Young girl standing in an open doorway.

Almost all children are infected by rotavirus by the time they're three years old.

A partnership helps countries fight the virus 

Regardless of where children live, they will become infected by rotavirus by their third birthdays. The fast-acting virus passes through the stool, clings to bottles, toys, and other surfaces, and soon invades a child’s system. Severe diarrhea and vomiting often follow and the risk of dehydration escalates. Because rotavirus infection is viral rather than bacterial, it does not respond to treatment with antibiotics, and cleaning up the water supply can’t prevent it.

In the United States and other industrialized nations, parents can give their children rehydration products like Pedialyte or take them to the emergency room. But in developing countries, rehydration treatments and emergency care are not always easy to come by. Babies can quickly become dehydrated and listless while their families struggle to get help.

A priority vaccine

In the early 1980s, the World Health Organization (WHO) called for vaccine companies to make development of a rotavirus vaccine for infants a priority. Twenty years later, rotavirus vaccines were close to delivery. But under the traditional trajectory of vaccine introduction, poor countries were likely to wait for years after the products' introduction in industrialized markets.

Communities in the world’s poorest countries had battled diarrhea outbreaks for years, but few knew the cause was often rotavirus.

In 2003, PATH joined forces with WHO and the US Centers for Disease Control and Prevention to close the gap between the availability of rotavirus vaccines in the developed and developing worlds. Under the wing of the GAVI Alliance—a partnership of public and private groups dedicated to accelerating access to immunization in poor countries—we began the Rotavirus Vaccine Program (RVP).

RVP was formed to help countries make critical decisions about rotavirus vaccines. How did rotavirus affect their communities? Could a vaccine stop severe diarrhea? And how would a vaccine developed for industrialized countries work in places like Malawi, Bangladesh, or Vietnam?

To answer these questions, the RVP partners set about collecting evidence of the effect of rotavirus from region to region. Then, they assessed the potential impact of rotavirus vaccines.

Measuring rotavirus' impact

Communities in the world’s poorest countries, especially in Africa and Asia, had battled diarrhea outbreaks for years, but few knew the cause was often rotavirus. The name was still obscure, its magnitude not fully measured.

To provide a picture of the virus’s impact, RVP helped expand global surveillance networks to capture data about rotavirus incidence. We brought together international teams to establish a common protocol for collecting crucial evidence on disease burden. We also began talking with health officials across the globe about the disease, laying the groundwork for eventual decision-making on vaccine introduction. Raising awareness about the illness and its effects would help to inform countries’ consideration of a vaccine.

During these conversations with health officials, it quickly became clear that countries wanted solutions to the problem of diarrheal disease in general, not just rotavirus. RVP’s approach evolved to include rotavirus vaccines within a broader portfolio of interventions to prevent and treat diarrhea, including low-osmolarity oral rehydration solution and zinc treatments, both recommended by WHO. PATH launched a new project, the Enhanced Diarrheal Disease Control Initiative, to help countries consider an overall approach that included rotavirus vaccine introduction.

Next Gathering the evidence

Photo: PATH/Mike Wang.