Contribution of the GAVI Alliance to improving health and reducing poverty

Abstract

The Global Alliance for Vaccines and Immunization (GAVI), now 10 years old, was established as a successful and innovative public -private partnership to deal with a fundamental inequity. The poorest children in the poorest parts of the world were being denied access to life-saving vaccines simply on the basis of cost. GAVI has been successful in mobilizing significant funding from donors and through innovative financing instruments, immunizing large numbers of children. GAVI has been less successful, at least in the time frames first envisaged, at quickly reducing the prices of new and under-used vaccines to levels affordable by the poorest countries. Vaccines remain some of the most cost effective of public health interventions. As GAVI seeks to introduce a new set of vaccines to tackle major killers such as pneumonia and diarrhoea, and emerging threats such as cervical cancer, it needs to raise significant additional funds. There is no single solution. Multiple and new instruments will be required to raise finance both globally and at the country level, and also to incentivize industry and others to provide vaccines at affordable prices to the poorest countries.

Vaccines and global health

“…Development of a new vaccine from first concept to a licensed product is an expensive process, perhaps costing as much $500 -1000 million. It is estimated that by 2030 there may be as many as 20 vaccines in routine use [40] whose application across the world might cost as much as $20 billion a year, a sum far in excess of the $1 -2 billion a year currently available to GAVI [39]. It cannot be expected that donors will contribute all the additional funds required and increasing contributions from recipient countries will be needed.…”

“…GAVI has developed a number of innovative approaches to the funding of vaccines for developing countries including establishing the Innovative Financing Facility for Immunization (IFFMIm) which raises bonds on the private financial markets which are guaranteed by donors. Another approach towards making new vaccines more affordable has been the establishment of the advanced market commitment which has initially focused on pneumococcal conjugate vaccines [39]. This project has raised over $2 billion for the purchase of pneumococcal conjugate vaccines that meet specified criteria at a lower than market price but one that it is still acceptable to the manufacturer and guaranteed over a set period of years.…”

“…Vaccines costing $40 -$50 a dose will not be used in developing countries. To facilitate the introduction of new vaccines in poor countries, GAVI subsidizes their cost in countries with an average national income of less than $1000, covering the difference between the contribution from the national vaccination programme and the costs charged by the manufacturer [39]. GAVI has developed a number of innovative approaches to the funding of vaccines for developing countries including establishing the Innovative Financing Facility for Immunization (IFFMIm) which raises bonds on the private financial markets which are guaranteed by donors.…”

“…To prevent this happening again with other new vaccines, GAVI was established by WHO, the United Nations Childern's Fund (UNICEF), the World Bank and the Bill and Melinda Gates Foundation in 2000 to make existing and new vaccines more widely available in the developing world, as described in the papers by Lob-Levyt [39] and Nossal [40]. GAVI established two Accelerated Development and Introduction Plans (ADIPs) to support the introduction of pneumococcal conjugate and rotavirus vaccines into the national immunization programmes of the developing countries where these vaccines would be an appropriate intervention.…”

World Health Organization perspectives on the contribution of the Global Alliance for Vaccines and Immunization on reducing child mortality

“…Increasing DTP vaccination coverage has led to a marked decline in Hib meningitis in countries for which impact has been measured 22. For example, in Uganda, ‘infant immunization with Hib vaccine has virtually eliminated Hib meningitis in Uganda within 5 years’, with vaccination preventing 28 000 cases of pneumonia and 5000 deaths per year, according to a 2008 study 23…”