Background and Objective:
Iberia (Spain and Portugal, IB) implemented the Expanded Program on Immunization (EPI) in 1974 and Latin America (LA) in 1979. Calendars and management evolved with differences, and the implementation and achievement of goals between countries show inequalities. We aimed to conduct an observatory of the EPIs in Ibero-América (IA) and build a Ranking based on their indicators.

Methods:
Descriptive study of 20 countries (2 from IB, 18 from LA). We searched public sites of the Ministries of Health, WHO, PAHO and UNICEF and conducted interviews with referents. We analyzed calendars of 2020, vaccination coverage rates (VCRs) of 2019 (LA) and 2020 (IB), and management variables. We defined 6 domains: vaccination of the 1st year; from 2 years to school entry; adolescents, pregnant women, adults, and elderly; against influenza; special populations; and programmatic aspects. The 149 variables analyzed, and their categories added up a maximum of 400 points. Country score is expressed as a percentage of the maximum possible.

Results:
Different schedules, vaccine combinations, VCRs and programmatic aspects were observed between countries and regions. Spain, Chile, and Portugal led the global ranking reaching a score of 286 (72%), 271 (68%) and 262 (66%), respectively. The rest of LA countries ranged from 209 (52%, Uruguay) to 96 (24%, Bolivia). The countries positioned down in the ranking showed lower VCRs, shorter scope calendars, information, and programmatic gaps. However, when domains were analyzed independently, the order of countries changed and the same pattern was not repeated, highlighting the strengths and weaknesses of each EPI.

Conclusions:
This first observatory of the IA EPIs shows large disparities between regions and countries. The ranking aims to encourage EPI leaders and decision-makers to identify remaining challenges and opportunities to improve outcomes. The periodicity of the analysis will allow to compare EPIs evolution over time.