Expanded Program on Immunization

The City Health Officer should prioritize the Expanded Program on Immunization (EPI)
so as to control measles based on several criteria (Ardal et al, 2008). For instance, in
terms of severity criteria, the mortality impact of measles is higher than that of HIV since
it is considered to be the leading cause of death among children. Measles also has
higher prevalence since it is highly contagious and can spread by coughing and
sneezing, close personal contact or direct contact with infected nasal or throat
secretions whereas HIV is through body fluids. The measles virus remains active and
contagious in the air or on infected surfaces for up to two hours. It can be transmitted by
an infected person from four days prior to the onset of the rash to four days after the
rash erupts. Hence, measles outbreaks can result in epidemics that cause many
deaths, especially among young, malnourished children (WHO, 2014).

Another criterion that can be used in prioritization is the risk/harm criteria (Ardal et al,
2008). Since there are only 2 AIDS cases, their condition can easily be controlled by
educating them of how to prevent other people from getting infected. However, measles
can lead to an outbreak infecting several people within days especially among children
and should therefore be controlled as a priority since it provide higher risk or harm to the
same community. This will also benefit the children since they are the most vulnerable
to the measles epidemic. Hence, it is more valuable to protect the children of having the
EPI to be the priority so that it can be more equitable for the most vulnerable population
to get protected against measles through such an initiative (Ardal et al, 2008).

The measles EPI is also more feasible to do since there is already government and
international support for measles control as this as stated in the Millennium
Development Goal 4 which aims to reduce the under-five mortality rate by two-thirds
between 1990 and 2015. In 2012, the WHO launched a new Global Measles and
Rubella Strategic Plan which covers the period 2012-2020. The Plan includes new
global goals for 2015 and 2020 (WHO, 2014). With this, it is more feasible to support
the measles EPI continually over the coming years as there is global emphasis on this
until 2020 especially with an available strategic plan in place already that can be
adopted easily.

The potential barrier to the prioritization of measles is the cost of the intervention which
is less for AIDS intervention as there are only 2 cases whereas the measles can have
more prevalence and would therefore require expanded funding to cover the community
especially the children. However, other criteria can be used to identify and support the
decision of proceeding with the measles as the priority over HIV/AIDS.

In summary, criteria can be set-up to guide in the evidence-based decision making for
the selection of priority. This can involve problem severity, prevalence, benefit criteria,
cost criteria, ethical/values, and feasibility as well as the risk/harm criteria. Combining
these criteria together can provide a weighting system to support which area to focus
funding and attention into for the practice of evidence-based approach in decision-
making (Ardal et al, 2008).
References:

Ardal, S. , Butler, j., Edwards, R, and |Lawrie, L. (2008). Priority setting. Availabel at:
http://www.health.gov.on.ca/transformation/providers/information/resources/health_plan
ner/module_7.pdf

WHO (2014). Measles Factsheet. Available at: http://www.who.int/mediacentre/

factsheets/fs286/en/