VoICE : Search Immunization Evidence

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The VoICE tool is a compendium of the many direct and downstream impacts of vaccine-preventable disease and immunization. The database contains summary explanations of the link between immunization and each impact, as well as sources of evidence for each link. You can browse the VoICE tool by topic, or use the filters to find results based on topic, disease or vaccine, location and published year.

42 Key Ideas, 27 Sources
Key Idea

An analysis of undernutrition and mortality in young children found that among the principal causes of death, 60.7% of deaths as a result of diarrhea, 52.3% of deaths as a result of pneumonia, 44.8% of deaths as a result of measles, and 57.3% of deaths as a result of malaria are attributable to undernutrition.

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Key Idea

Tens of millions of volunteers, social mobilizers, and health workers have participated in the Global Polio Eradication Initiative. The program contributes to efforts to deliver other health benefits, including health systems strengthening. Polio eradication legacy efforts include documenting and applying the lessons learned from polio eradication, and transitioning the capacities, assets and processes of polio to other key health priorities.

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Key Idea

In a study modeling the economic impact of immunization in 41 low- and middle-income countries, the authors estimate that 24 million cases of medical impoverishment would be averted through the use of vaccines administered from 2016-2030. The largest proportion of poverty cases averted would occur in the poorest 40% of these populations, demonstrating that vaccination can provide financial risk protection to the most economically vulnerable.

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Key Idea

The detection of H1N1 influenza virus in Mexico in 2009, and subsequently throughout other countries in the Americas, benefited from the laboratory experience with measles and rubella in the region…. [leading to] the rapid detection of and response to what eventually became a novel pandemic virus.

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Key Idea

Across many South Asian and sub-Saharan African countries, children with mothers who received no formal education were nearly 3 times as likely to die before reaching age 5 as those born to mothers with some secondary education.

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Key Idea

In urban residents in the Democratic Republic of Congo, chronically malnourished children were less likely to have received two doses of measles-containing vaccine, compared to healthy children (OR=0.4).

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Key Idea

In a modeled analysis of the economic impact of vaccine use in the world’s 72 poorest countries, for countries included in the analyses from the African region, scaling up coverage of the Rotavirus (RVV) vaccine to 90% was projected to result in more than $900 million in treatment costs averted.

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Key Idea

A study of 14 geographically diverse countries with a DPT vaccination rate below 70%, evaluated missed vaccination opportunities. Researchers found that children – and their mothers – who were fully immunized were more likely to have received other health interventions. In Cote d’Ivoire, children of mothers who had four or more antenatal care (ANC) visits were 54% more likely to be fully immunized than children of mothers who had no ANC visits. Large differences in full immunization coverage were also found in children who received Vitamin A vs. children who didn’t (greatest difference of 41% was noted in the DRC) and in mothers who had access to a skilled birth attendance (36 % difference in Nigeria) and postnatal care (31% difference in Ethiopia), as compared to mothers without access to these services.

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Key Idea

Researchers estimate that vaccinating against 10 diseases in the world’s 94 poorest countries between 2011-2020 will avert $586 Billion in costs of illness (including treatment costs, transportation costs, lost caretaker wages and productivity losses due to death and disability). The 73 Gavi-supported countries account for $544 billion of the treatment costs averted.

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Key Idea

Vaccines that can protect against pneumonia – Hib and S. pneumoniae vaccines – can together prevent over 1.25 million cases of poverty over 15 years, found researchers modeling the economic impact of immunization in 41 low- and middle-income countries.

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Key Idea

A recent study estimated that, during the decade from 2011-2020, every $1 invested in immunization programs in the world’s 73 poorest countries would yield a $16 return on investment. Using an approach accounting for additional societal benefits of vaccination (the “full income approach”, which quantifies the value that people place on living longer and healthier lives), researchers estimated the return could be as high as $44 per $1 invested.

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Key Idea

A study looking at WHO data from member states shows that globally, coverage of the third dose of DTP is 26% higher among children born to mothers with some secondary education compared to mothers with no education.

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Researchers looking at vaccination coverage in 45 low- and middle-income countries found that maternal education is a strong predictor of vaccine coverage. Children of the least educated mothers are 55% less likely to have received measles containting vaccine and three doses of DTP vaccine than children of the most educated mothers.

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Key Idea

Across multiple studies reviewed, the effect of measles vaccine appears to be more beneficial to girls than to boys.

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Key Idea

A study looking at DHS data from 67 countries found that, globally, girls and boys had the same likelihood of being vaccinated. In some countries where there is known gender inequity and son preference, girls were more likely to not be vaccinated.

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Key Idea

An ecological study designed to investigate the association between child mortality rates and Gender Inequality using the United Nations Development Programme’s Gender Inequality Index (GII), showed that low- and middle-income countries have significantly higher gender inequality and under-5 mortality rates than high-income countries. Greater gender inequality was significantly correlated with lower immunization coverage, and with higher neonatal, infant and under-5 mortality.

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To better understand the drivers of vaccination coverage and equity, a 2017 study examined the country-level factors influencing vaccination coverage in 45 low- and lower-middle income Gavi-supported nations. Countries with the least gender equality – as measured by reproductive health, women-held parliamentary seats, educational attainment and other factors – also had lower rates of vaccine coverage.

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Key Idea

In an analysis of immunization coverage in 45 low- and lower-middle income Gavi-eligible countries, researchers found that overall, maternal and paternal education were two of the most significant drivers of coverage inequities in these countries. Pooling the data from all countries, the authors found that “children of the most educated mothers are 1.45 times more likle to have received DTP3 than children of the least educated mothers.” The same held true for measles vaccines with a 1.45-fold likelihood of vaccination in children of the most educated mothers.

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Key Idea

Polio eradication investments in health infrastructure have been concentrated in some of the lowest performing health systems in the world, challenged internally by geography, poverty, armed conflict, etc. These assets can be leveraged to improve the health system and immunization overall nationally.

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Key Idea

Children in slum settings have higher burdens of vaccine-preventable disease (one study found children in slums in Manila, Philippines were 9 times more likely to have tuberculosis than other urban children) and lower rates of immunization (a study in Niger found 35% coverage in slums vs. 86% in non-slum urban areas).

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Key Idea

“HIV-infected individuals are living longer, and non-AIDS-defining conditions are affecting this population in increasing numbers. HPV infections are more prevalent and persistent in HIV-infected women and men. Earlier studies reported anal HPV prevalence rates of 76% in HIV-infected women and 46% in HIV-uninfected women and cervical prevalence rates of 48% to 73% compared to 28% in HIV-uninfected women.” In addition, the burden of HPV infections and HPV-associated diseases is higher in HIV-infected women compared with HIV-uninfected women.

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Key Idea

An analysis of undernutrition and mortality in young children found that among the principal causes of death, 60.7% of deaths as a result of diarrhea, 52.3% of deaths as a result of pneumonia, 44.8% of deaths as a result of measles, and 57.3% of deaths as a result of malaria are attributable to undernutrition.

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Key Idea

A group of experts evaluated a number of maternal, neonatal and child health interventions for equity across wealth quintiles using data from 1990-2006. Immunization was found to have the narrowest differences in coverage of services between the poorest and wealthiest children. In other words, of the interventions evaluated, immunization was the most equitable across income groups.

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Key Idea

Globally, coverage of the third dose of DTP is 15% higher among children in the highest compared to lowest wealth quintile. However, this masks differences of up to 64% in the most inequitable countries (Nigeria).

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Key Idea

A group of experts evaluated a number of maternal, neonatal and child health interventions for equity across wealth quintiles using data from 1990-2006. Immunization was found to have the narrowest differences in coverage of services between the poorest and wealthiest children (28% higher coverage in the highest wealth quintile compared to the lowest). By contrast, indicators of treatment coverage for children sick with diarrhea and pneumonia were nearly 60% higher in the highest wealth quintile compared to the poorest. This means that poor children are at a much greater disadvantage with respect to receiving treatment for pneumonia and diarrhea than they are for receiving vaccines to prevent these infections.

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Key Idea

A study modeling the economic impact of 10 childhood immunizations in 41 low- and middle-income countries found that the bulk of poverty averted through vaccination occurs in poor populations. For most of the vaccines in the study, at least 40% of the poverty averted would occur in the poorest wealth quintile. Particularly for pneumonia, more than half of the two million deaths averted by pneumococcal and Hib vaccines would occur in the poorest 40% of the population.

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Key Idea

A systematic review of studies from India found that prior to widespread use of the pneumococcal conjugate vaccine, antibiotic resistance in serious pneumoccocal infections among Indian children has been common. Penicillin resistance was found in 10% of invasive pneumococcal disease (IPD) cases, while trimethoprim/sulfamethoxazole resistance was found in more than 80% of these cases.

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Key Idea

Researchers investigating the causes of a measles outbreak in Burkina Faso that occurred despite a recent mass vaccination campaign, found that migration to and from Cote d’Ivoire was a major risk factor for children. Unvaccinated children who developed measles were 8.5x more likely to have recently traveled to Cote d’Ivoire than unvaccinated children who had not traveled across the border. Children returning to Burkina Faso after a period of time in Cote d’Ivoire were less likely to have been vaccinated due to low routine coverage of measles vaccines in Cote d’Ivoire. Conversely, unvaccinated children from Burkina Faso who traveled to Cote d’Ivoire and returned were more likely to be exposed to measles and thus had a higher rate of disease than children who never visited Cote d’Ivoire.

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Key Idea

Vaccines against yellow fever and cholera continue to be critical to managing outbreaks of disease and protecting national and international health security.

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Key Idea

In a 2014 review of the non-specific effects of measles vaccines, among others, the WHO Strategic Advisory Group of Experts indicated that some studies of measles vaccine were suggestive (but not conclusive) of a beneficial effect of measles vaccine on mortality beyond the expected direct effect of the vaccine against measles.

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Key Idea

Declining child mortality results in decreased fertility, ushering in demographic transition on the national and regional scale. “Improvements in public health are at the heart of the demographic transition. Improved sanitation, immunization programs, antibiotics, and contraceptives initiate the declines in mortality that lead to declines in fertility, which together cause changes in the age distribution and size of a population.”

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Key Idea

Mothers infected with rubella virus during the first trimester of pregnancy can give birth to children with permanent disabilities such as intellectual impairment, autism, blindness, deafness and cardiac defects. The infection is completely preventable if mothers are vaccinated before pregnancy.

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Key Idea

Children [in slums] suffer from higher rates of diarrhoeal and respiratory illness, malnutrition and have lower vaccination rates. Mothers residing in slums are more poorly educated and less likely to receive antenatal care and skilled birth assistance.

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Key Idea

Immunization against tetanus, pertussis and influenza during pregnancy has been shown to have a profound affect on the health of the mother and fetus, and increases survival of infants in their first months of life.

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Key Idea

Tens of millions of volunteers, social mobilizers, and health workers have participated in the Global Polio Eradication Initiative. The program contributes to efforts to deliver other health benefits, including health systems strengthening. Polio eradication legacy efforts include documenting and applying the lessons learned from polio eradication, and transitioning the capacities, assets and processes of polio to other key health priorities.

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Key Idea

In the Americas, a platform built to secure polio eradication has been expanded to help track, control, prevent and monitor immunization impact for measles and rubella. In India, highly trained polio health workers have become the basis for a trained workforce working towards the elimination of measles and rubella and helping ensure India’s certification by WHO for having eliminated maternal and neonatal tetanus.

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Key Idea

This study investigated the cost-effectiveness of multiple interventions against childhood pneumonia (including vaccination), and found that different combinations of expanded vaccine coverage with community or facility-based management, nutritional programs, or indoor air pollution measures, maximized child health by providing the greatest health yield per dollar spent.

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A systematic review of studies examining the broader economic impact of vaccination in low-middle income countries (LMICs) found that vaccination programs may improve the financial sustainability and affordability of healthcare programs in LMICs. The use of vaccines as part of a treatment cluster, or in combination with other infrastructure projects (such as water management systems) to maximize community health outcomes, offers opportunities for cost sharing between programs.

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Key Idea

The American Academy of Pediatrics and the International Pediatric Association were included as partners in the measles and rubella elimination initiative, allowing for more direct collaboration around the interactions of primary health and immunization services and concerns.

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Key Idea

The detection of H1N1 influenza virus in Mexico in 2009, and subsequently throughout other countries in the Americas, benefited from the laboratory experience with measles and rubella in the region…. [leading to] the rapid detection of and response to what eventually became a novel pandemic virus.

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Key Idea

This paper presents the first cost-benefit comparison of improved water supply investments and cholera vaccination programs. The study results showed that improved water supply interventions combined with targeted cholera vaccination programs are much more likely to yield attractive cost-benefit ratio outcomes than a community-based vaccination program alone.

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A systematic review of studies examining the broader economic impact of vaccination in low-middle income countries (LMICs) found that vaccination programs may improve the financial sustainability and affordability of healthcare programs in LMICs. The use of vaccines as part of a treatment cluster, or in combination with other infrastructure projects (such as water management systems) to maximize community health outcomes, offers opportunities for cost sharing between programs.

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Key Idea

Increased uptake of immunization for vaccine-preventable diseases, particularly in low- and middle-income countries, could save the lives of thousands of mothers and children each year. The disease burden of tetanus, influenza, and pertussis has been minimized in many countries through maternal immunization, but wider applications of this strategy are now needed.

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Key Idea

A literature review of impact evaluations from multiple countries following introduction of rotavirus vaccine showed a 32% median reduction in hospitalizations due to acute gastroenteritis (AGE) in children <1 year of age and a 38% median reduction in children <5 years. Laboratory confirmed rotavirus hospitalizations fell by 80% and 67% in children <1 and <5 years, respectively, after introduction of rotavirus vaccine. In high mortality setting, AGE decreased by 46% in children <5 years.

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Key Idea

Globally, coverage of the third dose of DTP is 8% higher among urban dwellers compared to children raised in a rural environment.

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Key Idea

Among the principal causes of death in young children, 60.7% of deaths as a result of diarrhea, 52.3% of deaths as a result of pneumonia, 44.8% of deaths as a result of measles, and 57.3% of deaths as a result of malaria are attributable to under nutrition.

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