Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Telethon Kids Institute, Perth, Australia; University of Western Australia, Perth, Australia.
Safinea, London, UK; London School of Economics and Political Science, London, UK; London School of Hygiene & Tropical Medicine, London, UK; University of Cambridge, Cambridge, UK.
Lancet. 2024 May 25;403(10441):2307-2316. doi: 10.1016/S0140-6736(24)00850-X. Epub 2024 May 2.
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.
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.
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.
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.
WHO.
世卫组织应其成员国的要求，于 1974 年启动了扩大免疫规划（EPI），旨在向全球所有人提供救命疫苗。值此 EPI 50 周年之际，我们旨在量化自该规划启动以来疫苗接种对全球公共卫生的影响。
在这项建模研究中，我们使用了一系列数学和统计模型，估算了自 1974 年以来 EPI 针对 14 种病原体进行 50 年疫苗接种的全球和区域公共卫生影响。对于所建模的病原体，我们考虑了自 1974 年以来提供的所有常规和补充疫苗的覆盖率，并根据没有历史疫苗接种的假设情况，估计了每个年龄组的死亡率和发病率的降低情况。然后，我们使用这些建模结果来估算在此期间疫苗接种对全球婴儿和儿童死亡率下降的贡献。
自 1974 年以来，疫苗接种已避免了 1.54 亿人死亡，其中包括 5 岁以下儿童的 1.46 亿人死亡，其中 1010 万人是 1 岁以下的婴儿。每避免一次死亡，平均就会增加 66 年的完全健康期，相当于增加了 102 亿年的完全健康期。我们估计，疫苗接种对全球婴儿死亡率的下降贡献了 40%，对非洲区域的下降贡献了 52%。到 2024 年，与没有历史疫苗接种的假设情况相比，10 岁以下的儿童在其下一个生日前存活的可能性增加了 40%。即使到了晚年，也可以观察到存活率的提高。
自 1974 年以来，每个全球区域的儿童生存率都有了显著提高。我们估计，EPI 是过去 50 年来改善婴儿生存率的最大贡献者。在加强初级卫生保健的背景下，我们的研究结果表明，公平地普遍获得免疫接种仍然是维持健康收益和继续防止可预防的传染病死亡率导致未来生命损失的关键。
世卫组织。
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