Xiang Li1, Christinah Mukandavire1, Zulma M Cucunubá1, Susy Echeverria Londono1, Kaja Abbas2, Hannah E Clapham3, Mark Jit4, Hope L Johnson5, Timos Papadopoulos6, Emilia Vynnycky7, Marc Brisson8, Emily D Carter9, Andrew Clark2, Margaret J de Villiers1, Kirsten Eilertson10, Matthew J Ferrari11, Ivane Gamkrelidze12, Katy A M Gaythorpe1, Nicholas C Grassly1, Timothy B Hallett1, Wes Hinsley1, Michael L Jackson13, Kévin Jean14, Andromachi Karachaliou15, Petra Klepac2, Justin Lessler16, Xi Li17, Sean M Moore18, Shevanthi Nayagam19, Duy Manh Nguyen20, Homie Razavi12, Devin Razavi-Shearer12, Stephen Resch21, Colin Sanderson2, Steven Sweet21, Stephen Sy21, Yvonne Tam9, Hira Tanvir2, Quan Minh Tran22, Caroline L Trotter15, Shaun Truelove16, Kevin van Zandvoort2, Stéphane Verguet23, Neff Walker9, Amy Winter16, Kim Woodruff1, Neil M Ferguson24, Tini Garske1. 1. MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK. 2. London School of Hygiene & Tropical Medicine. 3. Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Nuffield Department of Medicine, Oxford University, Oxford, UK. 4. London School of Hygiene & Tropical Medicine; University of Hong Kong, Hong Kong Special Administrative Region, China; Public Health England, London, UK. 5. Gavi, the Vaccine Alliance, Geneva, Switzerland. 6. Public Health England, London, UK; University of Southampton, Southampton, UK. 7. London School of Hygiene & Tropical Medicine; Public Health England, London, UK. 8. Laval University, Quebec, QC, Canada. 9. Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA. 10. Colorado State University, Fort Collins, CO, USA. 11. Pennsylvania State University, Pennsylvania, PA, USA. 12. Center for Disease Analysis Foundation, Lafayette, CO, USA. 13. Kaiser Permanente Washington, Seattle, WA, USA. 14. MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK; Laboratoire MESuRS, Conservatoire National des Arts et Métiers, Paris, France; Unité PACRI, Institut Pasteur, Conservatoire National des Arts et Métiers, Paris, France. 15. University of Cambridge, Cambridge, UK. 16. Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA. 17. Atlanta, GA, USA. 18. Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, USA. 19. MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK; Section of Hepatology and Gastroenterology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK. 20. Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; School of Computing, Dublin City University, Dublin, Ireland. 21. Center for Health Decision Science, Harvard T H Chan School of Public Health, Harvard University, Cambridge, MA, USA. 22. Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, USA. 23. Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Cambridge, MA, USA. 24. MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK. Electronic address: neil.ferguson@imperial.ac.uk.
Abstract
BACKGROUND: The past two decades have seen expansion of childhood vaccination programmes in low-income and middle-income countries (LMICs). We quantify the health impact of these programmes by estimating the deaths and disability-adjusted life-years (DALYs) averted by vaccination against ten pathogens in 98 LMICs between 2000 and 2030. METHODS: 16 independent research groups provided model-based disease burden estimates under a range of vaccination coverage scenarios for ten pathogens: hepatitis B virus, Haemophilus influenzae type B, human papillomavirus, Japanese encephalitis, measles, Neisseria meningitidis serogroup A, Streptococcus pneumoniae, rotavirus, rubella, and yellow fever. Using standardised demographic data and vaccine coverage, the impact of vaccination programmes was determined by comparing model estimates from a no-vaccination counterfactual scenario with those from a reported and projected vaccination scenario. We present deaths and DALYs averted between 2000 and 2030 by calendar year and by annual birth cohort. FINDINGS: We estimate that vaccination of the ten selected pathogens will have averted 69 million (95% credible interval 52-88) deaths between 2000 and 2030, of which 37 million (30-48) were averted between 2000 and 2019. From 2000 to 2019, this represents a 45% (36-58) reduction in deaths compared with the counterfactual scenario of no vaccination. Most of this impact is concentrated in a reduction in mortality among children younger than 5 years (57% reduction [52-66]), most notably from measles. Over the lifetime of birth cohorts born between 2000 and 2030, we predict that 120 million (93-150) deaths will be averted by vaccination, of which 58 million (39-76) are due to measles vaccination and 38 million (25-52) are due to hepatitis B vaccination. We estimate that increases in vaccine coverage and introductions of additional vaccines will result in a 72% (59-81) reduction in lifetime mortality in the 2019 birth cohort. INTERPRETATION: Increases in vaccine coverage and the introduction of new vaccines into LMICs have had a major impact in reducing mortality. These public health gains are predicted to increase in coming decades if progress in increasing coverage is sustained. FUNDING: Gavi, the Vaccine Alliance and the Bill & Melinda Gates Foundation.
BACKGROUND: The past two decades have seen expansion of childhood vaccination programmes in low-income and middle-income countries (LMICs). We quantify the health impact of these programmes by estimating the deaths and disability-adjusted life-years (DALYs) averted by vaccination against ten pathogens in 98 LMICs between 2000 and 2030. METHODS: 16 independent research groups provided model-based disease burden estimates under a range of vaccination coverage scenarios for ten pathogens: hepatitis B virus, Haemophilus influenzae type B, human papillomavirus, Japanese encephalitis, measles, Neisseria meningitidis serogroup A, Streptococcus pneumoniae, rotavirus, rubella, and yellow fever. Using standardised demographic data and vaccine coverage, the impact of vaccination programmes was determined by comparing model estimates from a no-vaccination counterfactual scenario with those from a reported and projected vaccination scenario. We present deaths and DALYs averted between 2000 and 2030 by calendar year and by annual birth cohort. FINDINGS: We estimate that vaccination of the ten selected pathogens will have averted 69 million (95% credible interval 52-88) deaths between 2000 and 2030, of which 37 million (30-48) were averted between 2000 and 2019. From 2000 to 2019, this represents a 45% (36-58) reduction in deaths compared with the counterfactual scenario of no vaccination. Most of this impact is concentrated in a reduction in mortality among children younger than 5 years (57% reduction [52-66]), most notably from measles. Over the lifetime of birth cohorts born between 2000 and 2030, we predict that 120 million (93-150) deaths will be averted by vaccination, of which 58 million (39-76) are due to measles vaccination and 38 million (25-52) are due to hepatitis B vaccination. We estimate that increases in vaccine coverage and introductions of additional vaccines will result in a 72% (59-81) reduction in lifetime mortality in the 2019 birth cohort. INTERPRETATION: Increases in vaccine coverage and the introduction of new vaccines into LMICs have had a major impact in reducing mortality. These public health gains are predicted to increase in coming decades if progress in increasing coverage is sustained. FUNDING: Gavi, the Vaccine Alliance and the Bill & Melinda Gates Foundation.
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