The GAVI Alliance (formerly the “Global Alliance for Vaccines and Immunisation”) is a public-private global health partnership committed to saving children’s lives and protecting people’s health by increasing access to immunisation in poor countries. The Alliance brings together developing country and donor governments, the World Health Organization, UNICEF, the World Bank, the vaccine industry in both industrialised and developing countries, research and technical agencies, civil society, the Bill & Melinda Gates Foundation and other private philanthropists.[1]
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The GAVI Alliance was launched in 2000, at a time when the distribution of vaccines to children in the poorest parts of the world had begun to falter. By the end of the 1990s, immunisation rates were stagnating or even declining. Nearly 30 million children born every year in developing countries were not fully immunised. With a US $ 750 million commitment from the Bill & Melinda Gates Foundation, the vision of delivering vaccines to these children suddenly came within reach.[2]
In GAVI’s first decade, 288 million children have been immunised against lifethreatening diseases including diphtheria, tetanus, pertussis (whooping cough), hepatitis B, Hib and yellow fever, and more than five million future deaths have been prevented (2010 WHO estimation).[3] GAVI has the opportunity to help countries save more lives with the introduction of two new vaccines. Pneumonia and diarrhoea are the two leading killers of children under the age of five, causing nearly 40% of all childhood deaths. Between now and 2015, GAVI can accelerate access to new vaccines that will save a further four million lives. This would have a significant impact on achieving the 4th Millennium Development Goal to reduce by two thirds, between 1990 and 2015, the under-five mortality rate by 2015.[4]
Countries that are eligible for GAVI support actively take the lead. They determine what their immunisation needs are, apply for funding and oversee the implementation of their vaccination programmes. GAVI’s co-financing policy requires that recipient countries contribute towards the cost of the vaccines. This further strengthens ownership and long-term sustainability of immunisation programmes. The fact that countries increasingly demand GAVI-funded vaccines and are prepared to cofinance them shows their strong commitment to improving the health of their populations.[5]
GAVI is a trailblazer in developing innovative methods to finance health programmes. The International Finance Facility for Immunisation (IFFIm) was created to rapidly accelerate the availability and predictability of funds for immunisation. IFFIm raises funds by issuing bonds in the capital markets, using long-term government pledges as a guarantee and to pay back interest. Since its launch in 2006, IFFIm has raised more than US$ 3 billion by tapping the capital markets, and has effectively doubled the funds available for GAVI’s immunisation programmes. IFFIm is funded by France, Italy, the Netherlands, Norway, South Africa, Spain, Sweden, the United Kingdom and Australia.[6]
GAVI’s Advance Market Commitment (AMC) is a new approach to public health funding designed to stimulate the development and manufacture of affordable vaccines tailored to the needs of developing countries. In an AMC, donors commit funds to guarantee the price of vaccines once they have been developed. These financial commitments provide vaccine manufacturers with the incentive to develop or build manufacturing capacity for urgently needed vaccines. In exchange, companies sign a legally binding commitment to provide the vaccines at a price affordable to developing countries in the long term. In March 2010, the first supply agreements for the AMC against pneumococcal disease were signed by GAVI and two pharmaceutical companies. These firms will supply vaccines tailored to the needs of developing countries over the long term and at a fraction of the price charged in industrialised countries. The AMC was launched with a US$ 1.5 billion commitment from donors. In addition, GAVI committed up to US$ 1.3 billion to the initiative.[7]
GAVI’s ability to secure predictable long-term funding and prompt demand for vaccines positively shapes markets. Thanks to the Alliance’s work, manufacturers – including those in emerging markets – have demonstrated increased commitment to providing suitable vaccines for developing countries. As a result, competition among firms has increased, which has led to a drop in prices of GAVI-supported vaccines.[8]
Immunisation is a major factor in lowering child-mortality and can help achieve Millennium Development Goal 4. GAVI’s support has already made a significant impact and new opportunities exist to prevent additional diseases. Through its Accelerated Vaccine Introduction initiative and contingent on increased donor support, GAVI plans to roll out new vaccines against the leading causes of pneumonia and infant diarrhoea – diseases that together take the lives of nearly three million children under five each year.[9]