This month, hundreds of thousands of children will get access to rotavirus vaccines in India with the start of a national introduction that marks Asia’s largest to date. But over 90 million children around the world still lack access.
Despite the fact that it can be prevented and treated, diarrhea continues to take its devastating toll on children around the world. It is a leading cause of child death, and is responsible for hospitalizing millions of children.
Rotavirus, the most common cause of severe, deadly diarrhea, claims the lives of more than 200,000 children each year, and hospitalizes hundreds of thousands more. This one virus is responsible for nearly 40 percent of all diarrhea hospitalizations. And a recent multicountry study showed that children who developed moderate to severe diarrhea had an eight-and-a-half times higher risk of dying in the subsequent two months compared to children who did not suffer from diarrhea.
The health — and economic — consequences of rotavirus ripple across families, communities and countries. Children with rotavirus diarrhea are more susceptible to the next illness that strikes. They cannot absorb nutrients as well, which can slow their growth during crucial stages of development. Weakened, malnourished children have less energy for school, and tend to grow up to learn less and earn less. Parents who must take time off work to care for a sick child lose income, which can plunge a family into poverty. Multiplied by thousands of children and families, these effects hobble entire economies.
Yet it’s all entirely preventable. We know how to stop rotavirus illnesses and deaths, and we have the tools today to do it.
Through concerted investment in improving water and sanitation, developing new vaccines and ensuring that the most marginalized people have access to the current prevention and treatment tools, we can significantly reduce EDDs, writes Anita Zaidi, director for enteric and diarrheal diseases program at the Bill & Melinda Gates Foundation, in this guest column.
Global health experts recommend a comprehensive approach focused on preventing illness in the first place and treating children if they do become sick. Mild to moderate cases of diarrhea can be treated with oral rehydration solution — a simple mixture containing sugar, salt and safe water — and zinc supplements. More severe cases require intravenous fluids and urgent medical care.
But though inexpensive and effective, ORS coverage is only about 30 percent in many of the places where the most diarrhea deaths occur. Hospitalization, too, is often out of reach. And while improvements in hygiene, sanitation and drinking water are important to prevent diarrhea in general, they cannot stop the spread of rotavirus. That’s why preventing rotavirus infections is essential.
Vaccination is the best tool available today to protect children from rotavirus. These vaccines are improving health, reducing health care costs and saving lives today in countries where they are in use.
The World Health Organization has recommended that every country introduce rotavirus vaccines into national immunization programs. So far, 80 countries have introduced the vaccines, but not enough countries in Asia or Africa have taken action — the regions where burden is highest.
The ROTA Council, a global body of scientific experts on rotavirus, strongly agrees with the WHO recommendation. In addition, to accelerate the introduction of lifesaving, health-improving rotavirus vaccines, the ROTA Council recommends that key stakeholders in countries where these vaccines have not yet been introduced take action in the following areas:
1. Take a comprehensive approach to diarrheal disease control.
In conjunction with the introduction of rotavirus vaccine, countries should work with WHO, UNICEF and other partners working on diarrheal disease to plan and implement a comprehensive set of interventions to reduce illnesses and deaths caused by diarrheal disease, consistent with the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea, or GAPPD.
2. Apply for Gavi support.
Eligible countries that have not yet introduced rotavirus vaccines should apply to Gavi, the Vaccine Alliance for new vaccine support for rotavirus vaccines as soon as possible.
3. Develop new, low-cost vaccines.
National governments and funding agencies should continue to support the research and development of new, low-cost rotavirus vaccines. Manufacturers in low- and middle-income countries have demonstrated the ability to develop and license low-cost rotavirus vaccines, such as Rotavin in Vietnam and ROTAVAC in India, with technology partnerships and public funding.
Global funding agencies should also support the development of parenteral rotavirus vaccines, which are likely to be more efficacious than the currently available oral vaccines.
4. Make sure vaccine prices are fair.
Global health entities — including UNICEF, WHO and Gavi — and nongovernmental organizations influential in vaccine programs — including Médecins Sans Frontières and Save the Children — should focus on efforts to ensure prices paid for rotavirus vaccines reflect true manufacturing costs, provide reasonable returns on manufacturers’ investment and take into account an individual country’s ability to pay.
Additional mechanisms may be required to provide innovative funding options for low-middle income, non-Gavi eligible countries.
5. Address vaccine program implementation challenges.
National governments, global health entities, funding agencies, manufacturers and other stakeholders should facilitate the development of new, live oral rotavirus vaccines that address supply shortages in Gavi-eligible and low- and middle-income countries. These new vaccines should also address implementation challenges such as cold chain capacity, volume of administration and storage, delivery systems, safety concerns and cultural sensitivity. And of course, all new vaccines must be safe, efficacious and available at low cost.
In 2016, it’s unconscionable that children are still suffering from diseases we have the knowledge and tools to prevent. It’s time to protect all children, everywhere, from the scourge of rotavirus.
Eighty countries, including India, have taken laudable steps to introduce and scale up the use of rotavirus vaccines. But millions more children await. It’s time to take action.
Dr. Mathuram Santosham is chair for the Rotavirus Organization of Technical Allies (ROTA) Council, director of the Johns Hopkins Center for American Indian Health, and senior advisor for the International Vaccine Access Center (IVAC) at the Johns Hopkins University, where he is also a professor of international health and pediatrics.
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