in the world by 1990; to promote countries' self-reliance in the delivery of immunization services within the context of comprehensive health services; and to promote regional self-reliance in matters of vaccine production and quality control. The EPI, which requires a longterm commitment to continued immunization activities, is an essential element of PAHO/WHO's strategy to achieve health for all by the year 2000. Immunization coverage has been included among the indicators which will be used to monitor the success of that strategy at regional and global levels. As of April 1985, available country reports showed that immunization coverage in the Americas had improved considerably since the EPI was launched in 1977. In 1978, for example, only a very small proportion of the children under 1 year of age (less than 10%) outside the US and Canada lived in countr ies where 50% immunization coverage with the EPI vaccines had been attained for this age group. By 1984, over 55% of these children were living in countries where at least 50% infant coverage with DPT and measles vaccines had been attained, and over 80% were living in countries where at least 50% infant coverage with polio vaccine had been attained. Immunization coverage generally improved between 1980-84, especially in the 12 smaller countries of the subregion with populations of less than 130,000. In the period since EPI training activities were initiated in early 1979 through the end of 1984, it is estimated that at least 15,000 health workers attended EPI workshops. Over 12,000 EPI training modules were distributed in the Region. In 1983 and 1984, the Cold Chain Regional Focal Point held special training workshops on cold chain equipment maintenance and repair in Bolivia, Colombia, and Nicaragua; technicians were also trained in Brazil. In Northern America, Canada, the US, and Mexico have the ability to produce all the EPI vaccines, and the first 2 are self-sufficient. Most countries have made notable strides in improving and expanding the cold chain, although cold chain failures have been identified through investigation of vaccine failures. During its 6 years of operation, PAHO's EPI Revolving Fund has placed vaccine orders worth over US$19 million. At present, all countries in the region are receiving adequate quantities of vaccines to cover their target populations.
