Date of Award

January 2024

Document Type


Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Virginia Pitzer


Rotavirus is the leading cause of cases and deaths related to diarrhea-related hospitalizations among children under five worldwide, especially in low- and middle- income countries. Although vaccination is proven to be the best strategy for preventing rotavirus, its impact has been suboptimal in LMICs.

The primary aim of this study was to evaluate the impact of and cost- effectiveness of the current Rotarix rotavirus vaccine, two alternative vaccine delivery schedules, and the next-generation vaccine (RV3-BB) in Malawi.

The cost-effectiveness of rotavirus vaccine strategies in Malawi was evaluated using moderate-to-severe and non-severe rotavirus cases derived from a mathematical model ofrotavirus transmission dynamics and published estimates of health-seeking behaviors and costs as inputs. A probabilistic sensitivity analysis was performed to evaluate the robustness of the model. Cost-effectiveness was evaluated from both the payer and societal perspectives.

Over ten years, the current two-dose strategy averts over 2 million cases and costs $95 per DALY averted compared to no vaccination. Adding a third dose at 14 weeks could avert over 600,000 cases and cost $94 per DALY averted compared to the current strategy. The neonatal RV3-BB vaccine could avert over 100,000 disability-adjusted life- years (DALYs) due to rotavirus and saves $190 per DALY averted compared to the current strategy.

The current vaccine program is cost-effective, reduces burden, and saves lives, and it should be sustained. However, switching to the neonatal RV3-BB vaccine is the most cost-effective, and in the absence of this vaccine, a three-dose alternative to the current strategy is preferred.


This thesis is restricted to Yale network users only. It will be made publicly available on 05/07/2025