GAVI

Gavi
2014 GAVI logo.png
2014 logo, evoking UN logos
Founded2000 (2000)
TypePublic–private partnership
Legal statusActive
FocusVaccination
Location
Key people
Seth Berkley, Dagfinn Høybråten, José Manuel Barroso, Anuradha Gupta
Websitewww.gavi.org

Gavi, officially Gavi, the Vaccine Alliance[1] (previously the GAVI Alliance, and before that the Global Alliance for Vaccines and Immunization)[2] is a public–private global health partnership with the goal of increasing access to immunization in poor countries.[3]

Gavi facilitates vaccinations in developing countries by working with donor governments, the World Health Organization,[4] UNICEF,[5] the World Bank,[6] the vaccine industry in both industrialised and developing countries, research and technical agencies, civil society, the Bill & Melinda Gates Foundation[7] and other private philanthropists. Gavi has observer status at the World Health Assembly.

Along with Global Health Initiatives (GHIs) in general, Gavi was described as innovative, effective, and less bureaucratic than multilateral government institutions like the WHO. Gavi programmes may produce quantified results within an election cycle, which is appealing to parties locked in an election cycle.[8] One author described Gavi's approach to public health as business-oriented and technology-focused, using market-oriented measures, and seeking quantifiable results. Gavi follows a model termed the "Gates approach" or US-type approach.[9][8] It contrasts with the approach typified by the Alma Ata Declaration, which focuses on the effects of political, social, and cultural systems on health.[8]

In the 21st century, Gavi supports the immunization of almost half the world's children, giving it power to negotiate better prices for the world's poorest countries and remove the commercial risks that manufacturers faced in serving this market. It also provides funding to strengthen health systems and train health workers across the developing world. Gavi has helped immunize over 760 million children, preventing over 13 million deaths worldwide, helping increase diphtheria vaccine coverage in supported countries from 59% in 2000 to 81% in 2019, contributing to reducing child mortality by half.[10][11]

GAVI has been criticized for giving private donors more unilateral power to decide on global health goals,[8] prioritizing new, expensive vaccines while putting less money and effort into expanding coverage of old, cheap ones,[12] harming local healthcare systems,[8] spending too much on subsidies to large, profitable pharmaceutical companies[13] without reducing the prices of some vaccines, and its conflicts of interest in having vaccine manufacturers on its governance board.[14] Gavi has taken steps to address some of these concerns.[8]

Sponsors

Five year contribution to Gavi (2016–2020)[15]
US$ million
DonorProceeds
 United Kingdom2,080
Bill & Melinda Gates Foundation1,552
 United States of America1,380
 Norway830
 Germany773
 France549
 Canada410
 Italy401
 Netherlands301
 Australia263
 Sweden205
 Japan195
European Commission183
  Switzerland36
 Spain33
Reed Hastings and Patty Quillin30
 Russia28
 Kingdom of Saudi Arabia23
 South Korea22
Anonymous Swiss Foundation22
"la Caixa" Foundation17
 Ireland17
 Denmark15
Lions Club International15
 Kuwait11
 Qatar10
Shell International10
TikTok10
 Brazil10
Comic Relief8
 India7
Audacious Alliance6
Red Nose Day Fund6
Unilever6
 China5
Mohamed bin Zayed Al Nahyan5
 New Zealand5
 Luxembourg5
LDS Charities4
 Finland3
Alwaleed Philanthropies3
Rockefeller Foundation3
 South Africa3
Girl Effect2
 Oman2
IFPW2
China Merchants Charitable Foundation2
Reckitt Benckiser Group1
 Monaco1
ELMA Vaccines and Immunization Foundation1
 Iceland1
Al Ansari Exchange1
UPS1
 Colombia1
Other donors3
Deferrals−714
Total8,804

Gavi runs in five-year funding cycles which enables it to negotiate long-term deals with manufacturers, secure in the knowledge that funding will be available.[16]

Following the latest Global Vaccine Summit in June 2020 hosted in the UK, $8.8 billion (USD) was raised for the funding cycle 2021 to 2025; exceeding the target of $7.4 billion. This included $2 billion from the UK, $1.6 billion from the Gates Foundation and $1 billion from Norway.[17]

The UK government stated that this round of funding would mean that 300 million more children in lower-income countries are immunized for diseases including measles, polio and diphtheria by the end of 2025. Additionally, the funding will support health systems to withstand the impact of coronavirus and maintain the infrastructure necessary to roll out a future COVID-19 vaccine on a global scale.[18]

In the period of 2016–2020 over which US$9.3 billion had been received by Gavi, the UK was the largest donor, providing around 25% of total funding, with the Bill & Melinda Gates Foundation (BMGF), the US and Norway close behind.[19]

Industrialised countries are GAVI's principal donors, providing approximately three-quarters of the total funding. All donor governments are represented on the Gavi Board through a constituency system (i.e. one donor country will represent several donors in their constituency).[20]

History and programs

Bill Gates, speaking at the UK-hosted GAVI pledging event in June 2011

Gavi was created in 2000 as a successor to the Children's Vaccine Initiative, which was launched in 1990.[21]

Gavi was awarded the 2019 Lasker-Bloomberg Public Service Award for "providing sustained access to childhood vaccines around the globe, thus saving millions of lives, and for highlighting the power of immunization to prevent disease".[22]

Coronavirus pandemic

CEO Seth Berkley commented that the global response to the COVID-19 pandemic had started off remarkably well. However he cautioned that there was a need for a co-ordination of production at a global level. He advocated that the pandemic needed a global response whereby the best global facilities for separate parts of the processes should then be integrated into a global process. He said he hoped that the G20 countries should work together with a budget of tens of billions of dollars, and that individual countries should be prepared for finished vaccines to be allocated according to greatest need.[23]

In September 2020, Gavi was announced as one of the organisations leading the COVAX vaccine allocation plan, created to ensure that any new COVID-19 vaccine would be shared equally between the world's richest and poorest countries.[24]

The following month, Gavi announced the approval of up to $150 million to help 92 low- and middle-income countries prepare for the delivery of future COVID-19 vaccines, including technical assistance and cold chain equipment.[25]

Later that month, Gavi backed Team Halo, a TikTok centered campaign from scientists in UK, US, South Africa, India and Brazil aimed at improving understanding of Coronavirus vaccine research.[26]

In January 2021, Seth Berkley announced that Gavi hoped to deliver 145 to 150 million doses of COVID-19 vaccines in the first quarter of 2021 and 500 million doses in the second quarter, and then 1.5 billion in the second half of the year.[27]

Leadership and positioning

Julian Lob-Levitt was Gavi's CEO between 2004 and 2010. He was rumoured to have left over conflicts around his support for health system strengthening.[8] Seth Berkley has been the CEO of Gavi since 2011, as of 2020.[28]

In August 2014, Gavi changed its name from "GAVI Alliance" and rebranded itself with a new logo deliberately reminiscent of UN organization logos, but using green as a mark of difference.[1]

Health systems strengthening debate

Preparing a measles vaccine supplied by GAVI at Mecha health centre, in northern Ethiopia

In the 20-naughts, Gavi had intense internal debate about its role in vaccinations and in health systems strengthening (HSS). Some argued that vaccination could not be effectively carried out and sustained without strengthening healthcare, citing experiences in Gavi's vaccination programmes, where availability of staff, training, transport, and funds had hindered vaccination and reporting of vaccination coverage and stocks. There were also worries that Gavi was undermining and paralyzing health care systems. Others argued that HSS was a distraction from Gavi's single-minded focus on vaccines, and HSS was a nebulous concept that could not be defined and quantified.[8]

In 2005, a narrow vote brought Gavi to endorse an HSS goal. Up to a quarter of Gavi's funding was dedicated to "strengthening the capacity of integrated health systems to deliver immunisation",[8] in practice it's been around 10%.[9] After 2010, this funding went through a joint-venture Health Systems Funding Platform. Gavi's funding for this platform was conditional on the platform meeting vaccine coverage goals.[8]

As of the mid-2010s, few in Gavi were working on HSS, most of the former pro-HSS people had left, and some at Gavi dismissed HSS as PR to gain support from pro-HSS donors and counter criticisms that Gavi was harming healthcare systems.[8]

Criticism

Public-sector workers and academics public health have criticized Gavi, and other global health initiatives (GHIs) with private-sector actors, saying that they have neither the democratic legitimacy nor the capacity to decide on public health agendas. Private donors often find it easier to exert influence through public-private partnerships like Gavi than through the traditional public sector. There is also criticism that staff at GHIs are often recruited directly from elite educational institutions, and have no experience in health care systems, especially those in poorer countries. Some WHO officials have privately criticized Gavi for infringing and weakening the WHO's mandate.[8]

Vaccine pricing and market shaping

In 2012, the first MSF "The right shot" report criticized Gavi for focussing on funding expensive new vaccines and neglecting to give children cheap old ones. "Twenty percent of the world's children aren't even getting the basic vaccines", MSF's vaccine policy adviser said.[12] MSF criticized the Global Vaccine Action Plan (GVAP), a WHO global collaboration of which Gavi is listed as a leader, as flawed for failing to help those 20%, which is some 19 million children.[29]

Pentavalent vaccine

In 2011 Gavi added "shape the market for vaccines and other immunisation supplies" to its strategic goals. It spent 15 years (2005–2020) with a program for shaping the pentavalent vaccine market to be more stable and competitive. The vaccine price fell with increased competition, and price discrimination declined. Whether Gavi met quantitative goals will be assessed in 2020.[30]

Pneumococcal vaccine

In 2011, Doctors Without Borders (MSF) recommended that Gavi change the ways in which it buy vaccines. They criticized the pneumococcal vaccine Advance Market Commitment, which means that GlaxoSmithKline (GSK) and Pfizer get a subsidy as well as a per-unit payment for supplying doses of pneumococcal vaccine, as "corporate welfare that is scandalously expensive to donors and taxpayers"[31] (in return, the companies committed to sell at least 30 million doses annually for ten years[14]).

In January 2015, MSF also called upon GSK and Pfizer to cut the price of the pneumococcal vaccine to US$5 per child in developing countries, a price they estimated as competitive.[32]

In August 2019, MSF asked Gavi to stop giving Advance Market Commitment subsidies to GSK and Pfizer, whom they called a duopoly, and instead buy vaccine from a new third manufacturer, the Serum Institute of India, which offered the vaccine at two-thirds of the price then offered by the two. As the pneumococcal vaccine made up 40% of Gavi's vaccine purchasing costs, a 33% price drop would save Gavi billions (13% of its total vaccine purchasing costs[33]).

In January 2020, MSF repeated the appeal for Gavi to bulk-buy the cheaper pneumococcal vaccine and vaccinate more of the 55 million children who are not vaccinated with it.[34] They also appealed to the World Health Organization, UNICEF, and the Gates Foundation, and said that Gavi could have done more to lower vaccine prices.[35]

Recognition

Gavi was nominated for the 2021 Nobel Peace Prize by Norwegian MP Carl-Erik Grimstad.[36][37]

Vaccine programs

Gavi supports the following vaccine programs:[38]

VaccineDisease(s)
Human Papillomavirus vaccineHuman Papillomavirus
Polio vaccinePolio
Japanese Encephalitis vaccineJapanese encephalitis
Meningococcal vaccineNeisseria meningitidis (Meningitis A vaccine)
Measles and rubella vaccineMeasles / Measles vaccine, Rubella / Rubella vaccine
Pneumococcal vaccineStreptococcus pneumoniae
Typhoid vaccineTyphoid
Cholera vaccineCholera
Rotavirus vaccineRotavirus
Yellow fever vaccineYellow fever
Pentavalent vaccineDiphteria, tetanus, pertussis, Haemophilus influenzae / haemophilus influenza vaccine (haemophilus influenza Type B), Hepatitis B
Ebola vaccineEbola

References

  1. ^ a b Ravelo, Jenny Lei (10 November 2014). "The evolution of global health's 'best-kept secret'". Devex. Retrieved 25 January 2017.
  2. ^ "GAVI – The Global Alliance for Vaccines and Immunizations". WHO. Retrieved 15 January 2020.
  3. ^ Boseley, Sarah (17 November 2011). "Green light from Gavi for cervical cancer vaccine". Guardian. Retrieved 29 April 2014.
  4. ^ "GAVI Alliance". WHO. Retrieved 15 January 2020.
  5. ^ "Supplies and Logistics – GAVI". UNICEF. 9 April 2007. Retrieved 27 January 2013.
  6. ^ "The World Bank's Partnership with the Gavi Alliance". World Bank Group. Retrieved 15 January 2020.
  7. ^ "What We Do -VACCINE DELIVERY- Strategy Overview". Bill&Melinda Gates Foundation. Archived from the original on 15 January 2020. Retrieved 15 January 2020.
  8. ^ a b c d e f g h i j k l Storeng, Katerini T. (14 September 2014). "The GAVI Alliance and the 'Gates approach' to health system strengthening". Global Public Health. 9 (8): 865–879. doi:10.1080/17441692.2014.940362. PMC 4166931. PMID 25156323.
  9. ^ a b Tsai, Feng-Jen; Lee, Howard; Fan, Victoria Y. (2016). "Perspective and investments in health system strengthening of Gavi, the Vaccine Alliance: a content analysis of health system strengthening-specific funding". International Health. 8 (4): 246–252. doi:10.1093/inthealth/ihv063. PMC 6281386. PMID 26612851.
  10. ^ Ikilezi, Gloria; Augusto, Orvalho J.; Dieleman, Joseph L.; Sherr, Kenneth; Lim, Stephen S. (2020). "Effect of donor funding for immunization from Gavi and other development assistance channels on vaccine coverage: Evidence from 120 low and middle income recipient countries". Vaccine. sciencedirect.com. 38 (3): 588–596. doi:10.1016/j.vaccine.2019.10.057. PMID 31679863.
  11. ^ "Has Gavi lived up to its promise? Quasi-experimental evidence on country immunisation rates and child mortality" (PDF). The British Medical Journal. Retrieved 4 October 2020.
  12. ^ a b Paulson, Tom (15 May 2012). "Doctors Without Borders criticizes Gates-backed global vaccine strategy". Humanosphere.
  13. ^ "GAVI money welcome but could it be more wisely spent?". Médecins Sans Frontières (MSF) International. 14 June 2011.
  14. ^ a b "Pneumococcal Vaccine is Launched in Africa, But Are Donors Getting a Fair Deal from Companies?". Doctors Without Borders – USA.
  15. ^ "Annual Contributions and Proceeds". Gavi. Annual Contributions and Proceeds 31 March 2021
  16. ^ "Funding". Gavi, The Vaccine Alliance. Retrieved 24 September 2020.
  17. ^ "Bill Gates-backed vaccine alliance raises $8.8 billion from world leaders and businesses". cnbc.com. 4 June 2020. Retrieved 24 September 2020.
  18. ^ "The Global Vaccine Summit, hosted by the UK, raises US$ 8.8 billion for immunisation". gov.uk. Retrieved 24 September 2020.
  19. ^ "Current Period 2016–2020". GAVI, The Vaccine Alliance. 12 March 2021. Retrieved 20 April 2021.
  20. ^ "BOARD AND BOARD COMMITTEE OPERATING PROCEDURES" (PDF). GAVI, The Vaccine Alliance. Retrieved 24 September 2020.
  21. ^ "Gavi – About". gavi.org. GAVI. Retrieved 24 October 2017.
  22. ^ "2019 Lasker~Bloomberg Public Service Award Providing sustained access to childhood vaccines around the globe". laskerfoundation.org. Lasker Foundation. Retrieved 4 October 2020.
  23. ^ Seth Berkley: interview BBC Radio 4 8:46 am 11 April 2020
  24. ^ "'Landmark moment': 156 countries agree to Covid vaccine allocation deal". theguardian.com. 21 September 2020. Retrieved 4 October 2020.
  25. ^ "GAVI providing $150 million to poorer countries to prepare for COVID-19 vaccines". reuters.com. October 2020. Retrieved 4 October 2020.
  26. ^ "Coronavirus: Scientists using TikTok to teach about vaccine". bbc.co.uk. Retrieved 26 October 2020.
  27. ^ "Covax scheme: 150m Covid-19 vaccine doses could be given to nations in Q1". Straits Times. Singapore. 27 March 2021. Retrieved 27 January 2021.
  28. ^ "BACK TO GAVI SECRETARIAT Dr Seth Berkley". www.gavi.org. GAVI. Retrieved 15 January 2020.
  29. ^ "Global vaccine plan draws criticism". Nature News Blog.
  30. ^ Malhame, Melissa; Baker, Edward; Gandhi, Gian; Jones, Andrew; Kalpaxis, Philipp; Iqbal, Robyn; Momeni, Yalda; Nguyen, Aurelia (18 July 2019). "Shaping markets to benefit global health – A 15-year history and lessons learned from the pentavalent vaccine market". Vaccine: X. 2: 100033. doi:10.1016/j.jvacx.2019.100033. PMC 6668221. PMID 31384748.
  31. ^ "Gavi must stop giving millions in subsidies to Pfizer and GSK for pneumococcal vaccine". Doctors Without Borders – USA. 3 December 2019.
  32. ^ "Access: MSF calls on GSK and Pfizer to slash pneumo vaccine price to $5 per child for poor countries ahead of donor meeting". Médecins Sans Frontières (MSF) International. 20 January 2015.
  33. ^ one-third of 40% is 13.3333...%
  34. ^ "MSF urges Gavi to work for more children to a get new, more affordable pneumonia vaccine". MSF. 21 January 2020.
  35. ^ "Gavi must work to ensure more children get new, more affordable pneumonia vaccine". Médecins Sans Frontières (MSF) International. 21 January 2020.
  36. ^ "Flere fredsprisforslag før fristen gikk ut". Aftenposten. Norwegian News Agency. 31 January 2021.
  37. ^ "Hektisk nomineringsaktivitet før fredsprisfrist". Dagsavisen. 31 January 2021.
  38. ^ "Vaccine support". Retrieved 12 March 2020.

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A nurse at Merawi health centre in northern Ethiopia prepares a measles vaccine for delivery.

Ethiopia is one of more than 70 developing countries benefitting from the support of the GAVI Alliance.

Three years ago, there were fewer than 750 health centres across Ethiopia. Now, thanks in part to support from British aid, there are more than 2100 health centres providing vaccinations and other life-saving care.

To find out more, please see the full story at: <a href="http://www.dfid.gov.uk/Media-Room/Features/2011/One-simple-jab-millions-of-lives-saved/" rel="nofollow">www.dfid.gov.uk/Media-Room/Features/2011/One-simple-jab-m...</a>

Picture: Pete Lewis / DFID

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Prequalified pentavalent and years of sales to UNICEF. Figure 5.jpg
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Increasing competition in the pentavalent vaccine market; the number of manufacturers making pentavalent vaccine, 2005-2019. From WP:pentavalent vaccine:
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Pentavalent per-dose price ranges paid by UNICEF, 2005–2019.