Taking stock of Zim’s Expanded Programme on Immunisation
Richard Nyamanhindi Correspondent
The Expanded Programme of Immunisation (EPI) was introduced in Zimbabwe in 1982 with support from the World Health Organisation (WHO). The primary objective was to vaccinate all children below the age of one year against six killer diseases: polio, diphtheria, tuberculosis, pertussis (whooping cough), measles and tetanus.
Since then, new vaccines against other severe vaccine-preventable diseases have been developed and introduced such as the pneumococcal vaccine introduced in 2012, human papilloma virus (HPV) and the rotavirus vaccines which were both introduced in May 2014.
Zimbabwe is in a fortunate position because the EPI National Policy adopted in 2000 is able to include many of the new options into the National EPI and adjust the EPI schedule according to the disease epidemiology in the country.
In the colonial period, epidemics were highly feared, as thousands of local children and even adults died from diseases about which there was little understanding. For example, it is estimated that between 10-20 percent of children under five died as a result of the six killer diseases in the 10 years before independence.
Before 1980, vaccination programmes were restricted to the urban elite and children of school-going age were the main target, in spite of the fact that younger children are often more vulnerable to diseases.
The major objective of the EPI in 1982 was thus to make immunisation available to every child by 1990.
Almost 80 percent of children below the age of one year were successfully vaccinated by the end of 1990 and WHO estimates that this prevented more than 80 000 deaths of under-fives every year.
The EPI used the successful global smallpox eradication campaign as a model to reach and vaccinate large numbers of people, even those in remote areas. In addition to the use of media other methods adopted included door-to-door campaigns, after-hours vaccination at clinics, outreaches at church gatherings and in remote areas among others.
At community level, headmasters, ward councillors, kraal heads, village headmen, village health workers, apostolic faith leaders and church leaders were also incorporated.
In 1982, about 25 percent of the country’s children were protected against the six killer diseases; today 95 percent are.
However, due to a number of challenges faced between 2005 and 2009 immunisation coverage declined to around 60 percent. During this period the country experienced the worst brain drain of qualified and experienced staff, a situation which concomitantly led to an increase in the numbers of unvaccinated children especially in hard to reach areas.
The result was the worst measles outbreak in 2009, which claimed the lives of over 630 children while more than 12 918 suspected cases were recorded.
However, the Government and development partners successfully responded to this outbreak and more than five million children were vaccinated in two months.
Countrywide, immunisation is being delivered effectively through both static and outreach activities. By integrating other activities such as the prevention of mother-to-child transmission, nutrition and health promotion is fostering concerted efforts to maximise comprehensive care and is further reducing the number of children lost before reaching five years.
Increased revitalisation of outreach activities and surveillance activities has greatly aided the immunisation programme since 2010.
The use of technology such as mobile phones to disseminate messages on immunisation is further yielding positive results. With mobile penetration rates at 105 percent, sms messages are reaching the previously hard to reach populations.
Customising immunisation services to meet the needs of the Apostolics for example remains critical in achieving full immunisation in the country.
Immunisation is a proven tool for controlling and eliminating life-threatening infectious diseases in young infants and more resources need to be uninterruptedly channelled to this noble cause.
The author is a Communications Officer at UNICEF Zimbabwe. For comments and contributions email: firstname.lastname@example.org