Critical conversations in Public-private
partnerships
Dr Ranjana Kumar
1st November 2007
The GAVI Alliance
 Public-private partnership bringing together all the major stakeholders
in immunization
 Launched in 2000
 Mission: Save children’s lives and protect people’s health by increasing
access to immunization in poor countries
 Vaccines and funding to strengthen immunization and health services to
70+ of the poorest countries
2
GAVI partners
Outline of innovations
 Raising resources – International Financing
Facility for Immunisation, IFFIm
 Making vaccines available – Advance Market
Commitment, AMC
 Facilitating introduction of new vaccines, ADIPs
 Supporting policy and programme
implementation, Civil Society Organisation
partnerships
 Programme level impact
Funding innovations
 IFFIm: International
Finance Facility for
Immunisation: using
markets differently – a
radical shift in scale – US$
1 billion frontloaded from
the capital markets
 AMC: Advance market
commitment pilot for
pneumoccocal vaccine:
accelerating access
PPP example: Immunization Services Support (ISS)
Background and Objectives
Partner Contribution

Public Sector

Funds managed by
governments


Performance-based and time
limited funding for developing
countries to improve their health
outcomes (i.e. increased
vaccination coverage)
ISS money is highly flexible to
use; governments and its
development partners make
local decisions on most effective
allocation and use of ISS funds
to strengthen their health
systems
Additional funding or
performance payments are
given to countries when they
have met or surpassed their self
set immunization goals after the
investment phase (almost
similar to sales representatives
receiving a commission bonus
after having met their targets)
Public and Social Sector

Implementation: Delivery of
immunization service in local
hospitals or health centres run
by local NGOs
Success factors

Monetary resources

Incentivisation principals

Economically minded and
committed governments

Rigorous control instance
(e.g. independent audit of
immunization coverage
data to ensure system
integrity)
Private Sector

Expertise: e.g. business based
funding approaches
Social Sector


Advise: The WHO and
UNICEF (renewable partner in
GAVI Alliance Board) e.g.
supported the Ministry of
Health of Cambodia with the
application process for ISS
funds
Implementation: UNICEF is
managing the transfer of ISS
funds
Lessons learnt

New performance based
approaches (e.g.
performance based
funding) in development

significantly increase its
efficiency

positively affects people’s
commitment through
increased selfdetermination
Results: Speeding availability
GAVI was designed to reduce the time lag in the availability of
vaccines between industrialised and developing countries
200
HepB - all
developing
countries
Millions of doses
150
GAVI
established
Hep B licensed
100
HepB combos
licensed
50
HepB
containing
combination
vaccines
0
1983
1985
1987
1989
1991
1993
1995
1997 1999
2001
2003
2005
Results: influencing the market
Vaccine prices drop as new manufacturers enter the market
DPT Hep B vaccines prices have declined by 40%
The growing role of the developing
country vaccine manufacturer
Presence of multiple suppliers in the market is critical to vaccine
security. In 2006, almost 30% of all the vaccines purchased by
UNICEF for GAVI were manufactured in developing countries.
Results to date
Health services
 Additional children reached




Hepatitis B: 126 million
Hib: 20 million
Yellow fever: 17 million
DTP3: 28 million
 Dramatic immunisation coverage increase
 DPT3: 63% in 1999 to 77% in 2006
 44% in 1999 to a 73% in 2006 in Africa
 Safe (auto-disable) syringes uptake
 1.2 billion syringes
Progress to date

Estimated additional children reached
with GAVI support (cumulative 200106)
 Hepatitis B: 126 million
 Hib: 20 million
 DTP3: 28 million
 Yellow Fever: 17 million
• 1.7 million cumulative deaths already
averted
• It is projected that, by end 2006, more
than 2.3 million future deaths will have
been prevented (600,000 in 2006 alone).
GAVI prospects and priorities
• A long-term vaccine investment strategy
• Ensuring effective implementation of scaled up resources
• Build on the PPP model and strengthened CSOs
participation in GAVI policy-making and programme
implementation
• Linking GAVI in with developments in international health
architecture and in particular health systems work
• Maintaining GAVI’s position as a leading innovative
Global Health Partnership
External validation of the GAVI Alliance business model

“The economic impact and benefits of immunisation have
been greatly underestimated; GAVI programmes could earn a
rate of return of 18 percent”
David Bloom, David Canning and Mark Weston (Harvard School of Public Health) “The Value of Vaccination”,
World Economics, September 2005

“This is the first time that there is hard evidence that one of
the major global health programmes is having a real impact.”
"Independent Evaluation of the Impact of GAVI on DTP3 Coverage,” Murray et al. The Lancet, 18 September, 2006