Gavi at 20 years -
Delivering on the promise of immunisation:
How far have we come?

This blog is co-authored by ACTION’s Yanira Garcia-M (Global Health Analyst) and Save the Children’s Claire Leonie Ward (Health Advocacy Adviser).

Celebrate progress

Today is the 50th anniversary of the World Economic Forum and the 20th anniversary of Gavi, the Vaccine Alliance. There’s lots to celebrate!

Gavi was born in 2000 at the World Economic Forum Annual Meeting in Davos. Since then, Gavi has successfully built a partnership between the public and private sectors to save children’s lives and protect populations’ health by increasing the equitable use of vaccines in lower-income countries. In less than 20 years, the Alliance has contributed to the immunisation of more than 760 million children, preventing more than 13 million deaths.

Gavi is arguably one of the most successful partnerships born out of the collaboration and entrepreneurial spirit of the World Economic Forum. The world faces huge challenges – conflict, mass urbanisation and migration, climate change and in healthcare, a rise in vaccine hesitancy and changes in the health financing landscape. But Gavi’s anniversary today is a welcome reminder that we have also made tremendous progress.

For example, in 2018 a total of 116 million children were fully vaccinated with all three recommended doses of diphtheria-tetanus-pertussis (DTP), up from 90 million in 2000 – an increase of nearly 30%. In the last 20 years, Gavi-supported low and middle-income countries have introduced more than 430 vaccines, including newer, critical vaccines such as rotavirus and pneumococcal conjugate (PCV). Overall, national immunisation coverage rates have improved substantially.

Not there yet

And yet, despite immunisation having been proved to be one of the most successful, cost-effective, and far-reaching public health interventions, the percentage of children who received their full course of routine immunisation has stalled at 86% — increasing only one percentage point between 2015 and 2018. This rate falls short of the 2020 global immunisation coverage target of 90% and leaves 19.4 million children vulnerable to vaccine preventable diseases​.

As of 2018, one in ten children still receive no vaccines, putting them at serious risk of potentially fatal yet preventable diseases such as rotavirus, measles and rubella, pneumonia, and polio. Without concerted efforts to improve coverage, more than 1 million children’s lives will be lost every year. Moreover, average coverage at national level often hides geographical and socioeconomic inequalities. To get the job done – to reach everyone everywhere – it is necessary to identify and focus on the hardest-to-reach underserved populations, including in rural remote areas, urban slums, and those who are poor and uneducated.

Deliver on the promise

Today, ACTION and Save the Children launch Delivering on the Promise of Immunisation: How far have we come? Gavi at 20 Years. Endorsed by the Gavi-CSO (civil society organisation) Constituency, it showcases why continued and increased investment for immunisation is needed and the importance of it for broader health agendas – so that all children everywhere have access to essential health services, including vaccination. Through analysis of five countries’ national immunisation coverage – Bangladesh, the Democratic Republic of Congo, Ethiopia, Indonesia and Somalia – the brief uncovers the hidden story of vaccine inequality. This assessment demonstrates countries’ programmatic and financial challenges, and the risks and opportunities for health systems and immunisation systems.

Call to action

Gavi, national governments, donors, development partners, vaccine manufacturers and the private sector have a responsibility to accelerate action to ensure that all children are reached through access to affordable vaccines and a strong primary health care (PHC) system, a first step towards universal health coverage.

Ahead of Gavi’s replenishment conference June 2020 in the UK, we call for:

Ambitious investments in Gavi

  • A fully funded Gavi will:
    • maintain predictability and stability of vaccine markets
    • accelerate equitable access to affordable vaccines
    • help to immunise an additional 300 million children between 2021 and 2025.
  • Gavi’s new strategy will invest:
    • $5.3 billion in vaccine programmes
    • $3.3 billion in immunisation systems and enabling infrastructure
    • $1.1 billion in health systems strengthening.

This investment opportunity is the best-buy in public health.

Equitable people-centred services

  • Leave no one behind: Prioritisation of ‘zero dose’ children in all policies. An equity lens is required to identify and focus on underserved children (including addressing gender differences, rural remote areas, fragile settings, urban slums, and low-income and uneducated children).
  • Safeguard immunisation in fragile settings: Delivering services for the hardest-to-reach communities in accordance with a best practice framework to ensure equitable access to immunisation services for migrant, displaced and disadvantaged populations, including those affected by conflict and humanitarian emergencies — as recommended by the SAGE 2018 report. In the decade ahead, we are likely to encounter new infectious diseases that could represent the threat of a global pandemic; with migratory populations, even countries with resilient health systems could be at risk of losing hard-won gains.

Sustainable systems

  • Strengthen primary health care: Gavi to ensure investments are tailored to and promote integrated immunisation services that deliver full immunisation coverage and other vital health services through the life-course and are aligned with efforts to strengthen national and sub-national PHC.
  • Enhance transition preparedness and capacity support: Frequent programmatic and financial analysis should be conducted and shared with national stakeholders, other funds and donors highlighting country-level risks, challenges and opportunities. Expectation-setting by global planning processes should ensure that comprehensive country analysis and needs inform policy decisions, including of Gavi-recipient country preparedness criteria, in order to deliver on comprehensive transition assessments prior to entering the accelerated Gavi transition phase.

Context-driven innovation

  • Ensure vaccine affordability: Prioritise cultivating vaccine markets, incorporating market-shaping mechanisms (such as a revised Advanced Market Commitment, model), and the entry of new suppliers to the market to continue to lower and maintain prices.
  • New life-saving vaccines and technology: Stronger collaboration between vaccine and vaccine-delivery innovations and programme implementers in communities, in order to ensure new product design development and evaluation are responsive to the needs of communities.
  • Monitor for equity: Leveraging of data and digital tools by donors, recipient-country governments and CSOs in order to identify unvaccinated children. This will improve the performance of sub-national immunisation systems to reach underserved populations
  • Optimise private sector engagement: Commitment to a people-centred approach from vaccine manufacturers and private sector partners, with affordable vaccine prices, and stable vaccine supply volumes that meet specific country demand.

Political will

  • Prioritise civil society’s role: Meaningful civil society engagement (e.g., representatives from all communities, including those left behind), where CSOs take part in Gavi’s planning, budgeting, implementation and monitoring of processes to ensure services are culturally appropriate, gender-sensitive, affordable, effective and sustainable.
  • Increase domestic investments in health: Commitment from Gavi-recipient countries to:
    • increasing public investment in immunisation by at least 5%
    • strengthening PHC systems
    • prioritising reaching the target of 90–95% immunisation coverage at the district level
    • developing comprehensive transition plans with clear milestones to protect health financing.

 

Let’s take action so that all children are able to grow up healthy to celebrate – like Gavi – their 20th birthday, and to live prosperous lives. Investments made today in integrated delivery of health systems, inclusive of immunisation services, will ensure that the full range of vaccine-related benefits are extended equitably to all, regardless of where they are born, where they live or who they are.

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