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
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The GAVI Alliance: an innovative partnership
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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
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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
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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
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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
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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)
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A strong platform
Source: WHO/UNICEF vaccine coverage estimates (July 2012)
Country income categories (World Bank) as of July 2012 (2011
GNI per capita)
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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
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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.
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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)
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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).
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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
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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
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15
Impact on the ground
Eliminating Hib meningitis in Kenya (Kilifi district)
Source: Cowgill KD et al. 2006
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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
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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
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Rising country demand
Countries approved for GAVI support
Source: GAVI Alliance data, as of 31 March 2013
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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
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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.
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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
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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
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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
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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
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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
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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
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Market shaping objectives
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Increased competition reduces vaccine price
Price decline of pentavalent vaccine and number of manufacturers
Source: UNICEF Supply Division, 2013
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Tiered pricing
Source: UNICEF Supply Division; CDC
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Vaccine supply
Source: UNICEF Supply Division, 2013
2001 – Vaccine supply:
5 suppliers from 5 countries
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Vaccine supply
Source: UNICEF Supply Division, 2013
2012 – Vaccine supply:
10 suppliers from 8 countries
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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
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How GAVI works
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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
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GAVI supports the world’s poorest countries
Type and value of support, 2000–2012
Source: GAVI Alliance , 2013
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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
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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
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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
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© 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
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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.
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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
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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
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facts about GAVI
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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
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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)
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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
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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
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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
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Goals for the Decade of Vaccines
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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
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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
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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
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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
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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.
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Thank you
GAVI/2011/Ed Harris
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