Merck is ending an agreement to supply a life-saving virus to low-income countries at reduced costs due to supply issues, but will begin selling the vaccine to China.

Pharmaceutical company Merck & Co., Inc. has ended a long-term agreement to supply life-saving rotavirus vaccines to countries in West Africa due to “supply constraints,” according to National Public Radio. Merck has instead just begun to sell the rotavirus vaccine, RotaTeq, to China, most likely for a much higher price.

Last April, Merck received approval to begin selling the vaccine in China where sales are expected to bring the company $80 million every year.

Merck had agreed in 2011 to sell the vaccine in low-income countries for a reduced cost of about $3.50 per dose, in the U.S. each dose sells for about $70.

What is Rotavirus?

A potentially deadly form of diarrhea, rotavirus kills approximately 200,000 babies and young children each year, according to the World Health Organization.

By age five, nearly every child globally has been exposed to rotavirus. According to the Centers for Disease Control and Prevention, more than 50,000 children were hospitalized each year due to rotavirus before the U.S. got the vaccine.

In affluent countries, rotavirus can be severe but is rarely deadly. In less affluent countries, however, rotavirus often becomes lethal, Dr. Mathuram Santosham at Johns Hopkins University says. Children with rotavirus can have up to 20 bouts of diarrhea a day.

Dr. Santosham said to NPR: “I’ve seen kids die right in front of my eyes. It’s heartbreaking. So it’s particularly important for the children in the poorest countries—and the poorest children in these countries—to get this vaccine.”

Gavi, the Vaccine Alliance, told NPR in an email that Merck’s decision to end their agreement could mean that a half-million children in the West African countries of Burkina Faso, Mali, Ivory Coast and Sao Tome and Principe could go without the rotavirus vaccine in 2018 and 2019. In 2020, potentially 2 million children could go without it.

Santosham continues, “The rotavirus vaccine is needed in every country, whether you’re affluent or not affluent. So I have no problem with Merck selling the vaccine in China. But kids should not be denied vaccines just because they belong to a poor country.”

Regarding the decision to end the agreement with West Africa and supply the vaccine to China, a spokesperson from Merck indirectly responded to NPR in an email:

“When faced with supply constraints, such as this, we evaluate all options to determine how we can fulfill the agreement we made with UNICEF and GAVI-eligible countries to the best of our ability, while at the same time meet the binding contract demands we have with other countries. The product we have allocated to China is what has been approved for use in that country to fulfill the terms of a binding agreement we signed with a local vaccine company in 2012. As I’m sure you can appreciate, the details of that contract is [sic] proprietary to Merck; as such, we cannot confirm the number of doses nor discuss price.”

New Rotavirus Vaccines are Available but May Take Two Years to Reach Children in West Africa

Fortunately, the World Health Organization pre-qualified two new rotavirus vaccines earlier this year. Both vaccines, Rotavac manufactured by Bharat Biotech and Rotasil manufactured by Serum Institute of India, are made in India.

The only downside is that it could take more than two years for these vaccines to become available on a national scale in West Africa, according to Frederick Cassels, a leader for enteric and diarrheal diseases with PATH Center for Vaccine Innovation and Access.

Although a delay of just a few years could put millions of babies and children at risk for rotavirus, which could devastate a multitude of families in West Africa, Cassels and other advocates for the new vaccines hope they will become readily available in fewer than five years.