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March 2001

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Hard work ahead

WITH two out of three eligible countries still to be approved for awards from the Vaccine Fund, the GAVI partners have a lot of work to do to meet the goal of supporting all 74 eligible countries by 2002. This is the conclusion of Alliance partners who are responsible for ensuring that countries have strong immunization plans in place so that they can attract new money from the Vaccine Fund.

Last month, the Alliance's independent review committee assessed applications from the third round of countries to apply to GAVI and the Vaccine Fund for support, following the first two rounds last year. Three new proposals for support to improve immunization services, from Cameroon, Pakistan and Tajikistan, were approved in principle pending some clarifications. But 10 countries did not receive approval for any request, either for new vaccines or for immunization services.

Of the 74 eligible countries with incomes below US$ 1000 GNP per capita, 25 have now been approved for awards, and 6 more have received conditional approval (see Graph). Another 14 countries have been asked to re-submit their proposals, while 2 countries have been turned down(1).

While relatively well-resourced countries submitted their applications in the first two rounds, most of the current wave of applications come from countries that tend to have weaker capacity in their health ministries – or other demands on their overstretched resources. For example, several of the countries asked to re-submit are in West Africa where a major polio campaign has been under way in the past few months.

Dr Tore Godal, executive secretary of GAVI, said that the review had served to highlight needs that might otherwise have been missed. "We can use the application process as a way to diagnose problems at country level and then start to provide longer-term assistance and capacity building for the countries that are weakest," he said. "Together with the GAVI Task Force on Country Coordination, we have identified as our first target 13 countries in Africa that need particular attention." The Task Force is starting to cost its plans for capacity building. Members say the needs are substantial.

Dr Bjorn Melgaard, head of the WHO's department of Vaccines and Biologicals, said that agencies such as WHO could provide consultants to offer technical support in the completion of each country's application. But, he stressed, external support would not be enough in the long term. "You are not building the capacity or the ownership that is needed," he said. He said many countries should be employing a full-time member of staff to develop the government's immunization plans and its application for funds. Dr Melgaard believes that most African countries already have qualified personnel available, but that they need to be recruited. He warns that capacity to plan and implement immunization cannot be built overnight.


(1) For details of applications and disbursements to date, see

Phyllida Brown


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