1. Epidemiology and Global Health
Download icon

Lives saved with vaccination for 10 pathogens across 112 countries in a pre-COVID-19 world

  1. Jaspreet Toor
  2. Susy Echeverria-Londono
  3. Xiang Li
  4. Kaja Abbas
  5. Emily D Carter
  6. Hannah E Clapham
  7. Andrew Clark
  8. Margaret J de Villiers
  9. Kirsten Eilertson
  10. Matthew Ferrari
  11. Ivane Gamkrelidze
  12. Timothy B Hallett
  13. Wes R Hinsley
  14. Daniel Hogan
  15. John H Huber
  16. Michael L Jackson
  17. Kevin Jean
  18. Mark Jit
  19. Andromachi Karachaliou
  20. Petra Klepac
  21. Alicia Kraay
  22. Justin Lessler
  23. Xi Li
  24. Benjamin A Lopman
  25. Tewodaj Mengistu
  26. C Jessica E Metcalf
  27. Sean M Moore
  28. Shevanthi Nayagam
  29. Timos Papadopoulos
  30. T Alex Perkins
  31. Allison Portnoy
  32. Homie Razavi
  33. Devin Razavi-Shearer
  34. Stephen Resch
  35. Colin Sanderson
  36. Steven Sweet
  37. Yvonne Tam
  38. Hira Tanvir
  39. Quan Tran Minh
  40. Caroline L Trotter
  41. Shaun A Truelove
  42. Emilia Vynnycky
  43. Neff Walker
  44. Amy Winter
  45. Kim Woodruff
  46. Neil M Ferguson
  47. Katy AM Gaythorpe  Is a corresponding author
  1. MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, United Kingdom
  2. London School of Hygiene and Tropical Medicine, United Kingdom
  3. Bloomberg School of Public Health, Johns Hopkins University, United States
  4. Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Oxford University Clinical Research Unit, Vietnam; Nuffield Department of Medicine, Oxford University, United Kingdom
  5. Colorado State University, United States
  6. Pennsylvania State University, United States
  7. Center for Disease Analysis Foundation, United States
  8. Gavi, the Vaccine Alliance, Switzerland
  9. Department of Biological Sciences, University of Notre Dame, United States
  10. Kaiser Permanente Washington, United States
  11. Laboratoire MESuRS and Unite PACRI, Institut Pasteur, Conservatoire National des Arts et Metiers, France
  12. University of Hong Kong, Hong Kong Special Administrative Region, China
  13. University of Cambridge, United Kingdom
  14. Rollins School of Public Health, Emory University, United States
  15. Independent, United States
  16. Princeton University, United States
  17. Section of Hepatology and Gastroenterology, Department of Metabolism, Digestion and Reproduction, Imperial College London, United Kingdom
  18. Public Health England, United Kingdom
  19. University of Southampton, United Kingdom
  20. Center for Health Decision Science, Harvard T H Chan School of Public Health, Harvard University, United States
Research Article
Cite this article as: eLife 2021;10:e67635 doi: 10.7554/eLife.67635
24 figures, 7 tables and 1 additional file

Figures

Mean predicted deaths due to the 10 Vaccine Impact Modelling Consortium (VIMC) pathogens per 100,000 population per country for years 2000–2019 under the no vaccination and with vaccination (routine immunisations; RI only) scenarios.

Countries are arranged by World Health Organisation (WHO) African (AFRO), Eastern Mediterranean (EMRO), European (EURO), Pan American (PAHO), South-East Asian (SEARO), and Western Pacific (WPRO) regions. The difference (i.e. deaths averted) between these two scenarios are shown in Table 2 and Figure 2.

Deaths averted per year of vaccination for hepatitis B (HepB), Haemophilus influenzae type b (Hib), human papillomavirus (HPV), Japanese encephalitis (JE), measles, Neisseria meningitidis serogroup A (MenA), Streptococcus pneumoniae (PCV), rotavirus (Rota), rubella, and yellow fever (YF).

The bars show the number of deaths averted (in millions) in each vaccination year. Error bars indicate 95% CI. The line shows the number of fully vaccinated persons (FVPs; in millions) achieved in each year’s vaccination activities.

Appendix 5—figure 1
Deaths averted per calendar year for hepatitis B (HepB), Haemophilus influenzae type b (Hib), human papillomavirus (HPV), Japanese encephalitis (JE), measles, Neisseria meningitidis serogroup A (MenA), Streptococcus pneumoniae (PCV), rotavirus (Rota), rubella and yellow fever (YF).

Coloured lines and areas indicate estimates based on this Vaccine Impact Modelling Consortium (VIMC) study and grey lines and areas indicate estimates based on previous VIMC results (Li et al., 2019). Ribbons indicate 95% CI.

Appendix 5—figure 2
Deaths averted per birth cohort year for hepatitis B (HepB), Haemophilus influenzae type b (Hib), human papillomavirus (HPV), Japanese encephalitis (JE), measles, Neisseria meningitidis serogroup A (MenA), Streptococcus pneumoniae (PCV), rotavirus (Rota), rubella and yellow fever (YF).

Coloured lines and areas indicate estimates based on this Vaccine Impact Modelling Consortium (VIMC) study and grey lines and areas indicate estimates based on previous VIMC results (Li et al., 2019). Ribbons indicate 95% CI.

Appendix 5—figure 3
Comparison of fully vaccinated persons (FVPs) in millions between 2017 and 2019 model estimates used within the previous Vaccine Impact Modelling Consortium (VIMC)-wide study Li et al., 2019 and this study, respectively.

FVPs shown for hepatitis B (HepB), Haemophilus influenzae type b (Hib), human papillomavirus (HPV), Japanese encephalitis (JE), measles, Neisseria meningitidis serogroup A (MenA), Streptococcus pneumoniae (PCV), rotavirus (Rota), rubella, and yellow fever (YF).

Appendix 5—figure 4
Estimated number of deaths averted per year of vaccination in 2000, 2019, and 2030 for all 10 Vaccine Impact Modelling Consortium (VIMC) pathogens.
Appendix 5—figure 5
Mean predicted deaths for children under-5 with and without vaccination due to the 10 Vaccine Impact Modelling Consortium (VIMC) pathogens per 1000 lives per country for years 2000–2019.

Countries are arranged by World Health Organisation (WHO) African (AFRO), Eastern Mediterranean (EMRO), European (EURO), Pan American (PAHO), South-East Asian (SEARO), and Western Pacific (WPRO) regions.

Appendix 5—figure 6
Global deaths for hepatitis B per calendar year (in thousands) for all ages and for children under-5.

Orange lines and areas indicate estimates from the Vaccine Impact Modelling Consortium (VIMC). Grey lines and areas indicate estimates from the Global Burden of Disease Study (GBD) 2019 from the Institute for Health Metrics and Evaluation (IHME). Ribbons indicate 95% CI.

Appendix 5—figure 7
Deaths for hepatitis B in the PINE countries (Pakistan - PAK, India - IND, Nigeria - NGA and Ethiopia - ETH) per calendar year (in thousands) for all ages and for under-5s.

Orange lines and areas indicate estimates from the Vaccine Impact Modelling Consortium (VIMC). Grey lines and areas indicate estimates from the Global Burden of Disease Study (GBD) 2019 from the Institute for Health Metrics and Evaluation (IHME). Ribbons indicate 95% CI.

Appendix 5—figure 8
Global deaths for measles per calendar year (in thousands) for all ages and for children under-5.

Red lines and areas indicate estimates from the Vaccine Impact Modelling Consortium (VIMC). Grey lines and areas indicate estimates from the Global Burden of Disease Study (GBD) 2019 from the Institute for Health Metrics and Evaluation (IHME). Ribbons indicate 95% CI.

Appendix 5—figure 9
Deaths for measles in the PINE countries (Pakistan - PAK, India - IND, Nigeria - NGA and Ethiopia - ETH) per calendar year (in thousands) for all ages and for children under-5.

Red lines and areas indicate estimates from the Vaccine Impact Modelling Consortium (VIMC). Grey lines and areas indicate estimates from the Global Burden of Disease Study (GBD) 2019 from the Institute for Health Metrics and Evaluation (IHME). Ribbons indicate 95% CI.

Appendix 5—figure 10
Global deaths for yellow fever per calendar year (in thousands) for all ages and for children under-5.

Yellow lines and areas indicate estimates from the Vaccine Impact Modelling Consortium (VIMC). Grey lines and areas indicate estimates from the Global Burden of Disease Study (GBD) 2019 from the Institute for Health Metrics and Evaluation (IHME). Ribbons indicate 95% CI.

Appendix 5—figure 11
Deaths for yellow fever in Nigeria - NGA and Ethiopia - ETH per calendar year (in thousands) for all ages and for children under-5.

Yellow lines and areas indicate estimates from the Vaccine Impact Modelling Consortium (VIMC). Grey lines and areas indicate estimates from the Global Burden of Disease Study (GBD) 2019 from the Institute for Health Metrics and Evaluation (IHME). Ribbons indicate 95% CI.

Appendix 5—figure 12
Fully vaccinated persons (FVPs) per vaccination target population for Hepatitis B for years 2000, 2010, 2020, and 2030.
Appendix 5—figure 13
Fully vaccinated persons (FVPs) per vaccination target population for Haemophilus influenzae type b (Hib) for years 2000, 2010, 2020, and 2030.
Appendix 5—figure 14
Fully vaccinated persons (FVPs) per vaccination target population for measles for years 2000, 2010, 2020, and 2030.
Appendix 5—figure 15
Fully vaccinated persons (FVPs) per vaccination target population for Streptococcus pneumoniae (PCV) for years 2000, 2010, 2020, and 2030.
Appendix 5—figure 16
Fully vaccinated persons (FVPs) per vaccination target population for rotavirus for years 2000, 2010, 2020, and 2030.
Appendix 5—figure 17
Fully vaccinated persons (FVPs) per vaccination target population for human papillomavirus (HPV) for years 2000, 2010, 2020, and 2030.
Appendix 5—figure 18
Fully vaccinated persons (FVPs) per vaccination target population for rubella for years 2000, 2010, 2020, and 2030.
Appendix 5—figure 19
Fully vaccinated persons (FVPs) per vaccination target population for yellow fever (YF) for years 2000, 2010, 2020, and 2030.
Appendix 5—figure 20
Fully vaccinated persons (FVPs) per vaccination target population for Neisseria meningitidis serogroup A (MenA) for years 2000, 2010, 2020, and 2030.
Appendix 5—figure 21
Fully vaccinated persons (FVPs) per vaccination target population for Japanese encephalitis (JE) for years 2000, 2010, 2020, and 2030.
Appendix 5—figure 22
Deaths averted per 100,000 population per year of vaccination for hepatitis B (HepB), Haemophilus influenzae type b (Hib), human papillomavirus (HPV), Japanese encephalitis (JE), measles, Neisseria meningitidis serogroup A (MenA), Streptococcus pneumoniae (PCV), rotavirus (Rota), rubella, and yellow fever (YF).

The bars show the number of deaths averted (per 100,000 population) in each vaccination year. Error bars indicate 95% CI. The line shows the number of fully vaccinated persons (FVPs; in millions) achieved in each year’s vaccination activities.

Tables

Table 1
Vaccine Impact Modelling Consortium (VIMC) pathogen-specific details.

RI denotes routine immunisations and NRI denotes non-routine immunisations. RI schedule details the number of doses given and the ages (in years, y) targeted. Vaccination over 2000 - 2030 shows whether vaccination has been occurring over the years 2000 to 2030; years are shown where the vaccines have been introduced in later years. Countries included shows the maximum number of VIMC countries that had coverage in specific year(s) (coverage information in supplementary spreadsheet and countries listed in Appendix 6.1).

PathogenCountries includedActivity typeRI scheduleVaccination over 2000 - 2030
Hepatitis B (HepB)112RIBirth dose + Infant 3 doses (<1y)Yes
Human papillomavirus (HPV)112RI + NRIAdolescent girls 2 doses (9-14 y)2014–2030
Haemophilus influenzae type B (Hib)112RIInfant 3 doses (<1y)Yes
Japanese encephalitis (JE)17RI + NRIInfant dose (<1y)2005–2030
Measles112RI + NRI1st dose (<=1 y) + 2nd dose (<2 y)Yes
Neisseria meningitidis serogroup A (MenA)26RI + NRIInfant dose (< 1 y)2010–2030
Streptococcus pneumoniae (PCV)112RIInfant 3 doses (<1y)2009–2030
Rotavirus (Rota)112RIInfant 2 doses (<1y)2006–2030
Rubella112RI + NRI1st dose (< 1 y) + 2nd dose (< 2 y)Yes
Yellow fever (YF)36RI + NRIInfant dose (< 1 y)Yes
Table 2
Deaths and disability-adjusted life years (DALYs) averted (in millions), and deaths and DALYs averted per 1000 fully vaccinated people (FVPs) due to vaccination activities in each time period. Numbers within brackets correspond to 95% credible intervals.
Time periodDeaths averted (in millions)Deaths averted per 1000 FVPsDALYs averted (in millions)DALYs averted per 1000 FVPs
2000–201950 [41, 62]4.8 [3.9, 5.9]2700 [2200, 3500]260 [210, 330]
2020–203047 [39, 56]3.7 [3.1, 4.4]2300 [1900, 2900]180 [150, 230]
2000–203097 [80, 120]4.2 [3.5, 5]5100 [4100, 6300]220 [180, 270]
Table 3
Deaths and disability-adjusted life years (DALYs) averted (in millions), and deaths and DALYs averted per 1000 fully vaccinated people (FVPs) per disease from vaccination activities occurring from 2000 to 2030.

Disease abbreviations: hepatitis B (HepB), human papillomavirus (HPV), yellow fever (YF), Haemophilus influenzae type b (Hib), Streptococcus pneumoniae (PCV), rotavirus (Rota), Neisseria meningitidis serogroup A (MenA), and Japanese encephalitis (JE). Numbers within brackets correspond to 95% credible intervals.

DiseaseDeaths averted (in millions)Deaths averted per 1000 FVPsDALYs averted (in millions)DALYs averted per 1000 FVPs
Measles47 [42, 60]6.5 [5.9, 8.2]3100 [2700, 3900]420 [380, 540]
HepB29 [17, 43]7.7 [4.7, 12]1000 [560, 1800]270 [140, 460]
HPV6.6 [6.1, 7.1]12 [11, 13]140 [130, 150]250 [230, 270]
YF5.6 [2.9, 13]2.1 [1.1, 4.6]210 [110, 510]81 [43, 200]
Hib4.1 [1.9, 7.9]2.4 [1.1, 4.5]280 [120, 540]160 [74, 310]
PCV2.8 [1.4, 4.4]2.3 [1.1, 3.7]190 [94, 300]160 [79, 260]
Rubella1.2 [0.47, 2.1]0.3 [0.1, 0.5]86 [56, 170]22 [14, 44]
Rota0.84 [0.56, 1.1]0.8 [0.5, 1]46 [36, 56]44 [35, 54]
MenA0.62 [0.47, 0.86]1 [0.8, 1.4]36 [24, 45]59 [39, 73]
JE0.23 [0.03, 0.52]0.4 [0, 0.8]24 [2.6, 46]40 [4.2, 76]
Table 4
Deaths and disability-adjusted life years (DALYs) averted (in millions), and deaths and DALYs averted per 1000 fully vaccinated people (FVPs) in children under-5 for birth cohorts born between each time period.

These are adjusted for double counting. Numbers within brackets correspond to 95% credible intervals.

Time periodDeaths averted (in millions)Deaths averted per 1000 FVPsDALYs averted (in millions)DALYs averted per 1000 FVPs
2000–201933 [27, 43]3.9 [3.2, 5]2100 [1700, 2800]250 [200, 330]
2020–203020 [14, 26]1.9 [1.3, 2.5]1300 [960, 1800]130 [95, 180]
2000–203052 [41, 69]2.8 [2.2, 3.7]3400 [2700, 4600]190 [140, 250]
Table 5
Global mortality estimates (in thousands) from the Vaccine Impact Modelling Consortium (VIMC) and the Global Burden of Disease Study (GBD) 2019 from the Institute for Health Metrics and Evaluation (IHME) attributed to Hepatitis B (HepB), measles and yellow fever (YF) for all ages and for children under-5 over the years 2000–2019.

Estimates for GBD 2019 are global and for VIMC are for 112 countries. 95% CI shown for VIMC estimates (see Appendix 5—figures 611).

DiseaseTime periodAll agesUnder-5
VIMC 2019GBD 2019VIMC 2019GBD 2019
HepB2000–20107200 [5100, 10000]5200100 [21, 360]72
2011–20197200 [5300, 9800]420033 [5.4, 110]43
Measles2000–20105600 [4100, 9500]42005300 [3800, 9400]3600
2011–2019920 [620, 1700]1200870 [560, 1700]1100
YF2000–2010600 [320, 1500]84100 [54, 250]10
2011–2019450 [240, 1100]4763 [32, 150]5.7
Appendix 1—table 1
Vaccine, non-routine immunisation activity type and target population for coverage forecasts.
VaccineType of non-routine immunisation activityTarget population
HPVMulti-age cohorts (MACs)Girls 10–14 year-olds
MRCatch-up9 months- 15 year-olds
M/MRFollow-up9 months- 5 year-olds
JECatch-up9 months −14 year-olds
Men AInitial catch-up1–29 year-olds
Mini-catch-upCountry dependent
YFVPreventive mass campaignsAt risk population older than 9 months
Appendix 6—table 1
112 countries included in the analysis.

Those TRUE for gavi73 receive GAVI support; those TRUE for vimc98 were included in the previous VIMC-wide study (Li et al., 2019).

CountryCountry namegavi73vimc98
AFGAfghanistanTRUETRUE
AGOAngolaTRUETRUE
ALBAlbaniaFALSETRUE
ARMArmeniaTRUETRUE
AZEAzerbaijanTRUETRUE
BDIBurundiTRUETRUE
BENBeninTRUETRUE
BFABurkina FasoTRUETRUE
BGDBangladeshTRUETRUE
BIHBosnia and HerzegovinaFALSETRUE
BLRBelarusFALSEFALSE
BLZBelizeFALSETRUE
BOLBolivia, Plurinational State ofTRUETRUE
BTNBhutanTRUETRUE
CAFCentral African RepublicTRUETRUE
CHNChinaFALSETRUE
CIVCote d’IvoireTRUETRUE
CMRCameroonTRUETRUE
CODCongo, the Democratic Republic of theTRUETRUE
COGCongoTRUETRUE
COLColombiaFALSEFALSE
COMComorosTRUETRUE
CPVCabo VerdeFALSETRUE
CUBCubaTRUETRUE
DJIDjiboutiTRUETRUE
DZAAlgeriaFALSEFALSE
ECUEcuadorFALSEFALSE
EGYEgyptFALSETRUE
ERIEritreaTRUETRUE
ETHEthiopiaTRUETRUE
FJIFijiFALSETRUE
FSMMicronesia, Federated States ofFALSETRUE
GEOGeorgiaTRUETRUE
GHAGhanaTRUETRUE
GINGuineaTRUETRUE
GMBGambiaTRUETRUE
GNBGuinea-BissauTRUETRUE
GTMGuatemalaFALSETRUE
GUYGuyanaTRUETRUE
HNDHondurasTRUETRUE
HTIHaitiTRUETRUE
IDNIndonesiaTRUETRUE
INDIndiaTRUETRUE
IRNIran, Islamic Republic ofFALSEFALSE
IRQIraqFALSETRUE
JAMJamaicaFALSEFALSE
JORJordanFALSEFALSE
KENKenyaTRUETRUE
KGZKyrgyzstanTRUETRUE
KHMCambodiaTRUETRUE
KIRKiribatiTRUETRUE
LAOLao People’s Democratic RepublicTRUETRUE
LBRLiberiaTRUETRUE
LKASri LankaTRUETRUE
LSOLesothoTRUETRUE
MARMoroccoFALSETRUE
MDAMoldova, Republic ofTRUETRUE
MDGMadagascarTRUETRUE
MHLMarshall IslandsFALSETRUE
MKDMacedonia, the former Yugoslav Republic ofFALSEFALSE
MLIMaliTRUETRUE
MMRMyanmarTRUETRUE
MNGMongoliaTRUETRUE
MOZMozambiqueTRUETRUE
MRTMauritaniaTRUETRUE
MWIMalawiTRUETRUE
NAMNamibiaFALSEFALSE
NERNigerTRUETRUE
NGANigeriaTRUETRUE
NICNicaraguaTRUETRUE
NPLNepalTRUETRUE
PAKPakistanTRUETRUE
PERPeruFALSEFALSE
PHLPhilippinesFALSETRUE
PNGPapua New GuineaTRUETRUE
PRKKorea, Democratic People’s Republic ofTRUETRUE
PRYParaguayFALSETRUE
PSEPalestine, State ofFALSETRUE
RWARwandaTRUETRUE
SDNSudanTRUETRUE
SENSenegalTRUETRUE
SLBSolomon IslandsTRUETRUE
SLESierra LeoneTRUETRUE
SLVEl SalvadorFALSETRUE
SOMSomaliaTRUETRUE
SRBSerbiaFALSEFALSE
SSDSouth SudanTRUETRUE
STPSao Tome and PrincipeTRUETRUE
SWZSwazilandFALSETRUE
SYRSyrian Arab RepublicFALSETRUE
TCDChadTRUETRUE
TGOTogoTRUETRUE
THAThailandFALSEFALSE
TJKTajikistanTRUETRUE
TKMTurkmenistanFALSETRUE
TLSTimor-LesteTRUETRUE
TONTongaFALSETRUE
TUNTunisiaFALSETRUE
TUVTuvaluFALSETRUE
TZATanzania, United Republic ofTRUETRUE
UGAUgandaTRUETRUE
UKRUkraineTRUETRUE
UZBUzbekistanTRUETRUE
VENVenezuela, Bolivarian Republic ofFALSEFALSE
VNMViet NamTRUETRUE
VUTVanuatuFALSETRUE
WSMSamoaFALSETRUE
XKKosovoFALSETRUE
YEMYemenTRUETRUE
ZAFSouth AfricaFALSEFALSE
ZMBZambiaTRUETRUE
ZWEZimbabweTRUETRUE

Additional files

Download links

A two-part list of links to download the article, or parts of the article, in various formats.

Downloads (link to download the article as PDF)

Download citations (links to download the citations from this article in formats compatible with various reference manager tools)

Open citations (links to open the citations from this article in various online reference manager services)