Successes, Challenges and Lessons Learned in Accelerating Introduction of Rotavirus Immunisation in Zambia


Introduction: Under five mortality in Zambia is unacceptably high and diarrhoea is the third leading contributor. The Programme for Awareness and Elimination of Diarrhoea (PAED) sought to support the government to accelerate the introduction of new vaccines, including the pneumococcal, second dose measles and rotavirus vaccines in Zambia. Here we present our approach, progress and lessons learned in two years of the programme. Stakeholder Engagement: Definite commitment and buy-in and sign off by the MOH were fundamental prerequisites. National and international stakeholders including the Inter Agency Coordinating Committee (ICC), GAVI Alliance, WHO, University Teaching Hospital, Paediatrics Association of Zambia, and UNICEF were engaged for stakeholder buy-in and integration. Progress made: Following successful integration, PAED was officially launched in January 2012. Preparatory work done included: Introduction and acceptance of the PAED agenda in ICC, new vaccines proposal to GAVI, resource mobilisation, Effective Vaccine Management implementation, national cold chain scale-up strategy, vaccine orientation and adapted data collection tools, health worker training, step-wise vaccine introduction to Lusaka province districts and finally national roll-out of the rotavirus vaccine immunisation. Between January 2011 and November 2013, over 270,000 vaccine doses were distributed in Lusaka province. When 94,500 infants were fully immunised, adequate preparations had been made to facilitate national launch of rotavirus immunisations countrywide on 27th November 2013. Discussion: The PAED model was successful at resource mobilization; it has demonstrated how private sector can contribute to new vaccine introduction. Lessons learned from this model can be replicated in other countries with similar need and constraints.

Share and Cite:

Chilengi, R. , Rudd, C. , Bolton, C. , Guffey, B. , Masumbu, P. and Stringer, J. (2015) Successes, Challenges and Lessons Learned in Accelerating Introduction of Rotavirus Immunisation in Zambia. World Journal of Vaccines, 5, 43-53. doi: 10.4236/wjv.2015.51006.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] World Health Organization (2007) Rotavirus Vaccines. Weekly Epidemiological Record, 82, 285-296.
[2] Parashar, U.D., Burton, A., Lanata, C., et al. (2009) Global Mortality Associated with Rotavirus Disease among Children in 2004. The Journal of Infectious Diseases, 200, S9-S15.
[3] Parashar, U.D., Gibson, C.J., Bresse, J.S. and Glass, R.I. (2006) Rotavirus and Severe Childhood Diarrhoea. Emerging Infectious Diseases, 12, 304-306.
[4] ZMOH (2009) Zambia Ministry of Health 2008. Annual Health Statistical Bulletin, 2009.
[5] Steele, A.D., Kasolo, F.C., Bos, P., et al. (1998) Characterization of VP6 Subgroup, VP7 and VP4 Genotype of Rotavirus Strains in Lusaka, Zambia. Annals of Tropical Paediatrics, 18, 111-116.
[6] Mpabalwani, M., Oshitani, H., Kasolo, F., et al. (1995) Rotavirus Gastro-Enteritis in Hospitalized Children with Acute Diarrhoea in Zambia. Annals of Tropical Paediatrics, 15, 39-43.
[7] (2014) Gavi. Value of Immunisation.
[8] Chilengi, R. and Gitaka, J. (2010) Is Vaccine the Magic Bullet for Malaria Elimination? A Reality Check. Malaria Journal, 9(S3).
[9] (2014) Global Health Research Policy Network. Making Markets for Vaccines—A Practical Plan.
[10] Taylor K., Nguyen A. and Stéphenne J. (2009) The Need for New Vaccines. Vaccine, 27, G3-G8.
[11] Gavi (2014) Health Equity.
[12] UNICEF/WHO (2009) Diarrhoea: Why Children Are Still Dying and What Can Be Done.
[13] WHO (2014) Introduction of rotavirus vaccines. Information for Policy Makers, Programme Managers and Health Workers.
[14] GlaxoSmithKline. Rotarix-Electronic Medicines Compendium.
[15] Ruiz-Palacios, G.M., Perez-Schael, I. and Velazquez, F.R. (2006) Safety and Efficacy of an Attenuated Vaccine against Severe Rotavirus Gastroenteritis. New England Journal of Medicine, 354, 11-22.
[16] Drug Lib. Com. Rotateq (Rotavirus Vaccine)—Summary.
[17] Vesikari, T., Matson, D.O., Dennehy, P., Van Damme, P., Santosham, M., Rodriguez, Z., et al. (2006) Safety and Efficacy of a Pentavalent Human-Bovine (WC3) Reassortant Rotavirus Vaccine. New England Journal of Medicine, 354, 23-33.
[18] Mwenda, J.M., Ntoto, K.M., Abebe, A., Enweronu-Laryea, C., Amina, I., Mchomvu, J., et al. (2010) Burden and Epidemiology of Rotavirus Diarrhoea in Selected African Countries: Preliminary Results from the African Rotavirus Surveillance Network. Journal of Infectious Diseases, 202, S5-S11.
[19] Levy, K., Hubbard, A.E. and Eisenberg, J.N.S. (2009) Seasonality of Rotavirus Disease in the Tropics: A Systematic Review and Meta-Analysis. International Journal of Epidemiology, 38, 1487-1496.
[20] Madhi, S.A., Cunliffe, N.A., Steele, D., Witte, D., Kirsten, M., Louw, C., et al. (2010) Effect of Human Rotavirus Vaccine on Severe Diarrhoea in African Infants. New England Journal of Medicine, 362, 289-298.
[21] Armah, G.E., Sow, S.O., Breiman, R.F., Dallas, M.J., Tapia, M.D., Feikin, D.R., et al. (2010) Efficacy of Pentavalent Rotavirus Vaccine against Severe Rotavirus Gastroenteritis in Infants in Developing Countries in Sub-Saharan Africa: A Randomised, Double-Blind, Placebo-Controlled Trial. The Lancet, 376, 606-614.
[22] Clemens, J. and Jodar, L. (2005) Introducing New Vaccines into Developing Countries: Obstacles, Opportunities and Complexities. Nature Medicine, 11, S12-S15.
[23] PATH, Vaccine Resource Library (2011) HPV Vaccination in Africa: Lessons Learned From a Pilot Program in Uganda.
[24] Ladner, J., Besson, M.H. and Rodrigues, M. (2014) Performance of 21 HPV Vaccination Programs Implemented in Low and Middle-Income Countries, 2009-2013. BMC Public Health, 14, 670.
[25] Clemens, J. and Jodar, L. (2005) Introducing New Vaccines into Developing Countries: Obstacles, Opportunities and complexities. Nature Medicine, 11, S12-S15.
[26] WHO (2006) Sixth Global Vaccine Research Forum: Many New Life-Saving Vaccines in Pipeline, but Challenges Persist.

Copyright © 2022 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.