The global impact of rotavirus vaccines

In 2006, two rotavirus vaccines—ROTARIX and RotaTeq—were licensed for use in the United States, and both the US and Nicaragua introduced rotavirus vaccines that year. It was the first-ever vaccine to be introduced in a high-income country and low-income country in the same year, closing the gap between high- and low-income country access.

PATH and partners conducted clinical trials in countries with high rates of child deaths from rotavirus—including Ghana, Kenya, Malawi, Mali, South Africa and Bangladesh—to ensure that the vaccines were safe and effective in a variety of settings. Rotavirus vaccines received a recommendation for global use from the World Health Organization and became eligible for financing from Gavi, the Vaccine Alliance in 2009.

Two additional vaccine products—ROTAVAC and ROTASIIL—have received WHO prequalification since then, enabling their procurement by UNICEF and Gavi for use in low-income countries. One hundred and twenty-three countries have introduced rotavirus vaccines into their national immunization programs, with more planning 
to do so this year.

Rotavirus vaccines represent a huge step forward in the fight against diarrhea mortality.
And as more countries commit to introducing rotavirus vaccines, we can expect the number of lives saved to grow.

140,000

child deaths prevented by rotavirus vaccines from 2006-2019

Rotavirus vaccines saved an estimated 140,000 children’s lives from 2006 to 2019
—and that number has only grown in the years since. Nigeria, a country that is among the highest for diarrheal disease burden, introduced the vaccine in 2022, marking a major milestone for rotavirus prevention and control. Preliminary results from Nigeria suggest a significant decline in diarrhea cases after the vaccine was introduced, despite limited coverage. Researchers estimate that if all countries used rotavirus vaccines at the same coverage as other infant vaccines, more than one-third of rotavirus deaths could be prevented.

59%

median reduction in rotavirus hospitalizations among children less than five years old

Rotavirus vaccines have a ripple effect that goes beyond lives saved: they lighten the burden of the disease for families, health systems, and economies. Countries that introduced the vaccine saw a 59% median reduction in rotavirus hospitalizations among children under 5, and a 36% decrease in deaths from severe diarrhea, with these percentages growing over time post-introduction. The greatest declines were highest in settings with the highest rotavirus vaccine coverage.

“After six months of distributing the vaccine, the number of children that needed help decreased so much that we had to close the pediatric diarrhea ward for a few months.”

Dr. Filemon Bucardo, Professor of Virology, National Autonomous University of Nicaragua, Léon

As countries across the globe introduced rotavirus vaccines, study after study have reinforced their value for money and national health impacts.

Nicaragua: Changing the conversation on rotavirus 3

In 2006, Nicaragua introduced the rotavirus vaccine through a unique public-private partnership. The introduction in Nicaragua, which had a high mortality and morbidity associated with rotavirus, marked the first time a vaccine was introduced in a high-income 
and a low-income country in the same year.

But the introduction was also a game-changer in another way: it brought the connection between rotavirus and the broader problem of diarrheal disease into the spotlight. Many health care workers in Nicaragua were initially unfamiliar with rotavirus, but they quickly understood that the vaccine could prevent seasonal diarrhea outbreaks, said Evan Simpson, Global Director, Vaccine Implementation at PATH. “They became our biggest champions for the vaccine, because they knew on a very personal level what this was about,” Simpson said.

Nicaragua’s introduction did more than just save lives and prevent cases in the country itself: it put rotavirus into context for health care workers, governments, and advocates, showing how the vaccine fit into a package of other diarrhea interventions like oral rehydration 
solution (ORS) and zinc. Nicaragua’s example helped make the case in other countries for vaccine introduction, and it showed the feasibility of quickly introducing a new vaccine in a low-income country.

Photo: Maritza Elena Pallaviccini Cruz, a nurse from from Los Brasiles, Nicaragua, administers vaccines against rotavirus and other diseases at the Xiloá Health Centre. Credit: WHO/S. Mey-Schmidt

Data on a vaccine’s potential costs and benefits are an invaluable resource for countries 
in the decision-making process. That was the case in Kenya and Uganda, where country leaders convened a national team of experts to conduct cost-effectiveness analyses for rotavirus vaccine introduction in each country. The study yielded striking results: in Kenya, research found that the rotavirus vaccine could avert over 60,000 deaths and 216,000 hospital admissions in children younger than five years old over a 20-year period, while in Uganda the numbers were 70,000 and 329,000, respectively. These reductions in hospital admissions would reduce diarrhea-related treatment costs. The analyses found that introducing the rotavirus vaccine would be highly cost-effective in a range of scenarios for both countries, strengthening the argument for introduction.

After Kenya and Uganda introduced the vaccine, data emerged confirming these anticipated trends. Both countries witnessed a drop in diarrhea hospitalizations associated with the vaccine—in Uganda, there was a 1 percent decrease in hospitalizations for every 1 percent increase in rotavirus vaccine coverage. The introduction also led to considerable cost savings in Uganda, with savings of $57 million in diarrhea-related treatment costs over just three years. In Kenya, a study found that rotavirus hospitalizations fell by nearly 60 percent at two sites in the first year after introduction.

Research in Kenya and Uganda, both pre- and post-introduction, was essential in informing decisions by policymakers on rotavirus vaccination—and the insights extend beyond the borders. The results contribute to the global estimates of rotavirus vaccine impact, especially in low- and middle-income countries, and the process can serve as a model for other countries as they gather evidence to inform decisions on vaccine introduction.

Photo: Annet Onyamasi administers the rotavirus vaccine at Khwisero Health clinic in Kakamega County, Kenya. Credit: PATH/Anthony Karumba

Unlike the bacteria and parasites that cause other forms of diarrhea, rotavirus cannot be prevented by improvements in water, hygiene, and sanitation—vaccines provide the best protection against it. Even less severe rotavirus cases can have a tremendous economic impact on families, including direct treatment costs and indirect costs of children missing school or caregivers missing work.

In the more than 120 countries where they are introduced, rotavirus vaccines are saving lives and easing the burden on families, health systems, and governments. But rotavirus still claims the lives of more than 100,000 young children each year, and dozens of the world’s countries have yet to introduce the vaccine. Uptake in Asia, in particular, remains slow. We must do more to reach the millions of children who still lack access to this critical intervention.