Rotavirus vaccine support

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Introduction target for 2011–2015 period met 12 months ahead of schedule

Rotavirus Ghana

In 2012, Ghana became the first country to introduce both rotavirus and pneumococcal vaccines simultaneously with support from Gavi. Rolling out two vaccines together required expansion of the country’s cold chain capacity, careful training of health workers and clear communication to the public. Credit: Gavi/2012/Doune Porter.


Accelerating access to rotavirus vaccines, which protect against the most severe and deadly form of diarrhoea in young children, in countries where they are needed most is one of the cornerstone objectives of the Vaccine Alliance.

Gavi set out to support the introduction of rotavirus vaccine in 33 countries by the end of 2015.This objective was surpassed 12 months ahead of schedule, in 2014, when 16 countries added the vaccine to their routine immunisation schedules with Gavi support. Three new rotavirus vaccine introductions in 2015 meant that we surpassed this target by a healthy margin of four. By the end of 2015, more than 36 million children had been immunised with rotavirus vaccine with Gavi support.

However, the Vaccine Alliance finished the 2011–2015 period 11 percentage points short of its coverage targets, mainly because of supply constraints experienced up until 2014. On the upside, projected introductions in several highly-populated countries are expected to boost coverage rates after 2018. The Democratic Republic of the Congo, India, Nigeria and Pakistan, which together account for almost half of the children born in Gavi-supported countries, are all expected to introduce rotavirus vaccine.

Number of countries that have introduced rotavirus vaccines to date


Coverage of rotavirus vaccines in Gavi-supported countries


Rotavirus is the leading cause of severe diarrhoea and diarrhoeal deaths in children worldwide


An estimated 760,000 children under five die from diarrhoeal disease each year, accounting for 12% of under-five deaths in Gavi-supported countries. Worldwide approximately 37% of hospitalisations for diarrhoea in children under five are due to rotavirus. More than 2.4 million child deaths can be prevented by 2030 through accelerating access to lifesaving rotavirus vaccines in Gavi-supported countries.1 

Nearly every child in the world will suffer a rotavirus infection by their third birthday. While rotavirus infects children in every country, more than 95%2 of rotavirus deaths occur in low-income countries in Africa and Asia, where access to treatment for severe rotavirus-related diarrhoea is limited or unavailable.

Children suffer primary rotavirus infection before 9 months of age, and the virus can spread to family members and other people with whom they have close contact. In addition to severe watery diarrhoea, symptoms include vomiting, fever and abdominal pain. In serious cases, children urgently need intravenous fluids, or they risk dying from dehydration.

Unlike other types of diarrhoea, the spread of rotavirus cannot be prevented by improvements in water and sanitation. The virus is so contagious and resilient that improving hygiene has little impact on preventing infection. Also, rotavirus cannot be cured with drugs such as antibiotics. Although it can be treated through adequate healthcare, this is often lacking in Gavi-supported countries. Therefore, vaccination is the best way to prevent rotavirus illness and death.

Map of the global burden of rotavirus diarrhoeal disease

Rotavirus global disease burden  


WHO recommends that rotavirus vaccines are included in all national immunisation programmes, particularly in countries in South and Southeast Asia and sub-Saharan Africa.

A study in 116 countries showed that rotavirus vaccination is cost effective and associated with significant decreases in disease burden, particularly in low- and lower-middle-income countries with high child mortality. Researchers found that without rotavirus vaccination, in 2010 there would have been:

  • 23 million outpatient cases
  • 3.3 million inpatient cases
  • over 290,000 deaths
  • US$ 987 million spent on treatment costs.3 

It is estimated that each year, the use of rotavirus vaccines in Gavi-supported countries could prevent 180,000 deaths and avert 6 million clinic and hospital visits, thereby saving US$ 68 million annually in treatment costs.4 

Countries that have introduced rotavirus vaccines have seen a dramatic improvement in child health. Recent studies show the swift and significant impact of rotavirus vaccines in the two to five years following their introduction in national immunisation programmes. For instance, diarrhoeal deaths in young children were reduced by 19–43% in Bolivia, 43–55% in Mexico and 57–64% in Venezuela following the introduction of rotavirus vaccines.5 

1Vaccine, Volume 30, Supplement 1, 27 April 2012: ‘Rotavirus vaccines for children in developing countries : Understanding the science, maximising the impact, and sustaining the effort’, Kathleen M. Neuzil, Umesh D. Parashar, A. Duncan Steele.
2 Tate JE, Burton AH, Boschi-Pinto C, et. al. 2008 estimate of worldwide rotavirus-associated mortality in children younger than 5 years before the introduction of universal rotavirus vaccination programmes: a systematic review and meta-analysis. The Lancet Infectious Diseases. 2012;12(2):136–141.
3 Palermina-Caicedo A, De la Hoz-Restrepo F, Alvis-Guzman N. Epidemiological and Economic Impact of Monovalent and Pentavalent Rotavirus Vaccines in Low and Middle Income Countries: A Cost-Effectiveness Modeling Analysis. The Pediatric Infectious Disease Journal, April 28 2015
4 Atherly DE, Lewis KDC, Tate J, Parashar UD, Rheingans, RD. Projected health and economic impact of rotavirus vaccination in GAVI-eligible countries: 2011-2030. Vaccine. 2012;30(Suppl 1):A7–A14).
5 Rotavirus vaccine impact. PATH website. Available at: Accessed 21 September 2016.

Gavi offers support to developing countries to introduce rotavirus vaccines


The Vaccine Alliance opened a funding window to help Gavi-supported countries in the Americas and Europe introduce rotavirus vaccines into their routine infant immunisation programmes in 2007 – just one year after the United States and other industrialised countries introduced the vaccine into their national immunisation programmes.

Gavi expanded this support worldwide in 2009, following WHO’s recommendation for universal rotavirus vaccination. This allowed for introduction of the vaccine in low-income countries in Asia and Africa, where most rotavirus deaths occur.

In addition to support for the rotavirus vaccine itself, countries also receive a one-time cash vaccine introduction grant for additional introduction costs.

Map of countries approved for Gavi's rotavirus vaccine support



WHO’s Strategic Advisory Group of Experts (SAGE), has emphasised the importance of providing rotavirus vaccination in the context of a comprehensive diarrhoeal disease control strategy.

In 2014, as part of the Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD), Bangladesh, India and Zambia piloted comprehensive programmes aimed at providing an integrated approach to preventing and treating pneumonia and diarrhoea.

This includes exclusive breastfeeding, adequate nutrition, handwashing with soap, safe drinking water and sanitation, treatment with oral rehydration solution, antibiotics and zinc as well as immunisation. All three countries have developed district and state-level work plans for pneumonia and diarrhoea prevention and control activities.


In addition to providing financial support to low-income countries for rotavirus vaccine introduction, Gavi has provided financial support for the Rotavirus Vaccine Program (RVP), a partnership between PATHWHO and the U.S. Centers for Disease Control and Prevention (CDC), to help speed up the introduction of rotavirus vaccines in low-income countries, which typically wait up to 15 years to introduce new vaccines.

RVP established rotavirus surveillance in all regions of the world to provide data on rotavirus disease burden, to study the potential impact of rotavirus vaccines, and to demonstrate the cost-effectiveness of rotavirus vaccines. RVP also developed an investment case and strategic demand forecast that served as the basis for Gavi’s decision in 2006 to fund rotavirus vaccine introduction through its new vaccine support programme.

In conjunction with Merck and GlaxoSmithKline, RVP conducted pivotal clinical trials to demonstrate the safety and efficacy of rotavirus vaccines around the world. This clinical research laid the groundwork for the 2009 WHO recommendation for universal introduction. In addition, RVP supported studies that demonstrated significant reductions in the number of hospitalisations due to severe rotavirus disease following vaccine introduction (see 'The Issue').

Proof of concept

WHO's 2009 rotavirus vaccine recommendation was based on two clinical studies carried out in high mortality, impoverished settings in Asia and Africa:

  • Clinical study in Asia (Bangladesh and Vietnam): during the first year of life, when children are at greatest risk for diarrhoea-related morbidity and mortality, the rotavirus vaccine significantly reduced severe rotavirus disease by 51%.1 
  • Clinical study in sub-Saharan Africa (Ghana, Kenya and Mali): rotavirus vaccination prevented 64% of severe rotavirus disease in African infants during the first year of life, when children are most vulnerable to rotavirus diarrhoea-related illness and death.2 
  • Clinical study in South Africa and Malawi: rotavirus vaccine significantly reduced severe rotavirus disease – by 61% – in African infants during the first year of life, when most of the severe disease and deaths from rotavirus occur.3 

1 Zaman K, Dang DA, Victor J, et al. Efficacy of pentavalent rotavirus vaccine against severe rotavirus gastroenteritis in infants in developing countries in Asia: a randomised, double-blind, placebo-controlled trial. The Lancet. 2010;376(9741):615-623.
2 Armah GE, Sow SO, Breiman RF, et al. Efficacy of pentavalent rotavirus vaccine against severe rotavirus gastroenteritis in infants in developing countries in sub-Saharan Africa: a randomised, double-blind, placebo-controlled trial. The Lancet. 2010;376(9741):606–614.
3 Madhi SA, Cunliffe NA, Steele D, et al. Effect of human rotavirus vaccine on severe diarrhoea in African infants. New England Journal of Medicine. 2010;362(4):289–298.
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