Almost half of India’s 1,76,000 diarrhoeal deaths in children below five are caused by rotavirus, the pathogen responsible for severe childhood diarrhoea. In addition, 8 lakh hospitalisations and over 30 lakh outpatient visits each year among children below 5 are triggered by diarrhoea of rotavirus origin.

WHO recommends the rotavirus vaccine for infants in all national immunisation programmes. Globally, at least 62 nations have already introduced it. These include not only most of the developed nations, but also low and middle income countries.

The Government recently decided to introduce a rotavirus vaccine in the universal immunisation programme. The broadened efforts to control childhood diarrhoeal disease means preventing deaths, disease, economic hardship and offering protection to the children of the poor.

Multi-level approach

Public health strategies are never one-dimensional, and it would be imprudent to undermine tried and tested interventions. Sanitation, clean drinking water, breastfeeding and hygiene are essential, even crucial, but so is immunising children with safe vaccines.

It has been argued that better sanitation alone would eliminate diarrhoeal disease. However, it is not entirely true for rotavirus diarrhoea. It also persists in socio-economically developed countries with high sanitation levels. In the US, it was a leading cause for severe diarrhoea till it introduced rotavirus vaccine.

While back-of-the-envelope calculations on the cost-effectiveness of vaccines are tempting, such an approach would be unwise as the analyses often only reflect the cost of delivering the vaccine, not the multiple health benefits of immunisation. Taking a long-term view, if India wants to protect its children from the most lethal form of diarrhoea, it will be unable to do so entirely through sanitation or treatment approaches. Because of the very fast fluid loss in rotavirus diarrhoea, children often rapidly become dangerously dehydrated despite oral rehydration efforts.

Moreover, public health experience shows that the poor are more likely to access, and benefit from, vaccination programmes than therapeutic interventions. It is easier to scale up immunisation than the referral and treatment because of the reach. Today’s science unequivocally supports the notion that the controlling rotavirus disease requires mass use of an effective vaccine.

Point to note

A noteworthy aspect of India’s battle against the rotavirus diarrhoea is a reasonable certainty that the vaccine to be deployed in the national programme would be an Indian preparation. This vaccine contains a strain isolated by scientists at the All India Institute of Medical Sciences. The vaccine has been manufactured by an Indian pharmaceutical company and field-tested by Indian researchers under the stewardship of the Ministry of Science and Technology. It is likely to cost ₹50-60 per dose in contrast to the two imported rotavirus vaccines in the market that cost ₹3,000-4,000 per dose.

The success of creating an Indian vaccine demonstrates the promise of India’s pharmaceutical industry to deliver products that can save millions of lives. The Indian rotavirus vaccine is also poised to give a strong competition to the existing vaccines. This triumph of India’s research and development enterprise should make every Indian proud.

The writer heads the paediatrics department at AIIMS, New Delhi. The views are personal

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