Persistent rotavirus burden despite vaccination: bridging coverage gaps and advancing innovation

Abstract

Rotavirus remains a leading cause of severe diarrhea and preventable deaths in children under five, despite safe and effective vaccines being available for more than two decades. Globally, the infection causes an estimated 150,000 deaths and millions of hospital admissions each year, with the greatest toll in low- and middle-income countries. Children in sub-Saharan Africa are over 40 times more likely to die from rotavirus than their counterparts in high-income settings—an inequity that persists despite proven tools for prevention. By December 2023, 43 of 47 countries in the World Health Organization African Region had introduced rotavirus vaccines, increasing regional coverage from 5% in 2012 to 61% in 2023. Yet progress remains uneven: coverage ranges from 48% in Central Africa to 73% in Southeast Africa, and an estimated 257 million eligible doses were missed between 2012 and 2023. Nigeria, for instance, only began phased introduction in 2022. Barriers such as delayed national rollouts, weak cold-chain systems, funding shortfalls, and reduced vaccine effectiveness in high-mortality settings continue to limit impact. Misinformation and vaccine hesitancy further erode public confidence. To close the rotavirus immunity gap, coordinated action is urgently needed—accelerating vaccine introduction in unserved countries, strengthening delivery systems, securing sustainable financing, and implementing catch-up campaigns for missed infants. Investment in next-generation vaccines with improved heat stability, broader serotype coverage, and simplified dosing is equally essential. Bridging this gap is not only a moral imperative but also central to advancing global child health and achieving Sustainable Development Goals 3 and 10.