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GAVI Update



Tuesday, 11 April 2000



Lisa Jacobs, GAVI Secretariat
+41 79 447 1935 (mobile)
in Washington, D.C. on 11 April


Vaccine fund needs just $200 million more per year to save millions of lives

A new international vaccine alliance has calculated that within five years it will be possible to reach nearly half of the 25 million children born every year in poor countries who are not currently being immunized, saving millions of lives, at a cost of $350 million per year. The Global Alliance for Vaccines and Immunization (GAVI), a public-private coalition that has the long-term goal of ensuring universal immunization and accelerating the development of new vaccines, has already received a commitment of $750 million, and is on its way to securing the $1 billion more that it projects will be needed to reach its five-year goal.

"More than one-quarter of children born each year in low-income countries have not been receiving basic immunization, and the time has come to solve this serious global health problem and reduce the three million deaths every year from vaccine-preventable diseases," said Dr. Gro Harlem Brundtland, Director-General of the World Health Organization (WHO) and Chair of the GAVI Board. "Over the past two decades we’ve learned important lessons about immunization strategies - both good and bad - that we will now use to set a new course for improving health outcomes for all the world’s children."

After a surge of global efforts in the 1980s, global immunization rates rose from 5% in 1974 to nearly 80% in 1990. However, since 1990, the proportion of children being reached has suffered a decline, to just under 75% -even less in many developing countries. The declining rates have been due to a number of factors including a reduction in global funding, conflict and turmoil, and a deterioration of basic health services in many countries.

Dr. Brundtland will describe how the GAVI partners will reverse this trend at a Senate hearing in Washington D.C. on April 11th. The committee is considering a Clinton Administration request of $50 million in U.S. funding this year for the Vaccine Fund, which has been established by GAVI to assist developing countries in their vaccination efforts.

The Bill and Melinda Gates Foundation has provided the initial commitment to the Vaccine Fund with a grant of $750 million over five years. In addition to the possible U.S. funding, governments, corporations and other donors are being approached to provide the additional resources required to reach the goal of $1.75 billion in five years.

Since GAVI announced the multimillion-dollar vaccine fund at the World Economic Forum in Davos, Switzerland in January, more than 50 developing countries have indicated their interest in becoming involved in the global vaccine effort. In May, the Alliance will issue an official call for proposals to 74 low-income countries (defined as those with less than $1,000 gross national product per capita), with the first grants to be made in the second half of this year.

In a brand new approach to global health funding, GAVI plans to use part of the resources from the vaccine fund for a performance-based system under which governments of countries with low current immunization coverage will receive financial incentives to strengthen their health systems to deliver immunization. While the details are still being negotiated, the basic principle will be to calculate support based on increases in the number of children immunized in a given country. It is hoped that if successful, this approach can become a model for other international health programs.

The vaccine fund will also be used to make bulk purchases of new and under-used vaccines for low-income countries. Newer vaccines against hepatitis B, Haemophilus influenzae type b (Hib) and yellow fever have been available for years, but are not widely incorporated into immunization programs in many of the poorest countries because of price and logistical difficulties. The Vaccine Fund will emphasize the use of safe and simple delivery techniques, such as combination vaccines - grouping more than one antigen in a single injection - and monodose delivery devices to reduce wastage and the possibility of unsafe injections from re-used needles.

"Vaccines provide the single most powerful strategy to improve the health and extend the lives of the world’s children," said Bill Foege, Senior Advisor of the Bill & Melinda Gates Foundation. "The world loses a million children a month because of simple disease problems and a quarter of them could be saved by the use of vaccines already available. We need to increase access of these vaccines to children in the poorest countries. The polio eradication effort has shown us that when the government and communities mobilize we can reach children even in the most remote areas. We are excited to be part this global effort."

GAVI partners include: national governments of donor and developing countries, the Bill and Melinda Gates Children’s Vaccine Program, the International Federation of Pharmaceutical Manufacturers Associations (IFPMA), the Rockefeller Foundation, UNICEF, the World Bank Group and the World Health Organization (WHO). The GAVI strategies to improve immunization services, and the roles that the different GAVI partners will play have been outlined in a paper entitled, "Immunize Every Child".

"This is not ’pie-in-the-sky’. With the commitments we are getting from partners, it’s doable. In fact, we may be able to reach even more children faster than the targets we’ve set," said Dr Tore Godal, Executive Secretary of GAVI. "With the increasing recognition that investing in health will reduce poverty, the scientific and technological advances in immunization, and the lessons we’ve learned about integrating health services without jeopardizing any single service, this is exactly the type of project we will see more of in the 21st Century."

Other speakers at the Senate hearing will be U.S. Treasury Secretary Lawrence Summers, Dr. Nils Daulaire of the Global Health Council, and Dr. Adel Mahmoud of Merck Vaccines. Senators Mitch McConnell (R-KY) and Patrick Leahy (D-VT) will be presiding at the hearing.

Based on current estimates of vaccine delivery costs, GAVI partners calculate that $1 billion is currently being spent each year in low-income countries on immunization services - most of the costs borne by the governments. An additional $350 million annually is needed to help those countries reach at least 80 percent coverage with the traditional and newer vaccines. The Gates commitment will provide $150 million a year; $200 million more per year will be sought.

GAVI officials point to the African country of Uganda to illustrate the difficulty of complete immunization. One third of the rural districts in Uganda lack any health center at all, much less an infrastructure to vaccinate children. One idea is to build a network of mobile services that do not use cars but rely on animals or motorcycles, which are better able to reach villages where roads are poor or non-existent. Health workers can then visit isolated villages to deliver not only vaccines but a whole range of health services.

The vaccine fund also plans to help countries avoid using expired - and therefore ineffective - vaccines. Under the old systems, health workers had no way to judge whether a vaccine was still effective. A new Vaccine Vial Monitor (VVM) is a container that carries a label that shows changes in conditions that can affect vaccine quality. As the vaccine ages or is exposed to undesirable levels of heat, the label changes color, from a pale white to almost black. VVM was first introduced in polio vaccine in 1996, and there are plans to broaden its use to all basic childhood vaccines.

GAVI is the Global Alliance for Vaccines and Immunization, a coalition of organizations formed in 1999 with the mission of ensuring that every child is protected against vaccine-preventable diseases. The partners include: national governments, the Bill and Melinda Gates Children’s Vaccine Program, the International Federation of Pharmaceutical Manufacturers Associations (IFPMA), research and technical health institutions, the Rockefeller Foundation, the United Nations Children’s Fund (UNICEF), the World Bank Group and the World Health Organization (WHO).

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