The Final Hurdle to Universal Rotavirus Vaccine Introduction

The burden of rotavirus is well known, particularly amongst the global health community.

It's a leading cause of death amongst children under five. The virus claims the lives of more than 500,000 children each year and causes the hospitalization of millions more. 

Almost half of the 500,000 lives lost are African children, and six of the seven countries with the highest infant mortality rates from rotavirus are in Africa. Yet only one African nation, South Africa, has introduced rotavirus vaccine into its national immunization program. Just 2 percent of the continent has access to rotavirus vaccines; how can this be? 

There certainly isn't a lack of proof of the effectiveness and safety of rotavirus vaccines.  Earlier this year, a study conducted in South Africa and Malawi showed that a rotavirus vaccine reduced severe rotavirus disease - by 61.2 percent -in African infants during their first year of life. Based on these and other efficacy data, the World Health Organization's Strategic Advisory Group of Experts on Immunization (SAGE) has recommended that rotavirus vaccination be included in all national immunization programs.

Once national governments understand the burden of rotavirus and the positive impact of vaccination, their next step is to obtain the necessary financing.  This is not easy. Governments in the developing world spend on average $6 per capita on healthcare, and just 4 percent of this amount goes to immunization programs.  Four percent of $6 is $0.24 cents. The price of rotavirus vaccine can range from $7.50 to $100 (in the wealthiest countries) and rotavirus is just one of several vaccines that every child should receive.  Adding rotavirus will push costs to over $30 per fully immunized child.

New and innovative immunization financing schemes are needed.  The Sustainable Immunization Financing (SIF) program, which is working in 15 countries in Africa and Asia, is tasked to create financing solutions. The objective is for governments to increase their share of immunization funding in sustainable ways.

The SIF team provides key stakeholders—parliamentarians and ministers of finance and health—with the latest vaccine data and then brings these parties together to determine sources of sustainable funding for introducing them. Already five of the 15 SIF pilot countries have increased their national immunization budgets.

At Sabin, we believe that the world should have access to several life-saving vaccines. We must ensure that they are not under-utilized due to economic and societal factors.  Where a family lives should not determine whether or not that family has access to rotavirus- or any- vaccine just as a family's income should not prevent them from living a long and healthy life.

We've come a long way from identifying rotavirus, developing vaccines to prevent the disease, and collecting data to ascertain the vaccine's economic and health benefits. Now we must concentrate on taking the last step—assuring affordable pricing and access.  These vaccines must reach those who need them the most.


Dr. Ciro de Quadros is Executive Vice President of the Sabin Vaccine Institute where he directs the Vaccine Advocacy and Education programs including SIF and the Pneumococcal Awareness Council of Experts (PACE) of which he is co-chair.