Saved and lost: The Health impact of routine vaccination and COVID-19 related restrictions in Democratic Peoples Republic of Korea (1980~2024), a modelling study

ObjectivesDemocratic Peoples Republic of Korea has historically achieved high routine vaccination coverage, but these programs were substantially restricted during the COVID-19 pandemic. We estimated the cumulative averted disease burden from routine vaccination (1980-2024) and the excess burden associated with coverage declines during the pandemic (2021-2024). MethodsWe conducted a modeling study using WHO-UNICEF coverage data to estimate vaccine-preventable deaths and disability-adjusted life years (DALYs) for 8 pathogens. Estimates were based on mathematical models from the Vaccine Impact Modelling Consortium (VIMC), a global network of over 20 institutions, and the Global Burden of Disease (GBD) study. We applied the year-of-vaccination (YoV) approach to evaluate program performance and the excess burden, and used the calendar-year (CY) approach to assess the impact of catch-up vaccination. Based on historical coverage, pathogen-specific mortality, and vaccine efficacy, we quantified deaths and DALYs averted. To assess COVID-19-related disruptions, we compared actual coverage with a counterfactual scenario of uninterrupted vaccination to estimate the excess burden. FindingsBetween 1980 and 2024, routine vaccination averted an estimated 219 071 deaths (95% credible interval [CrI] 199 896-239 734) and 9.3 million DALYs, with hepatitis B (44{middle dot}37%) and measles (28{middle dot}57%) contributing most. Pandemic-related disruptions in 2021-2024 resulted in 15 624 excess deaths (11 379-20 747) and 649,565 DALYs (525 172-787 409) under the YoV method, partly mitigated by catch-up. ConclusionRoutine vaccination has saved lives and prevented disability. The reduction in vaccination coverage associated with COVID-19 restrictions resulted in an excess burden that catch-up efforts cannot fully address.