National stakeholder preferences for next-generation rotavirus vaccines: Results from a six-country study

Jessica Price,Jessica Mooney,Carolyn Bain,John Tanko Bawa,Nikki Gurley,Amresh Kumar,Guwani Liyanage,Rouden Esau Mkisi,Chris Odero,Karim Seck,Evan Simpson,William P Hausdorff

doi:10.1016/j.vaccine.2021.11.009

Abstract

BackgroundCurrently available live, oral rotavirus vaccines (LORVs) have significantly reduced severe rotavirus hospitalizations and deaths worldwide. However, LORVs are not as effective in low- and middle-income countries (LMIC) where rotavirus disease burden is highest. Next-generation rotavirus vaccine (NGRV) candidates in development may have a greater public health impact where they are needed most. The feasibility and acceptability of possible new rotavirus vaccines were explored as part of a larger public health value proposition for injectable NGRVs in LMICs. ObjectiveTo assess national stakeholder preferences for currently available LORVs and hypothetical NGRVs and understand rationales and drivers for stated preferences. MethodsInterviews were conducted with 71 national stakeholders who influence vaccine policy and national programming. Stakeholders from Ghana, Kenya, Malawi, Peru, Senegal, and Sri Lanka were interviewed using a mixed-method guide. Vaccine preferences were elicited on seven vaccine comparisons involving LORVs and hypothetical NGRVs based on information presented comparing the vaccines’ attributes. Reasons for vaccine preference were elicited in open-ended questions, and the qualitative data were analyzed on key preference drivers. ResultsNearly half of the national stakeholders interviewed preferred a highly effective standalone, injectable NGRV over current LORVs. When presented as having similar efficacy to the LORV, however, very few stakeholders preferred the injectable NGRV, even at substantially lower cost. Similarly, a highly effective standalone injectable NGRV was generally not favored over an equally effective oral NGRV following a neonatal-infant schedule, despite higher cost of the neonatal option. An NGRV-DTP-containing combination vaccine was strongly preferred over all other options, whether delivered alone with efficacy similar to current LORVs or co-administered alongside an LORV (LORV + NGRV-DTP) to increase efficacy. ConclusionResults from these national stakeholder interviews provide valuable insights to inform ongoing and future NGRV research and development.

Highlights

While all children are susceptible to rotavirus infection, the majority of deaths occur in low- and middle-income countries (LMICs), more than half in sub-Saharan Africa [3]
As relates to Key Question 2, our findings suggest a coadministered LORV + injectable next generation rotavirus vaccine (iNGRV)-DTP schedule to improve efficacy may be attractive in LMICs, despite higher cost
Overwhelming preference across all countries for an iNGRV-DTP-containing vaccine over all other options, whether delivered as part a mixed schedule to improve efficacy or on its own offering no greater protection than existing LORVs, calls into question the assumption that a new rotavirus vaccine must demonstrate higher efficacy to be useful and acceptable

Summary

Introduction

LORVs are not as effective in low- and middle-income countries (LMIC) where rotavirus disease burden is highest. The feasibility and acceptability of possible new rotavirus vaccines were explored as part of a larger public health value proposition for injectable NGRVs in LMICs. Objective: To assess national stakeholder preferences for currently available LORVs and hypothetical NGRVs and understand rationales and drivers for stated preferences. Results: Nearly half of the national stakeholders interviewed preferred a highly effective standalone, injectable NGRV over current LORVs. When presented as having similar efficacy to the LORV, very few stakeholders preferred the injectable NGRV, even at substantially lower cost.

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Conclusion