Since Gavi, the Vaccine Alliance, was launched in 2000, it has played a major role in immunisation efforts across the developing world. Working with governments and the private sector, it works to improve childhood immunisation coverage and accelerate access to new vaccines.
In August, Gavi launched its latest fundraising drive, which will support new vaccine programmes for the years 2021-25. Billed as the 鈥榤ost comprehensive and cost-effective preventative health package in history鈥�, the investment will be used to deliver over 3.2 billion doses of life-saving vaccines to 55 eligible countries. Aurelia Nguyen, Gavi鈥檚 managing director for vaccines and sustainability, explains how this will work.
Abi Millar: Gavi, a Vaccine Alliance, recently launched a major fundraising drive, with a view to raising $7.4bn. How do you intend to raise these funds and who are your primary donors likely to be?
Aurelia Nguyen: We鈥檙e entering quite an exciting period, which will culminate in a replenishment event in London in June 2020. The $7.4bn we鈥檙e looking for will be from a combination of contributions 鈥� we have government donors and sovereign entities, we have foundations and regional funds, and we also have partnerships with the private sector. Another important part is the contributions we have through innovative financing mechanisms, such as the International Finance Facility for Immunisation (IFFIm).
In this upcoming replenishment, of course we鈥檙e going to be making a case to our current donors, but we鈥檙e also very interested in reaching out and diversifying our donor base, whether they be sovereign donors or the private sector.
AM: Developing country governments will invest $3.6bn in their own vaccine programmes in 2021-25, compared to $1.6bn in 2016-2020. What do you think lies behind this increase in investment, and how do you support countries in their transition to self-financing?
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By GlobalDataAN: That鈥檚 one of the things we鈥檙e extremely proud of. Gavi has embraced the principles of being country driven, and for us, country driven also means country funded. So when these countries request an investment programme, we ask them to make a contribution to the cost of each vaccine.
We understand we鈥檙e servicing the poorest countries in the world so they don鈥檛 have the money to be able to fully fund their programmes, but it鈥檚 important that they have some ownership in it right from the start. What happens is that as the country grows economically, the share of the money they put in increases.
Because we鈥檝e had a very intense engagement with the ministers of health and finance, we鈥檝e been able to increase the amount that countries spend on their vaccine programme over time. That鈥檚 led to the $3.6bn you鈥檙e referring to.
What鈥檚 not counted in here is another huge amount, $6.3bn, which the countries are funding themselves in terms of delivering the vaccines. So really it鈥檚 those two numbers together 鈥� the $3.6bn and the $6.3bn 鈥� that show the incredible commitment that developing countries have made towards immunisation.
AM: The investment will support 18 basic vaccines. Which are the priorities and which vaccines are new to the 2021-2025 Investment Opportunity?
AN: That鈥檚 a bit like trying to name your favourite child 鈥� you鈥檙e not allowed to do that! Joking aside, it鈥檚 difficult to single out a single vaccine because each one has a unique role in terms of being a lifesaver and preventing a disease that causes raises in mortality and morbidity.
A lot of our focus has been on rolling out the newer vaccines, for example HPV, rotavirus and pneumococcal. We鈥檒l be focusing on making sure that all the countries that need those vaccines are taking them up.
But as you alluded to, an important and exciting part of this next strategy is that we are expanding our portfolio quite a bit. And so on top of these existing vaccines we鈥檙e going to be adding boosters for diphtheria, tetanus, and pertussis. We鈥檙e going to be adding a hepatitis B birth dose, we鈥檙e going to be adding a new vaccine in our meningococcal programme that addresses more strains of the disease, and we鈥檙e going to be expanding our cholera programme into a routine programme. We鈥檙e also going to be looking at rabies, and as and when we get a good vaccine for respiratory syncytial virus (RSV) hopefully we鈥檒l be supporting that.
One thing I should mention is the work we鈥檙e doing on Ebola. In the Democratic Republic of Congo, we鈥檝e been supporting the response to Ebola with an investigational vaccine 鈥� 230,000 people have been vaccinated thanks to a deal between Gavi and the manufacturer. As soon as that vaccine gets licensed, we鈥檒l be looking for support from our board so as to have a regular Ebola programme. That鈥檚 one of my key projects.
AM: Can you comment on some of the work the Vaccine Alliance has done so far? What do you consider to be your main accomplishments?
AN: When Gavi was created in 2000, only 59% of children in the developing world were receiving the basic vaccinations, and usually when a new vaccine became available it was ten years in between when high-income countries could introduce the vaccine and developing countries could introduce it. Today, 81% of children receive the basic course of vaccines, and we鈥檝e really narrowed the gap between what鈥檚 happening in the developing world and what鈥檚 happening elsewhere.
In some instances we鈥檝e even superseded other countries. So if you take a vaccine like rotavirus or pneumococcal, the coverage that we have in countries supported by Gavi is actually higher than in some other countries. That is a key accomplishment.
And then to put it in terms of the magnitude of the work, we鈥檝e vaccinated 760 million children since the inception of Gavi, which means we鈥檝e averted 13 million deaths. Over this period of time, child mortality in the countries we work in has halved, and our vaccination programmes have been a key driver.
So a lot of work has been accomplished so far, and there鈥檚 a lot of work still to do. The world is becoming a more difficult place in terms of population displacement, climate change fragility, disease outbreaks etc, so that鈥檚 where we鈥檒l be focusing our attention next.
AM: What do you aim to achieve with this next round of funding? How will you ensure the vaccines go to those most in need?
AN: In the past 20 years we鈥檝e managed to vaccinate 760 million children, and now with the 2021-25 round of funding, we鈥檙e going to be aiming to cover 300 million more. That equates to seven to eight million additional lives saved. So, by the end of 2025, we鈥檒l have vaccinated 1.1 billion children and saved 22 million lives altogether if we鈥檙e successful in our funding and implementation.
The strategy we have in place for this period is to focus on the communities where immunisation is currently not taking place and children are being missed. With growing urbanisation there鈥檚 a lot of work for us to do in urban slums, as well in reaching remote areas, stigmatised populations and conflict settings.
AM: What are Gavi鈥檚 next steps?
AN: Our next step will be our replenishment event next year. What we鈥檙e doing at the moment is galvanising all the Alliance members, to be able to show the success that Gavi has had so far and the opportunity we have for further progress. That includes the pharmaceutical industry as a key partner, as well as all the implementation partners and the countries themselves.
In January at the World Economic Forum at Davos, we鈥檙e going to be celebrating our 20 years and it鈥檚 apropos since Gavi was launched at Davos 20 years ago. So that will be a key moment to build momentum towards a successful replenishment.
One of the things we need to come back to is just how amazing an investment immunisation is. If you invest $1 in immunisation in the countries we work in, you get $54 of return in wider societal benefits. That鈥檚 really a best buy as far as I鈥檓 concerned.
