Overcoming perceptions of financial barriers to rotavirus vaccine introduction in Asia

Figures & data

Table 1. Countries by regions that have introduced rotavirus vaccine in their National Immunization Programs (NIPs) ^a,47 as of June 2013 and subsequent reductions and rotavirus and all-cause gastroenteritis¹⁸

WHO region	Country	World Bank Classification	Month and year of introduction	Vaccine	Reduction in rotavirus admission < 2y	Reduction in all-cause GE admission < 2y
Americas (PAHO) (19)
	Brazil ^b	UMIC	2006	Rotarix	59%	17–48%
	El Salvador ^b	LMIC	2006	Rotarix		28–37%
	Nicaragua ^b	LMIC	2006	RotaTeq
	Panama ^b	UMIC	2006	Rotarix		37%
	USA ^b	HIC	2006	RotaTeq and later Rotarix	66–86%	29–50%
	Venezuela ^b	UMIC	2006	Rotarix
	Ecuador ^b	UMIC	2007	Rotarix
	Mexico ^b	UMIC	2007	Rotarix		40%
	Bolivia	LMIC	2008	Rotarix
	Cayman Islands ^c	HIC	2009	RotaTeq
	Colombia	UMIC	2009	Rotarix
	Honduras	LMIC	2009	Rotarix
	Paraguay	LMIC	2009	Rotarix
	Peru	UMIC	2009	Rotarix
	Guatemala	LMIC	2010	Rotarix
	Guyana	LMIC	2010	RotaTeq
	Canada (Ontario) ^d	HIC	2011	Rotarix
	Dominican Republic	UMIC	2012	Rotarix
	Haiti	LIC	2013	Rotarix
Europe (EURO) (8)
	Austria ^b	HIC	2006	Rotarix	74–79%
	Luxembourg ^b	HIC	2006	Rotarix
	Belgium ^b	HIC	2007	Rotarix and RotaTeq	50–77%	33%
	Finland	HIC	2009	RotaTeq
	Israel	HIC	2010	RotaTeq
	Armenia	LMIC	2012	Rotarix
	Republic of Moldova	LMIC	2012	Rotarix
	Georgia	LMIC	2013	Rotarix
Western Pacific (WPRO) (6)
	Australia ^b	HIC	2007	Rotarix and RotaTeq	87%
	Palau	UMIC	2008	Rotarix
	Marshal Islands	LMIC	2009	RotaTeq
	Federated States of Micronesia	LMIC	2011	RotaTeq
	Fiji	LMIC	2012	Rotarix
	Philippines ^e	LMIC	2012	Rotarix
Eastern Mediterrean (EMRO) (7)
	Bahrain	HIC	2008	Rotarix
	Qatar	HIC	2009	Rotarix
	Morocco	LMIC	2010	Rotarix
	Iraq	LMIC	2012	RotaTeq
	Yemen	LMIC	2012	Rotarix
	Saudi Arabia	HIC	2013	Rotarix
	Sudan	LMIC	2011	Rotarix
Africa (AFRO) (7)
	South Africa	UMIC	2009	Rotarix
	Botswana	UMIC	2012	Rotarix
	Ghana	LMIC	2012	Rotarix
	Malawi	LIC	2012	Rotarix
	Rwanda	LIC	2012	RotaTeq
	Tanzania	LIC	2012	Rotarix
	Zambia ^d	LIC	2012	Rotarix
South East Asia (SEARO) (1)	Thailand ^d	UMIC	2012	Rotarix

HIC, high income country; UMIC, upper middle income country—$4036 to $12 475 GNI; LMIC, lower middle income country—$1026 to $4035 GNI; LIC, low income country—$1025 or less per capita gross national income (GNI). ^aThe PATH Rotavirus Vaccine Access and Delivery website has timely and useful maps and tools that provide the status of rotavirus vaccines introductions around the world. ^bEarly adopters (rotavirus vaccine introduced into during 2006/2007). ^cInformation from PAHO—not a WHO member state. ^dIntroduction to only part of the country. ^eIntroduction to National Immunization Program but initially only funds available to vaccinate an estimated 700 000 infants from the poorest communities.

Table 2. Rotavirus disease burden reported from sites participating in the Asian Rotavirus Surveillance Network

Sites	Surveillance period	Proportion of diarrhea-related hospitalizations under the age of 5 y positive for rotavirus
Bangladesh ^c	2005–7	33
Cambodia ^c	2005–7	56
China ^a	2001–4	50
China ^b	2005–7	48
Fiji ^c	2005–7	39
Hong Kong ^a	2001–4	30
India ^b	2005–7	39
Indonesia ^b,d	2005–7	60
Japan ^a	2001–4	58
Kyrgyzstan ^c	2005–7	26
Lao ^c	2005–7	54
Mongolia ^b	2005–7	40
Myanmar ^a	2001–4	53
Myanmar ^c	2005–7	55
Nepal ^b	2005–7	33
Pakistan ^c,e	2005–7	17
Philippines ^b	2005–7	31
South Korea ^c	2005–7	22
Sri Lanka ^b	2005–7	24
Taiwan ^a	2001–4	43
Taiwan ^c	2005–7	25
Thailand ^a	2001–4	43
Uzbekistan ^b	2005–7	30
Vietnam ^a	2001–4	55
Vietnam ^c	2005–7	52

^a Data from J Infect Dis. 2005;192(suppl 1). ^bData from J Infect Dis. 2009;200(suppl 1). ^cData from Vaccine 2009;27(suppl 5). ^dAdmissions under 3 y of age. ^eCommunity study.

Figure 1. Cost-effectiveness plane showing how vaccine price typically drives the economic model and can easily change the conclusion that introducing a new vaccine will be cost-ineffective (price A), cost-effective (price B) or cost-saving (price C). Often the private sector list or catalog price lies in the region of Price A, whereas an eventual tender or agreed price for use of a vaccine in a National Immunization Program lies between Price B and C. Rotavirus vaccine introductions in early-adopter countries have resulted in a 35% decrease in all-cause gastroenteritis hospitalizations in children below 2 y of age.¹⁸

Table 3. Examples of prices per course in US$ for Rotarix ^® and RotaTeq ^®

Country / Region	Vaccine	Price (US $ per course)
United States of America^40
	RotaTeq^®	US $192 (CDC) US $226 (PVT)
	Rotarix^®	US $184 (CDC) US $213 (PVT)
United Kingdom ^a	Rotarix^®	US $45 Approximate estimate based on publically announced cost of program divided by birth cohort
PAHO^44
	RotaTeq^®	US $15.45
	Rotarix^®	US $13
GAVI	Rotarix^®	US $ 5
GAVI-eligible countries	Rotarix^®	US $ 0.30 – US $ 0.60 The is the subsidized co-pay price that countries pay during the time that they receive GAVI support ^b
Australia	RotaTeq^® or Rotarix^®	Not in public domain
Philippines	Rotarix^®	Not in public domain

^a Vaccine to be introduced July 2013 after previously considered cost-ineffective applying a 15% discount (US $125 per course) to the catalog price of US $148 per course for Rotarix®.^32bThis can be a major concern for decision-makers in countries that “graduate” for GAVI-eligiblity and have to purchase vaccine through some other mechanism.

PATH. Page on Country Introductions of Rotavirus Vaccines. PATH Rotavirus Vaccine Access and Delivery Website. http://sites.path.org/rotavirusvaccine/rotavirus-advocacy-and-communications-toolkit/country-introduction-maps-and-list/ (accessed 11 July 2013).

 Google Scholar

Patel MM, Glass R, Desai R, Tate JE, Parashar UD. Fulfilling the promise of rotavirus vaccines: how far have we come since licensure?. Lancet Infect Dis 2012; 12:561 - 70; http://dx.doi.org/10.1016/S1473-3099(12)70029-4; PMID: 22742639

 PubMed Web of Science ®Google Scholar

CDC. Vaccines for Children Program (VFC). http://www.cdc.gov/vaccines/programs/vfc/awardees/vaccine-management/price-list/index.html (accessed 3 July 2013).

 Google Scholar

PAHO. PAHO Revolving Fund. http://new.paho.org/hq/index.php?option=com_content&task=view&id=1864&Itemid=2234&lang=en (accessed 3 July 2013).

 Google Scholar

Jit M, Edmunds WJ. Evaluating rotavirus vaccination in England and Wales. Part II. The potential cost-effectiveness of vaccination. Vaccine 2007; 25:3971 - 9; http://dx.doi.org/10.1016/j.vaccine.2007.02.070; PMID: 17400341

 PubMed Web of Science ®Google Scholar