Catherine Bisignano

57211140934

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 burden of cancer in children and adolescents aged 0–19 years, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023

Jasvinder Singh Bhatti Sayeh Ezzikouri Ali Hasanpour- Dehkordi Takeshi Fukumoto Seyyed Shamsadin Athari Hala Rashad Elhabashy Aleksandr Y. Aravkin Paul Narh Doku Dariush Haghmorad Theophilus I. Emeto Adeniyi Francis Fagbamigbe Nermin Ghith Anis Ahmad Chaudhary Mahwish Arooj Hamidreza Hasani Robert Kaba Alhassan Salahdein Aburuz Lucas Guimarães Abreu Saeid Anvari Muhammad Sohail Afzal Jonathan M. Kocarnik Mosab Arafat Morenike Oluwatoyin Folayan Hanadi Al Hamad Ayesha Fahim Mohammad Farahmand Lisa M. Force Adewale Oluwaseun Fadaka Nadia M. Hamdy Demelash Areda Veer Bala Gupta Maha Moh'd Wahbi Atout Natalie Pritchett Souad Bouaoud Ayman Ahmed Aso Mohammad Darwesh Cem Bilgin Dong Woo Choi Wafa A. Aldhaleei Awais Altaf Ferrán Catalá-López Danish Ahmad Bashir Dabo Rakhi Dandona Mohammed Albashtawy Mohamed Abouzid Omotayo Francis Fagbule Shirin Barati Soham Bandyopadhyay Ahmed Y. Azzam Abdulfatai Aremu Teferi Gebru Gebremeskel Arvin Haj-Mirzaian Catherine Bisignano Aragaw Tesfaw Desale Benedetta Armocida Hasan Aalruz Kayleigh Bhangdia Isaac Sunday Chukwu Md Kamrul Hasan Promit Ananyo Chakraborty Louise Penberthy Maryam Bemanalizadeh Robert Kokou Dowou Giulia Carreras Xiaochen Dai Maysaa El Sayed Zaki Johannes Haubold Mohammad Asghari-Jafarabadi Fatemeh Afrashteh John Dube Ali Hasanpour- Dehkordi Shahkaar Aziz Logan M. Glasstetter Genanew K. Getahun Sri Harsha Boppana Alistair Acheson Chiranjib Chakraborty Saroja Devi Geetha Razieh Bahreini Yohannes Habtegiorgis Abate Sabah Al-Marwani Mohammad Farahmand Mohammad Mahdi Bastan Samuel Demissie Darcho Thao Huynh Phuong Do Miglas Welay Gebregergis Lee Deitesfeld Abdel Rahman E'mar Mohammed Elshaer Lemessa Assefa A. Ayana Chadi Eltaha Awoke Derbie Habteyohannes Abid Ali Safwat Aly Nguyen Hoang Anh Andrew Crist Miranda L. May Maha Moh d.Wahbi Atout Hasan Aalruz Syed Anees Ahmed Demelash Areda Mohammad Farahmand Lalit Dandona Karem H. Alzoubi Yasser Bustanji

Publication Name: Lancet

Publication Date: 2026-04-04

Volume: 407

Issue: 10536

Page Range: 1360-1373

Description:

Background Information on childhood cancer burden is crucial for effective cancer policy planning. Unfortunately, observed paediatric cancer data are not available in every country, and previous global burden estimates have not discretely reported several common cancers of childhood. We aimed to inform efforts to address childhood cancer burden globally by analysing results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, which now include nine additional cancer causes compared with previous GBD analyses. Methods GBD 2023 data sources for cancer estimation included population-based cancer registries, vital registration systems, and verbal autopsies. For childhood cancers (defined as those occurring at ages 0–19 years), mortality was estimated using cancer-specific ensemble models and incidence was estimated using mortality estimates and modelled mortality-to-incidence ratios (MIRs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths by the standard life expectancy at the age of death. Prevalence was estimated using survival estimates modelled from MIRs and multiplied by sequelae-specific disability weights to estimate years lived with disability (YLDs). Disability-adjusted life-years (DALYs) were estimated as the sum of YLLs and YLDs. Estimates are presented globally and by geographical and resource groupings, and all estimates are presented with 95% uncertainty intervals (UIs). Findings Globally, in 2023, there were an estimated 377 000 incident childhood cancer cases (95% UI 288 000–489 000), 144 000 deaths (131 000–162 000), and 11·7 million (10·7–13·2) DALYs due to childhood cancer. Deaths due to childhood cancer decreased by 27·0% (15·5–36·1) globally, from 197 000 (173 000–218 000) in 1990, but increased in the WHO African region by 55·6% (25·5–92·4), from 31 500 (24 900–38 500) to 49 000 (42 600–58 200) between 1990 and 2023. In 2023, age-standardised YLLs due to childhood cancer were inversely correlated with country-level Socio-demographic Index. Childhood cancer was the eighth-leading cause of childhood deaths and the ninth-leading cause of DALYs among all cancers in 2023. The percentage of DALYs due to uncategorised childhood cancers was reduced from 26·5% (26·5–26·5) in GBD 2017 to 10·5% (8·1–13·1) with the addition of the nine new cancer causes. Target cancers for the WHO Global Initiative for Childhood Cancer (GICC) comprised 47·3% (42·2–52·0) of global childhood cancer deaths in 2023. Interpretation Global childhood cancer burden remains a substantial contributor to global childhood disease and cancer burden and is disproportionately weighted towards resource-limited settings. The estimation of additional cancer types relevant in childhood provides a step towards alignment with WHO GICC targets. Efforts to decrease global childhood cancer burden should focus on addressing the inequities in burden worldwide and support comprehensive improvements along the childhood cancer diagnosis and care continuum. Funding St Jude Children's Research Hospital, Gates Foundation, and St Baldrick's Foundation.

Open Access: Yes

DOI: 10.1016/S0140-6736(26)00200-X

Global burden of enteric infectious diseases, diarrhoeal diseases, and corresponding aetiologies, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023

Usha Adiga Emad M. Abdallah Dariush Abtahi Eman Abu-Gharbieh Amr Selim Abu Lila Siddig Ibrahim Abdelwahab Rashad Abdul-Ghani Anirudh Balakrishna Acharya Mohd Adnan Lorainne Tudor Car Victor Adekanmbi Reda Abdel-Hameed Asrat Agalu Abejew Ayo Stephen Adebowale Samar Abd Elhafeez Jeza Muhamad Abdul Aziz Ripon Kumar Adhikary Muhammad Sohail Afzal Nermeen Abu-Elala Auwal Abdullahi Rana Kamal Abu Farha Isaac Yeboah Addo Ahmad Y. Abuhelwa Victor Ibukun Agbajelola Zeleke Dutamo Agde Obed Adonteng-Kissi Piyush Agrawal Swetha Acharya Charles Oluwaseun Adetunji Lisa C. Adams Fuad Hamdi A. Abuadas Madineh Abbasi Omar Ahmed Abdelwahab Nurudeen A. Adegoke Jiawei He Makinde Adebayo Adeniyi Austin Carter Abdu A. Adamu Rezheen Fatah Abdulrahman Olumide Thomas Adeleke Feleke Doyore Agide Babatope Oluwadamilare Adebiyi Olifan Zewdie Abil Samuel B. Albertson Dina Abushanab Sawsan Abuhammad David Adedia Kamoru Ademola Adedokun Percival Delali Delali Agordoh A. Bhoomadevi Catherine Bisignano Qorinah Estiningtyas Sakilah Adnani Oluwawemimo Oluseun Adebowale Ebenezer Afrifa-Yamoah Hasan Aalruz Avina Vongpradith Samuel M. Ostroff Richard Gyan Aboagye Molalign Aligaz Aligaz Adisu Melese Shenkut Abebe Navidha Aggarwal Rizwan Suliankatchi Abdulkader Arman Abdous Nagah M. Abourashed Toufik Abdul-Rahman Belete Muluadam Admassie Regina Mae Villanueva Dominguez Hana J. Abukhadijah Abdullahi Tunde Aborode Abdulrakib Abdulrahim Abdelmuhsin Abdelgadir Hassan Abolhassani Adedeji Adenusi Saheed Ayodeji Adekola Yirgalem Abere Shairyar Afzal Oluwatobi E. Adegbile None Abdullah Sadik Abdulwehab Belayneh Jejaw Abate Aishah Fadila Adamu Syed Hani Abidi Tajudeen Adesanmi Adebisi Kulmira Abdykerimova Wakgari Mosisa Abdisa Alqassem H. Abuarqoub Ahmed Abdelrahman Abdelgalil Amanda Movo Rofiat Adewumi Adewumi Aderinoye-Rabiu Hasan Aalruz Krishna Prasad Acharya Meklit Girma Abebe Abdulbasit Sherfa Abduljelil Bhoomadevi A Ahmed AH Abdellatif Nermeen Abu-Elala Adekola George Adepoju Zirak Ahmed Abdulrahman Kalkidan Yibeltal Admassu Yau Adamu Nagah M. Abourashed Daniel Adeyemi Adepoju Olumide Abiodun Saira Afzal

Publication Name: Lancet Infectious Diseases

Publication Date: 2026-01-01

Volume: Unknown

Issue: Unknown

Page Range: Unknown

Description:

Background: Enteric infectious diseases claim more than 1 million lives annually and are among the top ten causes of death in children younger than 5 years. Remarkable global investment has been dedicated to enteric infectious disease prevention and control; however, the shifting global health landscape is testing the continuance of progress. To evaluate the current status and guide future interventions, we present the latest epidemiological estimates of enteric infectious diseases from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 and assess progress towards the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) mortality target of fewer than 20 deaths per 100 000 children younger than 5 years by 2025. Methods: We quantified the incidence, mortality, and disability-adjusted life-years (DALYs) of enteric infectious diseases by age, sex, and year across 204 countries and territories from 1990 to 2023. In GBD 2023, the following were considered under the category of enteric infectious diseases: diarrhoeal diseases, enteric fever (typhoid and paratyphoid), invasive non-typhoidal Salmonella spp (iNTS) infections, and other intestinal infectious diseases. We also examined 15 aetiologies contributing to diarrhoeal diseases. Incidence and prevalence were estimated with DisMod-MR (version 2.1), a Bayesian meta-regression tool, drawing on data from systematic reviews, population-based surveys, claims data, and hospital sources. Cause-specific mortality was modelled with Cause of Death Ensemble Modelling based on data from sources including vital registration, mortality surveillance, verbal autopsy, and minimally invasive tissue sampling. Years of life lost and years lived with disability were computed and combined to derive DALYs. For aetiology-specific estimation, population-attributable fractions (PAFs) for 15 pathogens were derived with a counterfactual framework. Point estimates and 95% uncertainty intervals (UIs) were generated from 250 draws from the posterior distribution. Findings: In 2023, enteric infectious diseases resulted in an estimated 1·27 million (95% UI 0·963–1·68) deaths globally, declining from 3·69 million (3·04–4·56) in 1990. The global age-standardised mortality rate (ASMR) decreased from 74·1 (62·0–92·9) per 100 000 population to 16·4 (12·6–21·3) per 100 000 population during the same period. Diarrhoeal diseases accounted for most deaths in 2023 (1·11 million [0·811–1·54]), followed by enteric fever and iNTS. South Asia and sub-Saharan Africa remained the most affected regions in 2023, with 599 000 (441 000–882 000) and 501 000 (373 000–648 000) deaths due to enteric infectious diseases, respectively, predominantly from diarrhoeal disease. Rotavirus was the leading cause of all-age diarrhoeal disease deaths (PAF 16·3% [12·0–21·5]), followed by norovirus (10·2% [2·4–17·0]) and Shigella spp (9·3% [5·4–15·2]). Among children younger than 5 years, PAFs of deaths due to diarrhoeal diseases were 40·2% (32·5–48·5) for rotavirus, 24·0% (15·1–36·7) for Shigella spp, and 23·4% (13·7–34·3) for adenovirus. Across 204 countries and territories, 141 met the GAPPD mortality target in 2023. The driving aetiologies among countries that did not meet the target in 2023 varied slightly by GBD super-region, but the highest or second-highest number of deaths in children younger than 5 years were consistently attributed to rotavirus. Astrovirus and sapovirus, newly included in GBD 2023, were responsible for 24 600 (6290–49 000) and 18 800 (4650–44 400) deaths, respectively, in 2023, mainly in children younger than 5 years. Interpretation: Our findings show that mortality and ASMRs of enteric infectious diseases declined substantially between 1990 and 2023. This decline is consistent with the expansion of public health measures and broader socioeconomic development. However, the burden in 2023 remains considerably high, with the highest mortality concentrated in sub-Saharan Africa and south Asia. Considering that more than a quarter of all countries had yet to meet the GAPPD mortality target in 2023, sustained efforts are needed to address the persistent burden in affected countries and to adapt to the changing global health landscape. Funding: Gates Foundation.

Open Access: Yes

DOI: 10.1016/S1473-3099(26)00194-5