Rotavirus is the most common cause of diarrhea, one of the world’s leading killers of children. A safe and effective vaccine exists to protect children against Rotavirus, but many decision-makers in Asia have been slow to introduce it because of misconceptions that the vaccine is not cost effective, according to a recent study published in Human Vaccines & Immunotherapeutics.

The impact of this misconception has been felt most strongly throughout Asia. Only two countries in the region have introduced the vaccine despite the World Health Organization (WHO) recommendation that all countries introduce it into their national immunization programs (NIPs).

The study, co-authored by E. Anthony S Nelson, Sabin Vaccine Institute’s Ciro de Quadros, Mathuram Santosham et al., addresses the three factors that decision-makers indicated could accelerate the decision for introduction of new vaccines in developing countries. These are (1) proof of local disease burden, (2) proof of an available safe and effective vaccine, and (3) proof of cost-effectiveness.

Proof of local disease burden does exist thanks to extensive data collected by the Asian Rotavirus Surveillance Network (ARSN), according to the authors. However, they note that “having an extensive database of local disease burden alone has been insufficient to drive rapid introduction of rotavirus vaccine in the Asian region.”

In addition, several studies covering a variety of socioeconomic settings in Asia demonstrate the safety and efficacy of the vaccine. It also has a significant public health impact, even in countries where modest vaccine efficacy was observed. The authors state that many decision-makers still perceive a lack of quality efficacy data, particularly in low-income countries, and this perception may be a factor in delaying policy decisions for rotavirus vaccine introduction.

Lastly, proving value-for-money requires accurate information on vaccine pricing. In Asia’s case, many decision-makers have resorted to using private sector prices for the rotavirus vaccine rather than a final NIP price when determining cost-effectiveness. This is because the NIP price is often unknown at the time of economic evaluation. The authors note that, “unfortunately, with private sector list prices of vaccines often used in economic evaluations...policy makers may defer decisions on rotavirus vaccine introduction based on the belief that ‘the vaccine price is too high.’ even though this might be based on erroneous data.”

To address the barriers to rotavirus vaccine introduction listed above, the authors outline mechanisms to make vaccine pricing more competitive and transparent so that decision-makers will have the information they need to make evidence-based decision.

One such mechanism outlined by the authors is a bulk purchasing fund modeled after the Pan American Health Organization’s Revolving Fund which secures vaccines and related supplies—prequalified under WHO standards of safety and effectiveness—for its Member States in bulk, at affordable prices. The authors also recommend countries take advantage of tiered pricing provided by vaccine manufacturers, although this approach may come with legal challenges to some countries.

The authors also recommend separating technical decisions from economic evaluations and further exploring the recently presented UNICEF Hybrid Procurement Strategy for Asia.

Despite the mechanism used, decision-makers need accurate information on rotavirus vaccine pricing to evaluate and introduce these life-saving and health-improving vaccines. Each of the mechanisms outlined above have advantages and challenges, but one thing is certain: until these perceived financial barriers are addressed, Asian children won’t have the protection they need against a major threat.