It seemed like millions of babies would miss a vaccine that saves lives …

Imagine for a moment: a company makes a vaccine that protects children from a deadly disease but decides not to sell it, but without warning, in the United States.

This is exactly what happened last year in West Africa for a rotavirus vaccine – a disease that kills about 200,000 young children and babies each year.

As reported by NPR in November, pharmaceutical giant Merck & Co. Inc. announced it was terminating a long-term agreement to provide Rotateq, its rotavirus vaccine, at a discounted price to families of four West African countries. At the same time, the company started selling the vaccine in China at more than 12 times its price.

Merck's decision meant that more than two million babies were at risk of missing the vaccine, health experts told NPR.

"You have a major vaccine manufacturer announcing its exit from the market, which has created a bit of panic for countries accustomed to having this vaccine," says Deborah Atherly of PATH, a non-profit organization. develop vaccines for low-income countries.

Now the situation has changed – for good.

After NPR announced the withdrawal of Merck, other vaccine manufacturers mobilized to fill the void. "Thanks to these efforts, very few, if any, children will miss rotavirus vaccination in these four countries," Gavi wrote to NPR in an e-mail.

It's a huge achievement, says Atherly. "We face tons of global health challenges, and this is the case in which the global health community, gathered with countries, has really created success."

Rotavirus is an ubiquitous infection. "Almost all children, whether you live in the United States or in a developing country, are infected with this disease," says Dr. Mathuram Santosham, pediatrician at Johns Hopkins University, who has been studying the disease for more than 40 years.

In rich countries, infections are rarely fatal but can be serious. Prior to the introduction of the rotavirus vaccine in the United States in 2006, infections resulted in more than 50,000 hospitalizations each year, says the Center for Disease Control and Prevention.

In poor countries, without good health care systems, rotavirus can be deadly. Children can have six to 20 bouts of diarrhea a day and dehydrate extremely quickly, says Santosham. "It is especially important that children in the poorest countries – and those in the poorest countries in poor countries – receive this vaccine."

But the vaccine is expensive. Here in the United States, a course costs about $ 200 two to three injections administered during the first year of a baby's life. Thus, in 2012, the two companies producing a vaccine, Merck and GlaxoSmithKline, agreed to significantly reduce the price for poor countries to about $ 10 a share.

For six years, pharmaceutical companies have complied with these agreements. GSK has supplied nearly 220 million doses to 42 countries worldwide. And Merck has distributed more than 30 million doses to four West African countries – Burkina Faso, Côte d'Ivoire, Mali and Sao Tome and Principe.

But last year, Merck informed UNICEF and Gavi that she would not be sending one third of those doses in 2018 and 2019. And by 2020, the company would stop providing the vaccine in West Africa. The company told NPR that "supply constraints" prevented it from respecting its agreement with the countries of West Africa. The company also expressed "its deepest regrets to all concerned" in an email addressed to NPR.

It seemed that more than 2 million babies would be without the vaccine. At that time, GSK had told NPR not to be able to help West African countries because it was experiencing supply problems. "We also can not confirm the availability of doses needed to support new programs in 2019," the company wrote in an email.

But after the NPR story was released, GSK changed course. The company currently fills nearly half of the vaccine deficit left by Merck. Earlier this year, GSK began supplying Rotarix to Ivory Coast, where nearly a million babies are born every year. "GSK is excited about its ability and hopes to meet Rotarix's demand in Côte d'Ivoire as long as necessary, "said a spokesperson at NPR.

The other part of the vaccine shortage will be largely filled by one of the two Indian pharmaceutical companies. Last year, the World Health Organization recommended two new vaccines, Rotavac and Rotasill, manufactured by Bharat Pharmaceuticals and Serum Institute of India, respectively. In November, health experts had announced that three countries in West Africa – Mali, Burkina Faso and Sao Tome and Principe – would eventually switch to these vaccines. But that should take at least two years.

Now all three countries are speeding up the schedule and plan to roll out the new vaccine by 2020, said Heather Deehan, head of the UNICEF Immunization Center. Meanwhile, countries rely on Merck vaccine stocks to continue vaccinations.

"Through close collaboration between UNICEF, countries and manufacturers, country immunization programs have not been interrupted," said Deehan.

In a follow-up interview with NPR, Michael Nally, Merck's chief marketing officer, said that one of the reasons the company had terminated its deal with Gavi was that competing vaccines were more desirable for low-income countries than Rotateq. The GSK vaccine requires one less dose, while the Indian vaccines will be less expensive.

"We had to argue, we probably will not be the product of choice in these markets," said Nally.

In the meantime, Merck has successfully launched Rotateq sales in China. The vaccine is now available in at least seven Chinese provinces and a course costs about $ 130, about 12 times the cost of the vaccine in West Africa. The Chinese distributor of Merck, Chongqing Zhifei Biological Products Co., hopes to obtain more than 450 million dollars of this vaccine in the coming years.

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