Impact of introducing the rotavirus vaccine into the Expanded Program on Immunization in Niger

Objective/Research Question: Determine the potential vaccine distribution effects of introducing the rotavirus vaccine to the Niger routine immunization program.

Methods: Using ARENA modeling software, we constructed a stochastic computer simulation of the Niger vaccine supply chain that included all current World Health Organization (WHO) Expanded Program on Immunization (EPI) vaccines. The simulation was based on data collected from Niger on vaccine supply and distribution operations and population characteristics. We then simulated the introduction of rotavirus vaccine to the supply chain and determined the complex dynamic effects.

Results: Compared to the baseline scenario which included only seven current EPI vaccines, the introduction of the rotavirus vaccine increased the number of shipments required per year to meet demand, decreased the available storage capacity for all EPI vaccines, and increased the level of unmet demand at the district and clinic levels which decreased overall immunization coverage.

Conclusions: The simulation results showed that introducing a new vaccine into the routine EPI in Niger had overwhelming impacts on vaccine storage capacity, shipping logistics, and immunization coverage. Responding successfully to such an introduction would require additional cold chain resources.

Implications for Public Health: While rotavirus is a vaccine-preventable disease, it is still a major cause of severe diarrhea and fatal dehydration among children in West Africa. There are two WHO-prequalified rotavirus vaccines available for distribution in developing countries. Understanding the dynamic relationships between vaccine characteristics, population demand and supply chain logistics is an important step in making recommendations on potential advantages and disadvantages of vaccine introduction.