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      Estimating the health impact of vaccination against ten pathogens in 98 low-income and middle-income countries from 2000 to 2030: a modelling study

      research-article
      , PhD a , * , , PhD a , * , , PhD a , , PhD a , , PhD c , , , PhD d , e , f , , , Prof, PhD c , g , h , , , PhD i , , , PhD h , j , , , PhD c , h , , , Prof, PhD k , , PhD l , , PhD c , , PhD a , , PhD n , , PhD o , , BA p , , PhD a , , Prof, DPhil a , , Prof, PhD a , , PhD a , , PhD q , , PhD a , r , s , , Mmath t , , PhD c , , PhD m , , MSPH u , , PhD v , , PhD a , b , , BSc e , w , , PhD p , , BS p , , PhD x , , PhD c , , MSM x , , MS x , , MHS l , , MSc c , , MD e , v , , PhD t , , PhD m , , MSc c , , PhD y , , PhD l , , PhD m , , MA a , , Prof, DPhil a , * , , PhD a
      Lancet (London, England)
      Elsevier

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          Summary

          Background

          The past two decades have seen expansion of childhood vaccination programmes in low-income and middle-income countries (LMICs). 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

          16 independent research groups provided model-based disease burden estimates under a range of vaccination coverage scenarios for ten pathogens: hepatitis B virus, Haemophilus influenzae type B, human papillomavirus, Japanese encephalitis, measles, Neisseria meningitidis serogroup A, Streptococcus pneumoniae, rotavirus, rubella, and yellow fever. Using standardised demographic data and vaccine coverage, the impact of vaccination programmes was determined by comparing model estimates from a no-vaccination counterfactual scenario with those from a reported and projected vaccination scenario. We present deaths and DALYs averted between 2000 and 2030 by calendar year and by annual birth cohort.

          Findings

          We estimate that vaccination of the ten selected pathogens will have averted 69 million (95% credible interval 52–88) deaths between 2000 and 2030, of which 37 million (30–48) were averted between 2000 and 2019. From 2000 to 2019, this represents a 45% (36–58) reduction in deaths compared with the counterfactual scenario of no vaccination. Most of this impact is concentrated in a reduction in mortality among children younger than 5 years (57% reduction [52–66]), most notably from measles. Over the lifetime of birth cohorts born between 2000 and 2030, we predict that 120 million (93–150) deaths will be averted by vaccination, of which 58 million (39–76) are due to measles vaccination and 38 million (25–52) are due to hepatitis B vaccination. We estimate that increases in vaccine coverage and introductions of additional vaccines will result in a 72% (59–81) reduction in lifetime mortality in the 2019 birth cohort.

          Interpretation

          Increases in vaccine coverage and the introduction of new vaccines into LMICs 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

          Gavi, the Vaccine Alliance and the Bill & Melinda Gates Foundation.

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          Most cited references23

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          Global Cancer Incidence and Mortality Rates and Trends--An Update

          There are limited published data on recent cancer incidence and mortality trends worldwide. We used the International Agency for Research on Cancer's CANCERMondial clearinghouse to present age-standardized cancer incidence and death rates for 2003-2007. We also present trends in incidence through 2007 and mortality through 2012 for select countries from five continents. High-income countries (HIC) continue to have the highest incidence rates for all sites, as well as for lung, colorectal, breast, and prostate cancer, although some low- and middle-income countries (LMIC) now count among those with the highest rates. Mortality rates from these cancers are declining in many HICs while they are increasing in LMICs. LMICs have the highest rates of stomach, liver, esophageal, and cervical cancer. Although rates remain high in HICs, they are plateauing or decreasing for the most common cancers due to decreases in known risk factors, screening and early detection, and improved treatment (mortality only). In contrast, rates in several LMICs are increasing for these cancers due to increases in smoking, excess body weight, and physical inactivity. LMICs also have a disproportionate burden of infection-related cancers. Applied cancer control measures are needed to reduce rates in HICs and arrest the growing burden in LMICs.
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            Vaccination greatly reduces disease, disability, death and inequity worldwide

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              Measuring trust in vaccination: A systematic review

              ABSTRACT Vaccine acceptance depends on public trust and confidence in the safety and efficacy of vaccines and immunization, the health system, healthcare professionals and the wider vaccine research community. This systematic review analyses the current breadth and depth of vaccine research literature that explicitly refers to the concept of trust within their stated aims or research questions. After duplicates were removed, 19,643 articles were screened by title and abstract. Of these 2,779 were screened by full text, 35 of which were included in the final analysis. These studies examined a range of trust relationships as they pertain to vaccination, including trust in healthcare professionals, the health system, the government, and friends and family members. Three studies examined generalized trust. Findings indicated that trust is often referred to implicitly (19/35), rather than explicitly examined in the context of a formal definition or discussion of the existing literature on trust in a health context. Within the quantitative research analysed, trust was commonly measured with a single-item measure (9/25). Only two studies used validated multi-item measures of trust. Three studies examined changes in trust, either following an intervention or over the course of a pandemic. The findings of this review indicate a disconnect between the current vaccine hesitancy research and the wider health-related trust literature, a dearth in research on trust in low and middle-income settings, a need for studies on how trust levels change over time and investigations on how resilience to trust-eroding information can be built into a trustworthy health system.
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                Author and article information

                Contributors
                Journal
                Lancet
                Lancet
                Lancet (London, England)
                Elsevier
                0140-6736
                1474-547X
                30 January 2021
                30 January 2021
                : 397
                : 10272
                : 398-408
                Affiliations
                [a ]MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK
                [b ]Section of Hepatology and Gastroenterology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
                [c ]London School of Hygiene & Tropical Medicine
                [d ]Saw Swee Hock School of Public Health, National University of Singapore, Singapore
                [e ]Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
                [f ]Nuffield Department of Medicine, Oxford University, Oxford, UK
                [g ]University of Hong Kong, Hong Kong Special Administrative Region, China
                [h ]Public Health England, London, UK
                [i ]Gavi, the Vaccine Alliance, Geneva, Switzerland
                [j ]University of Southampton, Southampton, UK
                [k ]Laval University, Quebec, QC, Canada
                [l ]Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
                [m ]Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
                [n ]Colorado State University, Fort Collins, CO, USA
                [o ]Pennsylvania State University, Pennsylvania, PA, USA
                [p ]Center for Disease Analysis Foundation, Lafayette, CO, USA
                [q ]Kaiser Permanente Washington, Seattle, WA, USA
                [r ]Laboratoire MESuRS, Conservatoire National des Arts et Métiers, Paris, France
                [s ]Unité PACRI, Institut Pasteur, Conservatoire National des Arts et Métiers, Paris, France
                [t ]University of Cambridge, Cambridge, UK
                [u ]Atlanta, GA, USA
                [v ]Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, USA
                [w ]School of Computing, Dublin City University, Dublin, Ireland
                [x ]Center for Health Decision Science, Harvard T H Chan School of Public Health, Harvard University, Cambridge, MA, USA
                [y ]Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Cambridge, MA, USA
                Author notes
                [* ]Correspondence to: Prof Neil Ferguson, MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London W2 1PG, UK neil.ferguson@ 123456imperial.ac.uk
                [*]

                Contributed equally

                [†]

                Contributed equally

                Article
                S0140-6736(20)32657-X
                10.1016/S0140-6736(20)32657-X
                7846814
                33516338
                4004e718-4faa-47b6-9cfb-bee1b4683165
                © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

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