Healthcare provider perspectives on delivering next generation rotavirus vaccines in five low-to-middle-income countries

Abstract

Background Live oral rotavirus vaccines (LORVs) have significantly reduced rotavirus hospitalizations and deaths worldwide. However, LORVs are less effective in low- and middle-income countries (LMICs). Next-generation rotavirus vaccines (NGRVs) may be more effective but require administration by injection or a neonatal oral dose, adding operational complexity. Healthcare providers (HPs) were interviewed to assess rotavirus vaccine preferences and identify delivery issues as part of an NGRV value proposition. Objective Determine HP vaccine preferences about delivering LORVs compared to injectable (iNGRV) and neonatal oral (oNGRV) NGRVs. Methods 64 HPs from Ghana, Kenya, Malawi, Peru, and Senegal were interviewed following a mixed-method guide centered on three vaccine comparisons: LORV vs. iNGRV; LORV vs. oNGRV; oNGRV vs. iNGRV. HPs reviewed attributes for each vaccine in the comparisons, then indicated and explained their preference. Additional questions elicited views about co-administering iNGRV+LORV for greater public health impact, a possible iNGRV-DTP-containing combination vaccine, and delivering neonatal doses. Results Almost all HPs preferred oral vaccine options over iNGRV, with many emphasizing an aversion to additional injections. Despite this strong preference, HPs described challenges delivering oral doses. Preferences for LORV vs. oNGRV were split, marked by disparate views on rotavirus disease epidemiology and the safety, need, and feasibility of delivering neonatal vaccines. Although overwhelmingly enthusiastic about an iNGRV-DTP-containing combination option, several HPs had concerns. HP views were divided on the feasibility of co-administering iNGRV+LORV, citing challenges around logistics and caregiver sensitization. Conclusion Our findings provide valuable insights on delivering NGRVs in routine immunization. Despite opposition to injectables, openness to co-administering LORV+iNGRV to improve efficacy suggests future HP support of iNGRV if adequately informed of its advantages. Rationales for LORV vs. oNGRV underscore needs for training on rotavirus epidemiology and stronger service integration. Expressed challenges delivering existing LORVs merit further examination and indicate need for improved delivery.

Does Anybody Want an Injectable Rotavirus Vaccine, and Why? Understanding the Public Health Value Proposition of Next-Generation Rotavirus Vaccines

“…These results, presented in more detail by Mooney et al [31], suggest that introduction of any NGRV would face specific challenges in some settings and highlight the need for more education, training, and tailored messages for healthcare providers.…”

“…Whether delivered alone or co-administered with LORV, iNGRV-DTP emerged as the most cost-effective option compared both to existing products and oNGRVs [28]. It was also the option most preferred by country stakeholders against all other options [31], and, by extension, to likely have the greatest market demand, whether its efficacy was similar or superior to that of existing products. The combined findings from all three major analysesthe health impact and economic analysis, the feasibility and acceptability study, and the demand forecast-underscore a need for funders and manufacturers to consider prioritizing the necessary iNGRV compatibility and combinability studies with DTP-pentavalent and DTP-hexavalent, even if iNGRV efficacy ends up being no greater than that of existing LORVs [8].…”

“…The NGRV feasibility and acceptability study involved individual, in-person interviews with national stakeholders [30] and healthcare providers [31] from Ghana, Malawi, Kenya, Peru, Sri Lanka, and Senegal. Countries were selected to represent a variety of socio-economic and epidemiological situations as well as eligibility for Gavi co-financing.…”

Exploring Shigella vaccine priorities and preferences: Results from a mixed-methods study in low- and middle-income settings

“…Beyond Shigella , historical efforts to gain insight into preferences around vaccine attributes have seldom involved systematic surveys of those most directly involved at the country level. Recent precedents by Price and Mooney et al considered novel rotavirus vaccines which found similar preferences for oral and combination presentations [43] , [44] . Our study is timely, since Shigella vaccine candidates are still in development, providing manufacturers an opportunity to incorporate our findings into clinical trials plans, such as evaluating vaccine impact beyond diarrhea by integrating a stunting endpoint into Phase 3 clinical studies.…”