List Analysis Projects
LiST ANALYSIS PROJECT: Impact of vaccine scale-up in Pakistan for USAID
Question:
In Pakistan, between now and 2015, how much of an impact would there be from increasing coverage from
current levels to 90% for all 5 vaccines (measles, rotavirus, pneumococcal, Hib and DTP.).
Packages/Interventions of interest:
Rotavirus vaccine
Measles vaccine
Hib vaccine
Pneumococcal vaccine
DPT vaccine
Target values:
Coverage of 5 vaccines is increased to 90% in 2015 and held constant until 2020
LiST Version Used:
Spectrum 4.22 Beta 4
Outputs of Interest:
U5 Deaths averted by vaccine
U5 Deaths averted
U5 Total deaths
Baseline Coverage Values
Population trend is obtained from the The 2008 Revision of the World Population Prospects published by the
Population Division of the United Nations Department of Economic and Social Affairs of the United Nations
Secretariat. http://esa.un.org/unpd/wpp2008/index.htm
Child mortality estimates are obtained from http://www.childmortality.org. The estimates from year 2008.5
were used.
Causes of death in children under 5 are obtained from the following article

Black, Robert E , Simon Cousens, Hope L Johnson, Joy E Lawn, Igor Rudan, Diego G Bassani, Prabhat Jha,
Harry Campbell, Christa Fischer Walker, Richard Cibulskis, Thomas Eisele, Li Liu, Colin Mathers, for the Child
Health Epidemiology Reference Group of WHO and UNICEF (2010). Global, regional, and national causes of
child mortality in 2008: a systematic analysis. Lancet. 375 (9730): 1969 - 1987.

Vaccine coverage estimates are obtained from the WHO-UNICEF estimates of national immunization
coverage, data downloaded in Oct 2010. The estimates from year 2009 were used.
http://apps.who.int/immunization_monitoring/en/globalsummary/timeseries/tswucoveragedtp3.htm
Vaccine effectiveness is based on their impact on specific causes of death:
An affected fraction refers to the percent of a specific cause of death which can be averted by an intervention.
This refers to etiology when available.
Standard vaccine effect sizes and affected fraction used in LiST:

Pneumococcal and Hib vaccine’s effect on pneumonia and meningitis
o Pneumococcal vaccine (full coverage) has an effect of 0.26, meaning that full vaccination can
prevent 26% of pneumonia deaths, and since the review is not yet finished, we are assuming the
same effect (26%) on meningitis deaths.
o Hib vaccine (full coverage) has an effect of 0.18. This means that full vaccination can prevent
18% of pneumonia deaths and, since the review is not yet finished, we are also assuming the
same effect (18%) on meningitis deaths.
o The affected fraction for each of these vaccines is considered to be the entire population of
pneumonia deaths because that is how the reviews were completed. Thus the presented effect
sizes are in essence, combinations of both effectiveness of the vaccines and the affected
fraction, or proportion of pneumonia due to these bacteria.
o Reference: Theodoratou, Evropi, Sue Johnson, Arnoupe Jhass, Shabir A Madhi, Andrew Clark,
Cynthia Boschi-Pinto, Sunil Bhopal, Igor Rudan, Harry Campbell (2010). The effect of
Haemophilus influenzae type b and pneumococcal conjugate vaccines on childhood pneumonia
incidence, severe morbidity and mortality. Int. J. Epidemiol. 39: i172-i185.

Rotavirus vaccine’s effect on diarrhea
o Rotavirus vaccine can prevent 74% of diarrhea deaths, and 39% of diarrhea deaths can benefit
by full coverage of the vaccine.
Measles vaccine’s effect on measles
o Measles vaccine can prevent 85% of measles deaths, and 100% of measles deaths can benefit by
full coverage of the vaccine.


DPT vaccine’s effect on pertussis.
o DPT vaccine (3 doses) has an effect of 0.85, meaning that full vaccination can prevent 85% of
pertussis deaths.
o It is assumed that all (100%) pertussis deaths can benefit by full coverage of the vaccine.
Vaccine coverage in Pakistan
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Rotavirus
vaccine
Measles vaccine
Hib vaccine
Pneumococcal
vaccine
DPT vaccination
0
59.9
0
0
65.9
64.8
0
71.9
71.1
77.4
78
77.4
83.7
84
83.7
90
90
90
90
90
90
90
90
90
90
90
90
90
90
90
90
90
90
0
58.5
0
64.8
71.1
71.1
77.4
77.4
83.7
83.7
90
90
90
90
90
90
90
90
90
90
90
90
Results:


When coverage is maintained between 2015 and 2020 to show that between 2011 and 2020,
more than 300,000 deaths could be averted between 2011 to 2020
Total deaths averted in 2011-2020
o by Rotavirus vaccine: 86,700
o by Measles vaccine: 28,700
o by Hib vaccine: 85,000
o by Penumo vaccine: 113,600
o by DTP vaccine: 31,800