Diarrhoeal disease causes around 17% of deaths in children under 5 years worldwide.1 Hence, effective interventions are crucial to reaching the fourth millennium development goal of reducing mortality by two thirds in children under 5 between 1990 and 2015.2 Oral rehydration therapy is a highly cost effective intervention and has been described as one of the most important public health advances of the 20th century. A packet of oral rehydration salts costs only a few cents. However, because of a breakdown of health services in some of the world’s poorest communities, its use is not expanding and is actually falling in some countries. As a result, children are still dying from this curable disease.

Rotavirus causes about a third of diarrhoea related mortality worldwide.3 The linked study by Rose and colleagues (doi:10.1136/bmj.b3653) shows that although a newly licensed oral rotavirus vaccine is considered to be cost effective in India, the costs of introducing the vaccine are as much as 11.6% of the total budget of the Indian Ministry …