What is the value of supporting immunisation?
Immunisation has the potential to save millions of lives every year, as well as to protect against debilitating illness and disability. Vaccines are considered to be one of the “best buys” in public health, often cost-saving in the long run through reductions in healthcare and treatment expenses.
Today more than 30 common infectious diseases are preventable with vaccines. This includes vaccines protecting against major causes of death and illness in developing countries, such as pneumonia, diarrhoea and cervical cancer. The impact of immunisation is further amplified through so-called herd immunity effects, preventing disease even in non-vaccinated individuals.
What is the GAVI Alliance?
The GAVI Alliance is a public-private global health partnership, created in 2000 to save children’s lives and protect people’s health by increasing access to immunisation in the world’s poorest countries. Partners include developing country and donor governments, WHO, UNICEF, the World Bank, the vaccine industry in both industrialised and developing countries, research and technical agencies, civil society organisations, the Bill & Melinda Gates Foundation and other private philanthropists. WHO estimates that GAVI support has directly contributed to developing countries preventing more than 5.5 million future deaths since 2000.
The Alliance is supported by a small Secretariat based in Geneva and Washington, DC.
What differentiates GAVI from other actors involved in immunisation work?
GAVI was not established to compete with other agencies. Rather, the partners chose the alliance model in recognition of the fact that increasing access to immunisation in developing countries relies on strong partnerships. GAVI is more than just the sum of its members – it creates important synergies.
While UNICEF, for instance, works more broadly with children’s rights and WHO advises on health policy, GAVI focuses exclusively on introducing new and underused vaccines in the poorest countries, and on strengthening the systems needed to deliver these vaccines. In addition, GAVI is a funding mechanism, not an implementing agency. It works through national immunisation systems and with partners on the ground to deliver its programmes.
GAVI’s partners have traditionally focused on making vaccines that have been around for many years, such as hepatitis B vaccine, available in developing countries. GAVI funds help to support these efforts, but also to secure access to new life-saving vaccines.
Thanks to its public-private partnership dynamic, GAVI is able to boost government and private funding through innovative financing mechanisms. Further, by bundling country demand and providing predictable financing to meet the demand, GAVI helps attract new manufacturers to the market. This increases healthy competition and reduces vaccine prices in the long term.
The GAVI model has been tested and proved over the past decade, and has paved the way for innovative approaches to development financing.
Why was GAVI created?
At the end of the 1990s immunisation rates were stagnating and, in some areas, even falling. In sub-Saharan Africa, fewer than 50% of all children were being immunised. Three million lives were being lost each year to preventable infectious diseases.
The GAVI partners came together to improve vaccine coverage and accelerate access to new and underused vaccines in the world's poorest countries. This included vaccines widely used in industrialised countries, such as those addressing hepatitis B (hepB) and Haemophilus influenzae type b (Hib), as well as new vaccines against certain forms of pneumonia, meningitis and diarrhoea.
Who are the members of the GAVI Alliance?
The GAVI Alliance brings together all stakeholders that contribute to increasing access to immunisation in poor countries. These are the members of the GAVI Alliance Board.
The Bill & Melinda Gates Foundation is one of the founding partners of the GAVI Alliance. Its initial grant helped establish the Alliance, and it continues to support GAVI programmes.
Civil society organisations deliver a large portion of health and immunisation services in many developing countries. They also play a pivotal role in advocacy and policy development.
Developing country governments are the central partners of the Alliance. They identify their immunisation and health system strengthening needs, proactively apply for GAVI funding, implement programmes, and ensure effective and sustainable planning.
Donor country governments provide steady, predictable funding through Official Development Assistance (ODA).
Research and technical health institutes bring their knowledge and experience to the Alliance, keep the research community abreast of GAVI policy decisions, and help build capacity for research and development.
Unaffiliated Board members bring independent scrutiny to Board deliberations and provide expertise in a range of areas, such as investment, auditing, advocacy and fundraising.
UNICEF sources and procures vaccines, provides technical assistance, and helps raise awareness of and support for child immunisation at the national, regional and international level.
The developing country vaccine industry and the industrialised country vaccine industry have the research and production capacity to provide appropriate vaccines for developing countries.
WHO works at the national, regional and global level to develop policies and strategies for immunisation and vaccine use; provide normative guidance, quality assurance and quality control of vaccines; and give technical health support.
The World Bank Group plays a key role in innovative financing and helps implementing governments develop sustainable financing for health systems, including immunisation services.
How is the GAVI Alliance organised?
The GAVI Alliance Board reflects the public-private partnership dynamic of the Alliance. One third of the membership comprises independent unaffiliated individuals, who contribute their personal skills and networks. Two thirds of the members represent constituencies and organisations.
There are four renewable members representing WHO, UNICEF, World Bank and the Bill & Melinda Gates Foundation; fourteen rotating members representing the other Alliance partners; and nine unaffiliated Board members. The CEO of the GAVI Alliance Secretariat serves on the Board in a non-voting seat.
The Board is currently chaired by Dagfinn Høybråten, former Minister of Health of Norway. It meets twice per year.
What are GAVI’s achievements so far?
Since its launch in 2000, the Alliance has supported the immunisation of more than 325 million children. By the end of 2010, GAVI-funded vaccines had helped developing countries to prevent over 5.5 million future deaths caused by hepatitis B, Hib, pertussis, measles, yellow fever, pneumococcal disease, rotavirus diarrhoea and polio. Immunisation coverage in GAVI-eligible countries for three doses of the diphtheria-tetanus-pertussis vaccine (DTP3) rose from just over 65% in 2000 to 82% in 2011.
GAVI has played a pivotal role in increasing access to underused vaccines, such as those protecting against Hib and hepB. Through the introduction of Hib vaccine, Hib meningitis has been virtually eradicated in many sub-Saharan countries, including Uganda, Malawi and Zambia. HepB vaccine is now part of routine immunisation programmes in almost all low-income countries.
Through a catalytic programme of support, GAVI has helped set new standards for injection safety. Most low-income countries are now using auto-disable syringes and other injection safety tools, which prevent the potential spread of infectious disease.
Since GAVI was created, the number of children dying before reaching their fifth birthday has continuously gone down, falling below 8 million in 2010 for the first time on record.
What does GAVI do to make vaccines more affordable for the world’s poorest countries?
The GAVI business model fosters a healthy vaccine market by mobilising large financial resources, encouraging and pooling growing demand from developing countries, attracting new manufacturers and increasing competition to drive down prices.
The weighted average price projection for pentavalent vaccine for 2011 fell to US$ 2.58 – a reduction of almost US$ 0.40 compared with the year before. This represent a decrease of 30%. The price drop will allow GAVI to immunise many more children with pentavalent vaccine.
Through the Advance Market Commitment (AMC), pneumococcal vaccines will be available in GAVI-eligible countries at no more than US$ 3.50 per dose, subject to inflation adjustments. This is less than 5% of the public market price in the USA.
The entry of new vaccine manufacturers has risen in tandem with GAVI-funded purchases. In 2006, UNICEF was purchasing less than 50 million doses of pentavalent vaccine. Three years later, the number of doses purchased had risen to 100 million.
What is the role of the pharmaceutical industry in the GAVI Alliance?
Vaccines are different from drugs, and the development and production of vaccines involve unique technical challenges and costs. There are a small but growing number of pharmaceutical companies that produce vaccines for the global market. GAVI only supports vaccines that have been approved for use by WHO.
By bundling the vaccine demand from GAVI-eligible countries and mobilising significant funds to meet this demand, GAVI has had a big impact on the vaccine market. Suppliers now have the incentive to increase their production capacity and develop vaccines that are adapted to the needs of developing countries.
Increased competition between suppliers also results in product innovations, such as new antigen combinations, formulations and administration routes, and helps drive down vaccine prices.
Although newer vaccines, including rotavirus and pneumococcal vaccines, are currently only available from companies based in industrialised countries, developing country manufacturers are expected to start producing these within the next five years.
Two associations representing the vaccine industry in developing and industrialised countries, the Developing Country Vaccine Manufacturers Network and the International Federation of Pharmaceutical Manufacturers and Associations, hold one seat each on the GAVI Alliance Board. The two Board members representing the vaccine industry are recused from voting on issues where there is a potential for conflict of interest, such as those relating to vaccine procurement and strategy.
Which countries are eligible for GAVI support?
GAVI finances programmes in the poorest countries in the world, with a gross national income (GNI) per capita of below US$ 1,000. In order for a country to qualify for new vaccine support, its DTP3 coverage must be at least 50%.
From January 2011, GAVI applies an eligibility threshold of US$ 1,500 per capita GNI and 70% DTP3 coverage. As per the new eligibility criteria, there are 56 GAVI-eligible countries. However, all 72 countries are exceptionally able to apply for new support in 2011.
Existing support to countries will be honoured through to the end of multi-year commitments and, for vaccine support, at least until 2015.
What kind of support can countries apply for?
Countries can apply for new and underused vaccine support; health system strengthening support; support to civil society involvement in immunisation planning and delivery; immunisation services support (performance-based cash support) and injection safety support.
Which vaccines does GAVI support?
GAVI supports the introduction of vaccines against Hib, hepB, yellow fever and measles (second dose), as well as meningitis and yellow fever vaccine emergency stockpiles. Countries can also apply for support for pneumococcal and rotavirus vaccines, which address the main killers of children under five worldwide. In addition, GAVI has prioritised vaccines against HPV (the main cause of cervical cancer), Japanese encephalitis, rubella and typhoid for future support.
How is GAVI involved in health system strengthening?
Strong health systems are a prerequisite for expanding and maintaining immunisation coverage. By the end of 2009, 45 countries had successfully applied for GAVI health system strengthening (HSS) support. Areas approved for funding include human resource development, training and incentives, infrastructure, and management capacity building.
Support is provided for the duration of the national health plan, and funding levels are determined by the size of the country’s birth cohort and national income per capita.
With support from WHO, GAVI is developing a platform for funding health systems together with the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Bank. The platform harmonises and aligns health system support to countries around the national plan and a single monitoring framework. This will reduce transaction costs for countries receiving support, and thus help accelerate progress towards the Millennium Development Goals.
How does GAVI decide which programmes to fund?
All funding decisions are based on proposals received from countries. Proposals are reviewed by an Independent Review Committee (IRC), which provides its recommendations to the GAVI Alliance Board. IRC members are not connected to GAVI, and are selected for their expertise in public health and knowledge of vaccines and immunisation in developing country contexts.
How does GAVI ensure the sustainability of its programmes?
Financial sustainability has been a key principle for GAVI since its inception. GAVI’s co-financing policy encourages countries to make evidence-based decisions on which vaccines to introduce, and to institutionalise vaccine spending in national budgets and health planning.
The level of the contribution by developing countries to the purchase of vaccines is based on their ability to pay. The least poor GAVI-eligible countries are required to gradually increase their co-financing contributions over time. In 2010, 90% of the countries required to co-finance did so.
Through proactive efforts to shape vaccine markets, GAVI seeks to ensure access to appropriate vaccines that are affordable to developing countries.
How does GAVI monitor the impact and success of its programmes?
Once approved for funding, countries submit annual progress reports together with a WHO/UNICEF report, which measures progress against performance and quality indicators. The IRC reviews each annual progress report and makes recommendations to the Board on future support.
Who supports the GAVI Alliance?
GAVI is currently supported by 18 donor governments and the European Commission, as well as the Bill & Melinda Gates Foundation, the ”la Caixa” Foundation and individual philanthropists. Donors support GAVI programmes through direct contributions and long-term pledges to the Advance Market Commitment (AMC) and the International Finance Facility for Immunisation (IFFIm).
How does the AMC work?
The Advance Market Commitment (AMC) stimulates the development and manufacture of affordable vaccines, tailored to the needs of developing countries. Donor commitments give vaccine manufacturers the incentive to invest in vaccine research and development, and to expand manufacturing capacity.
In exchange, companies sign legally-binding commitments to provide the vaccines at a long-term, affordable price to developing countries. This enables governments to budget and plan for their immunisation programmes.
A pilot AMC for pneumococcal vaccines is being implemented from 2010. It is estimated that the pneumococcal AMC could save approximately 900,000 lives by 2015 and up to 7 million lives by 2030.
How does IFFIm work?
The International Finance Facility for Immunisation (IFFIm) raises money by issuing bonds on capital markets, converting long-term government pledges into immediately available resources for immunisation and health system strengthening.
By November 2011, IFFIm had raised US$ 3.6 billion for GAVI programmes and targeted immunisation initiatives. IFFIm funding has effectively allowed GAVI to double its spending on immunisation and health system strengthening programmes since 2006.
