Should Countries Switch To Using Five- Or Ten-Dose Rotavirus Vaccines Now That They Are Available?

Introduction: Single-dose rotavirus vaccines, which are used by a majority of countries, are some of the largest-sized vaccines in immunization programs, and have been shown to constrain supply chains and cause bottlenecks. Efforts have been made to reduce the size of the single-dose vaccines; however, with two-dose, five-dose and ten-dose options available, the question then is whether using multi-dose instead of single-dose rotavirus vaccines will improve vaccine availability. Methods: We used HERMES-generated simulation models of the vaccine supply chains of the Republic of Benin, Mozambique, and Bihar, a state in India, to evaluate the operational and economic impact of implementing each of the nine different rotavirus vaccine presentations. Results: Among single-dose rotavirus vaccines, using Rotarix RV1 MMP (multi-monodose presentation) led to the highest rotavirus vaccine availability (49-80%) and total vaccine availability (56-79%), and decreased total costs per dose administered ($0.02-$0.10) compared to using any other single-dose rota -virus vaccine. Using two-dose ROTASIIL decreased rotavirus vaccine availability by 3-6% across each sup-ply chain compared to Rotarix RV1 MMP, the smallest single-dose vaccine. Using a five-dose rotavirus vaccine improved rotavirus vaccine availability (52-92%) and total vaccine availability (60-85%) com-pared to single-dose and two-dose vaccines. Further, using the ten-dose vaccine led to the highest rota -virus vaccine availability compared to all other rotavirus vaccines in both Benin and Bihar. Conclusion: Our results show that countries that implement five-dose or ten-dose rotavirus vaccines con-sistently reduce cold chain constraints and achieve higher rotavirus and total vaccine availability com-pared to using either single-dose or two-dose rotavirus vaccines. (c) 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).