Introduction:

 

The Expanded Program on Immunization (EPI) aims to protect children and women against vaccine preventable diseases through vaccination. Globally, vaccination is believed to be the most cost-effective public health intervention and the EPI is primarily responsible for vaccination through skilled human resource. Vaccination significantly reduces childhood mortality and thus helps contribute towards achieving Sustainable Development Goal (SDG) 3, on reducing child morbidity and mortality. Vaccine quality, safety, transportation, cold chain, storage, surveillance of vaccine preventable diseases, data analysis and research and new vaccines are also some of the key areas that the Program looks after. 

 

The Program has a ubiquitous presence all the way from Provincial, District, Tehsil to Union Council Level. The Program carries out Routine Immunization at fixed centers as well as outreach sites. The EPI also conducts Supplementary Immunization Activities (SIA) to safeguard children and pregnant mothers from vaccine preventable disease.   

 

 

Brief History:

 The Expanded Programme on Immunization (EPI) was launched in Pakistan in 1978 to protect children by immunizing them against childhood tuberculosis, poliomyelitis, diphtheria, pertussis, tetanus and measles. Later, with the support of development partners, a number of new vaccines e.g. hepatitis B, haemophilus influenzae type b (Hib) and pneumococcal vaccine (PCV10) were introduced in 2002, 2009 and 2012 respectively, inactivated polio vaccine in 2015, Rota vaccine in 2017, DTP booster in 2018, Typhoid Conjugate Vaccine in 2021 and Measles & Rubella vaccine in 2021. 

Program was run under PC-I till 2020-21, when it was shifted to regular mode with independent Non development budget.

 

 

Vision:

The Expanded Program on Immunization envisions “to achieve the universal immunization coverage leaving no one behind to die from a vaccine preventable disease” (mortality from vaccine preventable disease should be less than 1 % of the total child mortality).

Goal:

The goal of the EPI is to reduce the infant and childhood mortality and morbidity linked with vaccine preventable diseases, as per EPI’s schedule, and to limit other infectious diseases (epidemics and pandemics) through emergency vaccination drives.

Objectives:

1. Achieving routine coverage of Penta 3 more than 98% at provincial and at least 90% in all districts.
2. Interrupting indigenous circulation of measles virus by 2024.
3. Interrupting polio circulation by 2023.
4. Decreasing deaths caused by tetanus from 0.03 to 0.01 per 10,000 newborn by 2024.
5. To introduce the new available vaccines based on evidence and epidemiological data complying to vaccine regulatory system of the country.
6. To strengthen the VPDs surveillance in order to provide complete and timely information backed with strong monitoring system for continuous improvement
7. To integrate EPI with Primary Health Care within a more comprehensive service delivery program (e) To institute robust vaccine supply chain system ensuring availability of potent vaccines
8. To enable the communities in enhancing their understanding and ownership of the value of vaccination, and demand vaccination as their right and responsibility.
9. To enhance facility-based vaccination with timely and effective AEFI management and improve immunization waste management system. 
10. To achieve sustainability in financing and resource mobilization for various immunization interventions in a timely and efficient manner.

Working Mechanism:

1. The Program adopted fixed site and outreach vaccination strategies for routine EPI service delivery to reach all targeted children and women
2. Implement supplementary immunization campaigns as per need and priority 
3.  EPI fixed sites are located in all public sector health facilities and few private hospitals in Punjab. A field force of around 4000 vaccinators working as outreach worker at UC level work as per their micro plan through out-reach kit stations in catchment population.

Services:

Program aims to immunize 3.39 million targeted children annually against vaccine preventable diseases. Currently, it includes vaccination against 12 fatal Childhood diseases like Tuberculosis, Poliomyelitis, Diphtheria, Pertussis, Hepatitis-B, Meningitis, Pneumonia, Tetanus, Measles, Rubbela, Diarrhea, and Typhoid.  Approximately the same number of pregnant women are vaccinated against Tetanus (TT)

1. VPD Surveillance & Response System
   1. 4275 VPD surveillance sites in Punjab

Achievements: 

 Punjab was the only province to complete all 9 DLIs and NISP Project 2016-2021 which were verified by TPVICS survey by AKU in 2020.

1. Punjab achieved Fully immunized coverage of children 12-23 Months 90% highest in all provinces
2. Program shifted from PC-I mode to regular Non development budget in 2019-20
3. Punjab introduced TCV, Hepatitis Birth dose and MR vaccines in Routine Immunization
4. Punjab achieved COVID-19 vaccination target, Fully immunized-76%, among eligible population (Above 12 years) and at least one dose to 91% of eligible population.

1. EPI Punjab conducted its history’s largest mass vaccination campaign, the Measles Rubella Catch-up Campaign from 15-27 Nov 2021 in all 36 districts. Target was 46.6 million children aged 9 months to 15 years (~39% of population) Coverage: 49.18m (105%)

1. Punjab enhanced Cold chain capacity by adding CCEOP Deployment. Existing Cold Chain Capacity (2488 cubic meter) in 2021
2. MNT elimination certification by WHO (  )

Activities for Year 2022  AND SPECIAL ASSIGNMENTS 

Sr no	Activity	Date
1	CEOs/DO (H) Conference	Monthly
2	Annual Reviews with Districts	Bi annual (March & August)
3	Celebration of Immunization week	Last week April
4	Mid Level Mangers training	March, May, August, Nov 2022
5	EPI Steering Committee Meetings	Quarterly