If national rotavirus vaccination were implemented in India within the existing immunization

coverage, then the states with the most favorable CERs and greatest disease burden would benefit the least. Their analysis also suggests that the value for money of rotavirus vaccination could be substantially increased by eliminating differences in coverage between richest and poorest quintiles; the number of deaths averted would increase by 89% among the poorest quintile and could increase the overall number of lives saved by 38%. This is equivalent to increasing buy UMI-77 vaccine efficacy against severe rotavirus infection from 57% to 79% [61]. In this discourse, we have critically examined the debate on whether rotavirus vaccine should be introduced in India’s immunization program. Our intent was to identify how arguments used by pro- and anti-vaccine lobbies could inform a policy decision process. While both sides have used epidemiological data, economic arguments, and clinical trial results, we could locate very few references pertaining to challenges in translating these evidences into action. A description LY2835219 mouse of policy making processes for any vaccine currently used in the national immunization program was also scarce. The first moot point we identified was if the public health problem surrounding rotavirus

morbidity was being overestimated. It has been argued that bacterial and parasitic co-infections in the gut are actually responsible for severity

of rotavirus diarrhea encountered in our setting [12] and [62]. In order to obtain clinching biological evidence in this regard, one needs to know which of the gut organisms had harmless presence, which increased the severity of diarrhea and which one was responsible for primary causation. The Global Enteric Multicenter Study (GEMS) focusing on the etiology and population-based Parvulin burden of pediatric diarrheal diseases in sub-Saharan Africa and south Asia has thrown some light on this issue by identifying that rotavirus was the most common cause of moderate-to-severe diarrhea at every study site during first year of life [27]. It is also important to know that rotavirus vaccines in clinical trials have shown efficacy in reducing ‘diarrhea of any severity’ and ‘SRVGE’. A policy making body may not have answers to all the questions, cited in this paragraph, at a given point in time but they can work under the principle that policy evolves through a process and is not a one-time event [63]. Secondly, the failure of vaccine uptake by the gut mucosa of a child due to anti-rotavirus antibodies in breast milk of mothers and the inability of natural rotavirus infections in preventing subsequent infections (reported from south India) were host related concerns.