On the frontline: Gavi's support to fragile states

GLOBAL VACCINE STOCKPILES

The Vaccine Alliance supports three vaccine stockpiles for emergency responses to yellow fever, meningitis and cholera epidemics.  We have also invested US$ 10 million annually to fund measles outbreak response and committed to financing an Ebola vaccine stockpile, once a vaccine is licensed and WHO recommended.

Oral cholera vaccine (OCV): prior to Gavi’s 2013 decision to contribute US$ 115 million towards the cost of maintaining the OCV stockpile over a five-year period, 2014–2018, supply was struggling to keep pace with the demand caused by the estimated 1–4 million new cases of cholera that occur each year. Gavi’s support for the OCV stockpile has helped to mitigate the global shortage. In 2015, the number of vaccine doses distributed worldwide increased by 60%, with more than two million doses delivered to six countries, including Bangladesh, Cameroon and Haiti.

Meningitis vaccines: although the meningitis A vaccine has virtually eliminated epidemics caused by the Neisseria meningitides serogroup A (NmA), four other meningococcus strains, including NmC, continue to cause outbreaks of viral meningitis across parts of Africa.Between February and June 2015, an NmC epidemic claimed 1,000 lives in the Niger and Nigeria. For the first time, Gavi funds were used to purchase a multivalent (ACWY) meningitis vaccine for use in the Niger’s emergency response.

Yellow fever vaccine: in the last 20 years, the combination of declining population immunity, rapid urban migration, climate change and deforestation have led to a resurgence in the number of yellow fever cases. Current estimates put the number of cases of yellow fever worldwide in the region of 200,000 per year, and the number of deaths at around 30,000 per year.

Between 2006 and 2014, and with support from Gavi, the International Coordination Group (ICG) deployed over 25 million doses of the yellow fever vaccine worldwide in response to yellow fever outbreaks. The ICG includes representatives from WHO, UNICEF, Médecins sans Frontières and the International Federation of Red Cross and Red Crescent Societies.

Gavi-supported mass prevention campaigns, which started in 2011, have so far protected over 98 million people in 14 countries. According to the Yellow Fever Initiative, mass campaigns have significantly reduced the risk of yellow fever outbreaks in Africa, lowering the disease burden by an average 27% among the 12 “high-risk” countries.

However, rapid urbanisation and environmental changes are shifting the geography of yellow fever such that the virus is now affecting areas previously considered non-endemic. In response, Gavi is working with WHO to rework its yellow fever control strategy.

Ebola vaccine: as the Ebola epidemic swept across West Africa in 2014 and 2015, vaccine manufacturers stepped up their efforts to develop a safe, effective vaccine not only to control the existing outbreak but also to prevent future devastating epidemics.

In late 2014, the Gavi Board sent a clear signal to manufacturers that there was strong demand by committing up to US$ 300 million for the production and procurement of up to 12 million doses of first-generation Ebola vaccines and to create a global stockpile for future outbreaks.

Gavi’s Ebola funding package also included up to US$45 million to support the roll-out of an Ebola vaccine and another US$ 45 million to help health and immunisation systems in Sierra Leone, Liberia and Guinea recover from the devastating 2014-2015 emergency. Gavi is already helping all three countries ensure children catch up on immunisation they missed during the epidemic.

Once an Ebola vaccine has been licensed and WHO recommended, it will be supplied to Gavi-supported countries at a not-for-profit price.

Measles vaccine: since 2013, Gavi has funded measles campaigns in six large countries considered at high risk of measles outbreaks, reaching a total of 118 million children in the past three years. In 2015, the Gavi Board approved measles follow-up campaigns in Chad, the Democratic Republic of the Congo, Ethiopia and Nigeria to mitigate the risk of outbreaks and further escalation of ongoing outbreaks.

FRAGILITY AND IMMUNISATION POLICY

In 2015, approximately one third of Gavi funding was invested in fragile states. Our fragility and immunisation policy, approved in 2012, has allowed us to adapt funding to address the unique challenges facing countries in short-term emergencies or protracted crises:

• In Yemen, for example, Gavi reprogrammed its health system strengthening support to channel funds through UNICEF and WHO and focus on integrated outreach activities. In 2015, this helped ensure more than 6,000 immunisation sessions took place across the country, even in remote villages. Learn more.
• In 2013, Gavi helped the Kenyan government to roll out pneumococcal vaccine to Somali children sheltering in the Dadaab refugee camp. Chad will also receive additional Gavi-funded vaccines for refugees.
• HSS support was reprogrammed in the Central African Republic in 2014 to allow Gavi-supported vaccines to be used for catch-up campaigns.

LOWER PRICES FOR CIVIL SOCIETY ORGANISATIONS (CSO)

CSOs often play a key role in immunisation in humanitarian crises. In emergency situations, through Gavi, CSOs are able to get access to lower vaccine prices.

In 2013, for example, we worked with Médecins sans Frontières to purchase pneumococcal vaccines for children in South Sudan’s Yida refugee camp.