lancet-header
Preprints with The Lancet is part of SSRN´s First Look, a place where journals and other research experts identify content of interest prior to publication. These preprint papers are not peer-reviewed. Authors have either opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet, or submitted directly via SSRN. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These papers should not be used for clinical decision making or reporting of research to a lay audience without indicating that this is preliminary research that has not been peer-reviewed. For more information see the Comment published in The Lancet, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com

Estimating the Health Impact of Vaccination Against 10 Pathogens in 98 Low and Middle Income Countries from 2000 to 2030

33 Pages Posted: 2 Oct 2019

See all articles by Xiang Li

Xiang Li

Imperial College London - MRC Centre for Global Infectious Disease Analysis

Christinah Mukandavire

Imperial College London - MRC Centre for Global Infectious Disease Analysis

Zulma M. Cucunubá

Imperial College London - MRC Centre for Global Infectious Disease Analysis

Kaja Abbas

London School of Hygiene and Tropical Medicine - Department of Infectious Disease and Epidemiology

Hannah E. Clapham

Hospital of Tropical Diseases - Oxford University Clinical Research Unit

Mark Jit

London School of Hygiene and Tropical Medicine - Department of Infectious Disease and Epidemiology

Hope L. Johnson

GAVI Alliance (Vaccine Alliance)

Timos Papadopoulos

Government of the United Kingdom - Public Health England

Emilia Vynnycky

London School of Hygiene and Tropical Medicine

Marc Brisson

Université Laval - Department of Social and Preventive Medicine

Emily D. Carter

Johns Hopkins University - Bloomberg School of Public Health

Andrew D. Clark

London School of Hygiene and Tropical Medicine

Margaret J. de Villiers

Imperial College London - MRC Centre for Global Infectious Disease Analysis

Kirsten Eilertson

Johns Hopkins University

Matthew J. Ferrari

Pennsylvania State University

Ivane Gamkrelidze

Center for Disease Analysis Foundation

Katy Gaythorpe

Imperial College London - MRC Centre for Global Infectious Disease Analysis

Nicholas C Grassly

Imperial College London - MRC Centre for Global Infectious Disease Analysis

Timothy B. Hallett

Imperial College London - Department of Infectious Disease Epidemiology

Wes Hinsley

Imperial College London - MRC Centre for Global Infectious Disease Analysis

Michael L. Jackson

Kaiser Permanente

Kévin Jean

Imperial College London - MRC Centre for Global Infectious Disease Analysis

Andromachi Karachaliou

University of Cambridge

Petra Klepac

London School of Hygiene and Tropical Medicine - Centre for Mathematical Modelling of Infectious Diseases

Justin Lessler

Johns Hopkins University - Department of Epidemiology

Xi Li

Independent

Sean M. Moore

University of Notre Dame - Department of Biological Sciences

Shevanthi Nayagam

Imperial College London - MRC Centre for Global Infectious Disease Analysis

Duy Manh Nguyen

Hospital of Tropical Diseases - Oxford University Clinical Research Unit

Homie Razavi

Center for Disease Analysis Foundation

Devin Razavi-Shearer

Center for Disease Analysis Foundation

Stephen Resch

Harvard University - T.H. Chan School of Public Health

Colin Sanderson

London School of Hygiene and Tropical Medicine

Steven Sweet

Harvard University - T.H. Chan School of Public Health

Stephen Sy

Pennsylvania State University

Yvonne Tam

Johns Hopkins University - Bloomberg School of Public Health

Hira Tanvir

London School of Hygiene and Tropical Medicine

Quan Minh Tran

Hospital of Tropical Diseases - Oxford University Clinical Research Unit

Caroline L. Trotter

University of Cambridge

Shaun Truelove

Johns Hopkins University - Department of Epidemiology

Kevin van Zandvoort

London School of Hygiene and Tropical Medicine - Department of Infectious Disease and Epidemiology

Stéphane Verguet

Harvard University - Department of Global Health and Population

Neff Walker

Johns Hopkins University - Bloomberg School of Public Health

Amy Winter

Johns Hopkins University - Department of Epidemiology

Kim Woodruff

Imperial College London - MRC Centre for Global Infectious Disease Analysis

Neil M. Ferguson

Imperial College London - MRC Centre for Global Infectious Disease Analysis

Tini Garske

Imperial College London - MRC Centre for Global Infectious Disease Analysis

Vaccine Impact Modelling Consortium

More...

Abstract

Background: The last two decades have seen substantial expansion of childhood vaccination programmes in low and middle income countries (LMICs). Here 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: Independent research groups provided model-based disease burden estimates under a range of vaccination coverage scenarios for ten pathogens: hepatitis B (HepB), Haemophilus influenzae type b (Hib), human papillomavirus (HPV), Japanese encephalitis (JE), measles, Neisseria meningitidis serogroup A (MenA), Streptococcus pneumoniae, rotavirus, rubella, yellow fever. Using standardized demographic data and vaccine coverage estimates for routine and supplementary immunization activities, the impact of vaccination programmes on deaths and DALYs was determined by comparing model estimates from the no vaccination counterfactual scenario with those from a default coverage scenario. We present results in two forms: deaths/DALYs averted in a particular calendar year, and in a particular annual birth cohort.

Findings: We estimate that vaccination will have averted 69 (2⋅5-97⋅5% quantile range 52-88) million deaths between 2000 and 2030 across the 98 countries and ten pathogens considered, 35 (29-45) million of these between 2000-2018. From 2000-2018, this represents a 44% (36-57%) reduction in deaths due to the ten pathogens relative to the no vaccination counterfactual. Most (96% (93-97%)) of this impact is in under-five age mortality, notably from measles. Over the lifetime of birth cohorts born between 2000 and 2030, we predict that 122 (96-147) million deaths will be averted by vaccination, of which 58 (39-75) and 38 (26-52) million are due to measles and Hepatitis B vaccination, respectively. We estimate that recent increases in vaccine coverage and introductions of additional vaccines will result in a 72% (61-79%) reduction in lifetime mortality caused by these 10 pathogens in the 2018 birth cohort.

Interpretation: Increases in vaccine coverage and the introduction of new vaccines into LMICs over the last two decades 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 Statement: VIMC is jointly funded by Gavi, the Vaccine Alliance, and the Bill & Melinda Gates Foundation (BMGF). Funding from Gavi is channelled via VIMC to the Consortium's modelling groups (VIMCfunded 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, The 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 BMGF was used for salaries of the Consortium secretariat (authors represented here: Professor Hallett, Professor Grassly, Dr Cucunuba, Professor Jit, Dr Xiang Li, Dr Mukandavire, Ms Woodruff, Professor Ferguson, Dr Garske); and channelled via VIMC for travel and subsistence costs of all Consortium members (all authors). In addition, the following funding declarations are noted: Dr Eilertson and Dr Ferrari report grants from BMGF, outside the submitted work. Mr Gamkrelidze, Dr Razavi and Mr Razavi-Shearer report grants from 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 the submitted work; all three authors 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. Dr Gaythorpe reports personal fees from Wellcome Genome Campus advanced courses and scientific conferences, and grants from MRC during the conduct of the study. Dr Hallett reports grants and personal fees from WHO, Pharos, Avenhir Health, outside the submitted work. Dr Nayagam reports Consultancy work for WHO and Pharos Global Health Advisors, and acknowledges support from NIHR Imperial Biomedical Research Centre (BRC). Dr Trotter reports personal fees from GSK, outside the submitted work. Professor Hallett, Dr Nayagam, Dr Garske, Dr Gaythorpe, Dr Hinsley, Dr Jean, and Professor Ferguson acknowledge joint Centre funding from the UK Medical Research Council and Department for International Development (MR/R015600/1). Development of LSHTM's models for HPV, measles, PCV, Hib and rotavirus was funded by WHO, Gavi and BMGF under several grants, past and current. BMGF supported the development and maintenance of the Lives Saved Tool. Dr Resch and Mr Sy acknowledge other funding from BMGF not related to this work and with no influence on the manuscript or the decision to submit it for publication.

Declaration of Interests: This publication is authored by members of the Vaccine Impact Modelling Consortium (VIMC, www.vaccineimpact.org). VIMC is jointly funded by Gavi, the Vaccine Alliance, and by the Bill & Melinda Gates Foundation. The views expressed are those of the authors and not necessarily those of the Consortium or its funders. The funders were given the opportunity to review this paper prior to publication, but the final decision on the content of the publication was taken by the authors. Consortium members received funding from Gavi and BMGF via VIMC during the course of the study (see funding statement above). In addition, the following potential conflicts of interest were disclosed: Dr Eilertson and Dr Ferrari report grants from Bill and Melinda Gates Foundation, outside the submitted work. Dr Gamkrelidze, Dr Razavi and Dr Razavi-Shearer report grants from 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 the submitted work. Dr Gaythorpe reports personal fees from Wellcome Genome Campus advanced courses and scientific conferences, and grants from MRC during the conduct of the study. Dr Hallett reports grants and personal fees from WHO, Pharos, Avenhir Health, outside the submitted work. Dr Nayagam reports Consultancy work for WHO and Pharos Global Health Advisors. Dr Trotter reports personal fees from GSK, outside the submitted work. Professor Ferguson reports grants from UK Medical Research Council during the conduct of the study, and grants from NIH NIGMS, UK National Institute of Health Research, Janssen Pharmaceuticals, outside the submitted work. Dr Garske reports grants from Janssen Pharmaceuticals, outside the submitted work.

Ethical Approval Statement: Not required.

Suggested Citation

Li, Xiang and Mukandavire, Christinah and Cucunubá, Zulma M. and Abbas, Kaja and Clapham, Hannah E. and Jit, Mark and Johnson, Hope L. and Papadopoulos, Timos and Vynnycky, Emilia and Brisson, Marc and Carter, Emily D. and Clark, Andrew D. and de Villiers, Margaret J. and Eilertson, Kirsten and Ferrari, Matthew J. and Gamkrelidze, Ivane and Gaythorpe, Katy and Grassly, Nicholas C and Hallett, Timothy B. and Hinsley, Wes and Jackson, Michael L. and Jean, Kévin and Karachaliou, Andromachi and Klepac, Petra and Lessler, Justin and Li, Xi and Moore, Sean M. and Nayagam, Shevanthi and Nguyen, Duy Manh and Razavi, Homie and Razavi-Shearer, Devin and Resch, Stephen and Sanderson, Colin and Sweet, Steven and Sy, Stephen and Tam, Yvonne and Tanvir, Hira and Tran, Quan Minh and Trotter, Caroline L. and Truelove, Shaun and Zandvoort, Kevin van and Verguet, Stéphane and Walker, Neff and Winter, Amy and Woodruff, Kim and Ferguson, Neil M. and Garske, Tini and Consortium, Vaccine Impact Modelling, Estimating the Health Impact of Vaccination Against 10 Pathogens in 98 Low and Middle Income Countries from 2000 to 2030 (September 27, 2019). Available at SSRN: https://ssrn.com/abstract=3460657 or http://dx.doi.org/10.2139/ssrn.3460657

Xiang Li

Imperial College London - MRC Centre for Global Infectious Disease Analysis

South Kensington Campus
Exhibition Road
London, Greater London SW7 2AZ
United Kingdom

Christinah Mukandavire

Imperial College London - MRC Centre for Global Infectious Disease Analysis

South Kensington Campus
Exhibition Road
London, Greater London SW7 2AZ
United Kingdom

Zulma M. Cucunubá

Imperial College London - MRC Centre for Global Infectious Disease Analysis

South Kensington Campus
Exhibition Road
London, Greater London SW7 2AZ
United Kingdom

Kaja Abbas

London School of Hygiene and Tropical Medicine - Department of Infectious Disease and Epidemiology ( email )

United Kingdom

Hannah E. Clapham

Hospital of Tropical Diseases - Oxford University Clinical Research Unit

Vietnam

Mark Jit

London School of Hygiene and Tropical Medicine - Department of Infectious Disease and Epidemiology

United Kingdom

Hope L. Johnson

GAVI Alliance (Vaccine Alliance)

Global Health Campus
Le Grand-Saconnex
Switzerland

Timos Papadopoulos

Government of the United Kingdom - Public Health England

Wellington House
133-155 Waterloo Road
London, SE1 8UG
United Kingdom

Emilia Vynnycky

London School of Hygiene and Tropical Medicine

Keppel Street
London, WC1E 7HT
United Kingdom

Marc Brisson

Université Laval - Department of Social and Preventive Medicine

Canada

Emily D. Carter

Johns Hopkins University - Bloomberg School of Public Health

615 North Wolfe Street
Baltimore, MD 21205
United States

Andrew D. Clark

London School of Hygiene and Tropical Medicine ( email )

Keppel Street
London, WC1E 7HT
United Kingdom

Margaret J. De Villiers

Imperial College London - MRC Centre for Global Infectious Disease Analysis

South Kensington Campus
Exhibition Road
London, Greater London SW7 2AZ
United Kingdom

Kirsten Eilertson

Johns Hopkins University

Baltimore, MD 20036-1984
United States

Matthew J. Ferrari

Pennsylvania State University

University Park
State College, PA 16802
United States

Ivane Gamkrelidze

Center for Disease Analysis Foundation

United States

Katy Gaythorpe

Imperial College London - MRC Centre for Global Infectious Disease Analysis

South Kensington Campus
Exhibition Road
London, Greater London SW7 2AZ
United Kingdom

Nicholas C Grassly

Imperial College London - MRC Centre for Global Infectious Disease Analysis

South Kensington Campus
Exhibition Road
London, Greater London SW7 2AZ
United Kingdom

Timothy B. Hallett

Imperial College London - Department of Infectious Disease Epidemiology

United Kingdom

Wes Hinsley

Imperial College London - MRC Centre for Global Infectious Disease Analysis

South Kensington Campus
Exhibition Road
London, Greater London SW7 2AZ
United Kingdom

Michael L. Jackson

Kaiser Permanente

United States

Kévin Jean

Imperial College London - MRC Centre for Global Infectious Disease Analysis

South Kensington Campus
Exhibition Road
London, Greater London SW7 2AZ
United Kingdom

Andromachi Karachaliou

University of Cambridge

Trinity Ln
Cambridge, CB2 1TN
United Kingdom

Petra Klepac

London School of Hygiene and Tropical Medicine - Centre for Mathematical Modelling of Infectious Diseases

London
United Kingdom

Justin Lessler

Johns Hopkins University - Department of Epidemiology

MD
United States

Xi Li

Independent

Sean M. Moore

University of Notre Dame - Department of Biological Sciences

South Bend, IN
United States

Shevanthi Nayagam

Imperial College London - MRC Centre for Global Infectious Disease Analysis

South Kensington Campus
Exhibition Road
London, Greater London SW7 2AZ
United Kingdom

Duy Manh Nguyen

Hospital of Tropical Diseases - Oxford University Clinical Research Unit

Vietnam

Homie Razavi

Center for Disease Analysis Foundation

United States

Devin Razavi-Shearer

Center for Disease Analysis Foundation

United States

Stephen Resch

Harvard University - T.H. Chan School of Public Health

677 Huntington Avenue
Boston, MA MA 02115
United States

Colin Sanderson

London School of Hygiene and Tropical Medicine

Keppel Street
London, WC1E 7HT
United Kingdom

Steven Sweet

Harvard University - T.H. Chan School of Public Health

677 Huntington Avenue
Boston, MA MA 02115
United States

Stephen Sy

Pennsylvania State University

University Park
State College, PA 16802
United States

Yvonne Tam

Johns Hopkins University - Bloomberg School of Public Health

615 North Wolfe Street
Baltimore, MD 21205
United States

Hira Tanvir

London School of Hygiene and Tropical Medicine

Keppel Street
London, WC1E 7HT
United Kingdom

Quan Minh Tran

Hospital of Tropical Diseases - Oxford University Clinical Research Unit

Vietnam

Caroline L. Trotter

University of Cambridge

Trinity Ln
Cambridge, CB2 1TN
United Kingdom

Shaun Truelove

Johns Hopkins University - Department of Epidemiology

MD
United States

Kevin van Zandvoort

London School of Hygiene and Tropical Medicine - Department of Infectious Disease and Epidemiology

United Kingdom

Stéphane Verguet

Harvard University - Department of Global Health and Population ( email )

665 Huntington Avenue
Building 1, Suite 1202
Boston, MA 02115
United States

Neff Walker

Johns Hopkins University - Bloomberg School of Public Health

615 North Wolfe Street
Baltimore, MD 21205
United States

Amy Winter

Johns Hopkins University - Department of Epidemiology

MD
United States

Kim Woodruff

Imperial College London - MRC Centre for Global Infectious Disease Analysis

South Kensington Campus
Exhibition Road
London, Greater London SW7 2AZ
United Kingdom

Neil M. Ferguson (Contact Author)

Imperial College London - MRC Centre for Global Infectious Disease Analysis ( email )

South Kensington Campus
Exhibition Road
London, Greater London SW7 2AZ
United Kingdom

Tini Garske

Imperial College London - MRC Centre for Global Infectious Disease Analysis

South Kensington Campus
Exhibition Road
London, Greater London SW7 2AZ
United Kingdom

No contact information is available for Vaccine Impact Modelling Consortium

Click here to go to TheLancet.com

Paper statistics

Abstract Views
266
Downloads
23