guest columnBy Dr. Ciro A. de Quadros and Dr. George Armah
Leaders of developing nations take note: a new study shows that rotavirus vaccines will have a powerful public health impact in your country. This pivotal study, just released in the British Medical Journal, shows that children who were vaccinated against rotavirus were 70 percent less likely to be hospitalized for rotavirus diarrhea compared to unvaccinated children. The vaccines also provided broad protection against rotavirus--even against strains of the virus not included in the vaccine--through the first two years of life, when children face the greatest risk of death from the dehydrating diarrhea rotavirus can cause.
The study, funded by the GAVI Alliance, examined the impact of introducing the rotavirus vaccine Rotarix (manufactured by GlaxoSmithKline) into the national immunization program of Bolivia, a lower-middle income country in Latin America. The findings provide the evidence other low and lower-middle income countries, such as those in sub-Saharan Africa, need to evaluate whether rotavirus vaccines are right for their children.
The study was conducted in Bolivia, but its implications are global.
Diarrhea is a leading cause of child death and rotavirus is the most common cause of severe and fatal diarrhea in young children. While unvaccinated children everywhere are at risk, those living in low and lower-middle-income countries with high child mortality due to rotavirus diarrhea, such as in regions of Africa, are more likely to die from rotavirus diarrhea than children in middle- and high-income countries.
In Africa, rotavirus kills more than 600 children each day and thousands more are hospitalized or require clinic visits, straining health care systems and resulting in lost productivity.
So, what does a study from Latin America have to do with Africa? A lot, it turns out. Both regions experience high rates of child mortality due to rotavirus diarrhea. Both have several different rotavirus strains circulating. And both have several countries eligible for vaccine introduction support from the GAVI Alliance. But the difference is, all the GAVI-eligible countries in the Americas are protecting their children with rotavirus vaccines.
Ninety-five percent of rotavirus deaths occur in countries eligible for support from the GAVI Alliance. Though the World Health Organization has recommended that all countries introduce rotavirus vaccines into their national immunization programs, only 45 countries have done so--just eight are in Africa. Twenty-two African nations applied and have received approval or conditional approval from GAVI to introduce rotavirus vaccines. But Benin, Chad, Comoros, Guinea, Ivory Coast, Liberia, Mauritania, Nigeria, São Tomé e Príncipe, Senegal and Somalia have yet to apply for rotavirus vaccine-introduction support, though they are eligible.
The Bolivian study findings provide precisely the kind of scientific evidence African decision-makers need to set priorities and guide smart policies and programs. Policymakers need to know that the interventions they are considering and investing in are proven and effective. As this study clearly demonstrates, rotavirus vaccines are both.
African nations considering whether or not to introduce rotavirus vaccines also need to understand the burden of diarrheal disease in their countries. Diarrhea is the second most common cause of death in children under five, but what does that mean at the country level?
Researchers like those who recently conducted the Global Enteric Multicenter Study (GEMS) of childhood diarrheal diseases in developing country settings are trying to help policymakers better understand the scope of the problem and its impact on child health and mortality.
Rotavirus was found to be the top cause of diarrhea across all of the GEMS sites, including those in Africa. The study concluded that "expanding access to existing tools to prevent and treat diarrhea--particularly rotavirus vaccines--can save a significant number of lives right now."
Researchers are doing their part--building the evidence base and shining a light on the problem. Now it is time for African policymakers to do theirs. As one of the first lower-middle income countries in the world to introduce rotavirus vaccines, Bolivia has set an example not just for Latin America, but also for the world. African leaders have an opportunity to follow in its path. Who will step up next?
Dr. Ciro A. de Quadros is executive vice president of the Sabin Vaccine Institute and co-chair of the Rotavirus Organization of Technical Allies (ROTA) Council, an organization of technical experts working to save children's lives and improve health. Dr. George Armah is a senior research fellow and associate professor at Ghana's Noguchi Memorial Institute for Medical Research at the University of Ghana, and is also a member of the ROTA Council.