Gavi Board approves malaria vaccine programme funding, COVAX 2022 strategic approach and measures to maintain, restore and strengthen routine immunisation

Gavi Board approves malaria vaccine programme funding, COVAX 2022 strategic approach and measures to maintain, restore and strengthen routine immunisation
A new malaria vaccination programme has been approved, providing Gavi-eligible countries in sub-Saharan Africa a powerful new tool with which to fight malaria
In 2022, Gavi, through COVAX, will continue to help countries meet COVID-19 vaccination targets, focusing mostly on lower-income countries and those most in need including support for delivery at scale
Gavi will invest US$ 250 million over 2022-2026 in its partnership with India; US$ 53 million over 2022-2025 will be channelled towards supporting the availability of diagnostic tests for yellow fever, cholera, typhoid, meningococcus, measles, and rubella
José Manuel Barroso, Board Chair: “I am greatly heartened that the Gavi Board has endorsed decisions that allow progress to be made on all fronts: for leveraging the latest innovations to tackle malaria, for COVAX to support national COVID-19 vaccination strategies, and for maintaining, restoring and strengthening routine immunisation programmes – including targeting the increasing numbers of zero dose children in the world today.”

Geneva, 3 December 2021 – The Board of Gavi, the Vaccine Alliance this week approved a number of measures aimed at tackling malaria, driving equitable global access to COVID-19 vaccines and maintaining, restoring and strengthening routine immunisation in 2022.

During the three-day meeting, the Board approved a new malaria vaccination programme to support the introduction, procurement and delivery of the malaria vaccine to Gavi-eligible countries in sub-Saharan Africa. An initial investment of US$ 155.7 million for 2022-2025 will initiate the implementation of this additional tool in the fight against malaria alongside currently recommended malaria control interventions, which could save tens of thousands of lives annually and drive down child mortality in Africa.

The Board also approved the Vaccine Alliance’s strategic direction and role in COVAX. In 2022, Gavi, through COVAX, will continue building the foundations of COVID-19 protection with a focus on lower-income countries and the most in need; deploying a flexible portfolio of COVID-19 vaccines to manage uncertainty and anticipate risk; and providing support for delivery at-scale.

 

“Events of 2021, illustrated most recently by the emergence of the omicron variant, have highlighted the danger of leaving COVID-19 to flourish unchecked in large parts of the world, but also of the vital importance of maintaining routine life-saving immunisation programmes that have been hit so hard by the pandemic”, said José Manuel Barroso, Chair of the Gavi Board. “I am greatly heartened that the Gavi Board has endorsed decisions that allow progress to be made on all fronts: for leveraging the latest innovations to tackle malaria, for COVAX to support national COVID-19 vaccination strategies, and for maintaining, restoring and strengthening routine immunisation programmes – including targeting the increasing numbers of zero dose children in the world today.”

Malaria vaccine programme
The Board’s historical approval of a malaria vaccine programme and financing will provide a critical new tool for African countries in the fight against malaria. With an initial investment of approximately US$ 155.7 million for 2022-2025, the Board noted that a successful malaria vaccine programme should support deliberate and intensive coordination between malaria control and immunisation programmes at global and country levels to ensure most impactful deployment of the vaccine alongside other interventions.

The Board also recognised the opportunity for integration and strengthening of primary healthcare given the wide acceptance of the vaccine among caregivers and healthcare workers, as was seen during the Malaria Vaccine Implementation Programme (MVIP). Child immunisation provides a powerful platform to reach vulnerable children, including those who are unreached with bednets or other existing prevention measures, and can help advance the equity agenda. Finally, the Board noted opportunities for next generation vaccines and a need for market-shaping efforts to support the development of a healthy malaria vaccine market.

“Today marks an important milestone in our fight against malaria,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “This decision by the Gavi Board to finance a new malaria vaccination programme for countries in sub-Saharan Africa could save tens of thousands of lives annually in Africa. The vaccine is an important additional tool to control malaria in Africa, alongside other interventions, such as routine use of insecticide-treated bed nets, indoor spraying with insecticides, malaria chemoprevention, and timely testing and treatment. We look forward to working with global malaria stakeholders to make sure that countries are able to implement this additional tool in the fight against malaria.”

After considerable gains in the past two decades, progress in malaria control has stalled and new tools are urgently needed to get back on track. More than 260,000 African children under the age of five die from malaria annually, and six Gavi-eligible countries account for 50% of global mortality. Africa continues to bear the heaviest malaria burden and African children are at highest risk of dying of malaria, especially at a time when the COVID-19 pandemic threatens disruptions to immunisation programmes.

Following the decision by the Gavi Board, a series of critical next steps will need to take place before the vaccine is rolled-out to Gavi-supported countries. This includes technical guidance on the use of the vaccine alongside other malaria interventions, procurement of the vaccine, and the opening of the funding window to allow applications from Gavi-supported countries. Additionally, countries will need to make decisions on the rollout of malaria vaccine, taking in consideration such factors as the public health priority of the disease, evidence of disease burden, and the optimal mix of malaria interventions tailored to the local context.

 

COVAX’s 2022 strategic approach
The Board approved the Vaccine Alliance’s strategic direction for 2022 to support 91 lower-income countries towards achieving their individual COVID-19 vaccination coverage ambitions in view of the WHO Global Vaccination Target of 70% by mid-2022 and taking into account sources of supply beyond COVAX. COVAX has supplied over 80% of all vaccines shipped to low-income countries and has secured access to enough additional doses to protect around 40% of each countries’ population by early next year.

Subject to funding availability for the COVAX AMC, the COVAX Facility’s approach to procurement of COVID-19 vaccines for 2022, devised to provide maximum flexibility in the event of new evidence appearing or markets evolving, was also approved by the Gavi Board. The core element of the approach, the Pandemic Vaccine Pool, will enable COVAX to manage demand- and supply-side risks, as well as provide doses to the countries that are most reliant on COVAX, including vulnerable countries, countries where current rates of coverage are the lowest and others that need certainty of supply in order to be able to plan successfully.

The COVAX 2022 strategic approach also recognises the difference in countries’ capacity to roll-out vaccines and the fact that many partners are providing support to countries to scale up delivery. The Alliance’s role in the scale up of COVID-19 vaccination in 2022 will focus on more systematic collaboration with other funders at global, regional and country levels; more targeted financial support and enhanced technical support to AMC-eligible countries; as well as enhanced monitoring of delivery progress and risks.

In order to strengthen COVAX’s processes from supply allocation to last mile delivery, the Board recognised the need to establish an enhanced and unified COVAX delivery coordination structure, agreeing to set up a temporary Steering Committee with delegated authority over delivery-related strategy and decisions of the COVAX Facility. The Committee will also oversee COVID-19 vaccination delivery support provided by COVAX, including alignment on allocation strategy, country absorptive capacity and funding. Recognising the important role that each Vaccine Alliance member needs to play in this coordination structure, it also requested that the new structure work with existing and additional partners and countries to rapidly accelerate vaccination delivery, including through campaigns, mass vaccination and hard-to-reach populations while safeguarding routine immunisation. The enhanced coordination structure will report on delivery progress to the Gavi Board through the temporary Steering Committee on a regular basis.

 

The Board also delegated to Gavi, at the guidance of the new COVAX coordination structure, the authority to allot current and future COVID-19 delivery funding without requiring independent review given the emergency context and urgent country needs, while utilising existing programmatic and fiduciary risk mitigation mechanisms.

The Board also noted the importance of COVAX’s cost-sharing mechanism as an important voluntary mechanism for countries to access additional doses and approved its extension until December 2023.

 

Disease surveillance and diagnostics
As part of Gavi’s efforts to restore, maintain and strengthen routine immunisation, the Board approved US$ 32 million in funding in 2022-2025 for costs related to the procurement and distribution of yellow fever, cholera, typhoid, meningococcus, measles, and rubella diagnostic test kits, reagents, supplies, and equipment. This market purchase commitment will put incentives in place for improved commercially available diagnostics. Additionally, US$ 21 million was approved to ensure that any test kits procured with Gavi funding are accurate, reliable, and useful for vaccine programmes’ efforts to use vaccines in the right places and times.

Fit-for-purpose diagnostic tools are critical for countries’ abilities to plan and implement targeted vaccination programmes. Making such diagnostic tools available to countries will help make sure that Gavi investments in these vaccine programmes, which are currently projected at over US$ 1.6 billion during 2021-2025, will be more efficient, effective, and equitable.

 

The Board also approved:
The renewed Gavi’s strategic partnership with India and the associated investment of US$ 250 million for 2022-2026, which will aim to further decrease the number of zero-dose and under-immunised children and expand full immunisation coverage in the next five years, as well as provide catalytic support for the introduction of Human papillomavirus (HPV) and Typhoid conjugate vaccines (TCV) in India.
The Gavi’s private sector engagement strategy which is expected to play a critical role in supporting the strategic priorities of Gavi 5.0 and COVAX related objectives, such as the zero-dose agenda, Covid vaccine delivery, innovation from the private sector and immunisation systems strengthening.
The Risk & Assurance Report 2021, which shows that Gavi’s overall risk profile remains elevated due to the ongoing uncertain environment, Gavi’s ambitious strategy and the unprecedented mission of the COVAX Facility. As per Gavi’s updated Risk Appetite Statement, approved by the Board in its June 2021 meeting, these risks are worth taking, but Gavi continues to actively monitor and mitigate them to the extent possible.
The Financial Forecast for Gavi 5.0 for the 2021-2025 strategic period and the Financial Forecast for Gavi COVAX AMC for the 2020-2022 period.

Finally, the Gavi Board gave a warm send-off to Maty Dia, Abdoulaye Sabre Fadoul, Gilbert Mokoki, David Sidwell and Joan Valadou, who have all made an important contribution to Gavi’s efforts to accelerate the introduction of new vaccines and improve routine immunisation. The Board also welcomed new members, including Bernhard Braune, Silvia Lutcuta, Bvudzai Magadrize, Charlemagne Marie Ragnag-Néwendé Ouedraogo, Jan Paehler, Anne Schuchat and Rafael Vilasanjuan.