Vesta Richardson, MD
Ministry of Health, Mexico
In this edition of the Rotavirus Champion Interview Series, Dr. Vesta Richardson explains how data-focused advocacy for child health in Mexico enabled policy makers to use sin tax revenue to invest in a new childhood vaccine and save thousands of lives per year.
Dr. Richardson, a clinical pediatrician and ROTA advisor who earlier led Mexico’s National Center for Child and Adolescent Health, explains how policy makers accomplished this. She also explains how the pandemic has strained Mexico’s vaccine program, jeopardizing progress.
“The challenge now is to get children up to date on their shots by bringing the vaccines out of the medical units and into safe, open air public places.”
– Vesta Richardson
What data signaled the need for rotavirus vaccine in Mexico?
When I joined the National Center at the end of 2006, rotavirus was a large burden to the health system and a major cause of death in young children. Diarrheal disease was the fourth leading cause of hospitalizations in children <5 and the second leading cause of outpatient medical visits.
What’s more, 7% of all deaths in children <5 were due to diarrheal disease—up to 2,000 deaths per year. At least 4 out of 10 of these deaths were due to rotavirus.
Although there was a marked reduction in deaths since Mexico introduced oral rehydration, and when water chlorination became mandatory in 1990, there were still peaks of deaths, especially during the winter. Deaths plateaued until we introduced rotavirus vaccine.
Did you know? WASH interventions are critical to reduce diarrheal disease cases, hospitalizations, and deaths, but only rotavirus vaccines will prevent this form of severe diarrheal disease, prevalent in low- and high-income countries alike in the absence of vaccination.
How did advocates make a case for rotavirus vaccination in Mexico?
As the head of Mexico’s National Center for Child and Adolescent Health, my role was to advocate with input from a group of national experts. We gathered evidence to support universal introduction of rotavirus vaccine, not only in the poor municipalities but for all children under a year old. Advocacy from the Minister and the vice minister really made a difference and the vote to introduce rotavirus vaccine was unanimous at the National Vaccination Council.
How did you fund the rotavirus vaccine?
Mexico had a Minister of Health that besides being a public health expert was a great economist, and he had figured out that there should be a pocket of resources from cigarettes, soda, and junk food taxes to allocate for public health measures. This idea may help other countries: tax what’s harmful for public health to finance crucial vaccines like rotavirus.
Was the vaccine well received by the public?
Rotavirus vaccine was very well received. Mothers and grandmothers in Mexico have seen several diseases disappear thanks to vaccines—first smallpox, then diphtheria, then wild poliovirus, and endemic measles. So, mothers and grandmothers love vaccines, and they trust doctors and nurses.
My mother used to tell me how she was the first one in line when the polio vaccine got into Mexico. One of her best friends had a child who had suffered polio and she didn’t want me to get it, so she was the first one in line.
Coverage estimates, being from 2019, do not reflect pandemic-related disruptions. Read more about Mexico’s rotavirus vaccine story on this country experiences map.
How has the pandemic affected the provision of routine immunization for children?
During this pandemic, people have avoided going to health centers and hospitals because they don’t want to risk getting COVID disease. Coverage rates have declined, probably under 80%. The challenge now is to get children up to date on their shots by bringing the vaccines out of the medical units and into safe, open air public places.
What was the impact of rotavirus vaccine in Mexico?
I am proud that Mexico was the first country to publish evidence of the impact of rotavirus vaccine on infant mortality, with support from Manish Patel and Umesh Parashar at the CDC. Together we were able to prove in a couple of years, that there was a 41% reduction in gastroenteritis mortality in children <1, 29% in children 12-23 months, and an overall 35% reduction in children under 5. And the reductions have been progressive and sustained for at least 10 years. Especially during rotavirus season—see peaks on graph below—deaths have decreased 67% in children <5. This means saving at least 1,000 lives every year.