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. 2024 May 25;403(10441):2307-2316.
doi: 10.1016/S0140-6736(24)00850-X. Epub 2024 May 2.

Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization

Andrew J Shattock  1 , Helen C Johnson  2 , So Yoon Sim  3 , Austin Carter  4 , Philipp Lambach  3 , Raymond C W Hutubessy  3 , Kimberly M Thompson  5 , Kamran Badizadegan  5 , Brian Lambert  6 , Matthew J Ferrari  6 , Mark Jit  7 , Han Fu  7 , Sheetal P Silal  8 , Rachel A Hounsell  8 , Richard G White  9 , Jonathan F Mosser  4 , Katy A M Gaythorpe  10 , Caroline L Trotter  11 , Ann Lindstrand  3 , Katherine L O'Brien  3 , Naor Bar-Zeev  12
Affiliations

Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization

Andrew J Shattock et al. Lancet. .

Abstract

Background: WHO, as requested by its member states, launched the Expanded Programme on Immunization (EPI) in 1974 to make life-saving vaccines available to all globally. To mark the 50-year anniversary of EPI, we sought to quantify the public health impact of vaccination globally since the programme's inception.

Methods: In this modelling study, we used a suite of mathematical and statistical models to estimate the global and regional public health impact of 50 years of vaccination against 14 pathogens in EPI. For the modelled pathogens, we considered coverage of all routine and supplementary vaccines delivered since 1974 and estimated the mortality and morbidity averted for each age cohort relative to a hypothetical scenario of no historical vaccination. We then used these modelled outcomes to estimate the contribution of vaccination to globally declining infant and child mortality rates over this period.

Findings: Since 1974, vaccination has averted 154 million deaths, including 146 million among children younger than 5 years of whom 101 million were infants younger than 1 year. For every death averted, 66 years of full health were gained on average, translating to 10·2 billion years of full health gained. We estimate that vaccination has accounted for 40% of the observed decline in global infant mortality, 52% in the African region. In 2024, a child younger than 10 years is 40% more likely to survive to their next birthday relative to a hypothetical scenario of no historical vaccination. Increased survival probability is observed even well into late adulthood.

Interpretation: Since 1974 substantial gains in childhood survival have occurred in every global region. We estimate that EPI has provided the single greatest contribution to improved infant survival over the past 50 years. In the context of strengthening primary health care, our results show that equitable universal access to immunisation remains crucial to sustain health gains and continue to save future lives from preventable infectious mortality.

Funding: WHO.

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Conflict of interest statement

Declaration of interests CLT and KAMG assert that their employer, Imperial College, receives funding for the Vaccine Impact Modelling Consortium from the Bill & Melinda Gates Foundation; Gavi, the Vaccine Alliance; and the Wellcome Trust. CLT has received consulting fees from GSK for attending an advisory board meeting on CMV vaccines in May, 2022 and is pro bono Chair of the Scientific Advisory Panel of the Meningitis Research Foundation. HF asserts that her employer, London School of Hygiene & Tropical Medicine, receives funding for the Vaccine Impact Modelling Consortium from the Gates Foundation. JFM asserts that his employer, University of Washington, receives grant funding from Gavi and from the Gates Foundation. KB and KMT assert that their organisation Kid Risk holds a cooperative agreement with the US Centers for Disease Control and Prevention and holds grants from the Gates Foundation. MJF asserts that his employer, Penn State University, is a subrecipient of funds from Imperial College London for a grant from Gavi and that he holds grants from the Gates Foundation and the US National Science Foundation. MJ asserts that his employer, London School of Hygiene & Tropical Medicine, receives funding from the UK National Institute of Health Research, RCUK; the Gates Foundation; Gavi; the Wellcome Trust; WHO; the European Commission; the US Centers for Disease Control and Prevention; the Hong Kong Special Administrative Region Government; and the Task Force for Global Health. RAH and SPS assert that their employer, University of Cape Town, receives grant funding from the African Field Epidemiology Network and the US Centers for Disease Control and Prevention. RGW asserts that he receives funding from the Wellcome Trust (grant numbers 218261/Z/19/Z), National Institutes of Health (1R01AI147321-01, G-202303-69963, and R-202309-71190), European and Developing Countries Clinical Trials Partnership (RIA208D-2505B), UK Medical Research Council (CCF17-7779 via SET Bloomsbury), UK Economic and Social Research Council (ES/P008011/1), Bill & Melinda Gates Foundation (INV-004737 and INV-035506), and WHO (2020/985800-0). AL, KLO-B, NB-Z, PL, RCWH, and SYS work for WHO. All other authors declare no competing interests.

Figures

Figure 1
Figure 1
Deaths averted, years of life saved, and years of full health gained due to vaccination Data are cumulative 1974–2024. Measles: deaths averted: 93·7 million; years of life saved: 5·7 billion; years of full health gained: 5·8 billion. Tetanus: deaths averted: 27·9 million; years of life saved: 1·4 billion; years of full health gained: 1·4 billion. Pertussis: deaths averted: 13·2 million; years of life saved: 0·8 billion; years of full health gained: 1 billion. Tuberculosis: deaths averted: 10·9 million; years of life saved: 0·6 billion; years of full health gained: 0·9 billion. Haemophilus influenzae type B: deaths averted: 2·8 million; years of life saved: 0·2 billion; years of full health gained: 0·2 billion. Poliomyelitis: deaths averted: 1·6 million; years of life saved: 0·1 billion; years of full health gained: 0·8 billion. Other diseases: deaths averted: 3·8 million; years of life saved: 0·2 billion; years of full health gained: 0·3 billion.
Figure 2
Figure 2
Infant mortality 1974–2024, the proportional effect of vaccination on overall decreasing trends, and global vaccine coverage DTP=diphtheria–tetanus–pertussis. PCV=pneumococcal conjugate vaccine.
Figure 3
Figure 3
Marginal increase in survival probability in 2024 by year of life and WHO Region, compared with the hypothetical scenario of no historical vaccination Relative represents proportional percent change in this baseline risk. Absolute represents percentage point reduction in 2024 risk of death for the next year for a person of a given age. (A) Relative marginal increase in survival probability in 2024. (B) Absolute marginal increase in survival probability in 2024.
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