Challenges and opportunities

Projected impact of GAVI vaccine support
Source: GAVI Alliance strategic demand forecast February 2010

By targeting the world’s two biggest child killers, pneumonia and diarrhoea, GAVI has the potential to immunise 250 million children by 2015 and prevent another four million future deaths.

Since 2000, the Alliance's impact has averted more than five and a half million future deaths, making a significant contribution toward achieving Millennium Development Goal 4 (MDG4): reducing child mortality by two-thirds before 2015.

That's not to mention the other benefits of preventing illness, such as greater productivity and less out of pocket health expenses for medical treatment that often drives families into poverty.

Everything is ready

Everything is in place for GAVI to seize this opportunity to save more lives:

• New life-saving and cost-effective vaccines offering protection against pneumococcal disease and rotavirus, the leading causes of pneumonia and diarrhoea respectively, are available to low-income countries through GAVI’s programme support;
• The platform for delivery is ready with immunisation coverage now reaching an average 79% of young children;
• Developing country demand is high: by the end of 2011, 61 countries had been approved for support for the pentavalent, the five-in-one vaccine against diphtheria, tetanus and pertussis (DTP), Haemophilus influenzae type b (Hib) and hepatitis B (hepB); 17 for yellow fever vaccine support, 37 for pneumococcal vaccine support and 21 for rotavirus vaccine support.

An independent evaluation of GAVI in 2010 concluded that demand for pneumococcal vaccine, in particular, was greater and faster growing than for any other vaccine to date.

In December 2010, Nicaragua became the first developing country to introduce the pneumococcal vaccine with support from GAVI. Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, The Gambia, Guyana, Honduras, Kenya, Mali, Malawi, Nicaragua, Rwanda, Sierra Leone, Yemen, Burundi and Ethiopia among the first GAVI-eligible countries to start rolling out pneumococcal vaccines in 2010 and 2011.

The potential

Fully resourced, GAVI can:

• Protect the health of 250 million additional children
  90 million children against pneumococcal disease – the leading cause of pneumonia;
  50 million children against rotavirus diarrhoea;
  230 million children with the five-in-one pentavalent vaccine;
  65 million children against yellow fever.
• Provide support for new vaccines against meningitis A, human papillomavirus (HPV) - a leading cause of cervical cancer in women, rubella, typhoid and Japanese encephalitis
• Further strengthen routine immunisation programmes and health services for women and children
  

Equity and the fifth child

Global immunisation rates in developing countries may have reached an historic high of 79%, but this still means that up to one in five children fail to receive the most basic vaccines against diphtheria, tetanus and pertussis (DTP3).

According to WHO’s recent report to the World Health Association, more than 19 million children remain un-vaccinated in the world.

"What of the fifth child -- the child we don't reach?" asked Tony Lake, Executive Director of UNICEF at GAVI's pledging conference in June 2011.

"We cannot rest until we reach that unreached child -- and everyone of the nearly two million children who die every year for the simple want of a simple vaccine."

Children's rights to the highest attainable standard of health are enshrined in the Convention on the Rights of the Child. GAVI is working on three fronts to increase equity of access to immunisation, both within and between countries:

Delivering vaccines to more children

To date, only 48 countries eligible for GAVI support have reached the average 79% immunisation coverage. To ensure life-saving vaccines can reach all sub-national districts in all GAVI-eligible countries, GAVI will continue to support the delivery of vaccines through health system strengthening, civil society support and immunisation services support.

• GAVI is funding WHO to build-up health service capacity in low-income countries where immunisation in districts falls below 70% coverage;
• GAVI is developing a new programme to further increase coverage in districts with the lowest immunisation coverage.

Making vaccines more affordable

The prices of new and underused vaccines supported by GAVI tend to be higher than the prices of traditional childhood vaccines. Lowering the prices of these life-saving vaccines will allow more children to be immunised with a given amount of resources.

GAVI is working to make vaccines more affordable for low- and middle-income countries than they are for their industrialised counterparts. The Alliance’s fourth strategic goal (2011-2015) targets reduced prices, secure supply and an increasing number of manufacturers.

In early June 2011, vaccine industry announcements facilitated by the Alliance included new manufacturers entering the vaccine development market and offers of major price reductions from developing country firms and multinational companies.

Sustainability

Developing country demand for GAVI vaccines has never been higher. In the recent round of applications for GAVI funding, a record 50 countries made 74 applications for new and underused vaccine support.

To enhance country ownership of vaccine financing and set countries on a path to financial sustainability after GAVI support ends, the Alliance requires countries to contribute towards the cost of the vaccines they receive – based on their national capacity to pay. It is expected co-financing will result in a three-fold increase amounting to US$ 100 million in developing countries’ contributions to GAVI-supported vaccines by 2015.

More on this topic

From the GAVI site

Country commitment to co-financing

 

Making vaccines more affordable

 

Health system strengthening support

 

Immunisation services support

Causes of child deaths in low-income countries
Source: WHO, World Health Statistics 2011

With the increased funding pledged by GAVI donors in June 2011, GAVI can start the process of offering support for four new vaccines which were prioritised for future investment in 2008.  These target the diseases which have the greatest burden in developing countries: Human papillomavirus (HPV), Japanese encephalitis, rubella and typhoid.

With the approval of the GAVI Board, the Alliance will work towards opening applications for eligible countries to apply for support to introduce these vaccines.

GAVI is also keeping a close eye on other new vaccines, particularly against malaria and dengue fever, which could have major impacts on the lives and health of people in the developing world.

Human papillomavirus

The HPV vaccine, prioritised in GAVI's new vaccine investment strategy, will protect women from the leading cause of cervical cancer. Eighty percent of cervical cancer cases are among women in the developing world. With full funding, GAVI will support the HPV vaccine.

Japanese encephalitis

Japanese encephalitis (JE) is a seasonal endemic that afflicts parts of China, the Russian Federation's south-east, and South and South-East Asia. Estimated annual mortality ranges from 10-15,000 deaths, while the total number of clinical cases may be as high as 50,000.  GAVI has prioritised JE under its new vaccine investment strategy and, if fully funded, will support its roll-out.

Rubella

When a woman is infected with the rubella virus early in pregnancy, she has a 90% chance of passing the virus on to her fetus. This can cause the death of the fetus, or it may cause congenital rubella syndrome (CRS) - possibly resulting in severe birth defects in the ears, eyes, heart and brain. It is estimated that there are 110 000 cases of CRS each year.  With sufficient resources, GAVI will support immunisation against the rubella virus.

Typhoid

Typhoid remains a serious public health problem around the world, with an estimated 16-33 million cases and 216,000 to 600,000 deaths annually. With full funding, GAVI plans to support typhoid vaccine.

More on this topic

From the GAVI site

Vaccine investment strategy