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Background EPI is one of the successful public health programs for the control and prevention of infectious diseases worldwide. In Latin America and the Caribbean, EPI achieved high rates of vaccination and reached both the eradication of poliomyelitis (1994) and the elimination of the indigenous transmission on the measles virus (2016). Between 2006 and 2011, 174. 000 deaths were also avoided. Objective To identify exogenous conditions that were in place before the establishment of the EPI, which contributed to a better implementation of the program and increased vaccine coverage levels since 1980. Methods an exploratory mixed ecological study with information from twenty-five Latin American and the Caribbean countries were studied in 1980. The exogenous variables were: Number of nurses per 10.000 inhabitants (as a proxy level for the level of development of the health services), Infant mortality (progress of health conditions), Annual GDP (Economy growth in production), and Human Development Index (HDI). The primary outcome was vaccine coverage (measles and OPV3) from 1980 to 2013, and secondary outcomes were inter and intersectoral coordination of PNI. The effects were estimated through regression models. Results In the univariate models, there was a positive relationship between HDI and vaccination coverage, and an inverse effect of infant mortality; an obvious situation since it is expected that as vaccination coverage increased, infant mortality declines. The number of nurses had a positive relationship between inter and intersectoral coordination. In the multivariate model, three of the four exogenous variables explained 35.7% of the increase in coverage: number of nurses, HDI, and GDP. Conclusions Exogenous factors played an essential role in the improvement of the immunizations program in Latin America and the Caribbean countries, as well as could be for other public health interventions. Key messages Economy growth and Human Development are essential for the implementation of public health programs. The level of development of health services contributes to the success of a public health program.

The Expanded Immunization Program (EPI): On which exogenous factors does it depend its success?