The GAVI Alliance was launched in 2000 with a mission to accelerate access to new and underused vaccines in the world’s poorest countries. At the time, immunization rates were dropping and the time lag between new vaccine introduction in developed and developing countries was averaging 15 years.
This year, GAVI is celebrating a decade of achievements and taking on an exciting mandate to deliver new vaccines for pneumococcal disease and rotavirus, the top two global disease killers of children worldwide. By 2015, these two vaccines could prevent more than 1 million deaths in GAVI-eligible countries and another 3 million could be averted through expanded coverage of the pentavalent vaccine (DTP-HepB-Hib). GAVI is ready to deliver these vaccines but is currently facing a financing gap of $4.3 billion between 2010 and 2015. Along with a comprehensive strategy to prevent and treat pneumonia, diarrhea, and other childhood illnesses, filling GAVI’s financing gap is critical to helping the world’s poorest countries meet the Millennium Development Goal on child survival by 2015.1
Unique Attributes of GAVI:
GAVI was launched to complement and strengthen existing immunization programs, not to replicate their efforts. While programs through WHO and UNICEF focus broadly on vaccine procurement, delivery, and monitoring, GAVI’s role is to ensure that new and underused vaccines are available to low-income countries at an affordable price and within a shorter time period; and then that countries are prepared and equipped to deliver them.
To do this, the GAVI model includes the following features:
- Market-shaping approach: Pooled purchasing through GAVI has both incentivized the late-stage development of key vaccines and increased the number of vaccine manufacturers (especially in developing countries), which in turn has helped lower prices and ensure a sustainable supply for developing countries.
- Innovative financing: GAVI has also harnessed the power of the private sector to raise long-term, sustainable resources for its programs and guarantee a market for vaccine producers. Through the International Finance Facility for Immunization (IFFIm), for example, donor countries make 10-20 year, legally-binding aid commitments. IFFIm borrows against these pledges on capital markets to front-load funding, which enables countries to rapidly ramp up immunization rates.
- Fiscal sustainability: GAVI introduced a co-financing scheme in 2007 to increase developing countries’ contribution towards vaccine purchases. In 2009, all GAVI countries began co-financing a certain portion of their vaccines based on their ability to pay. And because GAVI support is intended for the world’s poorest countries, only nations with a gross national income (GNI) per capita below US $1500 can apply for GAVI support.
- Coordination with partners: As an alliance, GAVI is pools the strengths and resources of all immunization stakeholders to deliver results beyond what any partner could achieve alone. GAVI’s market-shaping efforts, for example, are possible because it works closely with the private sector and developing countries to ensure that the supply and demand for critical vaccines is functioning properly. Close coordination is also essential at the country level, where GAVI relies on partners such as UNICEF and WHO to procure, deliver and monitor vaccines.
Signs of Impact
By the end of 2009, GAVI had raised $4.8 billion to support efforts in 75 countries for the period 2000-2015. This support helped push basic immunization rates in developing countries to an unprecedented 80 percent average. In GAVI countries, this support has been used to vaccinate more than 326 million children and avert 5.5 million deaths.
More specifically, GAVI has achieved measureable results on the following fronts:
Expanding access to underused vaccines:
GAVI’s first five years were dedicated to widening the use of vaccines for Hepatitis B (HepB), Hib (which causes meningitis and pneumonia), and yellow fever. In an effort to increase uptake of Hib and Hepatatis B vaccines, GAVI also supported the development of the pentavalent vaccine, or “five in one” shot, which protects against Hib and Hepatitis B as well as diphtheria, tetanus, pertussis, which has been adopted in 57 low-income countries.
Accelerating the access to new vaccines:
Since 2003, GAVI has funded two Accelerated Development and Introduction Plans (ADIPS) to hasten the availability of vaccines for pneumococcal disease and rotavirus in low-income countries. In the past, it has taken an average of 15 years for a vaccine introduced in developed countries to reach the developing world. Thanks to GAVI’s support, the pneumococcal and rotavirus vaccines were available seven and two years after their introduction in the United States, respectively, and at an affordable price. For example, the Advanced Market Commitment (AMC) launched by GAVI and its partners helped to stimulate the late-stage development of the pneumococcal vaccine by committing funds towards its purchase ahead of time, while also negotiating a 90% price drop for low-income countries (from $70 to $7).
Reshaping the global vaccine market:
New data shows that GAVI’s efforts to influence the vaccine market by aggregating demand are beginning to have an impact. Over the last three years, the price of the pentavalent vaccine (DTP-HepB-Hib) has dropped from $ 3.62 in 2007 to $ 2.50 in 2012, down 29% since 2007. This translates to a savings of approximately $55 million in savings in 2010 and could enable the immunization of 6.3 million more children. This is partly due to an increase in pentavalent vaccine manufacturers- from one in 2007 to four in 2010 (two in emerging markets). Today, 53% of the vaccines funded by GAVI are from developing country manufacturers.
(1) Millennium Development Goal 4 calls for a two-thirds reduction in child mortality rates between 1990 and 2015.