Rotavirus causes about one-third of child deaths due to diarrhea globally and millions of hospitalizations each year, particularly in LMICs with limited health resources. More than 110 countries worldwide have recently introduced Live Oral Rotavirus Vaccines (LORVs) in their national immunization programs. However, despite its positive effects in most countries, many scientists argue that LORVs are less effective when children are malnourished or have other competing pathogens in their gastrointestinal tract. Further, LORVs efficacy is scientifically lower in high-burden settings.
Two alternative approaches are in the advanced stages of clinical development. Firstly, injectable next-generation rotavirus vaccine (iNGRV) candidates. This vaccine is projected to better protect children against disease, be combined with existing routine immunizations, and be even more effective affordable than the current LORVs. The second new approach is oral NGRV (oNGRV) candidates that include a dose administered at birth followed by two infant doses.
PATH conducted this modeling study to assess the potential impact and cost-effectiveness of different rotavirus vaccination strategies in 137 LMICs. The study compared hypothetical iNGRVs and oNGRVs with varying levels of efficacy to the current LORVs. UNIVAC, a validated impact, and cost-effectiveness model were then used to project the costs and benefits of the different vaccines and strategies over 10 years starting in 2025. The model incorporated vaccine-specific attributes from documented sources such as efficacy, price, and product presentation, as well as other relevant data such as disease burden, vaccine coverage, and healthcare costs.
The result showed that currently available LORVs remain a good investment for countries. However, a standalone iNGRV is likely to save between US$1 to 15 billion compared to current LORV vaccination programs in 84% of LMICs at both higher or equivalent efficacy levels and is expected to provide substantial public health impact. An iNGRV-DTP combination vaccine was the least costly and most cost-effective option evaluated, should it be developed in the future.
Any organization or individual working in the field of immunization economics can submit findings, opportunities, calls to action, or other relevant work below to be shared with our community.