Excess vaccine-preventable disease mortality due to COVID-19
Authors: Kimberly M Thompson
Journal: The Lancet Global Health (2024)

January, 2024, started with warnings about measles outbreaks in the UK and the USA, which followed poliovirus outbreaks in London and New York during 2022–231Thompson KM Kalkowska DA Routh JA et al.Modeling poliovirus transmission and responses in New York state.J Infect Dis. 2023; (published online Aug 19.)https://doi.org/10.1093/infdis/jiad355Crossref Google Scholar and reports of other consequences of reduced immunisation coverage for vaccine-preventable diseases in countries with historically high overall immunisation coverage.2Cunniff L Alyanak E Fix A et al.The impact of the COVID-19 pandemic on vaccination uptake in the United States and strategies to recover and improve vaccination rates: a review.Hum Vaccin Immunother. 2023; 192246502Crossref PubMed Scopus (1) Google Scholar, 3Pan American Health OrganizationRisk of vaccine-preventable disease outbreaks at 30-year high, PAHO Director says.https://www.paho.org/en/news/20-4-2023-risk-vaccine-preventable-disease-outbreaks-30-year-high-paho-director-saysDate: 2023Date accessed: January 3, 2024Google Scholar Sadly, reports like these reflect failures to realise the full health benefits of lifesaving vaccines. In The Lancet Global Health, Anna-Maria Hartner and colleagues4Hartner A-M Li X Echeverria-Londono S et al.Estimating the health effects of COVID-19-related immunisation disruptions in 112 countries during 2020–30: a modelling study.Lancet Glob Health. 2024; 12: e563-e571Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar present important modelling estimates of how these failures translate into excess mortality for 14 pathogens in 112 low-income and middle-income countries after a reduction in routine immunisation coverage due to disruptions from the COVID-19 pandemic. Despite global efforts, such as the WHO Global Vaccine Action Plan, which aimed to "improve health by extending by 2020 and beyond the full benefits of immunisation to all people, regardless of where they are born, who they are, or where they live",5WHOGlobal Vaccine Action Plan.http://www.who.int/immunization/global_vaccine_action_plan/GVAP_doc_2011_2020/en/Date: 2013Date accessed: April 12, 2015Google Scholar immunisation coverage for many vaccines plateaued before the COVID-19 pandemic and efforts to increase them encountered, and still encounter, considerable challenges.4Hartner A-M Li X Echeverria-Londono S et al.Estimating the health effects of COVID-19-related immunisation disruptions in 112 countries during 2020–30: a modelling study.Lancet Glob Health. 2024; 12: e563-e571Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar Global health leaders still do not have answers to key questions, including what will be needed to end fatalities6Thompson KM What will it take to end fatalities from measles?.Lancet Glob Health. 2019; 7: e394-e395Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar and human suffering7Thompson KM What will it take to end human suffering from measles?.Lancet Infect Dis. 2017; 17: 1013-1014Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar from measles and the kind of world we want regarding polio eradication.8Thompson KM Polio eradication: what kind of world do we want?.Lancet Infect Dis. 2022; 22: 161-163Summary Full Text Full Text PDF PubMed Scopus (10) Google Scholar Immediately after missing global health and immunisation targets from the previous decade, 2020 started with the COVID-19 pandemic. The pandemic wreaked havoc on health systems globally and led to major disruptions in routine immunisation and vaccine supply chains.9The LancetRoutine immunisations: reversing the decline.Lancet. 2023; 4011313Summary Full Text Full Text PDF Scopus (1) Google Scholar The successful rapid development and deployment of COVID-19 vaccines owe part of their success to the emergency use of the health personnel and financial resources that had been budgeted for routine immunisation and global polio eradication. We are still realising and observing the full costs of the COVID-19 pandemic and the disruptions that it caused. However, although the diversion of routine immunisation resources to deliver COVID-19 vaccines saved many lives, we can now appreciate that it did so with mortality trade-offs. Through use of the 2022 WHO–UNICEF global estimates of immunisation coverage, which included substantial reductions in coverage of routine immunisation for 2020 and showed partial and uneven recovery in 2021 compared with before 2020, Hartner and colleagues estimated 49 119 additional deaths (95% credible interval [CrI] 17 248 to 134 941) during calendar years 2020–30 than would have been expected without COVID-19 disruptions in routine immunisation.4Hartner A-M Li X Echeverria-Londono S et al.Estimating the health effects of COVID-19-related immunisation disruptions in 112 countries during 2020–30: a modelling study.Lancet Glob Health. 2024; 12: e563-e571Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar These estimates of excess mortality come from six vaccine-preventable diseases, but the results were largely dominated by measles 44 544 (13 794 to 130 657) and yellow fever 329 (–107 to 1148).4Hartner A-M Li X Echeverria-Londono S et al.Estimating the health effects of COVID-19-related immunisation disruptions in 112 countries during 2020–30: a modelling study.Lancet Glob Health. 2024; 12: e563-e571Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar The study also modelled the effects of immunisation catch-up activities for these six pathogens, assuming they started by 2023,10WHOChildhood immunization begins recovery after COVID-19 backslide.https://www.who.int/news/item/18-07-2023-childhood-immunization-begins-recovery-after-covid-19-backslideDate: 2023Date accessed: July 18, 2023Google Scholar with an estimate that recovery to 2019 quality of immunisation coverage would be achieved by 2025.4Hartner A-M Li X Echeverria-Londono S et al.Estimating the health effects of COVID-19-related immunisation disruptions in 112 countries during 2020–30: a modelling study.Lancet Glob Health. 2024; 12: e563-e571Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar Hartner and colleagues estimated that catch-up immunisation activities could avert 78·9% (95% CrI 40·4 to 151·4) of excess deaths between calendar years 2023–30 (ie, 18 900 [7037 to 60 223] of 25 356 [9859 to 75 073]).4Hartner A-M Li X Echeverria-Londono S et al.Estimating the health effects of COVID-19-related immunisation disruptions in 112 countries during 2020–30: a modelling study.Lancet Glob Health. 2024; 12: e563-e571Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar For the full set of 14 vaccine-preventable diseases, Hartner and colleagues modelled the lifelong consequences of immunisation coverage for children vaccinated between 2020–30 considering the effects of the COVID-19 disruptions and a hypothetical world without COVID-19.4Hartner A-M Li X Echeverria-Londono S et al.Estimating the health effects of COVID-19-related immunisation disruptions in 112 countries during 2020–30: a modelling study.Lancet Glob Health. 2024; 12: e563-e571Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar For years 2020–30, they estimated 967 635 additional deaths (95% CrI 896 596–1 049 981) due to COVID-19 disruptions in routine immunisation, assuming recovery takes until 2025, a 2·7% reduction in overall effect attributable to COVID-19 disruptions on routine immunisation.4Hartner A-M Li X Echeverria-Londono S et al.Estimating the health effects of COVID-19-related immunisation disruptions in 112 countries during 2020–30: a modelling study.Lancet Glob Health. 2024; 12: e563-e571Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar The authors estimated considerable variability in the expected mortality burdens from WHO,4Hartner A-M Li X Echeverria-Londono S et al.Estimating the health effects of COVID-19-related immunisation disruptions in 112 countries during 2020–30: a modelling study.Lancet Glob Health. 2024; 12: e563-e571Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar with most of these deaths expected to occur in the WHO African and WHO South-East Asia regions, which include the largest numbers of people living in low-income and middle-income countries. The lasting adverse effects of the COVID-19 pandemic include consequences for many diseases. Public health leaders and researchers can benefit from an improved understanding as a result of insights from modelling studies such as this one. These new results should help to motivate catch-up activities to regain lost progress in immunisation, and perhaps will lead to support for plans to end the plateau in routine immunisation and fully realise the benefits of vaccines by 2030. I declare no competing interests. Estimating the health effects of COVID-19-related immunisation disruptions in 112 countries during 2020–30: a modelling studyOur results highlight the importance of the timing of catch-up activities, considering estimated burden to improve vaccine coverage in affected cohorts. We estimated that mitigation measures for measles and yellow fever were particularly effective at reducing excess burden in the short term. Additionally, the high long-term effect of HPV vaccine as an important cervical-cancer prevention tool warrants continued immunisation efforts after disruption. Full-Text PDF Open Access