Evolution of the Expanded Program on Immunization (EPI) in Panama: progress, challenges, and future perspectives

Abstract

Introduction: The Expanded Program on Immunization (EPI) has been one of the most successful public health strategies globally and regionally, significantly reducing morbidity and mortality from diseases. Methods: A historical review of the evolution of the EPI in Panama from 1978 to 2025 was conducted. Official documents from the Ministry of Health, technical reports, scientific publications, and current regulations were reviewed. The analysis was organized into four dimensions: initial implementation, expansion of the schedule, barriers and challenges, and regulatory frameworks. Results: Panama has introduced 24 vaccines and 5 immunoglobulins into its national schedule. Milestones include the universalization of hepatitis B, the incorporation of rotavirus, pneumococcus, varicella, influenza, human papillomavirus, and COVID-19, as well as the recent inclusion of the respiratory syncytial virus (RSV) vaccine. Childhood coverage has remained above 90%, contributing to reductions in morbidity and mortality and positioning Panama among the best-performing programs in the region. The country achieved interruption of endemic transmission of poliomyelitis and measles, in addition to the elimination of rubella and congenital rubella syndrome. The main challenges include missed opportunities for vaccination, greater independence of the National Immunization Technical Advisory Group (CONAPI), training of health personnel, and access to surveillance data. Conclusions: The EPI in Panama represents a model of equity and universal access. Its sustainability will depend on technological innovation, strengthened technical governance, and multisectoral collaboration to address emerging challenges.