Q&A: Haiti readies rotavirus vaccine rollout

On Saturday, Haiti raised awareness about its plan to roll out the rotavirus vaccine, which prevents the most severe form of diarrheal infection among children.

Diarrhea is a top cause of death for children under five, killing an estimated 700,000 children each year. The infectious disease is the second leading cause of death among children in Haiti, according to UNICEF.

The GAVI Alliance, a nonprofit organization dedicated to bringing vaccines to poor countries around the world, was instrumental in facilitating Haiti’s rotavirus campaign.

Since 2000, GAVI has increased access to vaccines in developing countries through partnerships with international health groups, corporations, nonprofits, and country governments, among others. As a result of GAVI’s efforts, pharmaceutical giant GlaxoSmithKline will soon provide the oral rotavirus vaccine, Rotarix, to Haiti for a fraction of the retail cost. GAVI has committed to funding $4.7 million worth of the vaccine until 2016, and Haiti’s government will contribute $0.20 for each dose, for a total of about $350,000, GAVI's Deputy CEO Helen Evans said. Haitian children will get the vaccine for free.

The unveiling of Haiti’s latest vaccine plan coincided with the World Health Organization’s “World Immunization Week” and the Pan American Health Organization's “Vaccination Week in the Americas.” As details of the plan are still being ironed out by Haiti’s Ministry of Health, Evans was in Port-au-Prince to raise public awareness about the vaccine. 

Helen Evans (Courtesy)

Q: What is the significance of introducing the rotavirus vaccine in Haiti?

A: Haiti has had many challenges. It’s an incredibly poor country — more than 50 percent of the population lives on less than one dollar a day.

To be able to make progress, the health of the children and the health of the population is incredibly important — and perhaps the best buy you can make is to immunize the children to prevent disease, particularly when there is such a poor health infrastructure. Prevention is always better than cure.

Rotavirus is the virus that causes gastroenteritis, which is an inflammation of the stomach intestine. The way it spreads is by very major diarrhea. It’s highly contagious, so it’s very easily passed from hand to hand and from objects to the touch – and it’s not responsive to antibiotics. Even if children and families have access to antibiotics – and that’s a big question – it’s not responsive. Often the only way of recovering from it is to have intravenous fluids because the children dehydrate so rapidly.

To introduce the rotavirus vaccine for the children in Haiti, I think, will make a huge difference. About 2,200 children die each year die in Haiti of rotavirus, and that’s not counting for the children who are sick and recover.

The vaccine is highly effective – it has about an 80 percent efficacy. If children are vaccinated against rotavirus, then they’re significantly protected.

Q: Haiti’s Ministry of Health plans to immunize more than 250,000 children against rotavirus. How, when, and where will children get the rotavirus vaccine?

A: It’s an oral vaccine — that means it’s taken by mouth; it’s not injected. You need two doses and it’s on the same schedule as the children’s routine immunization, the pentavalent vaccine, which GAVI also funds, and which was introduced last year. It will be administered through the health centers, through the health clinics, and also through mobile services that the Ministry of Health runs, and also through some of the non-government services. But the government will organize it.

We’ll be providing sufficient vaccine to cover the entire birth cohort each year of children in Haiti. It’s just for children in their first year. They’re the ones that are most vulnerable. 

Q: Will the vaccine immediately be available in every health center and mobile clinic?

A: That’s for the Ministry of Health to decide. The vaccine isn’t actually starting on Saturday. We’re announcing the introduction of it, but they’re not quite ready yet to roll it out, so we’re hopeful – and they’re hopeful – they’ll be ready by about June or July. They need to train workers in it and they need to make sure that they have the fridge capacity ready in all of the areas.

At this stage, they’re still looking at the logistics of it, and they’re still looking at whether they will roll it out nationally in one hit for all the children straight away, or whether, in fact, they’ll introduce it progressively.

Q: What steps did Haiti take to get to this point, to announce the rollout of the rotavirus vaccine?

A: The rotavirus application was approved last year. Then there was a negotiation with the country as to when they feel they’ll be ready and, secondly, when the supplies are available. With rotavirus, it’s a relatively new vaccine that GAVI is providing and the demands have been really significant. We need to make sure we match supply availability with when the countries are ready.

This was the time that Haiti felt they’d be ready — in the second quarter of 2013. And we all agreed that given there is “immunization week” in the Americas, it was a very good opportunity to provide publicity around it. The publicity then raises awareness in the community that this vaccine is coming and the value of the vaccine. You can’t just assume that parents know about it or that they see the value of it. To give some public exposure and some publicity around it is really important.

Q: In 2006, Nicaragua was the first GAVI-eligible country to receive the rotavirus vaccine. In 2013, Haiti is now the 14th country. Why has the rollout in Haiti taken so long?

A: Well, undoubtedly, the earthquake put a huge stop on things like this. Haiti wouldn’t have had the capacity in 2010 or 2011, really. At that point there were too many other pressing things on their plate so I think it’s not surprising that it’s taken a couple of years for them to get to a point where they can roll out rotavirus. They’re actually doing it in a tiered fashion, so last year, they started with pentavalent vaccine. This year, they’re rolling out rotavirus, and next year they’re going to be rolling out pneumococcal vaccine, which protects against pneumonia.

I think they’re also very aware of needing to take each step at a time. When you have such fragile infrastructure, just rolling out one new vaccine is a challenge. It’s a challenge in terms of training staff, in terms of making sure that you have the recordkeeping in place, and making sure that, particularly, you’ve got the cold chain, the fridge capacity to do it.

Making sure that children everywhere, including Haiti, have access to life-saving vaccines is really all about equity. We take it for granted in affluent, western countries that our children will have access to these vaccines. But this isn’t the case for children everywhere.

(Interview has been condensed and edited for clarity.)

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