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Strengthening the health system, including innovative budget mobilization, is an urgent issue for the Expanded Programme on Immunization
Jong-Koo Leeorcid
Osong Public Health and Research Perspectives 2024;15(3):187-188.
Published online: June 27, 2024

National Academy of Medicine of Korea, Seoul, Republic of Korea

Corresponding author: Jong-Koo Lee National Academy of Medicine of Korea, 51 Seochojungang-ro, Seocho-gu, Seoul 06654, Republic of Korea E-mail:
• Received: June 24, 2024   • Accepted: June 25, 2024

© 2024 Korea Disease Control and Prevention Agency.

This is an open access article under the CC BY-NC-ND license (

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This year marks the 50th anniversary of the introduction of the World Health Organization (WHO) EPI, originally known as the Expanded Programme on Immunization. On May 23, 1974, during the 27th World Health Assembly (WHA) in Geneva, Switzerland, WHO member states advocated for the development of immunization and surveillance programs targeting diphtheria, pertussis, tetanus, measles, poliomyelitis, tuberculosis, and smallpox. At that time, despite the availability of vaccines, these 7 disease continued to be major causes of mortality among children.
At a special event of the WHA on May 28 this year, WHO Director-General Dr. Tedros highlighted that immunizations have enabled 40% of children to celebrate their first birthday who would not otherwise been able to. He noted that vaccines have prevented approximately 154 million deaths, with the most significant impacts coming from vaccines against measles, tetanus, pertussis, and tuberculosis. This statement was part of a study examining the contribution of vaccination to improved survival and health over 50 years of the EPI [1]. Dr. Young-mee Ji, Commissioner of the Korea Disease Control and Prevention Agency (KDCA), emphasized in this event that the EPI has significantly contributed not only to immunization but also to Universal Health Coverage in many developing countries. She highlighted the critical role of WHO's regional and country offices in this success, stating that the roles of country offices should be further expanded. While personally participating in measles vaccination campaigns (2007, 2010, 2014) in Philippine, Dr. Ji underscored that the EPI has made substantial contributions to health system strengthening.
Reflecting on the history of the EPI, 1974 stands out as a pivotal year in public health. At that time, despite the availability of vaccines, many children remained unvaccinated. Former WHO Director General Dr. Halfan Mahler urged member states to intensify efforts at all levels to address this issue, which led to the establishment of the EPI. Now, 50 years later, the initiative is known as the Essential Programme on Immunization. It recommends 13 vaccines globally and up to 17 additional vaccines in specific countries [2]. According to the WHO, global immunization efforts have saved at least 154 million lives over the past 50 years.
Despite these successes, the recent coronavirus disease pandemic has widened immunity gaps and increased the number of zero-dose children, leading to a rise in diseases such as measles [3]. Reports from the 33rd WHO Western Pacific Region Technical Advisory Group on Immunization meeting in Manila last week highlighted ongoing Big Catch-Up campaigns in response to the increased cases of measles and pertussis.
To combat these challenges, new support organizations such as Gavi have been established to procure vaccines, and innovative vaccine delivery platforms, including patches and nasal sprays, are under development to enhance accessibility. However, innovative funding mechanisms are essential to ensure that vaccines are distributed to all children and that issues of equity in vaccination coverage are tackled. Strengthening health systems, such as governance, financing, information management, and the quality of human resources is crucial for improving vaccination rates and reducing the number of children left unvaccinated.
In the Republic of Korea, immunization programs play a crucial role in controlling infectious diseases. Following a decline in vaccination rates due to adverse events related to Japanese encephalitis vaccines in 1994, an Advisory Committee on Immunization Programs was established. This committee focused on compensation for adverse events, implementing guidelines for safe vaccination, and providing training for frontline health workers. Despite these measures, a significant measles outbreak occurred in 2000–2001, attributed to the low uptake of the second dose of the measles vaccine. This led to further strengthening of the health systems. Improvements were made in reporting diseases and outbreak investigations, including monitoring adverse vaccine reactions. Additionally, improvements were made to the registration of vaccination and the school entrance examination program. In 2002, child vaccination programs were transferred to the Communicable Disease Control division of the Korea National Institute of Health. After the severe acute respiratory syndrome outbreak, the Immunization Management Division was established in 2003 within the newly formed Korea Centers for Disease Control and Prevention.
In 2004, the terminology for routine and temporary vaccinations was updated to “national essential vaccinations,” and measures were implemented to alleviate the financial burden of vaccinations administered at private medical institutions. An electronic reporting system was also introduced to manage vaccination records, issue certificates, and provide recall and reminder services for vaccinations. By 2014, all essential vaccinations offered at medical institutions became free, representing a major advancement in public health. The funding for these vaccination programs was supported by an increase in tobacco taxes, leading to a substantial growth in the budget for health promotion accounts, which included vaccination programs. This budget expanded from 105.2 billion Korean won (KRW) in 2013 to 357.6 billion KRW in 2023 [4]. Considering the central government's subsidy of 1/2 to 1/3 of the cost, more than double the budget is being invested.
As we look forward to the next 50 years, it is essential to continue improving health systems and securing funding to improve access to both essential and new vaccinations. The Korea National Institute of Infectious Diseases is dedicated to developing innovative vaccine platforms that aim to boost global health, especially for children in low- and middle-income countries. The efforts of the KDCA, under the leadership of Commissioner Dr. JM Jee, are commendable and play a significant role in the global fight against infectious diseases.

Ethics Approval

Not applicable.

Conflicts of Interest

Jong-Koo Lee has been the editor-in-chief of Osong Public Health and Research Perspectives since October 2021.



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