The Global Pragramme For Immunization
The global programme launched by UNICEF and the world health Organization to immunize chilldren troughout the world is the greatest public health success story of the 1980s. By the and of the 1990, over 80 percent of under-one children had received immuniozation for five deadly diseases (tubercolosis, diphtheria, whooping cough, tetanus and polio) and 78 percent had received immuniozation against measles, probably the greatest killer of the children when combined with malnutrition, diarrhea and acute respiratory infection. It is estimated that, annually the programme is already saving 3,2 milion children from the premature death and 2 milion from the agonizing live of polio victim.
The Expanded Programme On Immunization (EPI) drew many lessons from the successful international campaign to eradicate smallpox. Althougt the concept of giving a protective inoculation of smallpox material was pradticed in China and West Africa for centuries, it was not until 1798 when Edward Jenner successfully experimented with a cowpox vaccine, that the seeds of widescale protection were planted. Smallpox did not discriminate community leaders were amongst the first to be vaccinated, a fact which helped accelerate its spread around the world within 10 years. However, massive vaccine production was not possible before 1842 and it was not until 1958. When the new ease of international travel brought with it the dengers of widespread infection, that a global vaccination and eradication programme was launched. The campaign involved massive immunization and surveillance and containment strategies supported by highly-developed logistics, information and communication system. In many area of the world, for the first time, the personnel and resources of government health structures were effectively energizeg and mobilized for a single goal within a giving time frame.
When the last ease of smallpos was reported and successfully isolated in Somalia. In October 1977, the success could not ignoreg. Many had claimed that the answer to solving the world’s helath problem was integrated health delivery and that vertical programmes, such as a drive to eradicate one disease, were discruptive ti this process. However, the fact speak for themselves. As late as 1967 it is estimated that there were 10 to 12 milio eases of smallpox in 33 countries, causing an estimated 2 milion deaths annually. By 1977, the scourge was erased from the face of the earth forever.
However, of the six deseases targeted by the global EPi programme, probably only polio can be totally eradicated of the other all but tetanus can be controlled by herd immunity the phenomenon of near-zero transmission rates which depend on coverage level of a least 80 percent. Otherwise know as Univesal Chilldren Immununization (UCI). Thefore, EPI had lesson to learn from the eradication of smallpox but could not take that experience as a total model to follow. Whereas smallpox vaccination is no longer necessary. At least 80 percent of newborns will have to be immunized each year for the foreseeable future. An important difference, therefore, is the need for sustained service delivery.
To many sustainability is equated with a fully-functioning, integrated, primary health care system supported an owned dy the community. However, when Epi began. The vaccines had been available for 20 years and still, two thirds of the world’s children had not been vaccinated. UnicevExecutive Director. James P.Grant. decided that taking the position “that universal immunization must await economic development and the coming of a permanent health clinic to every village is simply a sentence of unnecessary death and disability for many millions of today’s children and for even more millions of those who are still not born. There was, in other words a moral imperative to procced with an accelerated, vertical programme which could use many of the lessons of smallpox eradication but which would add another element, sustainability through social mobilization.
Through social mobilization, immunization breaks out of its “institutional and technical imprisonment” and “is debated by heads of state in international fora”. “is demanded by illiterate mothers and a wide spectrum of people” come to participate in its implementation. In social mobilization the concept of “the community” is expanded to include many social allies: heads of state and other political leaders, various ministries, district and local government authorities, community region leader, NGOs, service club, journalists, filmmakers, artists and enternainers to name the most common examples. In social mobilization in other words the procces take the programme beyong a vertical intervention directed by a single chain of command to horizontally spreading currents of energy which eventually cover most of a society. In this way a vertical programme becomes horizontal.
There are many experiences with social mobilization for EPI to draw upon. I will narrate the story of social mobilization in Banglandesh draw some conclusions and then synthesize some experiences with EPI anf other health and nutrition programmes in the final section of this chapter.
The Expanded Programme On Immunization (EPI) drew many lessons from the successful international campaign to eradicate smallpox. Althougt the concept of giving a protective inoculation of smallpox material was pradticed in China and West Africa for centuries, it was not until 1798 when Edward Jenner successfully experimented with a cowpox vaccine, that the seeds of widescale protection were planted. Smallpox did not discriminate community leaders were amongst the first to be vaccinated, a fact which helped accelerate its spread around the world within 10 years. However, massive vaccine production was not possible before 1842 and it was not until 1958. When the new ease of international travel brought with it the dengers of widespread infection, that a global vaccination and eradication programme was launched. The campaign involved massive immunization and surveillance and containment strategies supported by highly-developed logistics, information and communication system. In many area of the world, for the first time, the personnel and resources of government health structures were effectively energizeg and mobilized for a single goal within a giving time frame.
When the last ease of smallpos was reported and successfully isolated in Somalia. In October 1977, the success could not ignoreg. Many had claimed that the answer to solving the world’s helath problem was integrated health delivery and that vertical programmes, such as a drive to eradicate one disease, were discruptive ti this process. However, the fact speak for themselves. As late as 1967 it is estimated that there were 10 to 12 milio eases of smallpox in 33 countries, causing an estimated 2 milion deaths annually. By 1977, the scourge was erased from the face of the earth forever.
However, of the six deseases targeted by the global EPi programme, probably only polio can be totally eradicated of the other all but tetanus can be controlled by herd immunity the phenomenon of near-zero transmission rates which depend on coverage level of a least 80 percent. Otherwise know as Univesal Chilldren Immununization (UCI). Thefore, EPI had lesson to learn from the eradication of smallpox but could not take that experience as a total model to follow. Whereas smallpox vaccination is no longer necessary. At least 80 percent of newborns will have to be immunized each year for the foreseeable future. An important difference, therefore, is the need for sustained service delivery.
To many sustainability is equated with a fully-functioning, integrated, primary health care system supported an owned dy the community. However, when Epi began. The vaccines had been available for 20 years and still, two thirds of the world’s children had not been vaccinated. UnicevExecutive Director. James P.Grant. decided that taking the position “that universal immunization must await economic development and the coming of a permanent health clinic to every village is simply a sentence of unnecessary death and disability for many millions of today’s children and for even more millions of those who are still not born. There was, in other words a moral imperative to procced with an accelerated, vertical programme which could use many of the lessons of smallpox eradication but which would add another element, sustainability through social mobilization.
Through social mobilization, immunization breaks out of its “institutional and technical imprisonment” and “is debated by heads of state in international fora”. “is demanded by illiterate mothers and a wide spectrum of people” come to participate in its implementation. In social mobilization the concept of “the community” is expanded to include many social allies: heads of state and other political leaders, various ministries, district and local government authorities, community region leader, NGOs, service club, journalists, filmmakers, artists and enternainers to name the most common examples. In social mobilization in other words the procces take the programme beyong a vertical intervention directed by a single chain of command to horizontally spreading currents of energy which eventually cover most of a society. In this way a vertical programme becomes horizontal.
There are many experiences with social mobilization for EPI to draw upon. I will narrate the story of social mobilization in Banglandesh draw some conclusions and then synthesize some experiences with EPI anf other health and nutrition programmes in the final section of this chapter.
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