Challenges and opportunities

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

The successful resource mobilisation meeting, held in London in June 2011, means GAVI is now well-positioned  to achieve an ambitious immunisation agenda: assist developing countries to immunise a further 245 million children by 2015 and potentially save four million more lives.

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 achieve its agenda

• Donors pledged an additional US$4.3 billion at the GAVI Alliance resource mobilisation meeting in London in June 2011;
• Developing country demand is high, with applications to GAVI for new and underused vaccine support hitting a record high in 2011; by the end of 2011, country applications approved for rotavirus vaccine support had increased nine-fold in 2011 and nearly doubled for pneumococcal vaccine support;
• Pentavalent: GAVI is also on track to achieve its 2013 goal of providing full access to the five-in-one pentavalent (diphtheria-tetanus-pertussis, hepatitis B, Haemophilius influenzae type b to every GAVI eligible country;
• The platform for delivery is ready with routine immunisation rates across low-income countries averaging almost 80 percent.

The potential

Forecasts of future demand in GAVI-supported vaccines project that between 2011 and 2015:

• an additional 180 million children will be vaccinated with the one-in-five pentavalent vaccine;
• more than 80 million children will be immunised with pneumococcal vaccines against the leading cause of pneumonia with GAVI support;
• more than 30 million children will be immunised with rotavirus vaccines;
• almost 230 million people will be protected against meningitis A and close to 125 million are expected to be immunised against yellow fever through vaccine campaigns and routine immunisation;
• in addition, by 2020 more than 30 million girls will have been immunised with human papillomavirus (HPV)vaccines, protecting them against cervical cancer later in life.

Reaching the fifth child

Global immunisation rates may have reached 83 percent in 2012, but this still means that almost one in five children worldwide fail to receive the most basic vaccines against diphtheria, tetanus and pertussis (DTP3).

According to WHO/UNICEF 2011 coverage data, 22 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 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 the light of unprecedented demand from countries, GAVI will also focus, expecially in the short-term, on balancing supply and demand for the new vaccines its funds.

Improving vaccine introduction and performance

The need to improve the vaccine supply chain, the quality of introductions and the subsequent performance will be critical to ensuring equitable access to all children.

This will require real time evaluation of the introductions, including monitoring coverage and data quality, all with a focus on country level performance.

Focus on low-performing countries and sustainability

GAVI will accelerate its engagement with countries that have not yet achieved 70 percent immunisation coverage. Working with these countries to increase their DTP3 coverage rates is one element in GAVI's approach to sustainability but is also relevant to all countries, particularly as they graduate from GAVI 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 under-five deaths in GAVI-eligible countries – 2010 estimate
Source: CHERG, WHO and UNICEF 2012

With the increased funding pledged by GAVI donors in June 2011, GAVI invited eligible countries to apply for support for vaccines against human papillomavirus (HPV) and rubella in March 2012.

Human papillomavirus

Cervical cancer claims the lives of some 275,000 women every year with the vast majority living in developing countries.

New HPV vaccines, which can prevent approximately 70 percent of all cervical cancer cases, have recently been introduced in many wealthy countries. Making these vaccines available to girls in developing countries is vital as they often lack access to cancer screening and treatment services.

Countries will receive GAVI support provided that GAVI can secure acceptable price commitments from manufacturers and countries can prove their ability to deliver the vaccines. The aim is to immunise over 28 million women and girls by 2020.

HPV vaccines offer an exciting opportunity to help countries integrate vaccine delivery with other important interventions for girls such as adolescent reproductive health, HIV prevention, nutrition, family planning and maternal health.

Rubella

When a woman is infected with the rubella virus early in pregnancy, she has a 90 percent 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 of the 112,000 children born with rubella-related birth defects every year, 90,000 are in GAVI-eligible countries.

GAVI's support will help to fight this disease and protect both mothers and babies from its effects. GAVI will build on the success of measles control activities by supporting the combined measles-rubella vaccine.

Beginning in 2012, the Alliance plans to fund catch-up campaigns of measles-rubella vaccine for countries, on the condition they introduce the vaccines into their routine immunisation programmes at their own cost.

GAVI's 2008 vaccine investment strategy also identified two other priority vaccines for future investment:

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.

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.

Support for Japanese encephalitis and typhoid will be considered once appropriate products are prequalified.

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

More on this topic

From the GAVI site

Vaccine investment strategy