Country Experiences

From Introduction to Impact: The Story of Rotavirus Vaccines

Rotavirus vaccines are saving lives and improving health in countries where they have been introduced as part of the routine childhood immunization program. Our partners at PATH spoke with scientists, advocates, and leaders in three countries—Nicaragua, Ghana, and Malawi—who helped pave the way for rotavirus vaccine introductions in low-income countries and continue to advocate for expanded access.


Rota Council Recommendation

National governments, funding agencies, and global health entities (WHO, UNICEF and NGOs) should support media and advocacy groups to ensure that the benefits of rotavirus and other vaccines are successfully conveyed to the public.

Ghana: Monumental dual vaccine introduction combats leading causes of child death

Pneumonia and diarrhea are a deadly duo, particularly for children. In Ghana, they were responsible for about 20% of deaths among children under the age of 5. Rotavirus alone killed more than 2,000 children annually 1, 2.

But in April 2012, Ghana became the first Gavi-eligible country to simultaneously introduce pneumococcal and rotavirus vaccines into its national immunization program. To prepare for the dual introduction, the government built new vaccine storage rooms, issued millions of updated immunization cards and dispelled immunization myths through community campaigns 3, 4.

In the two years following the dual introduction, rotavirus diarrhea hospitalizations fell from nearly 50% to 28% of severe diarrhea hospitalizations 5. Ghana serves as a model for other African nations capable of dual introduction. Dual introduction can potentially minimize strain on a country’s limited resources, as the vaccines have similar cold chain requirement upgrades and training needs, and vaccine schedules.

India: Innovative partnership lead to development of an indigenous vaccine

India bears the greatest burden of rotavirus under-5 deaths in the world 6. More than 870,000 inpatient hospitalizations and 3 million outpatient visits are due to rotavirus, which incur more than Rs. 10 billion each year 7.

The development and implementation of the indigenous Indian vaccine, ROTAVAC, offers remarkable promise for curbing rotavirus disease and death in India and around the world. Manufactured by Bharat Biotech International Limited, ROTAVAC was developed through a public-private partnership that included the Indian government, international donors, global rotavirus experts and the private sector, all sharing the risk and cost of its development 8, 9.

Faced with new evidence from clinical trials and about the high rotavirus burden in India, the government began a phased introduction of rotavirus vaccines into the country’s national immunization program in 2016. If ROTAVAC is prequalified by WHO, the vaccine may also become available to other countries. Bharat Biotech announced ROTAVAC would be made available at US$1 per dose, making it an attractive option for countries seeking a more affordable vaccine 8, 9.

Zambia: A pilot program in Lusaka deploys an integrated, comprehensive approach to diarrheal disease prevention and control

Before rotavirus vaccine introduction, Zambia faced a devastating diarrhea burden. Diarrhea killed more than 5,700 children under age 5 annually, and rotavirus alone was responsible for 3,600 of those deaths 2, 10.

In 2012, Zambia launched the Programme for Awareness and Elimination of Diarrhoea (PAED) in Lusaka 11. This pilot program improved cold chain capacity, trained more than 500 health workers and informed communities of treatment options and the availability of the rotavirus vaccine. In just over one year, more than 100,000 children were immunized 11, 12.

PAED’s success can be attributed to strong stakeholder partnerships, its integration with existing child health programs and its comprehensive approach to diarrheal disease control, as well as continued advocacy and support networks 11, 12. In November 2013, thanks to the foundation built with PAED, Zambia expanded its vaccination efforts and introduced rotavirus vaccines into its national immunization program 12. PAED was a winning model for future vaccine introductions and the implementation of a framework like the GAPPD in high-burden settings 11.


1. Black, R.E., et al., Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet, 2010. 375(9730): p. 1969-87.

2. WHO. 2008 rotavirus deaths, under 5 years of age, as of 31 January 2012.; Available from: 

3. Gavi Ghana vaccine launch trailer. 2012.

4. PATH. Ghana takes on top two child killers simultaneously. 2012 April 27, 2012]; Available from:

5. Enweronu-Laryea, C.C., et al., Decline in severe diarrhea hospitalizations after the introduction of rotavirus vaccination in Ghana: a prevalence study. BMC Infect Dis, 2014. 14: p. 431.

6. Tate, J.E., 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. Lancet Infect Dis, 2012. 12(2): p. 136-41.

7. John, J., et al., Rotavirus gastroenteritis in India, 2011-2013: revised estimates of disease burden and potential impact of vaccines. Vaccine, 2014. 32 Suppl 1: p. A5-9.

8. PATH, Rotavirus vaccine developed in India demonstrates strong efficacy. 2013: DefeatDD.

9. Madhi, S.A. and U.D. Parashar, 116E rotavirus vaccine development: a successful alliance. Lancet, 2014. 383(9935): p. 2106-7.

10. WHO. Global Rotavirus Information and Surveillance Bulletin. 2011.

11. Chilengi, R.R., C., Zambia National Rotavirus Vaccine Rollout: New collaborative approaches to accelerating vaccine introduction into resource-poor countries—the case of rota introduction in Zambia. DEFEATDD.

12. PATH Zambia launches multifaceted attack to combat rotavirus and other causes of diarrhea. 2012.