GAVI's impact

Additional children immunised (2000-2012)¹

370m additional children immunised

Since 2000, 370 million additional children have been immunised against leading vaccine-preventable diseases in the world's poorest countries with GAVI support.

US$ 7.9 billion committed to countries
Source: GAVI Alliance data as at 31 May 2012

As of the end of August 2012, GAVI has committed US$ 7.9 billion in programme support until 2016 to developing countries, of which 80% has been committed towards the purchase of vaccines.

According to UNICEF's State of the world's vaccines and immunisation (2009), more children are being immunised than ever before and the reversal of the 1990s global decline in immunisation coverage is "directly attributable to the efforts of developing countries making good use of support provided by the GAVI Alliance and partners."

Accelerating access to pneumococcal and rotavirus vaccines

With GAVI support, countries are now introducing new vaccines against the primary causes of two of the biggest childhood killers in the world: pneumonia and severe diarrhoea. Together these diseases account for 30% - nearly one third - of child deaths in low-income countries.

By November 2012, 21 developing countries had already started to introduce the pneumococcal vaccine with GAVI support; the vaccine will soon be part of routine immunisation programmes in more than half of all GAVI-eligible countries.

By 31 December 2011, over 20 GAVI-eligible countries had been approved for support for vaccines against rotavirus, the main cause of deadly diarrhoea in children. As of November 2012, Malawi, Rwanda and Ghana had joined Sudan as the first African nations to introduce rotavirus vaccine with GAVI support.

In addition, 70 countries had introduced the 5-1 pentavalent vaccine, which protects against diphtheria-tetanus-pertussis, hepatitis B and Haemophilus influenzae type b.

Increasing demand

Applications to GAVI for new and underused vaccine support hit a record high in 2011. Countries made a total of 74 applications in the June application round, more than in any previous round.

Two-thirds of GAVI's approved programmes in late 2011 involved the introduction of the pneumococcal and rotavirus vaccines. Country applications approved for rotavirus increased nine-fold and nearly doubled for pneumococcal vaccines.

Countries approved and eligible for GAVI support
Source: GAVI Alliance data as at 31 December 2011

More on this topic

From the GAVI site

Hib Initiative: a GAVI success story

 

China's dramatic fall in hepatitis B infections

 

DTP3 rates in low-income countries
Source: WHO/UNICEF vaccine coverage estimates (July 2012).
Country income categories (World Bank) as of July 2012 (2011 GNI per capita)

Global immunisation rates

Prior to the foundation of GAVI in 2000, diphtheria-tetanus-pertussis (DTP) vaccination rates stood between 60 and 65 percent in low-income countries.

Now the percentage of children in an annual birth cohort receiving three doses of the combined diphtheria, tetanus and pertussis vaccine averages almost 80 percent in low-income countries.

This provides a solid platform for rolling out new life-saving vaccines.

Immunisation services support

According to the State of the world’s vaccine and immunization report, this increase is attributable to the efforts of developing countries, making good use of support provided by GAVI and partners.

In particular, the Alliance's immunisation services support (ISS) has played a key role, offering countries US$ 20 for each additional child vaccinated with DTP3.

Support for health system strengthening and civil society organisations has also laid the foundations for vaccine delivery to even the most remote village. In November 2011, GAVI approved funding for 51 immunisation and health system strengthening programmes for 37 countries, totalling US$ 1.1 billion.

However, with one in five children failing to receive the most basic vaccines against diphtheria, tetanus and pertussis (DTP3) and WHO estimating that 22 million children remain unimmunised, most of them in developing countries, GAVI’s mission is far from accomplished.

Why DTP3?

DPT3 is considered the best indicator of the reach of national immunisation programmes. It takes a fully-functioning immunisation system - trained health workers, robust supply and distribution systems, management and organisation and monitoring - to deliver three separate doses of DTP at the required six, 10 and 14 week intervals.

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From the GAVI site

Reaching the hard to reach in Ethiopia

 

GAVI helps DTP3 coverage rise after stagnation

 

There is evidence of GAVI's initial impact in the changing production and supply base, price declines in some specific vaccines and the entrenching of a tiered pricing approach that means poorer countries pay significantly less for vaccines:

Reduction in rotavirus and HPV vaccine prices
Source: GAVI Alliance, PAHO, UNICEF Supply Division, 2011

Reduction in rotavirus and HPV vaccine prices

As a result of long term supply agreements with manufacturers signed in 2012, GAVI will buy the bulk of rotavirus vaccine at a price of US$ 2.50 per dose (US$ 5 per course), a 67 percent reduction compared to the previous lowest price offered to GAVI of US$ 15 a course.

Another manufacturer offered its human papillomavirus (HPV) vaccine at US$ 5 per dose, a 64 percent reduction on the lowest public price at the time.

As countries prepare to apply for HPV vaccine support for the first time, GAVI is actively pursuing further price reductions from manufacturers.

Number of manufacturers and price decline of pentavalent vaccine
Source: UNICEF Supply Division, 2012

Pentavalent vaccine price falling

GAVI currently buys the majority of its vaccines in the pentavalent vaccine market. Predictable country demand for this vaccine and assured funding from GAVI has attracted new manufacturers to this market and led to a price decline:

• in 2001, GAVI procured vaccines from just one manufacturer. By 2011, this had increased to four manufacturers, two of which were based in emerging market economies;
• in 2011, GAVI paid a weighted average price of US$ 2.49 per dose of the combination pentavalent vaccine, a drop of 31% from US$ 3.61 in 2007 when most GAVI-eligible countries switched to pentavalent. This price drop will allow GAVI to immunise many more children against diphtheria, tetanus, pertussis, Haemophilus influenzae type b and hepatitis B.

Tiered pricing: vaccine prices in different markets
Source: UNICEF Supply Division, CDC Vaccine Price List. 2012

Tiered pricing

GAVI's business model has created an incentive for the pharmaceutical industry to set up a tiered pricing policy, whereby low-income countries are charged less than higher income countries for the same product.

GAVI-eligible countries are now firmly established as the accepted low-income pricing tier, with manufacturers using GAVI countries as a benchmark in their pricing strategies.

GAVI's 2011-2015 strategy includes a market-shaping goal that aims to ensure an adequate supply of vaccines to meet demand and minimise the costs of vaccines to GAVI and low-income countries.

Increasing number of GAVI suppliers based in emerging markets
Source: UNICEF Supply Division, 2011

More emerging market manufacturers

GAVI's ongoing success has signalled to vaccine manufacturers that there is a large and viable market for vaccines in low-income countries.

The emergence of this new market financially backed by GAVI has encouraged market entry, particularly from vaccine manufacturers based in emerging economies. In 2011, GAVI-supported vaccines were purchased from 10 vaccine manufacturers. Of these, five were based in emerging markets, compared with just one in 2001.

More on this topic

From the GAVI site

GAVI approach creates tiered pricing for vaccines

 

GAVI model increases vaccine manufacturers

 

GAVI impact on vaccine market behind price drop

 

From other sites

• International Finance Facility for Immunisation

To implement long-term immunisation programmes, developing countries require large-scale, predictable funding. To generate this kind of finance, GAVI has pioneered two highly innovative financing mechanisms:

International Finance Facility for Immunisation

The International Finance Facility for Immunisation (IFFIm) uses long-term government commitments to raise funds on international capital markets. This gives GAVI access to cash funding now that would otherwise only be available over 20 years. From 2006-2011, IFFIm raised US$ 3.6 billion in additional finance for GAVI programmes.

IFFIm donor contributions and bond issuances
Source: World Bank, July 2012

The Advance Market Commitment

An Advance Market Commitment (AMC) guarantees donors funds for the development of new vaccines. This gives manufacturers an incentive to develop appropriate vaccines for low-income countries. In turn, they legally commit to supplying the vaccines at a lower price; both GAVI and the beneficiary countries agree to pay for the vaccines at the negotiated price.

In 2010-11, the first ground-breaking AMC against pneumococcal disease played a key role in ensuring GAVI could start introducing a new generation of pneumococcal vaccines to developing countries less than a year after they reached industrialised countries.

GAVI Matching Fund

The GAVI Matching Fund, launched in 2011, offers businesses, charities and foundations a way to assist GAVI in fulfilling its mission.

The British Government and the Bill & Melinda Gates Foundation have collectively pledged approximately US$ 130 million to match contributions from corporations, foundations and other organisations, as well as from their customers, employees and business partners.

GAVI aims to raise US$ 260 million for immunisation through the Matching Fund by the end of 2015. Learn more about progress to date.

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From the GAVI site

About the pneumococcal AMC

 

Securing predictable financing

 

Pneumococcal vaccine support

 

GAVI's co-financing policy, by which developing countries contribute towards the cost of vaccines they receive, aims to ensure countries can eventually sustain their immunisation programmes without external support.

The size of the contribution is based on each country's ability to pay. Countries are divided into three groups:

Co-financing: countries fulfilling commitments
Source: GAVI Alliance data as of 19 September 2012

• low-income;
• intermediate;
• graduating.

Low-income countries contribute the least (US$0.20 per dose) while graduating countries are expected to take over the full cost of their vaccines, after five years of gradually increasing their contributions.

93 percent of countries fulfilling requirements

By the end of 2011, more countries than ever were contributing to their vaccine costs. Of the 59 countries required to co-finance in 2011, 55 had fulfilled the requirements by the end of the year -- equivalent to 93 percent.

Four countries defaulted, down from seven in the previous year. Four highly committeed countries chose to co-finance their vaccines head of the mandatory starting date, while six countries fulfilled their commitments to pay more than required.

Co-payments amounted to approximately US$ 37 million in 2011, representing eight percent of the total value of vaccine support to the co-financing countries.

More on this topic

From the GAVI site

Country commitment to co-financing

 

By preventing an estimated five million premature deaths in its first 10 years, GAVI vaccine support has reduced the burden of care on women, freeing their time and avoiding medical expenses that can cripple poor families.

Tetanus

GAVI has helped UNICEF deliver two doses of tetantus vaccine to 40 million women that protect against maternal neonatal tetanus.

Better access to MNCH

Whenever a mother brings her child to a health centre for vaccination, there is an opportunity to deliver maternal child health services that stretch beyond immunisation.

The high reach of immunisation (average 79% coverage in low-income countries) means that often a woman's point of contact with the health system is when she brings her children for immunisation, providing direct access to maternal, newborn and child health (MNCH) services -- family planning, antenatal and postpartum care, nutrition and treatment of childhood illnesses.

Better equipped health systems

GAVI helps ensure that health systems are better equipped to provide MNCH.

HPV and rubella

In future, GAVI plans to support two new vaccines with direct benefits for women's health:

• Human papillomavirus (HPV) vaccine will provide protection from cervical cancer, which claims approximately 275,000 women's lives every year;
• Rubella vaccine prevents congenital rubella syndrome as well as maternal morbidity through reducing miscarriage and stillbirth.

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