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New and underutilized vaccines are becoming available to combat important public health challenges.Each year, rotavirus is estimated to cause approximately 111 million episodes of gastroenteritis, which requires home care, 25 million clinic visits, 2 million hospitalizations, and approximately 440,000 deaths in children younger than 5 years of age worldwide.Children in the poorest countries account for 82% of rotavirus deaths.An estimated 16,000 deaths by rotavirus-induced diar-Editor's note: The thoughtful article by Dr. Andrus and his colleagues in describing the utility of the Pan American Health Organization's (PAHO's) ProVac model 1 reminds us of the startling childhood and adult disease statistics.Whether it is the 440,000 gastroenteritis annual deaths in children younger than age 5 or the 32,000 annual deaths from papillomavirus-with more than 80% in poor and developing countries-these numbers are staggering.Examples such as the experience in Mexico that was described by Santos et al. 2 show the ProVac model can work very well.The authors suggest that three essential factors need to be addressed if agencies and governments are to attain a sustainable impact: decisions should be nationally based; evidence used to support the decisions must be broad-based; and infrastructure must be in place to support a nationally based process.The ProVac program objectives are rather aggressive, with just a five-year horizon to achieve a series of ambitious goals.At the same time, PAHO is honest: the organization recognizes it has little choice but to move in this direction.PAHO can serve as a model for the rest of the developing world.Lessons learned in the ProVac experience will serve many others well as they attempt a similar, if not more aggressive approach.
Robson et al. (Thu,) studied this question.