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Friday, February 1 2002


Business-like approach to funding health programs in poor countries may save more than two million lives in 5 years

NEW YORK, 1 February – Two years after its official launch at the World Economic Forum annual meeting in Davos, Switzerland, the Global Alliance for Vaccines and Immunization, or GAVI, reports that its goal-oriented approach to development aid could raise basic immunization rates in funded countries by 17 percentage points and increase coverage of hepatitis B vaccine from 18 to 65 percent by 2007, ultimately saving more than two million lives, according to new data released at the World Economic Forum today.

GAVI is a public-private partnership focused on increasing access to vaccines among children in poor countries. Partners include national governments, UNICEF, WHO, The World Bank, the Bill & Melinda Gates Foundation, the vaccine industry, public health institutions and NGOs.

“GAVI was born out of the growing recognition that the global community must work harder to reduce the gap between rich and poor countries, and that we all must work together in new and unconventional ways,” said UNICEF Executive Director Carol Bellamy, current Chair of the GAVI Board.

At the time of its launch, GAVI also unveiled its financing arm the Vaccine Fund, created with $750 million from the Bill & Melinda Gates Foundation. Additional contributions have since increased the total to $1.2 billion. The fund provides vaccines and financial support to the 74 poorest countries – those with less than $1000 GNP per capita – to improve their health systems and introduce newer vaccines such as hepatitis B.

GAVI partners introduced a new idea in international development: outcome-based grants that give governments responsibility and autonomy to decide how money is used, but if they don’t show results, the funding stops. To ensure accountability, an initial effort to audit country data was undertaken in 2001 by an independent consortium that included the international auditing firm, Deloitte Touche Tomatsu.

“GAVI has not only made remarkable progress in improving the prospects for the world’s children, in many ways it is the precise embodiment of the increasing trend of taking a private sector approach to a public problem”, said Professor Klaus Schwab, President of the World Economic Forum.

While traditional health initiatives often start off by hand-picking countries to participate in a pilot project – thereby slowing down the process – GAVI threw the doors wide open, letting any country apply, as long as it was one of the poorest in the world. After just two years, 66, or 90% of eligible countries have applied for Vaccine Fund support, and 53 countries have already been approved – including some in the most difficult situations such as Sierra Leone, Liberia, and Afghanistan. Proposals from another 13 countries are pending, and most of the remaining 8 eligible countries are expected to apply this year.

“The pace at which the GAVI partners have designed a program 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.

GAVI partners are of course meeting hurdles, such as the weak state of health infrastrucure in countries, rampant unsafe injection practices and shortages of the most in-demand vaccines. These challenges have compelled the alliance to be flexible, creating and adapting policies to adjust to the realities in countries. For example, to address the problem of unsterile needles, the GAVI Board approved a new policy for the Vaccine Fund to provide auto-disable syringes – fitted with a mechanism that prevents re-use – for all routine immunizations in countries.

GAVI’s quick pace and approach have been criticised by some who are concerned that countries do not have the capacity to comply with GAVI’s funding requirements. While a recent study on the impact of GAVI from a country perspective concluded that “GAVI was generally seen as a positive development in all four countries” visited, countries were “concerned about the overall pace of the application process” and some “found the process of collating information difficult.”

Acknowledging the dire need for more resources to help overworked health staff in countries, Dr Godal welcomes the criticism. “Most international health initiatives are condemned for going too slow. It is an incredible twist of irony to be criticised for going too fast”, he said.

GAVI officials do accept, however, that in places where resources are extremely scarce, more support must be found. They stress that the Vaccine Fund cannot be considered the answer to all resource needs; it is intended to be a catalyst for other sources of funding including increases in national governments’ own health budgets, other bilateral donor funding and development loans, or through mechanisms such as debt relief.

In fact, GAVI’s role as a catalyst has been documented. According to the same study, 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] program”, and further, that “donors were also increasing pledges and expenditure.”

The GAVI data are based on the plans prepared by the countries and partners in the 53 approved countries. Five-year commitments to these countries total more than $800 million. GAVI partners estimate that this investment could result in more than two million lives saved, based on current data of disease burden and immunization costs. The projected results are subject to change, both because some countries may not reach their targets, and others may surpass them.

The Global Alliance for Vaccines and Immunization (GAVI) is a public-private partnership formed in response to stagnating global immunization rates and widening disparities in vaccine access among industrialized and developing countries. The GAVI partners include: national governments, the vaccine industry, NGOs, foundations, research and public health institutions, the United Nations Children's Fund (UNICEF), the World Bank Group and the World Health Organization (WHO). The Vaccine Fund is a new financing resource created to support the GAVI immunization goals, providing financial support directly to low-income countries to strengthen their immunization services and to purchase new and under-used vaccines.

“New Products into Old Systems”, by the London School of Hygiene and Tropical Medicine, in press.


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