Estimating the health impact of vaccination against ten pathogens in 98 low-income and middle-income countries from 2000 to 2030: a modelling study

Vaccine Impact Modelling Consortium

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30 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)398-408
Number of pages11
JournalThe Lancet
Volume397
Issue number10272
DOIs
Publication statusPublished - 30 Jan 2021

Bibliographical note

Funding Information:
VIMC is jointly funded by Gavi, the Vaccine Alliance, and the Bill & Melinda Gates Foundation (grant number OPP1157270). Funding from Gavi is channelled via VIMC to the Consortium's modelling groups (VIMC-funded institutions represented in this paper: Imperial College London, London School of Hygiene & Tropical Medicine, Oxford University Clinical Research Unit, Public Health England, Johns Hopkins University, Pennsylvania State University, Center for Disease Analysis Foundation, Kaiser Permanente Washington, University of Cambridge, University of Notre Dame, Harvard University, Conservatoire National des Arts et Métiers). Funding from the Gates Foundation was used for salaries of the Consortium secretariat (authors represented here: XiaL, CM, ZMC, SEL, MJ, NCG, TBH, KW, NMF, and TG); and channelled via VIMC for travel and subsistence costs of all Consortium members (all authors). We also acknowledge funding to support aspects of VIMC's work from the Medical Research Council (MRC) Centre for Global Infectious Disease Analysis (reference MR/R015600/1), which is jointly funded by the UK MRC and the UK Foreign, Commonwealth & Development Office (FCDO), under the MRC/FCDO Concordat agreement, and part of the EDCTP2 programme supported by the EU. Development of the London School of Hygiene & Tropical Medicine models for HPV, measles, S pneumoniae, H influenzae type b, and rotavirus was funded by WHO, Gavi, and the Gates Foundation under several grants, past and current. The Gates Foundation supported the development and maintenance of the Lives Saved Tool. The views expressed in this Article are those of the authors and not necessarily those of the VIMC or its funders.

Funding Information:
Consortium members received funding from Gavi and the Bill & Melinda Gates Foundation via VIMC during the course of the study. In addition, MJ reports grants from WHO and the Gates Foundation. KE and MJF report grants from the Gates Foundation, outside of the submitted work. IG, HR, and DR-S report grants from the John C Martin Foundation during the conduct of the study; and grants from AbbVie, Gilead, Intercept, Pan American Health Organization, and Association of State and Territorial Health Officials, outside of the submitted work. IG, HR, and DR-S are employees of the Center for Disease Analysis Foundation, which had no role in study design, data collection and analysis, interpretation of data, or preparation of the manuscript. KAMG reports personal fees from Wellcome Genome Campus advanced courses and scientific conferences. TBH reports grants and personal fees from WHO, Pharos, and Avenhir Health, outside of the submitted work. SN reports consultancy work for WHO and Pharos Global Health Advisors. CLT reports personal fees from GSK, outside of the submitted work. SV reports grants from the Gates Foundation and Gavi, outside of the submitted work. NMF reports grants from the UK Medical Research Council during the conduct of the study, and grants from the US National Institutes of Health National Institute of General Medical Sciences, UK National Institute of Health Research, and Janssen Pharmaceuticals, outside of the submitted work. TG reports grants from Janssen Pharmaceuticals, outside of the submitted work. All other authors declare no competing interests.

Funding Information:
VIMC is jointly funded by Gavi, the Vaccine Alliance, and the Bill & Melinda Gates Foundation (grant number OPP1157270). Funding from Gavi is channelled via VIMC to the Consortium's modelling groups (VIMC-funded institutions represented in this paper: Imperial College London, London School of Hygiene & Tropical Medicine, Oxford University Clinical Research Unit, Public Health England, Johns Hopkins University, Pennsylvania State University, Center for Disease Analysis Foundation, Kaiser Permanente Washington, University of Cambridge, University of Notre Dame, Harvard University, Conservatoire National des Arts et M?tiers). Funding from the Gates Foundation was used for salaries of the Consortium secretariat (authors represented here: XiaL, CM, ZMC, SEL, MJ, NCG, TBH, KW, NMF, and TG); and channelled via VIMC for travel and subsistence costs of all Consortium members (all authors). We also acknowledge funding to support aspects of VIMC's work from the Medical Research Council (MRC) Centre for Global Infectious Disease Analysis (reference MR/R015600/1), which is jointly funded by the UK MRC and the UK Foreign, Commonwealth & Development Office (FCDO), under the MRC/FCDO Concordat agreement, and part of the EDCTP2 programme supported by the EU. Development of the London School of Hygiene & Tropical Medicine models for HPV, measles, S pneumoniae, H influenzae type b, and rotavirus was funded by WHO, Gavi, and the Gates Foundation under several grants, past and current. The Gates Foundation supported the development and maintenance of the Lives Saved Tool. The views expressed in this Article are those of the authors and not necessarily those of the VIMC or its funders. Editorial note: the Lancet Group takes a neutral position with respect to territorial claims in published text and maps.

Publisher Copyright:
© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

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