Gavi, the Vaccine Alliance, just finalised its new strategic plan for 2021-2025, which aims to reach communities missed by previous immunisation efforts, including those most marginalised by poverty, geography and conflict. It also prioritises sustainability of vaccine programmes through co-financing arrangements with countries to build domestic investment in health and reduce reliance on Gavi funding.

“For the next five-year period equity will be the Alliance’s key guiding principle,” said Dr Ngozi Okonjo-Iweala, Chair of the Gavi Board, quoted in a Gavi press release. “This will mean focusing on those left behind, whether they be girls and women, refugees or remote communities, to ensure nobody goes without lifesaving vaccines.”

“With this new strategy we will make the millions of children around the world who are missing out on vaccines our absolute priority. By bringing immunisation to these missed communities the Alliance will also be extending primary health care systems, building a foundation for Universal Health Coverage,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance.

“[T]he 2021-25 period will mean new vaccines, new technologies and new approaches to help build healthier, wealthier communities across the developing world,” Berkley said, adding that this will bring “all the economic benefits that come with a healthier population.”

The Gavi Board yesterday approved the new strategy at the close of its latest meeting, which took place in Geneva from 26-27 June, according to the release.

The new strategy, “anchored in the Sustainable Development Goals” and “echoing its driving mission to leave no one behind,” is the culmination of 18 months of consultations with stakeholders. It will target four goals to increase the equitable and sustainable use of vaccines:

1. To introduce and scale-up vaccines
2. Strengthen health systems to increase equity in immunization
3. Improve sustainability of immunisation programmes
4. Ensure healthy markets for vaccines and related products

Since 2000, Gavi has greatly expanded the scope of its work, supporting countries to introduce more than 400 new and under-used vaccines. Gavi initially supported vaccines protecting against six infectious diseases, but by 2025, this number is expected to increase to at least 18. Over the next 5 year period, Gavi will also support vaccines to tackle outbreaks of infectious diseases such as Ebola, cholera and typhoid, and will increase its role in fighting antimicrobial resistance, the release said.

While “Gavi-supported countries reached a record 64 million children with a full course of basic vaccines in 2017, up from 41 million in 2000,” there are “still as many as one in ten children in Gavi-supported countries [that] receive no routine vaccines,” it said. To address this, Gavi is focusing its new strategy on closing this gap, including through innovative service delivery, strengthening primary care, and addressing gender-related barriers.

Co-Financing for Sustainability

In the new plan, Gavi will continue its co-financing arrangements with countries. These arrangements maximise the reach of Gavi funding while supporting countries to build domestic investment in health, particularly towards strengthening primary care systems, which are essential for effective vaccine programmes. As low-income countries become wealthier, they are expected to increase their proportion of financing, and to ultimately transition away from Gavi funding to self-finance their vaccine programmes.

“From 2011 to 2018, countries have increased the amount they themselves spend on Gavi-supported vaccines from US$ 36 million to US$ 475 million, and 19 countries are expected to have transitioned out of Gavi support completely by 2020,” according to the release.

At their meeting earlier this week, the Gavi Board requested that Gavi also “explore approaches to engaging with self-financing lower middle-income countries in recognition of major challenges in those countries.”

To further global efforts towards eradicating polio, the Board agreed to a new cost-sharing approach for inactivated polio vaccine (IPV). “Gavi will fully-finance the vaccine for the very poorest countries, however other countries which receive Gavi support for IPV will need to use the amount they currently spend on bivalent oral polio vaccine (bOPV) – roughly US$ 0.60 per child – for IPV once bOPV is withdrawn after eradication is certified.”

In an exception to their co-financing rule, the Gavi Board also approved an extension of Papua New Guinea’s transition from Gavi funding, extending it from 2020 until the end 2025, in light of particular challenges the country is facing with recent outbreaks of polio and measles, despite its considerable economic growth. “The Board therefore agreed that this exceptional situation warranted an extension to the country’s transition, subject to the government setting out and committing to reforms to the health sector,” the release said.

All of these plans set out in the strategy depend on Gavi’s successful replenishment for the 2021-2025 period, beginning with a high-level event hosted by the Japanese government in August 2019 at which Gavi will launch its call for investment, and culminating at a pledging event in London in summer 2020. Successful replenishment will enable Gavi to provide predictable financing for both vaccine manufacturers and implementing countries throughout the five year period.

Image Credits: Gavi, the Vaccine Alliance.