Success from the South: the rotavirus vaccine story and its lessons

• Published in: The Lancet (British edition) 2024-01, Vol.403 (10421), p.111-116
• Main Author: Kang, Gagandeep
• Format: Article
• Language: English
• Subjects: 20th century; Antibodies; Antibody response; Biotechnology; Capsid protein; Children; Cholera; Collaboration; Colonialism; COVID-19 vaccines; Diarrhea; Diarrhea - prevention & control; Double-stranded RNA; Electron microscopy; Enzymes; Epithelial cells; Epithelium; Gastroenteritis; Humans; Immunization; Immunoassay; Infant; Manufacturing; Meningitis; Pandemics; Rotavirus; Rotavirus Infections - epidemiology; Rotavirus Infections - prevention & control; Rotavirus Vaccines; Smallpox; South Africa; Tropical diseases; Typhoid; Vaccines; Vaccines, Attenuated; Viruses
• ISSN: 0140-6736; 1474-547X; 1474-547X
• DOI: 10.1016/S0140-6736(23)02520-5

In 1990, the Children's Vaccine Initiative was established by the World Bank and Rockefeller Foundation with UNICEF, UNDP, and WHO to support the use of existing and new vaccines for all children and to develop combination vaccines.7 A paucity of coordination and support led to dissolution of this organisation by 1999. In India, work on rotavirus diarrhoea was initiated 2 years after Ruth Bishop and colleagues published a paper in The Lancet describing viral particles in epithelial cells of the duodenal mucosa of children with acute non-bacterial gastroenteritis.9 Ian Holmes, a coauthor of this paper and an electron microscopist, trained an Indian pathologist to conduct negative staining and recognise the distinctive wheel-shaped viruses. The first Indian paper on rotavirus was published in 1977 and showed that rotavirus was associated with 26% of severe gastroenteritis in Indian children.10 The identification of rotaviruses was initially based on electron microscopy and then by electropherotyping, a method that distinguished rotaviruses based on the pattern of migration of 11 segments of double-stranded RNA. A study showed that the infected children did mount an antibody response, and it was postulated that the presence of the bovine capsid protein allowed the children to get infected even though transplacental or breastmilk antibodies were received from the mother.14 This research on the 116E strain was then taken further with support from the Indo-US Vaccine Action Program, which was established in the 1980s as a collaborative research programme between the Department of Biotechnology in India and the National Institutes of Health (NIH) in the USA.