Despite the introduction of live oral rotavirus vaccines into more than 90 countries worldwide, rotavirus remains a leading cause of severe diarrhea in children and a major source of morbidity and mortality in low- and middle-income countries (LMICs). Rotavirus vaccination has been effective at controlling the burden of rotavirus-associated gastroenteritis (RVGE) in high-income countries, but the response, efficacy, and impact of current live oral rotavirus vaccines is lower in LMICs for multiple reasons that are still not fully understood. New vaccines and approaches may be needed to overcome the poor immune response to current live oral rotavirus vaccines in LMICs. Next-generation rotavirus vaccines, including neonatal and parenteral subunit vaccines, are currently in development and undergoing clinical trials at our field sites in Malawi and Ghana. Models are needed to extrapolate the results of these trials to the population level. We will use mathematical models to predict the potential impact of different rotavirus vaccination strategies, accounting for both the direct and indirect effects of vaccination. We will then conduct economic evaluations to determine the most cost-effective approach to reducing the burden of diarrhea due to rotavirus. We will begin by focusing on Malawi and Ghana, where we have previously developed models and have good pre- and post-vaccination surveillance data. We will then extend our approach to predict vaccine impact and cost-effectiveness across all LMICs. Our analyses will help to better define the vaccine response, duration of immunity, and price at which next-generation rotavirus vaccines are likely to be cost-effective, and will provide a validated platform that decision-makers in LMICs can use to weigh the costs and benefits of different rotavirus vaccination strategies in their country.
Rotavirus remains a major source of morbidity and mortality in low- and middle-income countries, even despite the introduction of live oral rotavirus vaccines. In collaboration with researchers in Malawi and Ghana, we will use mathematical models combined with economic models to evaluate the potential impact and cost- effectiveness of different rotavirus vaccination strategies, including those based on next-generation neonatal and parenteral rotavirus vaccines. Our analysis will provide a validated platform for assessing the cost- effectiveness of different rotavirus vaccination strategies in low- and middle-income countries.
