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Questions & Answers about GAVI and the Vaccine Fund

(Updated January 2005)

1. What is GAVI?

2. Why was GAVI created?

3. There have been global immunization programs before, how is GAVI different?

4. What specific role do the various GAVI partners play?

5. How is GAVI organized?

6. What is the Vaccine Fund, and how is it related to GAVI?

7. What kind of support does the Vaccine Fund provide?

8. Who is eligible for Vaccine Fund support?

9. How does the Vaccine Fund help strengthen countries' immunization services?

10. How much support do the countries get?

11. What percentage of Vaccine Fund resources are allocated for buying vaccines versus support for immunization systems?

12. How does GAVI make its funding decisions?

13. Why create a Vaccine Fund? Why not just put more resources into UNICEF, WHO, NGOs, and other institutions already involved in immunization work?

14. How will GAVI ensure that programs are sustainable beyond the first five years of support?

15. What is the supply situation regarding combination vaccines?

16. What is GAVI's commitment toward injection safety?

17. What is the status of R&D projects under GAVI?

1. What is GAVI?

The Global Alliance for Vaccines and Immunization (GAVI) is a public-private partnership focused on increasing children's access to vaccines in poor countries. Partners include national governments, UNICEF, WHO, The World Bank, the Bill & Melinda Gates Foundation, the vaccine industry, public health institutions and nongovernmental organizations (NGOs). The Alliance provides a forum for partners to agree upon mutual goals, share strategies, and coordinate efforts.

The Alliance is strengthened by The Vaccine Fund (See Question 6), an innovative financing mechanism designed to help GAVI achieve its objectives by raising new resources and swiftly channeling them to developing countries.

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2. Why was GAVI created?

In the history of international public health, there has been no other routine health intervention that has received such high coverage as vaccination. However, as a new century begins, the world falls short of realizing the full benefit of childhood immunization. By the end of the 1990s approximately 34 million children were born every year that would not become immunized. In sub-Saharan Africa fewer than half of the children were being immunized. As a result, every year, approximately three million lives could be saved from easily prevented infectious diseases.

Moreover, vaccines such as those against hepatitis B and Haemophilus influenzae type b have not been introduced quickly enough in the poorest countries. New vaccines at late stages of development, such as those being created against certain forms of pneumonia, meningitis and diarrhea - diseases that kill millions of children every year in the developing world - are at risk of not reaching those who most need them. Finally, the search for vaccines against the most critical infectious disease threats of our time - HIV/AIDS, malaria and tuberculosis - must persist and be strengthened, and effective health delivery systems must be in place to ensure that once they are found, all those in need can access them.

By joining together in this Alliance, the partners saw an historic opportunity to use their collective strength to reverse the decline, and to make life-saving immunization available to every child, including those living in the harshest conditions, in the poorest nations.

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3. There have been global immunization programs before, how is GAVI different?

The GAVI partnership is different from past immunization initiatives in a number of ways:

  • GAVI is an alliance of partners, not a new organization that might be seen as competitive or duplicative.

  • Each of the GAVI partners has made high level commitments to carry out the necessary work. They will not rely on the small GAVI Secretariat to do that work for them.

  • The Vaccine Fund adds significant resources to the alliance.

  • For the first time, vaccine manufacturers are full partners - with representatives on the GAVI Board and implementing groups.

  • The GAVI partners have the benefit of lessons learned from past immunization efforts.

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4. What specific role do the various GAVI partners play?
The GAVI alliance is only as strong as the contributions of each partner - at the international, regional and national levels. Examples of the primary objectives of some of the partners are as follows:

Developing country governments: To make certain that the health sector develops effective measures to reach out and provide health services to those most in need.

Donor governments: To ensure that health gets an adequate proportion of external aid channeled through the sector coordination mechanisms.

The World Bank Group: To support national governments' efforts toward sustainable financing mechanisms for immunization services including vaccine purchase and infrastructure support, through policy dialogue with governments, lending, and funding from the debt relief process.

WHO: To develop global policies and strategies for immunization and vaccine development.

UNICEF: To advocate and mobilize leaders from global to community levels to make immunization of children a key priority for development.

The Bill & Melinda Gates Foundation: To invest in global health efforts, especially in support of immunization and to raise awareness of the value of immunization.

Vaccine industry: To contribute actively to the supply of high quality vaccines to the poorest populations, and the development and supply of new breakthrough vaccines.

Nongovernmental organizations: With a strong history in the field of child health and immunization, NGOs provide technical advice and staff to government programs, while others provide additional financial support.

The specific role a GAVI partner plays in any specific country is based on the needs of that country.

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5. How is GAVI organized?
The GAVI Board sets the policies of the alliance. Composed of the highest-level representation from the partners, there are five renewable members - WHO, UNICEF, The World Bank, The Vaccine Fund and the Bill & Melinda Gates Foundation. Tweleve additional, rotating members responsible for representing the collective expertise and perspective of their constituencies. Click here for the current GAVI Board membership.

Dr JW Lee, Director General of WHO, started his two-year term as GAVI Chair in December 2003. The Board meets on average twice a year and schedules periodic teleconferences as needed to review progress and policies.

Established in July 2003, the Executive Committee of the GAVI Board facilitates closer supervision and implementation of GAVIís activities. Membership includes four renewable members (WHO, UNICEF, the World Bank, and the Gates Foundation), one rotating member each from developing and industrialized country governments and one rotating member each from industrialized countries and developing countries vaccine industry.

The GAVI Working Group supports the Board in policy development and implementation. Composed of managers in the GAVI partner institutions, these staff are able to translate GAVI priorities into their respective agency work plans. The Working Group currently includes ten members, representing WHO; UNICEF; the World Bank; the GAVI Secretariat; and the NGO, government, vaccine industry and research constituencies.

The GAVI Secretariat - a small group of professional and administrative staff housed in the European regional office of UNICEF in Geneva - facilitates coordination between the partners and manages the review of country proposals for support from The Vaccine Fund. The Executive Secretary reports to the GAVI Board. The Secretariat's budget is financed by membership fees paid by the GAVI Board members.

GAVI Task Forces are established to address specific issues of concern to the Board. They are funded and managed by their respective lead agency(ies), and include representatives of the relevant partner agencies. Their work was especially vital at GAVIís founding, and had an additional benefit of providing a forum outside of the Board and Working Group for the Partners to work together. Currently, the only active task force is the Financing Task Force, chaired by the World Bank. The other three task forces have been dissolved, having successfully completed their work, or to clear the way for new entities which will need to be formed to address new challenges. Former task forces include: The Advocacy Task Force (chaired by UNICEF); the Implementation Task Force (chaired by WHO); and the Research and Development Task Force (co-chaired by WHO, the University of Maryland and Chiron Vaccines).

Regional working groups (RWGs) were established by partners with a technical presence at the regional level - in most cases WHO and UNICEF - in response to the need to more quickly identify and address the technical assistance requirements of countries, improve communication and streamline efforts between the national and international levels. RWGs have been created in Africa, Europe, Western Pacific, South East Asia, and the Eastern Mediterranean.

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6. What is the Vaccine Fund, and how is it related to GAVI?
The Vaccine Fund is a financing mechanism designed to help the GAVI alliance achieve its objectives by raising new resources and swiftly channeling them to developing countries. Since the partners of the Alliance provide direction and support in policy development and the processing of countries' proposals, administrative costs are kept low - approximately 98% of Vaccine Fund resources go directly to countries.

The Vaccine Fund has received commitments from the governments of Norway, the United Kingdom, the United States, the Netherlands, Denmark, Sweden, Canada, Ireland, and France, and from the private sector, adding to its start-up grant from the Bill & Melinda Gates Foundation, pushing its total resources to above $1 billion so far for 2001-2005.

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7. What kind of support does the Vaccine Fund provide?
The Vaccine Fund provides countries with resources to strengthen routine immunization services; pays for vaccines against hepatitis B, Hib disease and yellow fever, and safe injection materials; and provides a small one-time investment to help support introduction activities. Hepatitis B, Hib and yellow fever vaccines were selected because they have been available and recommended for routine use by WHO for a number of years but are not being widely used in low-income countries despite extreme need. For example, if they do not receive the vaccines to protect them, over 500,000 people will die from hepatitis B; 450,000 children will die from Hib disease, and 30,000 people will die from yellow fever every year.

Though The Vaccine Fund does not procure the six "traditional" vaccines for countries (except in the case of combination vaccines that include DTP), Fund resources, aimed at strengthening immunization systems, often contribute to strengthening a countryís overall health system, so that they are capable of delivering all necessary vaccines to children.

Vaccine Fund resources are also being used to investigate accelerating the development and introduction of vaccines against two diseases, rotavirus and pneumococcus, which are responsible for significant mortality in developing countries.

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8. Who is eligible for Vaccine Fund support?
Governments in the 75 poorest countries (GNI below US$1000) are eligible to apply for support. So far, 71 out of the 75 countries eligible for support have successfully applied for GAVI support. The Vaccine Fund and GAVI have made five-year commitments of more than USD 1.2 billion to these 71 countries. Cuba, Papua New Guinea, Solomon Islands, and Timor Leste have not yet approached GAVI for support.

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9. How does the Vaccine Fund help strengthen countries' immunization services?
The Vaccine Fund provides cash support to improve immunization programs based on the application submitted by the country and the findings of immunization program assessments. But these grants are a distinct departure from traditional funding systems that impose strict guidelines on use of resources. Instead, this system imposes strict performance requirements, relying upon governments and their interagency ICCs to set goals and monitor progress.

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10. How much support do the countries get?
The amount of support provided by The Vaccine Fund depends on a country's goals and its population size. This varies considerably for each country. For example, for a larger country like Kenya, which is introducing hepatitis B and Hib vaccine, and increasing its basic immunization coverage, received approximately $7 million in vaccines and infrastructure support in 2001. A smaller country like Albania, which already has strong routine coverage, received hepatitis B from The Vaccine Fund in 2001, at a value of approximately $200,000.

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11. What percentage of Vaccine Fund resources are allocated for buying vaccines versus support for immunization systems?
Vaccine Fund allocations are based on proposals received from countries. By mid 2004, The Vaccine Fund and GAVI had made five-year commitments of more than USD 1.2 billion to 71 countries. Of that, approximately two-thirds are used to purchase vaccines and supplies and the rest is for support for capacity development and infrastructure.

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12. How does GAVI make its funding decisions?
Funding decisions are made based on proposals received from countries. Country proposals are reviewed by an Independent Review Committee (IRC) which meets at set times throughout the year at the GAVI Secretariat in Geneva. IRC members have been selected for their broad expertise in health with specific knowledge of vaccines and immunization, independence from the partners of GAVI, and integrity. These experts have been selected primarily from low- and middle-income countries.

The IRC reviews and discusses proprosals in accordance with the policies laid down by the GAVI Board, with the following being the main conditions for support:

  • An Inter-agency Coordination Committee (ICC) led by government and including representatives of local agencies involved with immunization. The ICC helps guide the application process and assists government with program management.

  • A recent review (within 3 years) of immunization services; and

  • A multi-year plan outlining improvement and expansion of immunization services and mechanisms f or sustainable financing.

The IRC provides its recommendations to the GAVI Board; the Board then makes its request to the Vaccine Fund Board, which votes on providing financial support for the approved proposals.

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13. Why create a Vaccine Fund? Why not just put more resources into UNICEF, WHO, NGOs, and other institutions already involved in immunization work?
The Vaccine Fund has been designed to make a rapid positive impact, using independent financial and administrative structures to ensure efficient transfer of support from donors to countries. The Vaccine Fund provides resources directly to country governments, not through other agencies.

An additional purpose of the Vaccine Fund is to demonstrate to vaccine manufacturers that a developing country market exists for newer vaccines. GAVI partners are hoping that this will encourage manufacturers to increase current vaccine production, and to develop new and even better vaccines in the future.

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14. How will GAVI ensure that programs are sustainable beyond the first five years of support?
One of the overriding concerns of the GAVI partners is to help countries formulate strategies to sustain improved immunization performance over time. The Vaccine Fund has been designed to give governments of low-income countries a temporary financial boost to their immunization systems and to provide a foundation for them to expand support from other sources, especially their own government budgets. While the lowest income countries may require continued external support for their immunization programs, support from The Vaccine Fund cannot continue indefinitely. The GAVI Financing Task Force is therefore developing tools and resources for countries, and will provide technical support to help countries establish independent, long-term funding for their immunization programs.

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15. What is the supply situation regarding combination vaccines?
The demand for DTP-based combination vaccine significantly exceeded projected supply. There is currently only one producer of DTP-Hep B and DTP-HepB-Hib, and manufacturing difficulties have lead to a sharp decrease in expected production output. However, 11 new suppliers are expected to come online by 2006. Based on approvals already made by the GAVI Board, countries that already have introduced these products in 2001 will continue to be supplied. Due to low production levels, however, no additional countries were able to introduce this particular type of combination vaccine until 2004.

Other vaccine formulations (DTP-Hib) may be available at end 2002 or 2003, depending on U.N. pre-qualification. Supplies of Hep B monovalent remain nearly nine times the current demand.

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16. What is GAVI's commitment toward injection safety?
The GAVI Board strongly supports the use of safe injection equipment, including disposal, and that of vaccine combinations. From inception, GAVI and The Vaccine Fund provided new vaccines (Hep B, Hib, yellow fever) bundled with necessary auto-disable syringes and safety boxes.

The Vaccine Fund now also provides additional support to countries which establish a comprehensive national plan to improve injection safety and waste disposal for immunization. This support will be provided on an annual basis in the form of auto-disable syringes and safety boxes for vaccines according to the standard EPI schedule, or equivalent cash grant, for a maximum period of three years. This support is available to all countries that have received approval for new and under-used vaccines or for immunization services support.

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17. What is the status of R&D projects under GAVI?
With all of the current activity in vaccine R&D, it is important that in the context of GAVI efforts focus on identifying those gaps where an alliance can have a strategic advantage. Thus, while the GAVI partners recognize that a high priority lies in HIV/AIDS and malaria, given the massive global effort to these projects worldwide, the Alliance decided to prioritize other vaccines that are receiving less attention.

The GAVI Task Force on Research and Development (R&D TF) conducted a wide consultation process which identified three vaccines that should receive high priority in the context of GAVI: pneumococcal, rotavirus and meningitis A/C conjugate. The Board approved this proposal because of these vaccines' high probability of success in the next 5-7 years and their high potential impact on reducing morbidity and mortality in developing countries. The rotatvirus and pneumococcal ADIPs have been successfully launched.

GAVI Partners have also focused on seeking out and developing new technologies that will improve safety, effectiveness, utility or performance of immunization systems in developing countries.

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Background materials

GAVI: Questions and Answers

Fact sheets

About GAVI

Immunization facts and figures

The impact of immunization on economic development

Vaccine-preventable diseases: an overview

About the GAVI Board Members

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