30041144462_055c6cdb9a_zOver 350 people from more than 55 countries gathered to discuss progress on a unanimous mission: lowering deaths due to rotavirus, the global leading cause of severe diarrhea among children under 5 years of age. The event was organized by the Sabin Vaccine Institute with PATH, CDC, Murdoch Childrens Research Institute, ROTA Council, and other partners.

In 2013, rotavirus took the lives of an estimated 215,000 children under the age of 5 worldwide. Despite the enormous achievement of over 80 countries introducing the vaccine so far, speakers emphasized that there is much work ahead to increase the number of children who are vaccinated.

“We have rotavirus vaccines that work—they reduce hospitalizations—but we are still not getting them to the most vulnerable populations or countries with the highest rotavirus mortality,” said Duncan Steele, PhD, a ROTA Council member from the Bill and Melinda Gates Foundation who helped build a diarrhea surveillance network across Africa.

New rotavirus vaccines on the horizon

30041144612_70861faf4a_z“We need to have adequate supply, which means generating demand for manufacturers,” said Steele. At present, there are only two global manufactures of rotavirus vaccine. A potential benefit of more competitors in the field is lower costs—a necessary change if more middle-income nations are to adopt the vaccine in their immunization programs, Steele and others repeated.

Fortunately, as others at the event shared, three vaccines are licensed locally—Rotavin in Vietnam, Lanzhou’s product in China, and Bharat Biotech’s ROTAVAC in India. ROTAVAC is being rolled out in four states and could be, as soon as next spring, made available through WHO pre-qualification to children around the world. Many other vaccines are in various stages of development, especially in Asia.

High impact vaccines even with lower efficacy

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Gagandeep Kang, MBBS, MD, PhD, who established an internationally recognized rotavirus surveillance network in India, said that we need better vaccines to improve effectiveness for children, no matter where they live.

She said that oral vaccines don’t completely deliver on their promise in developing countries. Factors like the child’s microbiome, genetics, nutrition, or maternal antibodies from breastfeeding may affect how the vaccine performs, leading to lower efficacy.

However, vaccine impact is higher in low-income settings, since the burden of disease is so much greater. For example, despite lower efficacy observed in Malawi, the vaccine had a greater impact, preventing seven cases of severe rotavirus diarrhea for every 100 vaccinated Malawian children, compared with four cases per 100 vaccinated South African children. The disease is transmitted year-round in Malawi and the country had a higher baseline rate of rotavirus.

Vaccine introductions picking up steam in the region

While the Philippines has faced roadblocks in its rollout of rotavirus vaccine, experts are hopeful they will broaden access in the coming year. Bangladesh also shared optimism about completing an application to Gavi for financial support to introduce the vaccine. Pakistan is poised to start an introduction later this year.

A success story from Fiji served as a model for the region. Their strategy included introducing the rotavirus vaccine as part of a comprehensive child health strategy, maintaining a strong routine immunization program, and securing donor support. As a result, Fiji saw a decline in all-cause diarrhea hospital admissions after vaccine introduction.

“There has been a decline of 70 percent in rotavirus diarrhoea admissions in children of all ages under five years old,” said Associate Professor Fiona Russell from the Murdoch Childrens Research Institute, about the impact seen in Fiji.

mathu-speakingMathuram Santhosham, MD, MPH, from the International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health, also talked of the need to scale up access to oral rehydration therapy. “We have powerful strategies,” he said. “We need the political will, mobilization of resources, accountability, and community engagement to implement them.”

Attending the symposium were many leading scientists in the field, including Ruth Bishop, the Australian scientist who discovered the virus over 40 years ago.

“We see the fruition of the community that Ruth started so long ago,” said Steele. Described as a national treasure in Australia, Bishop’s life-long achievements laid the foundation for understanding the epidemiology of rotavirus and developing vaccines.

30070684791_09cdea7270_zFurther impact of her unyielding work was illuminated during a panel discussion with women leaders from almost every continent, moderated by Roger Glass, MD, MPH, of the Fogarty International Center, who worked at the NIH on the molecular biology of rotavirus soon after its discovery. The women’s personal stories of how they joined the tight-knight rotavirus community shared the common thread of shouldering their way through a male-dominated field.

Despite challenges facing countries today in controlling rotavirus, a symbiotic and supportive community bound leaders from corners of the world. “The discovery by Ruth brought all of us here,” said Glass, turning to look at her in the audience. “You’ve been a great inspiration to all of us.”