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

Objectives Democratic People Republic of Korea has historically achieved high routine vaccination coverage, but these programs were substantially restricted during the COVID19 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). Methods We 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 COVID19 related disruptions, we compared actual coverage with a counterfactual scenario of uninterrupted vaccination to estimate the excess burden. Findings Between 1980 and 2024, routine vaccination averted an estimated 219 071 deaths (95% credible interval [CrI] 199896~239734) and 9.3 million DALYs, with hepatitis B (44.37%) and measles (28.57%) contributing most. Pandemic related disruptions in 2021~2024 resulted in 15 624 excess deaths (11379~20 747) and 649,565 DALYs (525 172~787 409) under the YoV method, partly mitigated by catch up. Conclusion Routine vaccination has saved lives and prevented disability. The reduction in vaccination coverage associated with COVID19 restrictions resulted in an excess burden that catch-up efforts cannot fully address.