Dhiraj Motilal Agarwal

54398213500

Publications - 3

Global, regional, and national trends in routine childhood vaccination coverage from 1980 to 2023 with forecasts to 2030: a systematic analysis for the Global Burden of Disease Study 2023

Catherine Bisignano Ashley A. Harris Amanda E. Smith Paulina A. Lindstedt Simeon Okechukwu Ajakwe Olivia D. Nesbit Taylor Noyes Noga Shalev Latera Tesfaye Olana Catherine M. Antony Nancy Fullman Sharareh Eskandarieh Mushood Ahmed Naveed Ahmed Rana Kamal Abu Farha Kamoru Ademola Adedokun Nurudeen A. Adegoke Aanuoluwapo Adeyimika Afolabi Giuseppina Affinito Dolapo Emmanuel Ajala Eman Abu-Gharbieh Reed J.D. Sorensen Chun Wei Yuan Stein Emil Vollset Stephen S. Lim Jonathan F. Mosser Andy Stergachis Farbod Khosravi Sonali Kochhar Armita Abedi Usha Adiga Mitra Abbasifard Mohammad Amin Aalipour Faezeh Abbaspour Tomislav Mestrovic Dariush Abtahi Ripon Kumar Adhikary Mohd Adnan Aqeel Ahmad Simon I. Hay Abdollah Jafarzadeh Williams Agyemang-Duah Hana J. Abukhadijah Danish Ahmad Amin Sharifan Rotimi Felix Afolabi Saira Afzal Emad M. Abdallah Samar Abd Elhafeez Meqdad Saleh Ahmed Muktar Beshir Ahmed Syed Anees Ahmed Suneth Buddhika Agampodi Khurshid Ahmad Tauseef Ahmad Sepehr Aghajanian Ayman Ahmed Ramy Mohamed Ghazy Meriem Abdoun Salahdein Aburuz Lucas Guimarães Abreu Alireza Shakeri Qorinah Estiningtyas Sakilah Adnani Emily Haeuser Sam Byrne Jason Nguyen Catalina Raggi Susan A. McLaughlin Hedayat Abbastabar Rana Kamal Abu Farha Sherief Abd-Elsalam Dmitry Abramov Adam Abdullahi Faezeh Abbaspour Reda Abdel-Hameed Samar Abd ElHafeez Atef Abdelkader Deldar Morad Abdulah Haroon Ahmed Lisa C. Adams Toufik Abdul-Rahman Constanza Elizabeth Aguilera Arriagada Mahsa Ahadi Rabbiya Ahmad Shoaib Ahmad Asrat Agalu Abejew Abdu A. Adamu Juliana Bunmi Adetunji Kulmira Abdykerimova Rahim Abo Kasem Nagah M. Abourashed Mohamed Abouzid Roberto Ariel Abeldaño Zuñiga Juan Manuel Acuna Anirudh Balakrishna Acharya Meshack Achore Ousman Adal Habeeb Abiodun Afolabi Hasan Aalruz Arman Abdous Auwal Abdullahi Bilyaminu Abubakar David Adedia Syed Hani Abidi Olumide Abiodun Hassan Abolhassani Richard Gyan Aboagye Ulric Sena Abonie Abdullahi Tunde Aborode Wakgari Mosisa Abdisa Oyelola A. Adegboye Mohammad Mahdi Bastan Dhiraj Motilal Agarwal Tajudeen Adesanmi Adebisi Oluwatobi E. Adegbile Olumide Thomas Adeleke Mache Tsadik Adhana Molalegne Bitew Feven Sahle Gebre Leticia Akua Adzigbli Alireza Mirkheshti Sohrab Salimi Seyed Mohammad Seyed Alshohadaei Hafsa Zia Gizachew Taddesse Akalu Jiawei He Prince Owusu Adoma Dorsa Salabat Mohamed Jalloh Vafa Rahimi-Movaghar Sina Shool Melika Jameie Jafar Karami Farzad Kompani Mohammad Ali Mansournia Abdolreza Mohammadi Amin Mohsenzadeh Aleksandr Y. Aravkin Omid Dadras Iman M. Talaat Ali H. Mokdad Xiaochen Dai Lalit Dandona Rakhi Dandona Sara Bagheri Fereshteh Baghizadeh Mahdis Bayat Minoo Heidari Almasi Ali Asghar Kolahi Ali Nikoobar Mohammad Mahdi Rashidi Firoozeh Madadi Mehdi Safari Mastooreh Sagharichi Maryam Shayan Georgia Smith Samuel James Herold Annie Haakenstad Christopher J.L. Murray Zahra Siavashpour Mohsen Rezaeian Shakiba Ghasemi Assl Atakan Orscelik Yigit Can Senol Michael Zastrozhin Hannah Elizabeth Robinson-Oden Amin Azizan Nazila Rezaei Pegah Salimi Pormehr Amin Sedigh Farshad Shahkarami Kazem Ghaffari Ghazal Arjmand Mahsa Asadi Anar Rasoul Ebrahimi Seyed Ataollah Madinezad Behnaz Niroomand Seyed Kiarash Sadat Rafiei Antonio Olivas-Martinez

Publication Name: Lancet

Publication Date: 2025-07-19

Volume: 406

Issue: 10500

Page Range: 235-260

Description:

Background: Since its inception in 1974, the Essential Programme on Immunization (EPI) has achieved remarkable success, averting the deaths of an estimated 154 million children worldwide through routine childhood vaccination. However, more recent decades have seen persistent coverage inequities and stagnating progress, which have been further amplified by the COVID-19 pandemic. In 2019, WHO set ambitious goals for improving vaccine coverage globally through the Immunization Agenda 2030 (IA2030). Now halfway through the decade, understanding past and recent coverage trends can help inform and reorient strategies for approaching these aims in the next 5 years. Methods: Based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2023, this study provides updated global, regional, and national estimates of routine childhood vaccine coverage from 1980 to 2023 for 204 countries and territories for 11 vaccine-dose combinations recommended by WHO for all children globally. Employing advanced modelling techniques, this analysis accounts for data biases and heterogeneity and integrates new methodologies to model vaccine scale-up and COVID-19 pandemic-related disruptions. To contextualise historic coverage trends and gains still needed to achieve the IA2030 coverage targets, we supplement these results with several secondary analyses: (1) we assess the effect of the COVID-19 pandemic on vaccine coverage; (2) we forecast coverage of select life-course vaccines up to 2030; and (3) we analyse progress needed to reduce the number of zero-dose children by half between 2023 and 2030. Findings: Overall, global coverage for the original EPI vaccines against diphtheria, tetanus, and pertussis (first dose [DTP1] and third dose [DTP3]), measles (MCV1), polio (Pol3), and tuberculosis (BCG) nearly doubled from 1980 to 2023. However, this long-term trend masks recent challenges. Coverage gains slowed between 2010 and 2019 in many countries and territories, including declines in 21 of 36 high-income countries and territories for at least one of these vaccine doses (excluding BCG, which has been removed from routine immunisation schedules in some countries and territories). The COVID-19 pandemic exacerbated these challenges, with global rates for these vaccines declining sharply since 2020, and still not returning to pre-COVID-19 pandemic levels as of 2023. Coverage for newer vaccines developed and introduced in more recent years, such as immunisations against pneumococcal disease (PCV3) and rotavirus (complete series; RotaC) and a second dose of the measles vaccine (MCV2), saw continued increases globally during the COVID-19 pandemic due to ongoing introductions and scale-ups, but at slower rates than expected in the absence of the pandemic. Forecasts to 2030 for DTP3, PCV3, and MCV2 suggest that only DTP3 would reach the IA2030 target of 90% global coverage, and only under an optimistic scenario. The number of zero-dose children, proxied as children younger than 1 year who do not receive DTP1, decreased by 74·9% (95% uncertainty interval 72·1–77·3) globally between 1980 and 2019, with most of those declines reached during the 1980s and the 2000s. After 2019, counts of zero-dose children rose to a COVID 19-era peak of 18·6 million (17·6–20·0) in 2021. Most zero-dose children remain concentrated in conflict-affected regions and those with various constraints on resources available to put towards vaccination services, particularly sub-Saharan Africa. As of 2023, more than 50% of the 15·7 million (14·6–17·0) global zero-dose children resided in just eight countries (Nigeria, India, Democratic Republic of the Congo, Ethiopia, Somalia, Sudan, Indonesia, and Brazil), emphasising persistent inequities. Interpretation: Our estimates of current vaccine coverage and forecasts to 2030 suggest that achieving IA2030 targets, such as halving zero-dose children compared with 2019 levels and reaching 90% global coverage for life-course vaccines DTP3, PCV3, and MCV2, will require accelerated progress. Substantial increases in coverage are necessary in many countries and territories, with those in sub-Saharan Africa and south Asia facing the greatest challenges. Recent declines will need to be reversed to restore previous coverage levels in Latin America and the Caribbean, especially for DTP1, DTP3, and Pol3. These findings underscore the crucial need for targeted, equitable immunisation strategies. Strengthening primary health-care systems, addressing vaccine misinformation and hesitancy, and adapting to local contexts are essential to advancing coverage. COVID-19 pandemic recovery efforts, such as WHO's Big Catch-Up, as well as efforts to bolster routine services must prioritise reaching marginalised populations and target subnational geographies to regain lost ground and achieve global immunisation goals. Funding: The Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.

Open Access: Yes

DOI: 10.1016/S0140-6736(25)01037-2

Global, Regional, and National Burden of Cardiovascular Diseases and Risk Factors in 204 Countries and Territories, 1990-2023

Nermeen Abu-Elala Rana Kamal Abu Farha Madineh Abbasi Abdallah H.A. Abd Al Magied Kamoru Ademola Adedokun Nurudeen A. Adegoke Eman Abu-Gharbieh Lisa C. Adams Mesfin Abebe Armita Abedi Mohammad Amin Aalipour A. Bhoomadevi Bedru J. Abafita Ukachukwu O. Abaraogu Dariush Abtahi Ripon Kumar Adhikary Mohd Adnan Hasan Aalruz E. S. Abhilash Hana J. Abukhadijah Muhammad Sohail Afzal Nasir Abbas Bedru J. Abafita Tanin Adl Parvar César Agostinis Sobrinho Saira Afzal Samar Abd Elhafeez Navidha Aggarwal Olorunsola Israel Adeyomoye Nermeen Abu-Elala Prof Bhoomadevi A Benjamin A. Stark Nicole K. DeCleene Prerna Agarwal Emily C. Desai Johnathan M. Hsu Catherine O. Johnson Laura Lara-Castor Suneth Buddhika Agampodi Sepehr Aghajanian Prof Ahmed Abdelalim Salahdein Aburuz Omar M. Abdelfattah Prof Reda Abdel-Hameed Prof Wael M Abdel-Rahman Mahmoud Abdelnabi Lucas Guimarães Abreu Prof Olumide Abiodun Rui Adão Mujahid Abdullah Apurba Acharya Aminu Kende Kende Abubakar Ibrahim Jatau Abubakar Swetha Acharya Charles Oluwaseun Adetunji Rishan Adha Wirawan Adikusuma Lawan Hassan Adamu Qorinah Estiningtyas Sakilah Adnani Gina Agarwal Ahmed M. Afifi Fatemeh Afrashteh Hedayat Abbastabar Samar Abd ElHafeez Asrat Agalu Abejew Kulmira Abdykerimova Aidin Abedi Olugbenga Olusola Abiodun Shady Abohashem Rahim Abo Kasem Nagah M. Abourashed Dmitry Abramov Anirudh Balakrishna Acharya Meshack Achore Ousman Adal Habeeb Abiodun Afolabi Hasan Aalruz Arman Abdous Auwal Abdullahi Isaac Yeboah Addo David Adedia Hassan Abolhassani Richard Gyan Aboagye Ulric Sena Abonie Abdullahi Tunde Aborode Parsa Abdi Wakgari Mosisa Abdisa Victor Adekanmbi Kate E. LeGrand Mohammad Abavisani Oladimeji Muritala Adebayo Oyelola A. Adegboye Daba Abdissa Mohammadreza Abbasian Arya Afrooghe Dhiraj Motilal Agarwal Temesgen Anjulo Ageru Dina Abushanab Tajudeen Adesanmi Adebisi Oluwatobi E. Adegbile Olumide Thomas Adeleke David Adzrago Leticia Akua Adzigbli Nasir Abbas Prince Owusu Adoma Kishor Adhikari Salahdein Aburuz

Publication Name: Journal of the American College of Cardiology

Publication Date: 2025-12-02

Volume: 86

Issue: 22

Page Range: 2167-2243

Description:

Background: Cardiovascular diseases (CVDs) are the leading cause of mortality and are among the foremost causes of disability globally. CVD burden has continued to increase in most countries since 1990, with trends driven by changing exposures to harmful risk factors, population growth, and population aging. Objectives: We report estimates of global, national, and subnational CVD burden, including 18 subdiseases and 12 associated modifiable risk factors. We analyzed change in CVD burden from 1990 to 2023 and identified drivers of change including population growth, population aging, and risk factor exposure. Methods: The Global Burden of Disease (GBD) 2023 study, a multinational collaborative research study, quantified burden due to 375 diseases including CVD burden and identified drivers of change from 1990 to 2023 using all available data and statistical models. GBD 2023 estimated the population-level burden of diseases in 204 countries and territories from 1990 to 2023. Results: CVDs were the leading cause of disability-adjusted life years (DALYs) and deaths estimated in the GBD. As of 2023, there were 437 million (95% UI: 401 to 465 million) CVD DALYs globally, a 1.4-fold increase from the number in 1990 of 320 million (292 to 344 million). Ischemic heart disease, intracerebral hemorrhage, ischemic stroke, and hypertensive heart disease were the leading cardiovascular causes of DALYs in 2023 globally. As of 2023, age-standardized CVD DALY rates were highest in low and low-middle Socio-demographic Index (SDI) settings and lowest in high SDI settings. The number of CVD deaths increased globally from 13.1 million (95% UI: 12.2 to 14.0 million) in 1990 to 19.2 million (95% UI: 17.4 to 20.4 million) in 2023. The number of prevalent cases of CVD more than doubled since 1990, with 311 million (95% UI: 294 to 333 million) prevalent cases of CVD in 1990 and 626 million (95% UI: 591 to 672 million) prevalent cases in 2023 globally. A total of 79.6% (95% UI: 75.7% to 82.5%) of CVD burden is attributable to modifiable risk factors 347 million [95% UI: 318 to 373 million] DALYs in 2023). Globally, high systolic blood pressure, dietary risks, high low-density lipoprotein cholesterol, and air pollution were the modifiable risks responsible for most attributable CVD burden in 2023. Since 1990, changes in exposure to modifiable risk factors have had mixed effects on CVD burden, with increases in high body mass index, high fasting plasma glucose, and low physical activity leading to higher burden, while reductions in tobacco usage have mitigated some of these increases. Population growth and population aging were the main drivers of the increasing burden since 1990, adding 128 million (95% UI: 115 to 139 million) and 139 million (95% UI: 126 to 151 million) CVD DALYs to the increase in CVD burden since 1990. Conclusions: CVD remains the leading cause of disease burden and death worldwide with the greatest burden in low, low-middle, and middle SDI regions. Large variation exists in CVD burden even for countries at similar levels of development, a gap explained substantially by known, modifiable risk factors that are inadequately controlled. The decades-long increase in CVD burden was the result of population growth, population aging, and increased exposure to a subset of risk factors led by metabolic risks. Countries will need to adopt effective health system and public health strategies if they are to progress in achieving global goals to reduce the burden of CVD.

Open Access: Yes

DOI: 10.1016/j.jacc.2025.08.015

Global, regional, and national burden of tuberculosis and multidrug-resistant tuberculosis by HIV status, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023

Usha Adiga Emad M. Abdallah Meriem Abdoun Eman Abu-Gharbieh Amr Selim Abu Lila Siddig Ibrahim Abdelwahab Rashad Abdul-Ghani Anirudh Balakrishna Acharya Mohd Adnan Victor Adekanmbi Dhiraj Motilal Agarwal Asrat Agalu Abejew Samar Abd Elhafeez Jeza Muhamad Abdul Aziz Ripon Kumar Adhikary Muhammad Sohail Afzal Auwal Abdullahi Ukachukwu O. Abaraogu Rana Kamal Abu Farha Isaac Yeboah Addo Bilyaminu Abubakar Ahmad Y. Abuhelwa Olatunji O. Adetokunboh Ali Abuhaliema Obed Adonteng-Kissi Lawan Hassan Adamu Sherief Abd-Elsalam Swetha Acharya Williams Agyemang-Duah Mei Fong Liew Charles Oluwaseun Adetunji Juliana Bunmi Adetunji Aseel Aburub Deldar Morad Abdulah Abiola Victor Adepoju Jiawei He Makinde Adebayo Adeniyi Abdu A. Adamu Rezheen Fatah Abdulrahman Olumide Thomas Adeleke Feleke Doyore Agide Jorge R. Ledesma Babatope Oluwadamilare Adebiyi Olifan Zewdie Abil Sawsan Abuhammad Kamoru Ademola Adedokun Percival Delali Delali Agordoh Oluwawemimo Oluseun Adebowale Arailym Abilbayeva Ebenezer Afrifa-Yamoah Yasir M. Abdulateef Abdul Momin Rizwan Ahmad Mai Abdel Haleem Abusalah Aanuoluwapo Adeyimika Afolabi Samuel M. Ostroff Richard Gyan Aboagye Molalign Aligaz Aligaz Adisu Shimaa M. Aboelnaga Huong Thi Chu Navidha Aggarwal Wondimnew Desalegn Addis Ridwan Olamilekan Adesola Ali Abdolizadeh Arman Abdous Nagah M. Abourashed Prince Owusu Adoma Gizachew Beykaso Agafari Belete Muluadam Admassie Regina Mae Villanueva Dominguez Hana J. Abukhadijah Abdullahi Tunde Aborode Meixin Zhang Jianing Ma Abdulrakib Abdulrahim Hassan Abolhassani Saheed Ayodeji Adekola Sophie Mei Lin Whikehart Oluwatobi E. Adegbile Habtamu Abebe Getahun Nuhu Lawan Adamu None Abdullah Sadik Abdulwehab Belayneh Jejaw Abate Megan Verma Syed Hani Abidi Tajudeen Adesanmi Adebisi Wakgari Mosisa Abdisa Amanda Movo Mahdi Aghaalikhani Yasir M. Abdulateef Krishna Prasad Acharya Adamu Adamu Ahmad Hassan A. Abdou Zirak Ahmed Abdulrahman Nagah M. Abourashed Hatem A Eltaly Mazhar Abbas Vijay K. Aggarwal Adnan Ahmad Nermeen Abu-Elala Olumide Abiodun Saira Afzal

Publication Name: Lancet Infectious Diseases

Publication Date: 2026-01-01

Volume: Unknown

Issue: Unknown

Page Range: Unknown

Description:

Background: Tuberculosis (TB) is the leading global cause of death from a single infectious agent. Recent reductions in global health funding have threatened TB control, making comprehensive assessment of TB, HIV-related TB, and drug-resistant TB burdens before these disruptions essential for shaping effective responses. The WHO End TB Strategy sets targets of a 95% reduction in TB deaths and a 90% reduction in TB incidence between 2015 and 2035. Using results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, this study aims to assess the burden of TB and multidrug-resistant TB (MDR-TB) across 204 countries and territories, and to evaluate progress towards the WHO End TB incidence and mortality targets. Methods: We quantified TB mortality using the Cause of Death Ensemble modelling platform with global vital registration, surveillance, verbal autopsy, and minimally invasive tissue sampling data. For TB morbidity estimation, we simultaneously modelled incidence, prevalence, and mortality by age and sex using DisMod-MR 2.1. A population attributable fraction (PAF) approach was applied to stratify morbidity and mortality estimates by HIV and drug-resistance status. We also calculated disability-adjusted life-years (DALYs) as the sum of years of life lost and years lived with disability. For the risk factor analysis, a comparative risk assessment framework was used and PAFs were derived for alcohol use, smoking, and high fasting plasma glucose to determine the proportion of TB burden associated with these risk factors. Findings: In 2023, there were an estimated 9·11 million (95% uncertainty interval 8·04–10·3) incident cases of all-form TB, 1·22 million (0·98–1·49) deaths, and 54·6 million (43·8–65·5) DALYs globally. HIV-related TB comprised 781 000 (690 000–879 000) incident cases and 210 000 (142 000–279 000) deaths, contributing 11·0 million (7·56–14·3) DALYs. MDR-TB accounted for 466 000 (198 000–1 080 000) incident cases, 102 000 (31 700–238 000) deaths, and 3·96 million (1·31–9·01) DALYs. From 2015 to 2023, global all-form TB incidence rates declined by 19·2% (17·8–20·5) and deaths declined by 22·6% (4·7–35·7); declines were larger for drug-susceptible TB than for MDR-TB. Sub-Saharan Africa and south Asia had the highest mortality burdens in 2023; reductions in all-form TB incidence and mortality were uneven between 2000 and 2023, with limited progress in both measures in Latin America and the Caribbean. Removing smoking, alcohol use, and high fasting plasma glucose would reduce global TB deaths to 768 000 (592 000–970 000) and DALYs to 34·9 million (27·8–43·8) in 2023; MDR-TB deaths would decrease to 77 200 (23 400–183 000) and DALYs to 3·12 million (1·03–7·29). Interpretation: Global progress towards WHO End TB targets is disparate and fragile. Although many regions achieved meaningful gains, others have stagnated in recent years. The complexity of TB prevention is amplified by divergent MDR-TB trends, the persistent burden of HIV, and growing exposure to modifiable risk factors. Recent volatility in global health financing threatens to further destabilise this vulnerable epidemiological landscape; concerted action is urgently needed to temper disruptions and preserve progress. Funding: Gates Foundation.

Open Access: Yes

DOI: 10.1016/S1473-3099(26)00295-1