Pneumococcal vaccine support

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2015 target of 45 introductions achieved more than one year ahead of schedule

In April 2015, Bangladesh introduced the pneumococcal vaccine alongside inactivated polio vaccine.

In April 2015, Bangladesh introduced the pneumococcal vaccine alongside inactivated polio vaccine. As a result, one of the world’s largest birth cohorts – three million children – is now being reached with two life-saving vaccines. This required training health workers and strengthening the national cold chain. Credit: Gavi/2015/GMB Akash.

Roll-out across three continents

Since 2010, more than 50 Gavi-supported countries have introduced pneumococcal vaccines into their routine immunisation programmes.

Pneumococcal vaccines are highly complex and sophisticated vaccines that in the past might have taken 15 years or more to reach lower-income countries. Thanks to the work of Gavi, its donors and Vaccine Alliance partners, the world's poorest children are now receiving the newest pneumococcal vaccines simultaneously with children in high-income countries.

Pneumococcal vaccine roll-outs

Gavi aimed to support the pneumococcal vaccine introductions in 45 countries by 2015. This target was reached already in November 2014, 13 months ahead of schedule, when Georgia added the vaccine to its routine immunisation schedule. By the end of 2015, 54 countries had rolled out the vaccine.

Included in the group of countries that introduced in 2015 were Bangladesh, which simultaneously rolled out pneumococcal and inactivated polio vaccine, and Nepal, which continued to roll out the vaccine even in the aftermath of a devastating earthquake.

More than 70 million children reached

Strong demand means that pneumococcal vaccines are now being administered in two-thirds of all Gavi–supported countries.

WHO estimates that to date over 76 million children have been protected against pneumococcal disease with Gavi support. By the end of 2015, just 15 of those countries eligible for Gavi funding had yet to apply for pneumococcal vaccine support.

While coverage levels increased to 35% in 2015, they still fell 5 percentage points short of our five-year target. This is largely the result of supply issues in the early years of the programme and delayed introductions in countries with large populations. Vaccine Alliance partners are working to ensure that supply remains stable, that adequate support is provided for those countries yet to introduce and that programmes, once established, are sustainable over the long term.

Advance Market Commitment

The implementation of this AMC is on track ... reducing morbidity and mortality from pneumococcal diseases in developing countries

Source: AMC process and design evaluation

The introduction of these vaccines is largely thanks to the generosity of Italy, the United Kingdom, Canada, the Russian Federation, Norway, and the Bill & Melinda Gates Foundation who together contributed US$ 1.5 billion through an innovative financing mechanism, the Advance Market Commitment (AMC) for pneumococcal vaccines.

The aim of the AMC is to stimulate the development and manufacture of new vaccines for developing countries.

Two manufacturers have thus far committed to supply 600 million doses over the next 10 years. It is expected that additional manufacturers will have new pneumococcal vaccines ready to participate in the AMC in future years.

Map of countries approved for Gavi's pneumococcal vaccine support


Pneumococcal disease is the leading vaccine-preventable cause of death in children under five years of age.

Causes of under-5 child deaths in low-income countries

Six leading vaccine-preventable diseases
Percentage of global child deaths
Source: WHO

World's biggest child killer

The most common cause of pneumonia – the world’s leading killer of children – is the pneumococcal bacterium, Streptococcus pneumonia.

WHO estimates that more than 500,000 young children die each year from pneumococcal infection. The vast majority of these deaths occur in developing countries.

In addition to pneumonia, the pneumococcus is also responsible for an important cause of meningitis, which often leaves survivors with permanent disabilities, including mental retardation, paralysis and seizures.

The bacterium also causes sepsis (blood poisoning), which can lead to death or amputations, and otitis media (infection of the middle ear), which can lead to permanent deafness.

Safe and affordable vaccines

The most effective way to prevent these deaths is to ensure that all children have access to safe, affordable vaccines. This was recognised in the 2007 WHO recommendation – and subsequently reinforced in 2012 – that pneumococcal vaccines be introduced into all national immunisation programmes, particularly in countries with high child mortality.

Advance Market Commitment accelerates access to pneumococcal vaccines adapted to the needs of developing countries

Pneumococcal AMC

To accelerate the development and production of a new generation of pneumococcal vaccines – better targeted to the epidemiology in developing countries and made more affordable – Gavi, the World Bank and donors launched the pneumococcal Advance Market Commitment (AMC) in 2009.

Thanks to agreements between Gavi and two manufacturers to date, the Vaccine Alliance and developing countries pay a maximum US$ 3.50 per dose of pneumococcal vaccines procured in the coming years – less than 10% of the cost of the same vaccines sold in the European Union and the United States.1  

Gavi expects additional manufacturers from emerging markets to submit new pneumococcal vaccines for participation in the AMC in future years.

The AMC was designed to give manufacturers an incentive to invest in:

  • finalising pneumococcal vaccines that protect against additional serotypes which commonly cause disease and death in low-income countries;
  • increasing manufacturing capacity to provide the appropriate pneumococcal vaccines in sufficient quantities to meet demand.

At the same time, developing country governments can budget and plan for their immunisation programmes, knowing that vaccines will be available in sufficient quantity and at a price they can afford in the long term.

The Vaccine Alliance and the pneumococcal AMC

  • The World Bank: fiduciary support.
  • Industrialised countries: the governments of Italy, the United Kingdom, Canada, Russia, Norway and the Bill & Melinda Gates Foundation committed a total US$1.5 bilion to launch the programme.
  • Gavi has committed approximately US$ 1.9 billion to support the cost of vaccines from 2010-2015, as well as programmatic and administrative support.
  • WHO established the minimum technical criteria for the vaccines and provides technical assistance as required.
  • UNICEF is responsible for vaccine procurement and distribution.

Routine immunisation support

WHO recommends the use of pneumococcal vaccines in all countries, with the highest priority given to those with high pneumonia and under-five mortality rates. Gavi provides support for the pneumococcal conjugate vaccine, as well as associated injection supplies. Countries also receive a one-time cash vaccine introduction grant for additional introduction costs.

For the period 2010–2015, Gavi has committed approximately US$ 1.9 billion to fund pneumococcal vaccines that are suitable for developing countries through the AMC.

To be AMC eligible, vaccines must meet specific criteria developed by WHO and be approved by the Independent Assessment Committee of the AMC.

1 For approximately 20% of doses, companies receive an additional payment of US$3.50 for each dose they provide; donor commitents cover the extra cost.

>1 million

Since its creation in 2013, the global oral cholera vaccine stockpile has been used to vaccinate more than 1 million people; in 2015, campaigns took place in Bangladesh, Cameroon, Haiti, Malawi, Tanzania and South Sudan.


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