GAVI's impact

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Since 2000, GAVI has prevented approximately six million future deaths.
All countries eligible for support have applied for at least one vaccine

440m additional children immunised

Since 2000, an additional 440 million children have been immunised against leading vaccine-preventable diseases in the world's poorest countries with GAVI support, preventing approximately six million future deaths.

US$ 8.4 billion committed to countries

US$ 8.4 billion committed to countries
Source: GAVI Alliance data as at 31 August 2013

GAVI-supported vaccine campaigns have resulted in a further 100 million individuals being immunised against meningitis A and 68 million against yellow fever since 2000.

As of 31 August 2013, GAVI has committed US$ 8.4 billion in programme support until 2016 to developing countries, of which almost 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

The historic gap in access to immunisation between low- and high-income countries is starting to close. In 2000, virtually no low-income countries had introduced vaccines against hepatitis B and Haemophilus influenzae type b, even though these were widely available to children in high-income countries. By the end of 2012, all but one of the world's low-income countries had included the two vaccines in their national immunisation programmes.

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

Driving equity in vaccine access - Pneumococcal vaccine

Driving equity in Pneumococcal vaccine access
Source: The International Vaccine Access Center (IVAC).
Country income categories (World Bank) as of July 2012 (2011 GNI per capita)

Pneumococcal and rotavirus vaccines

Prior to the launch of GAVI, it was common for 10 to 15 years to pass between the time a vaccine was developed and the time it was introduced in developing countries. In 2010, Nicaragua was the first GAVI-supported country to introduce a new pneumococcal vaccine -- less than a year after the vaccine was first licensed. By the end of 2012, 24 developing countries had started to introduce the pneumococcal vaccine with GAVI support, including the first-ever dual introduction of pneumococcal and rotavirus vaccines in both Ghana and Tanzania; pneumococcal vaccine will soon be part of routine immunisation programmes in more than half of all GAVI-eligible countries.

Pentavalent vaccine

By 31 December 2012, over 30 GAVI-eligible countries had been approved for support for vaccines against rotavirus, the main cause of deadly diarrhoea in children.

By the end of 2014, all 73 countries that GAVI works with will have introduced the 5-in-1 pentavalent vaccine, which protects against diphtheria-tetanus-pertussis, hepatitis B and Haemophilus influenzae type b - exceeding GAVI's end-2015 target of 69 countries.

Driving equity in vaccine access - Hep B

Driving equity in vaccine access : Hepatitis B
Source: The International Vaccine Access Center (IVAC).
Country income categories (World Bank) as of July 2012 (2011 GNI per capita)

Driving equity in vaccine access - Hib

Driving equity in vaccine access : Hib
Source: The International Vaccine Access Center (IVAC).
Country income categories (World Bank) as of July 2012 (2011 GNI per capita)

Vaccines against HPV and measles rubella

Similarly, GAVI support is accelerating access to vaccines against human papillomavirus, the main cause of cervical cancer, for adolescent girls in developing countries and the combined measles-rubella vaccine. To date, 10 countries have been approved for support for HPV vaccine demonstration projects.

Meningococcal A vaccine impact in the meningitis belt

Seasonal meningitis A epidemics threaten the lives of the 450 million people in the meningitis belt, which stretches across 26 African countries from the Gambia in the west to Eritrea in the east. Together with partners, GAVI helps to support the introduction of a new meningococcal A vaccine developed in 2010. Since the start of 2011, seven countries have launched new campaigns against meningitis A, including Burkina Faso, Mali and Niger. In these latter three countries, the number of confirmed cases of meningitis A dropped from a collective 1,512 in 2009 to 0 in 2012.

Impact in the meningitis belt

Impact in the meningitis belt (as of the end of 2012)
Source: GAVI 2013

Immunisation rates in low-income countries have risen to their highest rates ever

A strong platform

DTP3 rates in low-income countries
Source: WHO/UNICEF vaccine coverage estimates (July 2013).
Country income categories (World Bank) as of July 2013 (2012 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 74 percent in GAVI-supported 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.

Support for health system strengthening (HSS) has laid the foundations for vaccine delivery to even the most remote village. Since 2000, more than 70 countries had received support to HSS and immunisation services from GAVI, supporting more widespread and equitable access to immunisation and other health services.

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.

 


1 Source: WHO-UNICEF coverage estimates for 1980-2009, as of July 2010; WHO ICE- T coverage projections for 2010-2011, as of September 2010; World Population Prospects, the 2008 revision. New York, United Nations, 2009; (surviving infants).

GAVI is shaping the vaccine market to the benefit of the developing world

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 HPV vaccine price - Source: GAVI Alliance, UNICEF Supply Division, 2013

Reduction in HPV vaccine price
Source: GAVI Alliance, UNICEF Supply Division, 2013

Reduction in HPV vaccine price

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.

GAVI works with manufacturers to bring down human papillomavirus (HPV) vaccine prices. In 2013, a new price of US$ 4.50 per dose was agreed, a two-thirds reduction on the current lowest public price.




Number of manufacturers and price decline of pentavalent vaccine

Number of manufacturers and price decline of pentavalent vaccine
Source: UNICEF Supply Division, 2013

Pentavalent infographic preview

View infographic: 10 years of turning up the volume on the pentavalent vaccine

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 April 2013, this had increased to five manufacturers, three of which were based in middle-income countries;
  • while the weighted average price for pentavalent vaccine has declined steadily, a tender in early 2013 also resulted in a record low price for pentavalent vaccine of US$ 1.19 per dose. This is a reduction of more than 60% compared to the 2010 weighted average price of US$ 2.98 and will have a potential impact of up to US$ 150 million over the next four years compared with previous lowest-cost alternative suppliers. This price drop will allow GAVI to immunise many more children against diphtheria, tetanus, pertussis, Haemophilus influenzae type b and hepatitis B.







Tiered pricing

Tiered pricing: vaccine prices in different markets
Source: UNICEF Supply Division, CDC

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 developing countries.


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 middle-income countries.

GAVI develops ground-breaking market-based financing solutions to raise large-scale predictable funds 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-September 2013, IFFIm raised US$ 4.55 billion in additional finance for GAVI programmes.

IFFIm donor contributions and bond issuances

IFFIm donor contributions and bond issuances
Source: World Bank, July 2013


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 were developed.

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.

More GAVI-eligible countries than ever are contributing a share of their vaccine costs

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.

How GAVI's co-financing policy works

How GAVI's co-financing policy works
Source: GAVI Alliance 2013

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

  • 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.

More than 60 countries co-financing

Of the 67 countries required to co-finance in 2012, 64 had fulfilled the requirements by August 2013.

Three highly committed countries chose to start co-financing their vaccines before the mandatory starting date, and many others are co-financing at higher levels than the minimum requirement.

More on this topic

GAVI has recognised the intrinsic link between women's and children's health

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By preventing more than five million premature deaths since 2000, 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 and 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

Immunisation contributes to gender equity

Research by WHO's Strategic Advisory Group of Experts shows that, globally, girls and boys have the same access to life-saving vaccines - although exceptions exist in settings with high gender inequality. Since 2009, GAVI implements a gender policy that aims to ensure all girls, boys, women and men have equal access to immunisation and health services.

From 2013, GAVI is supporting two vaccines that directly benefit women's health:

  • Human papillomavirus (HPV) vaccine helps 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.

 


440 million

Since 2000, 440 million additional children have been immunised through GAVI support to routine immunisation in the world's poorest countries.

WHO-UNICEF 2013

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