The Expanded Program for Immunization (EPI) was first introduced in Vietnam in 1981 supported by WHO and UNICEF, and then expanded nationally in 1985. Providing vaccines against 11 diseases for children, and tetanus vaccines for pregnant women and women aged 15-35 years old in high-risk areas, the EPI has been successfully implemented with national coverage at more than 90% annually. Vietnam has also announced polio eradication in 2000 and neonatal tetanus elimination in 2005.
Despite its achievements, the EPI in Vietnam has faced a number of emerging issues including: a significant decline in uptake in response to a series of adverse effects following immunization with vaccine Hepatitis B and 5-in-1 vaccine (2011-2013), as well as outbreaks of vaccine preventable diseases such as measles nationwide and neonatal tetanus and diptheria in rural areas in recent years. More recently, the Covid-19 pandemic has impacted the program when a 1-month national lockdown and suspension of all vaccination services placed the vaccination program under pressure to meet required goals within a tighter timeframe.
Dak Lak province, located in the central highlands of Vietnam, was among the few locations where the EPI was initially piloted in a few districts in 1983. This province is a unique area with 47 ethnic groups that populate large towns and remote mountainous communes and practice different traditions, languages and religions. Until 2019, 66% of the communes (121/184) in the province were still categorized as areas with disadvantaged socio-economic conditions. Frequent migration in and out of the province also creates difficulties for policy makers in maintaining public health and social administration.
The immunization program in Dak Lak province has encountered multiple challenges in promoting vaccine uptake. Overall, the provincial coverage is high but local data shows that vaccination rates are low in areas with high ethnic minority population and have led to sporadic cases of neonatal tetanus and Japanese encephalitis in the province (2007 -2013). Most recently, Dak Lak has also been affected by a diptheria outbreak (49 reported cases since May 2020), and 3 Covid-19 cases in July placing an increased pressure on the provincial health system as it became the only province in the country to deal with two outbreaks simultaneously.
Dr Mai Thi Phuoc Loan, of the Infection Prevention Department, Centre for Disease Control in Dak Lak, shares about the challenges and highlights of implementing the Extended Immunisation program in Dak Lak Province. | Access her interview here
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