GAVI The Global Alliance for Vaccines
As the Alliance enters its third year, Carol
Bellamy, chair of the GAVI Board and Executive Director of UNICEF,
explains how the immunization initiative is moving forward
Bellamy is a realist. She knows what it
takes to work against donor fatigue and political apathy. So when
she sets out her vision for protecting more children worldwide against
killer diseases through immunization, it is clear that she believes
it can and will happen. Despite the challenges.
Why? Because it is hard to find a better
story, a better real story, she says. Immunization works.
It is highly cost-effective and there is an increasing understanding
that it plays a very important role in reducing child and infant
. This is a positive development story that can really
shoot a hole in development fatigue.
As Executive Director of the United Nations
Childrens Fund, UNICEF, Ms Bellamy is also currently the chair
of the Board of the Global Alliance for Vaccines and Immunization.
Two years after GAVIs launch, she is pushing ahead towards
its goals, as well ensuring that the Alliance builds on what it
has learnt so far.
By the end of the five-year commitments made
by GAVI, she hopes, the health ministries in the poorest countries
will have built stronger infrastructures for immunization than ever
before. A broader array of vaccines will be part of routine immunization
everywhere. And a new mechanism of international aid pioneered by
the Alliance awards that are made according to results
will be seen as a success.
How far has the Alliance progressed towards
these goals so far? It is still early days, says Ms Bellamy, because
the first deliveries of vaccines to countries have only recently
begun. But no one doubts that the pace so far has been fast: 53
of the 74 eligible countries those with an income per head
of less than US$1000 have already been approved for support
from GAVI and the Vaccine Fund.
Just as important, she says, the world has been
sent a strong message. The initial gift of US$750 million from the
Bill and Melinda Gates Foundation to the Vaccine Fund was a
much needed financial infusion at a time of increasing aid
drowsiness, says Ms Bellamy. The new private-public
partnership drew attention at the highest political level to a very
efficient health intervention and it has attracted substantial further
donations from seven industrialized countries. So far, over US$1
billion has been committed to the Fund.
But Ms Bellamy is under no illusions about
the tasks ahead. A key challenge is to harness more money. The Vaccine
Fund puts the total cost of achieving the Alliances five-year
goals at around $2 billion, so another $1billion is needed. But
the climate is tougher than at the end of the 1990s. We are
now dealing with a much tighter global economy, says Ms Bellamy.
She believes the Alliance partners need to work hard with countries
to explore different mechanisms, including allocating debt relief
in the poorest countries towards immunization. Hopefully countries
will see this as a good opportunity for investing some of these
funds, says Ms Bellamy. With evidence of such commitment from
the countries themselves, even at modest levels, she hopes that
traditional donors may be willing to come up with new support.
But funding is not everything: a critical requirement
for success is the commitment of each government to improving its
own immunization system. There really has to be a buy-in at
country level, says Ms Bellamy. In her visits to Mozambique
and Cambodia, where the first GAVI vaccines were delivered last
year, she saw this commitment at first hand.
This is also where the new approach to funding
pioneered by GAVI comes in. Hoping to increase political buy-in,
the Alliance and the Vaccine Fund award countries money to strengthen
their immunization systems on the basis of performance. From each
countrys point of view, there is greater freedom than in most
international aid programmes: the government can decide exactly
how it will use the money to improve its performance. In return,
the Alliance focuses on results: if a country increases its coverage
(the percentage of children fully immunized), it gets more money.
If it does not and the figures are independently audited
the funding stops.
The brand-new mechanism is being evaluated now,
as a high priority, says Ms Bellamy. Outside GAVI, too, the idea
has attracted interest from other international development initiatives.
I think this approach has the potential to be emulated elsewhere,
says Ms Bellamy, although she cautions that definitions of the results
of any health-related investment need to be carefully thought out.
What has the Alliance learnt so far that could
change its approach? First, says Ms Bellamy, there has been an important
recognition that the Alliance needs to support countries in strengthening
their routine immunization services, as well as helping them to
increase the number of vaccines they provide. Initially, GAVI was
criticised for allocating less than one-fifth of its spending from
the Fund to strengthening immunization services, while spending
most of the money on under-used vaccines. Today, five-year commitments
for strengthening routine services have increased markedly, to some
$269 million, just over one-third of the total; in addition, more
than $11 million has been allocated over three years to help countries
increase injection safety. Strengthening routine immunization
has a multiplier effect and helps the strengthening of the health
system as a whole, says Ms Bellamy.
There are several other key questions that the
Alliance must ask itself as it moves into its third year. First,
how to ensure a steady supply of vaccines in a market with few players.
In the first two years of the Alliances work, demand from
the countries for certain combination vaccines has far exceeded
the available supply and countries have been asked to accept alternative
presentations of the vaccines. UNICEF, which procures vaccines on
behalf of most of the governments and the Vaccine Fund, must work
with the industry to find ways of making the supply more predictable,
says Ms Bellamy. She also wants to streamline the procurement system
The role of the vaccine industry within the
Alliance itself has attracted some critics who say individual companies
should not have seats on the Board because of the potential conflict
of interest. Ms Bellamy responds that the goal of the partnership
increasing childrens access to immunization
is probably brought closer overall by having the industry directly
At all times, Ms Bellamy makes clear that the
ultimate goal is better immunization, beyond the lifetime of the
Alliance itself. Immunization existed before GAVI and it will
continue after GAVI, she says. While the Alliance partners
will need to keep convincing potential investors of the value of
immunization, she says, governments own commitment will determine
whether sustainable funds can always be mobilized.
Equally important, she says, it is vital that
all players face up to the fact that there are real costs
in bringing a broader range of vaccines to a greater number of the
worlds children. Immunization cannot be done well on the cheap.
But its costs are still relatively small, she says, compared with
the enormous benefits that the increased investment will bring.
Arguing that case effectively is a key task for GAVI. Lets
make sure we make a difference.