What a difference a year makes

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Gavi’s 2016 Annual Progress Report is first of five for our 2016-2020 strategic period, placing greater emphasis on the global context in which the Alliance Partners – the World Health Organization, UNICEF, the World Bank and expanded partners – are working.

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1 November 2017 - For years to come, 2016 will be remembered as a year of considerable change and uncertainty. Conflicts such as Syria fuelled the displacement of 10.3 million people, contributing to a global displaced population that is now the highest on record. Zika, a neglected tropical disease that previously had only caused local outbreaks, was declared a global health emergency. The Brexit referendum and the United States presidential election signalled a new, more inward-looking politics.

Gavi’s 2016 Annual Progress Report, released last month, reflects this rapidly changing global landscape. The first of five for our 2016-2020 strategic period, this report places greater emphasis on the global context in which the Alliance Partners – the World Health Organization, UNICEF, the World Bank and expanded partners – are working, and the challenges that are not just significant for Gavi’s mission but the entire global community.

Immunisation is increasingly seen as an essential part of the solution to the health and humanitarian problems that continue to rise up the global agenda. Gavi-supported vaccine stockpiles proved crucial in facilitating a rapid response to major disease outbreaks in 2016. The Gavi-funded global stockpile of yellow fever vaccines contributed 30 million doses to help tackle major outbreaks in Angola, the Democratic Republic of the Congo and Uganda. Stockpiles have continued to be an invaluable resource in 2017. In October, Gavi supported the delivery of 900,000 doses of oral cholera vaccine to Bangladesh to protect Rohingya refugees and their host communities, as well as supporting other outbreaks in Sierra Leone, Nigeria and Haiti.

A child receiving oral cholera vaccine in Bangladesh. Photo: UNICEF / Lemoyne. 

However, stockpiles are not a sustainable solution. The scale of yellow fever outbreaks in 2016 left the global stockpile dangerously low and diverted doses away from routine immunisation campaigns, threatening global health security. As urban populations soar, keeping a stockpile large enough to tackle outbreaks in urban areas could quickly become unfeasible. That’s why improving routine immunisation in countries must remain a priority, to act as a defence mechanism against such outbreaks.

On top of this, the figures suggest that basic immunisation coverage could be stalling. Since Gavi was launched in 2000, coverage as measured by the proportion of children receiving all three doses of a diphtheria-tetanus-pertussis-containing vaccine has risen from just over 60% to 80% in Gavi supported countries, but the latest WHO/UNICEF figures suggest this progress may be slowing. However, a lack of reliable data in this area means we cannot take these numbers at face value. With one-in-three births globally not registered, the first hurdle in targeting the hardest-to-reach children will be in finding them.

Addressing this data and accessibility problem will require novel approaches. That’s why Gavi launched a new private sector initiative in 2016. Innovation for Uptake, Scale and Equity in Immunisation (INFUSE) aims to scale-up innovations with proven potential to improve vaccine delivery. Using the Vaccine Alliance as a kind of informed middle-man, INFUSE gives countries an expert review of novel solutions while offering service providers introductions to the right people in governments. One such project is Khushi Baby: a necklace that doubles as a medical passport. Medical records can be viewed and updated via an app, simply by tapping a smartphone against the necklace. It is exactly this kind of innovation that will be crucial to reaching every child with vaccines.

Gavi also launched our Cold Chain Equipment Optimisation Platform (CCEOP) in 2016. It will support new technology, like modern solar fridges, that can address one of the major bottlenecks in vaccine delivery – keeping vaccines cold enough, but not too cold that they freeze, so that they remain safe and effective on their journey to the most remote communities. Haiti has already been approved for support with more set to follow.

Assembling solar panels that will power Gavi-supported fridges in Haiti. Photo: Gavi/2017/Frédérique Tissandier. 

However, innovations are only worth their salt if they can be properly implemented on the ground. Targeting the hardest-to-reach children requires close collaboration with countries themselves. With this in mind Gavi has shifted to a more country-centric approach. By working closely with governments, we enabled four countries to transition out of Gavi support in 2016. This means that they now entirely self-fund vaccination programmes previously supported by Gavi.  In interviews published in the Progress Report, health ministers from Angola and Honduras and a senior health ministry representative from Sri Lanka, all emphasised the importance of the technical support they received from Gavi during the transitioning process.

The strong commitment of African leaders to immunisation was illustrated in early 2017 by the Addis Declaration on Immunisation, an historic agreement that prioritises immunisation on a continental scale. Gavi’s work in driving down the price of essential vaccines will be hugely beneficial in enabling this. In 2016, with Gavi’s help, the cost of full vaccinating a child with pneumococcal, rotavirus and pentavalent vaccines fell below US$ 20 for the first time. This represents significant progress towards our 2020 market shaping goals.

Since Gavi’s launch 16 years ago, we have seen amazing progress. Global immunisation rates have increased by a third and cases of deadly diseases, from measles to polio, are at historic lows. However, in the face of global challenges, from climate change to urbanisation to anti-microbial resistance, we need to employ new tactics to ensure every child has access to life-saving vaccines. I am confident that the innovative approaches taken and progress made in 2016, and set out in this Annual Report, leave Gavi well-placed to meet these challenges.


US$ 1 = US$ 18

A study in Health Affairs covering 73 Gavi-supported countries over the 2011–2020 period shows that, for every US$ 1 spent on immunisation, US$ 18 are saved in healthcare costs, lost wages and lost productivity due to illness. If we take into account the broader benefits of people living longer, healthier lives, the return on investment rises to US$ 48 per US$ 1 spent.

Ozawa S, Clark S, Portnoy A et al. Return on investment from childhood immunizations in low- and middle-income countries, 2011-20, Health Affairs 2016

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