More About GAVI
Questions & Answers about GAVI and the Vaccine
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
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.
2. Why was
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.
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
- For the first time, vaccine manufacturers are full
partners - with representatives on the GAVI Board and implementing
- The GAVI partners have the benefit of lessons learned
from past immunization efforts.
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
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, and other foundations: 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
Children's Vaccine Program
at PATH: To provide technical assistance and support to GAVI
partner agencies and countries and represent an NGO perspective.
The specific role a GAVI partner plays in any specific
country is based on the needs of that country.
5. How is GAVI
The GAVI Board sets the policies of the alliance. Composed of the
highest-level representation from the partners, there are four renewable
members - WHO, UNICEF, The World Bank, and the Bill & Melinda
Gates Foundation. Eleven additional, rotating members responsible
for representing the collective expertise and perspective of their
constituencies. The current (May 2002) rotating members are:
- Foundation: United Nations Foundation (Jul '01
- Jun '03);
- Government - two developing countries: India (Jan
'02 - Dec '03) and Mali (Jan '01 - Dec '02);
- Government - three industrialized countries: Norway
(Jan '01 - Dec '02) , the United Kingdom (Jul '01 - Jun '03),
the United States (Jan '02 - Dec '03).
- Nongovernmental organization (NGO): Children's
Vaccine Program at PATH (Jul '00 - Jun '02);
- Pharmaceutical industry - industrialized country:
Wyeth-Lederle Vaccines (Jan '02 - Dec '03);
- Pharmaceutical industry - developing country: Center
for Genetic Engineering and Biotechnology, Cuba (Jan '01 - Dec
- Research institute: Institut Pasteur, Paris (Jul
'01 - Jun '03); and
- Technical health institute: U.S. Centers for Disease
Control and Prevention (CDC) (Jan '01 - Dec '02)
Carol Bellamy, Executive Director of UNICEF, started
her two-year term as GAVI Chair in July 2001. The Board meets on
average twice a year and schedules periodic teleconferences as needed
to review progress and policies.
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 workplans. The Working Group currently
includes ten members, representing WHO; UNICEF; the World Bank;
the GAVI Secretariat; the Vaccine Fund ; and the NGO, government,
vaccine industry and research constituencies.
The GAVI Secretariat - five professional staff and
three secretaries 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.
Four GAVI Task Forces have been established to address
specific issues of concern to the Board. Task forces are funded
and managed by their respective lead agency(ies), and include representatives
of the relevant partner agencies. The Advocacy Task Force is chaired
by UNICEF; the Task Force for Country Coordination is chaired by
WHO; the Financing Task Force is co-chaired by the World Bank and
USAID; and the Research and Development Task Force is 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.
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
The Vaccine Fund has received commitments from the
governments of Norway, the United Kingdom, the United States, the
Netherlands, Denmark and Sweden, 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.
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 disease 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, about 900,000 people
will die from hepatitis B; 400,000 children will die from Hib disease,
and 30,000 children will die from yellow fever every year.
Though the Vaccine Fund does not procure the six "traditional"
vaccines for countries, Fund resources aimed at strengthening immunization
systems contribute to strengthening health systems so that they
are capable of delivering all necessary vaccines to children.
In the future, Vaccine Fund resources may also be
used to accelerate the development and introduction of vaccines
against diseases responsible for significant mortality in developing
countries, such as viral diarrhea (rotavirus), meningitis and pneumonia.
8. Who is eligible
for Vaccine Fund support?
Governments in the 74 poorest countries (GNP below US$1000 per capita)
are eligible to apply for support. So far, 66 of these countries
have applied and 54 countries have been approved. The Vaccine Fund
and GAVI have made five-year commitments of more than USD800 million
to these 54 countries.
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.
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, is receiving
hepatitis B from the Vaccine Fund, at a value of approximately $200,000
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 the end of 2002, the Vaccine Fund and GAVI had made five-year
commitments of more than USD800 million to 54 countries. Of that,
approximately two-thirds is used to purchase vaccines and supplies
and the rest is for support for capacity development and infrastructure.
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
- A multi-year plan outlining improvement and expansion
of immunization services and mechanisms for
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.
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
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.
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.
15. What is
the supply situation regarding combination vaccines?
The demand for DTP-based combination vaccine significantly exceeded
projected supply. There is only one producer of DTP-Hep B and DTP-HepB-Hib,
and manufacturing difficulties have lead to a sharp decrease in
expected production output. Based on approvals already made by the
GAVI Board, countries that already have introduced these products
in 2001 will continue to be supplied. Due the current production
levels, however, no additional countries will be 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.
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
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
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.
GAVI Partners are also focused on seeking out and
developing new technologies that will improve safety, effectiveness,
utility or performance of immunization systems in developing countries.