GAVI's challenges: funding and leadership

Abstract

Since its launch in 2000, the mission of the GAVI Alliance has been to fund vaccination programmes in low-income countries with an annual domestic gross product below US$1000 per head. The Alliance so far has provided access to immunisation for more than 250 million children worldwide, contributed to an estimated 5·4 million saved lives, and protected many more against disabilities. The Alliance's accomplishment has been the result of a unique public–private partnership that has pioneered and supported innovative and performance-based financing and programming-based approaches to global health. By bringing together developing countries, donor governments, research and technical institutes, civil society organisations, vaccine producers, and private philanthropists, the dynamics of the global vaccine market have changed through sustainable supply, research, competition, and price reduction. The current 5-year goal of GAVI is to expand by 2015 its vaccination programmes to include combined vaccine against diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae type B, together with pneumococcal and rotavirus vaccines. This initiative needs $7 billion in funding. So far, only $2·7 billion has been secured. The funding shortfall of $4·3 billion must be solved by June, 2011, during GAVI's pledging conference if more than 4 million child deaths are to be prevented. The Alliance's future will depend on its soon to be appointed new leader, who must be an excellent fundraiser. GAVI depends too heavily on one foundation and the changing priorities of core donor countries. The new leader must be a strong global advocate to endorse vaccination as one of the most cost-effective health and developmental interventions, and one that is crucial for achieving the Millennium Development Goals. The individual must also be a passionate campaigner in promoting children's immunisation as a global public good and a shared responsibility of the world community—by being the voice of millions of children threatened by a preventable illness. Immunisation is far overdue to become a right rather than a privilege. The GAVI Alliance's new vaccine strategyOn June 25, the GAVI Alliance launched its 5-year vaccine strategy, announcing plans to focus attention on seven key diseases: cervical cancer, cholera, Japanese encephalitis, meningitis A, rabies, rubella, and typhoid. This is a huge leap for the Alliance, with a change in both its long-term aims and its strategic approach. At conception, the GAVI Alliance aimed to support immunisation programmes in 72 poor countries across the world, as a means of reducing the global under-5 mortality rate. This new strategy continues here, but also hopes to reduce the overall disease burden in these countries—hence the inclusion of diseases such as cervical cancer, which affects half a million women a year, and rabies, for which vaccination is the only effective option. Full-Text PDF Vaccines and the world of child healthFor those in developed countries the few vaccinations of our early years are a distant memory. It is easy to take for granted not only the invisible and longlasting protective veil that vaccinations draw against potentially fatal infectious diseases, but also the public health transformation wrought by vaccines and other interventions in the past century. Our enviable life expectancy and economic success both depend on them. Full-Text PDF GAVI's Advance Market CommitmentThe World Report on GAVI's Advance Market Commitment (AMC; Dec 5, p 1879)1 contains irreconcilable claims by GAVI and reveals the inability of the AMC approach to make new vaccines available to low-income countries on a sustainable basis. Full-Text PDF The GAVI, Global Fund, and World Bank joint funding platformOn Sept 23, the Taskforce on Innovative International Financing for Health Systems presented its report to the UN General Assembly.1 It proposed more aid for health systems, recognising that, currently, more than 50% of health aid is for infectious diseases, mostly HIV, with little for basic services. In response, GAVI, the Global Fund, and the World Bank are forming a Joint Funding Platform2 and significant new financing is expected. Full-Text PDF Vaccine coverage and the GAVI Alliance Immunization Services Support initiativeEnsuring robust data-collection systems is a significant challenge in resource-poor countries. The research on data quality, WHO-UNICEF estimates, and the GAVI Alliance Immunization Services Support (ISS) initiative by the Institute for Health Metrics and Evaluation (IHME; Dec 13, p 2031)1 is, therefore, of great added value. In particular we welcome a wider debate on results-based financing, as a number of donor agencies and governments seek to introduce such instruments to achieve better results in development. Full-Text PDF GAVI enters its second decade with massive funding gapAs governments pull back on aid commitments, the GAVI Alliance is facing a funding shortfall for the next decade that could hamper the roll-out of new vaccines. Ann Danaiya Usher reports. Full-Text PDF