GAVI, the vaccine alliance

At the start of the 21st century there were still 30 million children in developing countries who were not being immunised against preventable life-threatening and life-changing diseases such as polio and yellow fever. As a result, at least three million children were dying worldwide each year who could easily have been saved. The Global Alliance for Vaccines and Immunisation (GAVI) was set up in 2000 to turn the situation around and help immunise those children most at risk.

The challenge

At the turn of the last century, despite the promising progress of the previous two decades, prompted in particular by the work of the Expanded Programme on Immunisation (EPI), there were still 30 million children living in poor countries who were not fully immunised against life-threatening diseases. Coverage was “stagnating and in some places even declining”. [1] Despite the fact that new, potentially life-saving vaccines were being produced, hardly any were getting to children in developing countries – those whose need was greatest – because they were too expensive.

The director of the WHO and chair of the Global Alliance for Vaccines and Immunisation (GAVI), Dr Gro Harlem Brundtland, summarised the problem: “nearly three million children worldwide still die needlessly each year of vaccine-preventable illnesses." [2]

The initiative

In order to address this challenge, GAVI was launched in January 2000 at the World Economic Forum (WEF) [3]. Its aim was to improve access to new and underused vaccines for children living in the world’s poorest countries. It was funded with the help of a US$ 750 million five-year pledge from the Bill and Melinda Gates Foundation [4]. It is based in Geneva and unites the public and private sectors in “the shared goal of creating equal access to vaccines for children, wherever they live”.

GAVI’s overarching goal is broken down into five distinct objectives:

  • “To improve access to sustainable immunisation services.
  • To expand the use of all existing cost-effective vaccines.
  • To accelerate the development and introduction of new vaccines.
  • To accelerate research and development effort for vaccines and related products specifically needed by developing countries.
  • To make immunisation coverage an integral part of the design and assessment of health systems and international development efforts."

GAVI’s structure is based on a division into two parts: the Vaccine Alliance itself and the Vaccine Fund, which is GAVI’s financing arm. At its formation, GAVI introduced a new idea: outcome-based grants, which give governments the responsibility and autonomy to decide how the money is used, but if they do not show results in terms of successful vaccination programmes, the funding is ended.

The public impact

It is estimated that the use of GAVI-supported vaccines from the start of 2011 to the end of 2014 will have averted approximately three million deaths. Between 2010 and 2013, child mortality in GAVI-supported countries fell from 77 to 69 deaths per 1,000 live births, with vaccines considered to be responsible for reducing mortality from vaccine-preventable diseases. Compared to the number of vaccinations in 2010, an additional 207 million children had been immunised with GAVI-supported vaccines by the end of 2014.

What did and didn't work

All cases in our Public Impact Observatory have been evaluated for performance against the elements of our Public Impact Fundamentals.

Legitimacy

Stakeholder Engagement Strong

GAVI received funding from the Gates Foundation, with the support of governments, such as Norway’s, and many private and public organisations. Business leaders from the pharmaceutical industry promised to accelerate the delivery of available but underused vaccines for yellow fever, hepatitis B and Hib. These diseases claim over a million lives each year in the developing world and improving access to effective vaccines was one of GAVI’s main objectives.

Political Commitment Strong

GAVI was supported by global NGOs such as UNICEF, the WHO, the WEF, and the governments of countries with strong international development department functions. It was “born out of the growing recognition that the global community must work harder to reduce the gap between rich and poor countries," said UNICEF’s then executive director Carol Bellamy in 2002. [5]

GAVI secured funding commitments from Norway, the UK and the US at the time of the launch:

  • The Norwegian prime minister, Jens Stoltenberg, announced a pledge from Norway to provide NOK 1 billion over five years as part of the government’s strategy to promote stronger health systems in low-income countries.
  • The UK announced that it would purchase 250 000 shares in the Global Fund to vaccinate 250 000 additional children, at a value of £3 million.
  • The US vice president, Al Gore, announced plans to ask Congress for US$50 million to support the objectives of the Children's Challenge, which was GAVI’s initial project.

Policy

Clear Objectives Strong

GAVI was formed with a clear goal, that of creating equal access to vaccines for children, with five more detailed objectives as set out above. The main targets were six high-risk diseases for children - diphtheria, measles pertussis, polio, tetanus and tuberculosis, as well as hepatitis B, yellow fever and Hib, the principal cause of infant pneumonia and meningitis.

Evidence Strong

GAVI uses in-depth analysis along with the input from various experts, partners and stakeholders to make informed decisions about its priorities, focus and investment.

A landscape analysis, conducted by the WHO identified fifteen vaccines not yet in GAVI’s portfolio or which were in development with an anticipated licensing date by 2019. Each vaccine was evaluated to estimate the potential health impact, cost and value for money alongside additional strategic and programmatic considerations.

With a view to prioritise vaccines providing good ‘value for money’ and with the highest impact on disease, the GAVI Board shortlisted vaccine options for further evaluation, vaccines against oral cholera, seasonal influenza, rabies and yellow fever.

Feasibility Good

A report published in 2002 found that GAVI had considered the overall feasibility of its initiatives thoroughly. Two responses, published by UNICEF, are indicative of this thoroughness [6]:

  • “The pace at which the GAVI partners have designed a programme funding process, solicited and reviewed proposals, and distributed vaccines and resources to the field is unheard of in the history of international initiatives," said GAVI executive secretary, Tore Godal, a public health physician with years of international health experience.
  • Health officials in Tanzania's Ministry of Health "viewed the initiative as a catalyst to attract a greater proportion of government budget to the [immunization] programme."

Action

Management Strong

The management structure is very sound. [7] The GAVI board comprises members from organisations such as UNICEF, the World Bank, the WHO, the Gates Foundation, the OECD, and national governments.

The major mechanisms are: the partners meetings, the board meetings, the working group and the GAVI secretariat. The composition of the working group is skill-based and linked to implementation partners and the priority activities of the alliance. As part of the oversight function, the board periodically reviews its composition of the working group will be periodically reviewed by the board. The working group facilitates implementation of the decisions and policies of the GAVI board.

The GAVI secretariat is responsible for preparing a consolidated working plan, including schedules and budgets.

Measurement Strong

GAVI has put in place strict measurement yardsticks, based on the OECD framework criteria of relevance, efficiency, effectiveness, impact and sustainability, to evaluate the programmes that it conducts. It also takes into account criteria such as policy coherence, social return on investments, value for money, equality, impact on poverty and financial viability.

Alignment Strong

GAVI’s initiatives have been backed by numerous partners (as described above) and beneficiaries and their alignment is evident:

  • The combined efforts of GAVI partners have helped to ensure that available resources are used efficiently to meet immunisation goals at global and country levels.

GAVI has been able to generate donor support for countries and partner agencies that WHO alone could not have secured. 3. Agencies, such as Catholic Relief Services, that use GAVI funds have established civil society organisations in over 20 countries.