Basic facts about the GAVI Alliance Jon Pearman, Senior Adviser Vaccine Implementation World Health Editors Network (WHEN) 66th World Health Assembly Overview 1. About the GAVI Alliance 2. Accelerated vaccine uptake 3. Rising demand 4. Innovative finance 5. Shaping the market 6. Programmes of support for countries 7. Moving forward Basic facts about GAVI 19.05.13 The GAVI Alliance: an innovative partnership Basic facts about GAVI 19.05.13 Mission and strategic goals 2011–2015 To save children’s lives and protect people’s health by increasing access to immunisation in poor countries 1 The vaccine goal Accelerate the uptake and use of underused and new vaccines 2 The health systems goal Contribute to strengthening the capacity of integrated health systems to deliver immunisation 3 The financing goal Increase the predictability of global financing and improve the sustainability of national financing for immunisation 4 The market shaping goal Shape vaccine markets to ensure adequate supply of appropriate, quality vaccines at low and sustainable prices Basic facts about GAVI 19.05.13 What developing countries have achieved with GAVI support Immunised 370 million children Additional children immunised Prevented more than 5.5 million future deaths Accelerated vaccine introductions in over 70 countries Strengthened health systems to deliver immunisation Sources: WHO-UNICEF coverage estimates for 1980-2011, as of July 2012. Coverage projections for 2012, as of September 2012. World Population Prospects, the 2010 revision. New York, United Nations, 2010; (surviving infants) Helped shape the market for vaccines Basic facts about GAVI 19.05.13 GAVI making a difference Catalysing accelerated uptake of vaccines Contributed to preventing more than 5.5 million future deaths 370 million additional children immunised Supporting increasing country demand Rising demand for new vaccines US$ 7.5 billion committed to countries Introducing innovative finance mechanisms IFFIm raised US$ 3.7 billion on capital markets AMC accelerates access to pneumococcal vaccines GAVI Matching Fund – engaging the private sector Shaping markets for vaccines More manufacturers producing more appropriate vaccines Increased capacity secures supply, decreases prices Basic facts about GAVI 19.05.13 Overview 1. About the GAVI Alliance 2. Accelerated vaccine uptake 3. Rising demand 4. Innovative finance 5. Shaping the market 6. Programmes of support for countries 7. Moving forward Basic facts about GAVI 19.05.13 Countries have immunised an additional 370 million children with GAVI support Sources: WHO-UNICEF coverage estimates for 1980-2011, as of July 2012. Coverage projections for 2012, as of September 2012. World Population Prospects, the 2010 revision. New York, United Nations, 2010; (surviving infants) Basic facts about GAVI 19.05.13 A strong platform Source: WHO/UNICEF vaccine coverage estimates (July 2012) Country income categories (World Bank) as of July 2012 (2011 GNI per capita) Basic facts about GAVI 19.05.13 Immunisation coverage in 73 GAVI-supported countries Source: WHO/UNICEF vaccine coverage estimates (July 2012) Note: This estimate includes the 73 countries supported by GAVI 2011–2015 Basic facts about GAVI 19.05.13 Taking stock: the immunisation gap 130 million surviving newborns in 2011: Note: Coverage refers to the final dose of each vaccine. Sources: WHO/UNICEF coverage from July 2012; United Nations, Department of Economic and Social Affairs, Population Division (2011). World Population Prospects: The 2010 Revision, CD-ROM Edition. Basic facts about GAVI 19.05.13 Driving equity in vaccine access Hepatitis B Hib Source: WHO, Vaccine introduction database. Country income categories (World Bank) as of July 2012 (2011 GNI per capita) Basic facts about GAVI 19.05.13 Driving equity in vaccine access Pneumococcal *Planned 2012 introductions as of July 2012 Source: WHO, Vaccine introduction database. Country income categories (World Bank) as of July 2012 (2011 GNI per capita). Basic facts about GAVI 19.05.13 Total projected number of children immunised by the end of 2012 (increase relative to the end of 2011) Sources: WHO-UNICEF coverage estimates for 1980-2011, as of July 2012. World Population Prospects, the 2010 revision. New York, United Nations, 2010; (surviving infants). GAVI Alliance, 2013 Basic facts about GAVI 19.05.13 Vaccine introductions in 2011–2012: pentavalent, pneumococcal, rotavirus Number of newborns (millions) Sources: UN DESA, Population Division, 2011: World population prospects, 2010; GAVI Alliance, 2012 Basic facts about GAVI 19.05.13 15 Impact on the ground Eliminating Hib meningitis in Kenya (Kilifi district) Source: Cowgill KD et al. 2006 Basic facts about GAVI 19.05.13 Early impact of pneumococcal vaccine in Kenya Admissions of children under five for invasive pneumococcal disease, Kilifi District Hospital, 2003–2012 Source: Anthony Scott, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya, 2012 Basic facts about GAVI 19.05.13 Overview 1. About the GAVI Alliance 2. Accelerated vaccine uptake 3. Rising demand 4. Innovative finance 5. Shaping the market 6. Programmes of support for countries 7. Moving forward Basic facts about GAVI 19.05.13 Rising country demand Countries approved for GAVI support Source: GAVI Alliance data, as of 31 March 2013 Basic facts about GAVI 19.05.13 Country demand: number of approved vaccine applications Note: In 2011 the majority of countries were approved for pentavalent vaccine, rather than for Hib and hepatitis B vaccine separately. Therefore, from 2011 onwards GAVI changed its reporting method to include the combination pentavalent vaccine only. Source: GAVI Alliance data, as of 31 March 2013 Basic facts about GAVI 19.05.13 US$ 7.5 billion committed to countries As of 31 December 2012 Source: GAVI Alliance data as of 31 December 2012. Note: These commitments are from inception until 31 December 2012. Basic facts about GAVI 19.05.13 Overview 1. About the GAVI Alliance 2. Accelerated vaccine uptake 3. Rising demand 4. Innovative finance 5. Shaping the market 6. Programmes of support for countries 7. Moving forward Basic facts about GAVI 19.05.13 International Finance Facility for Immunisation (IFFIm) Supports GAVI by accelerating availability and predictability of funds for immunisation Uses US$ 6.3 billion in long-term donor pledges to back the issuance of bonds (AAA/Aaa/AA+) on the capital markets Raised US$ 3.7 billion since 2006 Provides long-term predictable funding for immunisation This helps multi-year planning, market shaping and rapid roll-out of new vaccines Basic facts about GAVI 19.05.13 Advance Market Commitment (AMC) Accelerates the manufacture and delivery of vaccines: Donors commit funds for new vaccines at preagreed price Manufacturers get incentive to invest in R&D for new vaccines Vaccines must meet stringent criteria and be requested by developing countries Manufacturers legally commit to supplying vaccines at lower price long term Long-term price is paid by beneficiary countries and GAVI Basic facts about GAVI 19.05.13 The GAVI Matching Fund Public-private partnership initiative The UK Department for International Development (DFID) and the Bill & Melinda Gates Foundation pledged US$ 130 million to match private sector contributions to GAVI Also match funds from customers, employees and business partners Brings private sector funding, visibility and innovation to GAVI programmes Basic facts about GAVI 19.05.13 Contributions from corporate partners and matches bring total to more than US$ 84 million Absolute Return for Kids (ARK) Anglo American Children’s Investment Fund Foundation (CIFF) Comic Relief Dutch Postcode Lottery J.P. Morgan “la Caixa” Foundation LDS Charities Vodafone Basic facts about GAVI 19.05.13 Overview 1. About the GAVI Alliance 2. Accelerated vaccine uptake 3. Rising demand 4. Innovative finance 5. Shaping the market 6. Programmes of support for countries 7. Moving forward Basic facts about GAVI 19.05.13 Market shaping objectives Basic facts about GAVI DATE Increased competition reduces vaccine price Price decline of pentavalent vaccine and number of manufacturers Source: UNICEF Supply Division, 2013 Basic facts about GAVI 19.05.13 Tiered pricing Source: UNICEF Supply Division; CDC Basic facts about GAVI 19.05.13 Vaccine supply Source: UNICEF Supply Division, 2013 2001 – Vaccine supply: 5 suppliers from 5 countries Basic facts about GAVI 19.05.13 Vaccine supply Source: UNICEF Supply Division, 2013 2012 – Vaccine supply: 10 suppliers from 8 countries Basic facts about GAVI 19.05.13 Overview 1. About the GAVI Alliance 2. Accelerated vaccine uptake 3. Rising demand 4. Innovative finance 5. Shaping the market 6. Programmes of support for countries 7. Moving forward Basic facts about GAVI 19.05.13 How GAVI works Basic facts about GAVI 19.05.13 GAVI vaccine support Currently supported vaccines: Routine: pentavalent, pneumococcal, rotavirus, human papillomavirus (HPV), yellow fever, measles second dose Campaign: yellow fever, meningococcal A conjugate, measles, rubella Stockpile: meningitis and yellow fever vaccines for outbreak response Prioritised for future support: Japanese encephalitis and typhoid conjugate vaccines Monitoring development: malaria, dengue Basic facts about GAVI 19.05.13 GAVI supports the world’s poorest countries Type and value of support, 2000–2012 Source: GAVI Alliance , 2013 Basic facts about GAVI 19.05.13 Health system strengthening (HSS) support Strong health systems essential to expand and sustain immunisation coverage Objective of GAVI HSS: address systems bottlenecks to achieve better immunisation outcomes Examples: Health workforce Courtesy of Aga Khan Health Services, Pakistan Supply, distribution, maintenance Organisation, management More than 50 countries approved for support by end 2012 Basic facts about GAVI 19.05.13 Six building blocks of a health system Good health services Well-performing health workforce Well-functioning health information system Equitable access to medical products, vaccines and technologies Good health financing system Leadership and governance Basic facts about GAVI 19.05.13 Support to civil society organisations (CSOs) CSOs deliver up to 60% of immunisation services in some countries GAVI provides support: to involve local CSOs in planning and delivery of immunisation and other child health services to encourage cooperation and coordination between the public sector and civil society Basic facts about GAVI 19.05.13 © UNICEF/NYHQ2007-1495 Anita Khemka Women’s health and immunisation Child and maternal mortality inextricably linked Immunisation a platform for other child and maternal health services GAVI supported immunisation of 40 million women against maternal and neonatal tetanus Supports HPV and rubella vaccines Supports strengthening of health systems to better meet needs of women and children Basic facts about GAVI 19.05.13 GAVI/09/Olivier Asselin Equal immunisation coverage of girls and boys 2010 study by WHO’s Strategic Advisory Group of Experts (SAGE) on gender and immunisation found no significant difference in immunisation coverage for girls and boys at the global level. low status of women may prevent them from accessing immunisation services for their children. GAVI instigated the SAGE study (in collaboration with WHO and PATH) to ensure that all girls and boys have equal access to vaccines. Basic facts about GAVI 19.05.13 Vaccines have a long-term positive impact beyond health outcomes Protecting children from infectious diseases raises IQ, improving cognitive function Vaccination keeps children healthy, thereby reducing the burden of care on parents; improving their productivity and freeing them from crippling medical costs Decrease in child mortality leads to a decline in birth cohort: families have fewer children to achieve ideal family size 30-50% of Asia’s economic growth from 1965 to 1990 attributed to reductions in infant and child mortality and fertility rates Spending on child health has the greatest impact on improving lifetime earnings Source: David Bloom, “The Value of Vaccination,” January 2011 Basic facts about GAVI 19.05.13 The economic value of vaccines Child vaccinated More politically & economically stable countries Improved community stability and productivity Strengthened economic condition within family Child lives longer Immunisation is one of the most cost-effective ways of improving living standards, health and the global economy More reliable workforce Fewer illnesses Birth rates drop – mother’s health improves Lower ongoing healthcare costs Greater educational opportunities Basic facts about GAVI 19.05.13 Overview 1. About the GAVI Alliance 2. Accelerated vaccine uptake 3. Rising demand 4. Innovative finance 5. Shaping the market 6. Programmes of support for countries 7. Moving forward Basic facts about GAVI 19.05.13 More than 22 million children still unimmunised Global number of under-five children unimmunised with 3 doses of DTP, 2011 Note: Revised figures for 2011 ( July 2012) Source: WHO/UNICEF vaccine coverage estimates (July 2012) Basic facts about GAVI 19.05.13 Impact 2011–2015 With GAVI support, countries can prevent 3.9 million future deaths between 2011 and 2015 Source: GAVI Alliance Strategic Demand Forecast version 2.0 and Long Range Cost and Impact Model Basic facts about GAVI 19.05.13 Global Vaccine Action Plan Shaping Immunization Programmes in the Current Decade Global vaccine action plan The vision for the Decade of Vaccine is a world in which all individuals and communities enjoy lives free from vaccine-preventable diseases. Its mission is to extend, by 2020 and beyond, the full benefits of immunization to all people, regardless of where they are born, who they are, or where they live Basic facts about GAVI 19.05.13 Why a Decade of Vaccines? Significant progress in the past decade Progress with disease eradication or elimination Millions of deaths averted Ability for deliver immunization with high coverage Already reaching over 80% children globally Higher than any other intervention across continuum of care Increasing number of diseases now vaccine preventable Robust vaccine pipeline Progress with adding vaccines in national programmes Despite many challenges, opportunities to do much better Basic facts about GAVI 19.05.13 Goals for the Decade of Vaccines Basic facts about GAVI 19.05.13 From GIVS to GVAP Focus on mortality Focus on mortality, morbidity and economic impact Top-down decision-making Country ownership Supply-side emphasis Supply and demand-side interventions Reaching Every District Reaching Every Community Immunization coverage Comprehensive disease prevention and control / focus on surveillance Access focus on low-income countries Access focus on low and middle-income countries A strategy (GIVS) Predefined accountability framework that includes all stakeholder and not just countries Key actions for the Decade of Vaccines Generate political commitment Better governance Requisite investments Promote greater community awareness and participation Address "vaccine hesitancy" Strengthen systems Supply chains Data quality and use Greater integration with broader health systems Targeted approaches to reach the "unreached" Affordable pricing and procurement for middle-income countries Regular monitoring and corrective actions Basic facts about GAVI 19.05.13 Translating the GVAP into National Priorities and Actions Using the cMYPs and annual implementation plans as the basis for implementing GVAP at the country level cMYP guidelines reviewed and updates to: Accommodate the transition from GIVS to GVAP Place immunization more firmly within the context of PHC and National health Plans Better use of programme reviews in situational analysis Promote greater engagement of sub national managers in the development of the cMYP Opportunities for countries to pilot the new guidelines Basic facts about GAVI 19.05.13 GVAP Goals Indicators No Goal Indicator G1.1 G1.2 G2.1 G2.2 G2.3 Achieve a world free of poliomyelitis Interrupt wild poliovirus transmission globally Certification of poliomyelitis eradication Neonatal tetanus elimination Measles elimination Rubella/CRS elimination Reach 90% national coverage and 80% in every district or equivalent administrative unit for diphtheria-tetanus-pertussiscontaining vaccines Reach 90% national coverage and 80% in every district or equivalent administrative unit for all vaccines in national programmes, unless otherwise recommended Licensure and launch of vaccine or vaccines against one or more major currently non-vaccine preventable diseases G3.1 G3.2 Meet global and regional elimination targets Meet vaccination coverage targets in every region, country and community G4.1 G4.2 Develop and introduce new and improved vaccines and technologies Number of low- and middle-income countries that have introduced one or more new or underutilized vaccines G4.3 G5.1 G5.2 Licensure and launch of at least one new platform delivery technology Exceed the Millennium Development Goal 4 target for reducing child mortality Reduce under five mortality rate Basic facts about GAVI 19.05.13 GVAP Strategic Objectives Indicators SO Strategic objective SO1 All countries commit to immunization as a priority Indicator 1.1 Domestic expenditures for immunization per targeted person 1.2 Presence of an independent technical advisory group that meets defined criteria Individuals and communities 2.1 % of countries that have assessed (or measured) the level of confidence in vaccination at subnational level understand the value of vaccines SO2 and demand immunization both as 2.2 % of un- and under-vaccinated in whom lack of confidence was a factor that influenced their decision a right and a responsibility 3.1 Percentage of districts with more than 80% coverage with 3 doses of diphtheria-tetanus-pertussis-containing The benefits of immunization are vaccine SO3 equitably extended to all people 3.2 Reduction in coverage gaps between wealth quintiles AND other appropriate equity indicators Strong immunization systems are 4.1 DTP1 to DTP3 dropout rate SO4 an integral part of a well-functioning health system 4.2 Immunization coverage data assessed as high quality by WHO and UNICEF Immunization programmes have sustainable access to predictable SO5 funding, quality supply and Country, regional and global research and development SO6 innovations maximize the benefits of immunization 5.1 Percentage of doses of vaccine of assured quality used worldwide 6.1 Progress towards development of HIV, TB, malaria and broad spectrum influenza vaccines 6.2 Progress towards a universal influenza vaccine (protecting against drift and shift variant) 6.3 New indicator to track innovation in vaccine delivery systems Basic facts about GAVI 19.05.13 GVAP Progress Reporting and Review In line with the guiding principles and request of member states to build on existing systems: Country Level: Immunization Coordinating Committees , … Regional Level: Regional Immunization Technical Advisory Groups , Regional Committees. Global Level: WHO SAGE, Executive Board and WHA. The GVAP Monitoring and Accountability frameworks will be presented to the 2013 WHA. 2014 WHA to be presented with the first progress report of member states towards achieving the GVAP goals and objectives. Basic facts about GAVI 19.05.13 Thank you GAVI/2011/Ed Harris Basic facts about GAVI 19.05.13 Basic facts about GAVI 19.05.13