- There have been significant improvements in the performance of the Expanded Programme on Immunization (EPI) in Africa since its inception in 1974. However, there exist wide inter- and intra-country differences.
- Successes such as the introduction of hepatitis B (HepB), Haemophilus influenzae type B (Hib), and meningococcal group A vaccines across the continent are milestones indicating growth and development in the right direction. Conversely polio and measles outbreaks, as well as high vaccine drop-out rates across the continent, indicate failures within the EPI system that require evidence-informed corrective interventions.
- With the 2015 deadline for the Millennium Development Goals (MDGs) approaching, it is necessary for Africa to take stock, critically assess its position, take ownership of the regional and country-specific problems, and develop precise strategies to overcome the challenges identified.
- There is need for increased immunisation systems strengthening, as many are plagued by weak infrastructure and shortage of skilled human resources. More affordable and adapted vaccines need to be made available.
- Increased political and financial commitments from African governments are key factors for both maintaining current achievements and making additional progress for EPI in Africa.
Immunisation is amongst the most cost-effective public health interventions for reducing global child morbidity and mortality ,. The global effort to use vaccination as a public health intervention began when the World Health Organization (WHO) launched the Expanded Programme on Immunization (EPI) in 1974. Over the years there have been several international efforts to increase EPI coverage, including Universal Childhood Immunisation ; the Global Alliance for Vaccines and Immunisation (GAVI) ; Millennium Development Goals (MDGs) ; the Global Immunisation Vision and Strategy (GIVS) ; and most recently, the Global Vaccine Action Plan (GVAP) . These initiatives, coupled with specific regional efforts such as the WHO African Region's EPI strategic plans of action for the periods 2001–2005 and 2006–2009 , and the Reach Every District (RED) approach , as well as the efforts of national EPIs, have seen global coverage with three doses of the diphtheria-tetanus-pertussis vaccine by 12 months of age (DTP3) rise from 5% in 1974 to 85% in 2010 ,. However, sub-Saharan Africa reached only 77% DTP3 coverage in 2010 . Although DTP3 is an acknowledged indicator of EPI performance, it is important to understand other EPI indicators in Africa. Here, we assess immunisation systems strengthening, accelerated disease control efforts, and the introduction of new and underutilised vaccines across Africa.