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New 2021-2025 high level strategy to leave no-one behind with immunisation approved by Gavi Board
Equitable and sustainable use of vaccines, support for health systems and healthier markets to drive Gavi’s work
Geneva, 27 June 2019 – The Gavi Board today approved a new strategy to guide the Vaccine Alliance’s work over the 2021-2025 period, prioritising reaching communities with immunisation that are currently missed, such as those in urban slums, remote areas and conflict settings.
“Gavi has achieved an incredible amount since it was founded in 2000,” said Dr Ngozi Okonjo-Iweala, Chair of the Gavi Board. “Over those two decades hundreds of millions of children have been protected against some of the world’s deadliest diseases, vaccine prices have dropped and new vaccines for diseases like pneumonia and cervical cancer have reached countries they otherwise wouldn’t have, all thanks to support from the Vaccine Alliance. For the next five-year period equity will be the Alliance’s key guiding principle. This will mean focussing on those left behind, whether they be girls and women, refugees or remote communities, to ensure nobody goes without lifesaving vaccines.”
The new strategy, which is the culmination of 18 months of consultations with stakeholders, analysis and discussion, will be anchored in the Sustainable Development Goals, echoing its driving mission to leave no one behind. To do this it will target four goals to save lives and protect people’s health by increasing the equitable and sustainable use of vaccines:
1. To introduce and scale-up vaccines
Since 2000, Gavi has supported countries to conduct more than 400 introductions of new and under-used vaccines. In Gavi’s first phase the Alliance began by supporting vaccines that protect against six infectious diseases. By 2025 this will have increased to at least 18, including the inactivated polio vaccine (IPV) and new vaccines like rabies, hepatitis B birth dose and multivalent meningococcal. Gavi will also support vaccines, like those for Ebola, cholera and typhoid, that tackle outbreaks, fight antimicrobial resistance and boost global health security. Given the increasing number of Gavi-supported vaccines, the Alliance will help countries to prioritise vaccines based on local epidemiology, national capacity and sustainability considerations.
2. Strengthen health systems to increase equity in immunisation
Gavi-supported countries reached a record 64 million children with a full course of basic vaccines in 2017, up from 41 million in 2000. Yet still as many as one in ten children in Gavi-supported countries receive no routine vaccines. To reach these missing millions Gavi will bring a much stronger focus on reaching those most marginalised, by strengthening primary healthcare systems, building and sustaining community demand, and using innovation to ensure that immunisation services reach these children. It will also bring a greater focus and enhanced approach to tackle gender-related barriers that stand in the way of reaching every child.
3. Improve sustainability of immunisation programmes
Gavi actively works with supported countries so they co-finance and gradually take over the financing of their vaccines as they get wealthier. In this regard, countries transition out of Gavi support over time, with the Alliance supporting them so their immunisation programmes remain strong. From 2011 to 2018, countries have increased the amount they themselves spend on Gavi-supported vaccines from US$ 36 million to US$ 475 million, and 19 countries are expected to have transitioned out of Gavi support completely by 2020. Gavi will continue its work building political support and increasing domestic public resources for immunisation and primary health care, as well as supporting countries as they move away from Gavi funding to self-finance their vaccine programmes.
4. Ensure healthy markets for vaccines and related products
Since Gavi was founded in 2000, its market shaping work has helped increase the number of vaccine manufacturers supplying Gavi-eligible countries has expanded from 5 to 17 and prices have reduced dramatically. In recent years the Alliance has widened the focus of its market shaping work towards building healthy markets for each of its vaccines, as well as related products like cold-chain equipment. Gavi will continue to work on balancing all the elements necessary to ensure healthy market dynamics for vaccines and immunisation-related products, focusing on reliable, consistent and affordable supply as an overarching objective. It will also bring a more purposeful approach to driving innovation for immunisation-related products and services.
“For Gavi, the 2021-25 period will mean new vaccines, new technologies and new approaches to help build healthier, wealthier communities across the developing world,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “With this new strategy we will make the millions of children around the world who are missing out on vaccines our absolute priority. By bringing immunisation to these missed communities the Alliance will also be extending primary health care systems, building a foundation for Universal Health Coverage. We will be bringing all the economic benefits that come with a healthier population, and we will provide a first line of defence against deadly outbreaks, boosting global health security. That’s why this strategy will help ensure that immunisation makes a powerful contribution to the success of the Sustainable Development Goals.”
To support the global effort to eradicate polio and mitigate the risk of the disease re-emerging, the Board also agreed a cost-sharing approach for the inactivated polio vaccine (IPV). Gavi will fully-finance the vaccine for the very poorest countries, however other countries which receive Gavi support for IPV will need to use the amount they currently spend on bivalent oral polio vaccine (bOPV) – roughly US$ 0.60 per child – for IPV once bOPV is withdrawn after eradication is certified. Gavi will provide the remaining finance.
In addition, the Board requested that the Gavi Secretariat explore approaches to engaging with self-financing lower middle-income countries in recognition of major challenges in those countries.
As part of the Gavi Board meeting, which took place in Geneva on 26-27 June, the Board also exceptionally approved an extension of Papua New Guinea’s (PNG) accelerated transition phase until the end of 2025. The country had been due to transition out of Gavi support at the end of 2020. But it remains extremely fragile, with a very weak health system, the lowest vaccine coverage in the region, high child mortality and recent outbreaks of polio and measles despite considerable economic growth driven by the extractive industries. The Board therefore agreed that this exceptional situation warranted an extension to the country’s transition, subject to the government setting out and committing to reforms to the health sector.
The plans set out in the strategy, including funding for all vaccines, are dependent on a successful replenishment for the 2021-25 period, which will culminate in a pledging event next summer in London. The replenishment process will begin at a high-level event hosted by the Japanese government on the occasion of TICAD 7 in Yokohama in August 2019, where Gavi will launch its investment opportunity for the next period. Richard Clarke, Director General for Policy, Research and Humanitarian at the UK Department for International Development (DFID), and Masashi Nakagome, Minister at the Permanent Mission of Japan in Geneva, both addressed the Board meeting to discuss these events and the road to replenishment.
Gavi’s unique public-private partnership model means it needs predictable financing to allow manufacturers and implementing countries to forecast demand over a five-year period. This helps to drive value for money and maximise the impact of every dollar invested in the Vaccine Alliance. The upcoming 2021-25 strategic period will be Gavi’s fifth.