This commentary, co-authored by Drs. Ciro de Quadros and Tony Nelson, was originally posted on Trust.org on April 26, 2013.
While the recent cholera outbreaks tend to dominate health news coming out of Haiti, there is another dangerous disease that should be on the front page, but isn’t. It’s rotavirus diarrhea. Rotavirus is the most common cause of severe diarrhea in children worldwide, and the devastating dehydration it can cause is responsible for nearly half of all diarrhea deaths in Haitian children under age 5.
In a bold, headline-grabbing move, the Haitian government is taking action by arming its children with the best defense available—rotavirus vaccines. This week, with the support of the GAVI Alliance, Haiti will introduce rotavirus vaccines into its national immunization program, joining 16 other Latin American countries that have already introduced these vaccines. Haiti is the last of five GAVI-eligible countries in the Americas to introduce rotavirus vaccines. Vaccines are an essential tool in the fight against rotavirus because improvements in drinking water, sanitation and hand-washing, which can prevent other forms of diarrhea such as cholera, do not adequately prevent the spread of rotavirus.
As a region, Latin America has taken on rotavirus aggressively and the progress is profound. In Mexico and Brazil, deaths from all causes of diarrhea among children under age 5 declined by approximately 30 percent following the introduction of rotavirus vaccines in these countries’ national immunization programs. Sharp declines have also been observed in child hospitalizations for rotavirus, as well as diarrhea in general, in El Salvador, Nicaragua, Panama, Mexico and Brazil following rotavirus vaccine introduction.
Today, the countries with the greatest rotavirus burden—meaning not only deaths, but also hospitalizations and doctor visits—are found in Africa and Asia. Africa is making progress and vaccines are being introduced, but Asia has a long way to go. Only two Asian countries—the Philippines, which has implemented a targeted vaccine introduction strategy, and Thailand, which has made the vaccines available to an initial single region—have introduced these vaccines. With nearly half of all rotavirus deaths occurring in Asia, there is an urgent need for action in the region. The progress made in Latin America could illustrate a path forward.
One reason so many Latin American nations have been able to introduce rotavirus vaccines (and many other vaccines) is the Pan American Health Organization (PAHO) Revolving Fund for Vaccine Procurement, a mechanism to facilitate the bulk purchase of vaccines, syringes, cold chain equipment and related supplies. It’s had a game-changing impact. Taking advantage of economies of scale, the Fund secures vaccines—prequalified under World Health Organization standards of safety and effectiveness—for Member States at affordable prices. By purchasing through the Revolving Fund instead of directly from producers, countries can save on the purchase price, which quickly adds up when purchasing vaccine doses by the tens of millions.
Founded on the principle of equity, PAHO’s Revolving Fund works like this: all participating member states have access to the same products, offered at the lowest price, which is the same regardless of the country’s size or economic situation. Member States all contribute 3 percent of each net purchase price to a common fund used as working capital, so Member States in need can take out lines of credit to purchase their vaccines, repaying within 60 days of vaccine receipt. The Revolving Fund also handles key processes like planning, demand estimates, price negotiations, purchase orders, supply coordination, shipment monitoring and billing.
As a result, Latin American countries have had continuous access to safe and effective vaccines at low, stable prices for over 30 years. Not only does this assist national governments with budget planning, it fosters sustainable immunization programs. Today, the vast majority of vaccines being used in Latin America were acquired through the Revolving Fund. These vaccines reach some 44 million people, protecting them against diseases ranging from rotavirus to polio.
In addition to the Revolving Fund’s efforts, the GAVI Alliance also provides assistance for rotavirus vaccine introduction to the world’s lowest-income countries—those with a gross national income per capita of US $1,500 or below. But for the countries beyond the reach of the Revolving Fund and GAVI, particularly middle-income countries in Asia, more must be done.
That’s why we recommend that Asian governments use PAHO’s experience to establish their own mechanism similar to the Revolving Fund. Currently, policymakers in the region must guess the future price of rotavirus vaccines, making long-term budgeting impossible and vaccine introduction difficult. Just as it has in Latin America, transparency and stability of vaccine pricing would enable policymakers in Asia to expedite their decisions on including rotavirus vaccines in their national immunization programs, improving child health and saving lives.
As we mark World Immunization Week 2013, we call on leaders across Asia to prioritize the fight against rotavirus and to consider every option available to accelerating access to these vaccines. As Latin America has shown, smart buys can save lives.
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. Before joining Sabin, he was director of the Division of Vaccines and Immunization at PAHO. Dr. Tony Nelson is a professor in the Chinese University of Hong Kong’s Department of Pediatrics, and a member of the ROTA Council.