Lives saved with vaccination for 10 pathogens across 112 countries in a pre-COVID-19 world
- 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
- London School of Hygiene and Tropical Medicine, United Kingdom
- Bloomberg School of Public Health, Johns Hopkins University, United States
- 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
- Colorado State University, United States
- Pennsylvania State University, United States
- Center for Disease Analysis Foundation, United States
- Gavi, the Vaccine Alliance, Switzerland
- Department of Biological Sciences, University of Notre Dame, United States
- Kaiser Permanente Washington, United States
- Laboratoire MESuRS and Unite PACRI, Institut Pasteur, Conservatoire National des Arts et Metiers, France
- University of Hong Kong, Hong Kong Special Administrative Region, China
- University of Cambridge, United Kingdom
- Rollins School of Public Health, Emory University, United States
- Independent, United States
- Princeton University, United States
- Section of Hepatology and Gastroenterology, Department of Metabolism, Digestion and Reproduction, Imperial College London, United Kingdom
- Public Health England, United Kingdom
- University of Southampton, United Kingdom
- Center for Health Decision Science, Harvard T H Chan School of Public Health, Harvard University, United States
Figures
Figure 1
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.
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).
| Pathogen | Countries included | Activity type | RI schedule | Vaccination over 2000 - 2030 |
|---|---|---|---|---|
| Hepatitis B (HepB) | 112 | RI | Birth dose + Infant 3 doses (<1y) | Yes |
| Human papillomavirus (HPV) | 112 | RI + NRI | Adolescent girls 2 doses (9-14 y) | 2014–2030 |
| Haemophilus influenzae type B (Hib) | 112 | RI | Infant 3 doses (<1y) | Yes |
| Japanese encephalitis (JE) | 17 | RI + NRI | Infant dose (<1y) | 2005–2030 |
| Measles | 112 | RI + NRI | 1st dose (<=1 y) + 2nd dose (<2 y) | Yes |
| Neisseria meningitidis serogroup A (MenA) | 26 | RI + NRI | Infant dose (< 1 y) | 2010–2030 |
| Streptococcus pneumoniae (PCV) | 112 | RI | Infant 3 doses (<1y) | 2009–2030 |
| Rotavirus (Rota) | 112 | RI | Infant 2 doses (<1y) | 2006–2030 |
| Rubella | 112 | RI + NRI | 1st dose (< 1 y) + 2nd dose (< 2 y) | Yes |
| Yellow fever (YF) | 36 | RI + NRI | Infant 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 period | Deaths averted (in millions) | Deaths averted per 1000 FVPs | DALYs averted (in millions) | DALYs averted per 1000 FVPs |
|---|---|---|---|---|
| 2000–2019 | 50 [41, 62] | 4.8 [3.9, 5.9] | 2700 [2200, 3500] | 260 [210, 330] |
| 2020–2030 | 47 [39, 56] | 3.7 [3.1, 4.4] | 2300 [1900, 2900] | 180 [150, 230] |
| 2000–2030 | 97 [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.
| Disease | Deaths averted (in millions) | Deaths averted per 1000 FVPs | DALYs averted (in millions) | DALYs averted per 1000 FVPs |
|---|---|---|---|---|
| Measles | 47 [42, 60] | 6.5 [5.9, 8.2] | 3100 [2700, 3900] | 420 [380, 540] |
| HepB | 29 [17, 43] | 7.7 [4.7, 12] | 1000 [560, 1800] | 270 [140, 460] |
| HPV | 6.6 [6.1, 7.1] | 12 [11, 13] | 140 [130, 150] | 250 [230, 270] |
| YF | 5.6 [2.9, 13] | 2.1 [1.1, 4.6] | 210 [110, 510] | 81 [43, 200] |
| Hib | 4.1 [1.9, 7.9] | 2.4 [1.1, 4.5] | 280 [120, 540] | 160 [74, 310] |
| PCV | 2.8 [1.4, 4.4] | 2.3 [1.1, 3.7] | 190 [94, 300] | 160 [79, 260] |
| Rubella | 1.2 [0.47, 2.1] | 0.3 [0.1, 0.5] | 86 [56, 170] | 22 [14, 44] |
| Rota | 0.84 [0.56, 1.1] | 0.8 [0.5, 1] | 46 [36, 56] | 44 [35, 54] |
| MenA | 0.62 [0.47, 0.86] | 1 [0.8, 1.4] | 36 [24, 45] | 59 [39, 73] |
| JE | 0.23 [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 period | Deaths averted (in millions) | Deaths averted per 1000 FVPs | DALYs averted (in millions) | DALYs averted per 1000 FVPs |
|---|---|---|---|---|
| 2000–2019 | 33 [27, 43] | 3.9 [3.2, 5] | 2100 [1700, 2800] | 250 [200, 330] |
| 2020–2030 | 20 [14, 26] | 1.9 [1.3, 2.5] | 1300 [960, 1800] | 130 [95, 180] |
| 2000–2030 | 52 [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 6–11).
| Disease | Time period | All ages | Under-5 | ||
|---|---|---|---|---|---|
| VIMC 2019 | GBD 2019 | VIMC 2019 | GBD 2019 | ||
| HepB | 2000–2010 | 7200 [5100, 10000] | 5200 | 100 [21, 360] | 72 |
| 2011–2019 | 7200 [5300, 9800] | 4200 | 33 [5.4, 110] | 43 | |
| Measles | 2000–2010 | 5600 [4100, 9500] | 4200 | 5300 [3800, 9400] | 3600 |
| 2011–2019 | 920 [620, 1700] | 1200 | 870 [560, 1700] | 1100 | |
| YF | 2000–2010 | 600 [320, 1500] | 84 | 100 [54, 250] | 10 |
| 2011–2019 | 450 [240, 1100] | 47 | 63 [32, 150] | 5.7 | |
Appendix 1—table 1
Vaccine, non-routine immunisation activity type and target population for coverage forecasts.
| Vaccine | Type of non-routine immunisation activity | Target population |
|---|---|---|
| HPV | Multi-age cohorts (MACs) | Girls 10–14 year-olds |
| MR | Catch-up | 9 months- 15 year-olds |
| M/MR | Follow-up | 9 months- 5 year-olds |
| JE | Catch-up | 9 months −14 year-olds |
| Men A | Initial catch-up | 1–29 year-olds |
| Mini-catch-up | Country dependent | |
| YFV | Preventive mass campaigns | At 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).
| Country | Country name | gavi73 | vimc98 |
|---|---|---|---|
| AFG | Afghanistan | TRUE | TRUE |
| AGO | Angola | TRUE | TRUE |
| ALB | Albania | FALSE | TRUE |
| ARM | Armenia | TRUE | TRUE |
| AZE | Azerbaijan | TRUE | TRUE |
| BDI | Burundi | TRUE | TRUE |
| BEN | Benin | TRUE | TRUE |
| BFA | Burkina Faso | TRUE | TRUE |
| BGD | Bangladesh | TRUE | TRUE |
| BIH | Bosnia and Herzegovina | FALSE | TRUE |
| BLR | Belarus | FALSE | FALSE |
| BLZ | Belize | FALSE | TRUE |
| BOL | Bolivia, Plurinational State of | TRUE | TRUE |
| BTN | Bhutan | TRUE | TRUE |
| CAF | Central African Republic | TRUE | TRUE |
| CHN | China | FALSE | TRUE |
| CIV | Cote d’Ivoire | TRUE | TRUE |
| CMR | Cameroon | TRUE | TRUE |
| COD | Congo, the Democratic Republic of the | TRUE | TRUE |
| COG | Congo | TRUE | TRUE |
| COL | Colombia | FALSE | FALSE |
| COM | Comoros | TRUE | TRUE |
| CPV | Cabo Verde | FALSE | TRUE |
| CUB | Cuba | TRUE | TRUE |
| DJI | Djibouti | TRUE | TRUE |
| DZA | Algeria | FALSE | FALSE |
| ECU | Ecuador | FALSE | FALSE |
| EGY | Egypt | FALSE | TRUE |
| ERI | Eritrea | TRUE | TRUE |
| ETH | Ethiopia | TRUE | TRUE |
| FJI | Fiji | FALSE | TRUE |
| FSM | Micronesia, Federated States of | FALSE | TRUE |
| GEO | Georgia | TRUE | TRUE |
| GHA | Ghana | TRUE | TRUE |
| GIN | Guinea | TRUE | TRUE |
| GMB | Gambia | TRUE | TRUE |
| GNB | Guinea-Bissau | TRUE | TRUE |
| GTM | Guatemala | FALSE | TRUE |
| GUY | Guyana | TRUE | TRUE |
| HND | Honduras | TRUE | TRUE |
| HTI | Haiti | TRUE | TRUE |
| IDN | Indonesia | TRUE | TRUE |
| IND | India | TRUE | TRUE |
| IRN | Iran, Islamic Republic of | FALSE | FALSE |
| IRQ | Iraq | FALSE | TRUE |
| JAM | Jamaica | FALSE | FALSE |
| JOR | Jordan | FALSE | FALSE |
| KEN | Kenya | TRUE | TRUE |
| KGZ | Kyrgyzstan | TRUE | TRUE |
| KHM | Cambodia | TRUE | TRUE |
| KIR | Kiribati | TRUE | TRUE |
| LAO | Lao People’s Democratic Republic | TRUE | TRUE |
| LBR | Liberia | TRUE | TRUE |
| LKA | Sri Lanka | TRUE | TRUE |
| LSO | Lesotho | TRUE | TRUE |
| MAR | Morocco | FALSE | TRUE |
| MDA | Moldova, Republic of | TRUE | TRUE |
| MDG | Madagascar | TRUE | TRUE |
| MHL | Marshall Islands | FALSE | TRUE |
| MKD | Macedonia, the former Yugoslav Republic of | FALSE | FALSE |
| MLI | Mali | TRUE | TRUE |
| MMR | Myanmar | TRUE | TRUE |
| MNG | Mongolia | TRUE | TRUE |
| MOZ | Mozambique | TRUE | TRUE |
| MRT | Mauritania | TRUE | TRUE |
| MWI | Malawi | TRUE | TRUE |
| NAM | Namibia | FALSE | FALSE |
| NER | Niger | TRUE | TRUE |
| NGA | Nigeria | TRUE | TRUE |
| NIC | Nicaragua | TRUE | TRUE |
| NPL | Nepal | TRUE | TRUE |
| PAK | Pakistan | TRUE | TRUE |
| PER | Peru | FALSE | FALSE |
| PHL | Philippines | FALSE | TRUE |
| PNG | Papua New Guinea | TRUE | TRUE |
| PRK | Korea, Democratic People’s Republic of | TRUE | TRUE |
| PRY | Paraguay | FALSE | TRUE |
| PSE | Palestine, State of | FALSE | TRUE |
| RWA | Rwanda | TRUE | TRUE |
| SDN | Sudan | TRUE | TRUE |
| SEN | Senegal | TRUE | TRUE |
| SLB | Solomon Islands | TRUE | TRUE |
| SLE | Sierra Leone | TRUE | TRUE |
| SLV | El Salvador | FALSE | TRUE |
| SOM | Somalia | TRUE | TRUE |
| SRB | Serbia | FALSE | FALSE |
| SSD | South Sudan | TRUE | TRUE |
| STP | Sao Tome and Principe | TRUE | TRUE |
| SWZ | Swaziland | FALSE | TRUE |
| SYR | Syrian Arab Republic | FALSE | TRUE |
| TCD | Chad | TRUE | TRUE |
| TGO | Togo | TRUE | TRUE |
| THA | Thailand | FALSE | FALSE |
| TJK | Tajikistan | TRUE | TRUE |
| TKM | Turkmenistan | FALSE | TRUE |
| TLS | Timor-Leste | TRUE | TRUE |
| TON | Tonga | FALSE | TRUE |
| TUN | Tunisia | FALSE | TRUE |
| TUV | Tuvalu | FALSE | TRUE |
| TZA | Tanzania, United Republic of | TRUE | TRUE |
| UGA | Uganda | TRUE | TRUE |
| UKR | Ukraine | TRUE | TRUE |
| UZB | Uzbekistan | TRUE | TRUE |
| VEN | Venezuela, Bolivarian Republic of | FALSE | FALSE |
| VNM | Viet Nam | TRUE | TRUE |
| VUT | Vanuatu | FALSE | TRUE |
| WSM | Samoa | FALSE | TRUE |
| XK | Kosovo | FALSE | TRUE |
| YEM | Yemen | TRUE | TRUE |
| ZAF | South Africa | FALSE | FALSE |
| ZMB | Zambia | TRUE | TRUE |
| ZWE | Zimbabwe | TRUE | TRUE |
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Lives saved with vaccination for 10 pathogens across 112 countries in a pre-COVID-19 world
eLife 10:e67635.
https://doi.org/10.7554/eLife.67635
