Raising awareness of the value of vaccines to decision-makers in donor and developing countries.
Getting new and underused vaccines on the development agenda is the first obligatory step toward introducing life-saving antigens against pneumococcal, rotavirus, Haemophilus influenzae type b (Hib), hepatitis B, measles 2nd dose, yellow fever and meningitis A. Gavi's modus operandi tackles this challenge at two levels:
- In industrialised countries by demonstrating to donor governments that investing in immunisation programmes is one of public health's 'best buys';
- In developing countries by supplying the evidence required for government ministers to make key policy decisions about adopting new vaccines.
Gavi's added value
In the 1990s, other health problems had pushed immunisation down the aid agenda. With US$ 5.7 billion committed over the past 10 years, Gavi has clearly repositioned immunisation as a centrepiece of international development.
This shift reflects Gavi's success in uniting donors around a cohesive agenda that concentrates their resources on introducing vaccines via routine immunisation programmes rather than one-off campaigns.
Face-to-face meetings with donor governments and the provision of supporting data have helped underline the cost-effectiveness of vaccinations compared to other health interventions.
Increasingly, Gavi is also reaching out to the general public in industrialised countries, particularly through partner civil society organisations. Gavi is a key player in the annual World Pneumonia Day, held every November 12, to raise awareness of the world's biggest child killer, pneumonia, and how it can be prevented.
Gavi strategy: the vaccine goal
Putting vaccines on the agenda is key to Gavi's first strategic goal for 2011-2015: accelerating the uptake and use of underused and new vaccines.
All members of the Vaccine Alliance work to ensure that countries have the information, data, policy standards and systems required to decide whether to apply for one or more of the vaccines available for Gavi support.
Despite the advent of Gavi’s new and underused vaccine (NVS) support in 2000, there were still delays in developing country uptake of life-saving vaccines such as Hib. It quickly became apparent that dedicated campaigns were required to increase understanding about the severity of diseases and the need for immunisation.
To help put vaccines against yellow fever, Hib, pneumococcal disease and rotavirus infection on the policy-making agendas of low-income countries, Gavi funding and the work of its partners has significantly improved the available evidence base on disease burden, vaccine safety and effectiveness, cost-effectiveness data and programmatic feasibility data.
This has been achieved in particular through the work of the Gavi-funded Accelerated Development and Introduction Plans (ADIPs), launched in February 2003, the June 2005 Hib Initiative, the Yellow Fever Initiative and, more recently, the Accelerated Vaccine Introduction initiative (AVI).
Based at the Johns' Hopkins University Bloomberg School of Public Health, the pneumoADIP gathered data to draw the attention of regional, national and local health officials in developing countries to the burden of pneumococcal disease and to the value of new life-saving pneumococcal vaccines.
Second Gavi evaluation
According to Gavi’s 2nd Evaluation, both the ADIPs and the Hib Initiative helped put new vaccines on developing countries’ agenda, providing the evidence required for key decision makers in the health ministries to make a vaccine adoption decision.
Country-based managers of WHO’s Expanded Program on Immunization (EPI) have named the evidence-based information received from Gavi as a valuable resource in helping health ministries understand the importance of specific vaccines.
Its activities included regional surveillance networks, estimates of vaccine impact, calculating the vaccine’s cost-effectiveness and forecasting vaccine demand to help countries calculate health impact. The evidence also helped make the case to the vaccine industry for manufacturing pneumococcal vaccines for the developing world.
A partnership of PATH, the US Centers for Disease Control and Prevention and WHO and based in Seattle, the Rotavirus Vaccine Program (RVP) established surveillance networks in at least 40 countries to establish rotavirus disease burden and played a key role in facilitating the clinical trials in Africa and Asia which paved the way for WHO’s global recommendation that rotavirus should be introduced in all national immunisation programmes.
With the help of the programme, rotavirus vaccine is now being made available to eligible countries within two years of licensing in industrialised markets.
The Hib Initiative was approved in June 2005 because of the slow uptake of Hib vaccine into developing countries despite the availability of Gavi funds.
Established for a period of four years with a financing of US$ 28 million, plus US$ 9 million for the India Hib Vaccine Probe Study, the Hib Initiative brought together the knowledge of the Johns Hopkins Bloomberg School of Public Health, WHO, the London School of Hygiene & Tropical Medicine, and the Centers for Disease Control and Prevention (CDC).
The partnership used a combination of collecting and disseminating existing data, research and advocacy to help countries build a case for adopting the Hib vaccine.
Yellow Fever Initiative
The Yellow Fever Initiative, led by WHO and UNICEF, was set-up with Gavi funding in 2005 to help advance the evidence base within developing countries for introducing yellow fever vaccination. Between 2006 and 2013, Gavi has committed US$ 129.2 million to the Initiative.
Accelerated Vaccine Introduction Initiative
In January 2009, the advocacy work of the ADIPS and the Hib Initiative were combined into Gavi's Accelerated Vaccine Introduction Initiative (AVI).
A key part of the AVI strategy is to facilitate informed country decision- and policy-making. AVI collects the evidence needed to drive decisions regarding vaccine introduction. It assesses the readiness of countries to introduce vaccines, establishes global and regional support, and assists countries in the preparation of applications to Gavi.
AVI also ensures that global and country-level decision-makers have access to the latest information about the vaccines and policy.
AVI is led by the Gavi Secretariat and implemented by a management team comprising representatives of WHO, UNICEF and a Technical Assistance Consortium (TAC), which includes PATH, the US Centers for Disease Control and Prevention and the Bloomberg School of Public Health at Johns Hopkins University.