COVID-19 Related Immunisation Disruptions from 2020-2030: Projecting Health Impact and Mitigation Strategies for 14 Pathogens Across 112 Low- and Middle-Income Countries

Abstract

Background: There have been notable declines in immunisation coverage across the globedue to the COVID-19 pandemic. Recovery has begun but is geographically variable;many regions are still experiencing serious disruption as of 2021. This has led to underimmunisedcohorts and interrupt progress in reducing vaccine-preventable disease burden.

Methods: We present vaccine impact projections for 14 pathogens in 112 low- and-middleincome countries (LMICs); we further examine a subset of diseases and catch-up vaccinationactivities. We projected vaccination coverage in the absence of disruptions, withnonlinear recovery following disruption and/or with catch-up vaccination activities.

Findings: We estimate that disruption to measles, rubella, human papillomavirus (HPV),Hepatitis B, Meningitis A, and yellow fever (YF) vaccination could lead to 49,119 (95%[17,248,134,941]) additional deaths over calendar years 2020-2030, largely due to measles. Foryears of vaccination 2020-2030 for 14 pathogens we found disruption leads to a 2.7%(95%[2.5, 2.8]) reduction in long-term impact. We project that catch-up activities couldavert 78.9% (95%[40.2%, 119.6%]) of excess deaths between calendar years 2023-2030.

Interpretation: Our results highlight the importance of timing catch-up activities givenprojected burden to improve vaccine coverage in affected cohorts. We found mitigationmeasures for measles and YF to be effective at reducing excess burden. Additionally, thehigh long-term impact of HPV vaccine as an important cervical cancer prevention toolwarrants continued immunisation efforts following disruption.

Funding:This work was supported, in whole or in part, by the Bill & Melinda Gates Foun- dation, via the Vaccine Impact Modelling Consortium (Grant Number OPP1157270 / INV-009125). AMH, JR, SEL, XL, SN, MJdV, TH, WH, KW, NMF, CLT, KAMG also acknowledge funding from the MRC Centre for Global Infectious Disease Analysis (refer- ence MR/R015600/1), jointly funded by the UK Medical Research Council (MRC) and the UK Foreign, Commonwealth Development Office (FCDO), under the MRC/FCDO Con- cordat agreement and is also part of the EDCTP2 programme supported by the European Union; and acknowledge funding by Community Jameel.

Declaration of Interest: This work was carried out as part of the Vaccine Impact Modelling Consortium (VIMC, www.vaccineimpact.org). At the time of the analysis, VIMC was jointly funded by Gavi, the Vaccine Alliance, and by the Bill & Melinda Gates Foundation (BMGF). The views expressed are those of the authors and not necessarily those of the Consortium or its funders. Consortium members received funding from Gavi and BMGF via VIMC during the course of the study. KAMG reports speaker fees from Sanofi Pasteur outside the submitted work. VEP is a member of the WHO Immunization and Implementation Research Advisory Committee (IVIR-AC). BAL reports personal fees outside the submitted work from Epidemiologic Research and Methods, LLC and Hillevax, Inc.

Keywords: vaccine, mathematical model, COVID-19 disruption