The evidence is clear: vaccines are one of the most cost-effective investments in health and development in history. Established in 2000, Gavi helps save lives and protect people’s health by increasing equitable and sustainable use of vaccines.
60% of the global birth cohort live in Gavi-supported countries. This means that as a global alliance, we help protect nearly half the world’s children through vaccination.
From 2000 through 2019, Gavi helped vaccinate more than 822 million children in 77 countries through routine immunisation and supported more than 1.1 billion campaign vaccinations.
With approximately 1.5 million future deaths prevented in 2019 alone, Gavi has helped lower-income countries to prevent more than 14 million future deaths through its support for routine immunisation programmes and vaccination campaigns since 2000.
Coverage with three doses of diphtheria-tetanus-pertussis-containing vaccine (DTP3), including pentavalent vaccine, in Gavi-supported countries was 81% in 2019 – just 4 percentage points below the global average. This represents an increase of 22 percentage points since 2000. Over 50% more children were immunised with DTP3 in 68 of the world’s poorest countries in 2019 than in 2000.
In 2019, 65 million children were immunised with Gavi-supported vaccines to protect each child against on average seven infectious diseases. Between 2016 and 2019, Gavi immunised 259 million children, putting us well on target to immunise 300 million children by 2020. Immunisation is often a key component in forging contact between children and the primary health care system, as well as providing a robust platform for other health interventions.
Gavi has supported more than 495 vaccine introductions and campaigns since 2000. In 2019 alone, 60 introductions and campaigns took place with Gavi support. This was up 14 from 2018 and exceeded the target of 56 for 2019.
The year 2019 saw significant progress in Gavi’s work to support health systems: countries delivered a record number of routine vaccinations, more than 230 million, supported by an unprecedented US$ 331 million in health system funding from Gavi to support immunisation and protect children in the countries where it is most needed.
The Vaccine Alliance has helped strengthen health systems and immunisation services in
69 countries, and 49 out 57 eligible countries have applied for support from Gavi’s Cold Chain Equipment Optimisation Platform (CCEOP).
A study covering the 73 Gavi-supported countries shows that, for every US$ 1 spent on immunisation in the 2021–2030 period, US$ 21 are saved in health care costs, lost wages and lost productivity due to illness and death. When considering the value people place on lives saved by vaccines – which is likely to include the value of costs averted plus the broader societal value of lives saved and people living longer and healthier lives – the return on investment is estimated to be US$ 54 per US$ 1 spent.
By preventing illness, death and long-term disability, Gavi-supported vaccines helped generate more than US$ 150 billion in economic benefits between 2000 and 2017. Constenla et al. Estimating the economic impact of vaccinations in 73 resource-constrained countries, 2001–2030.
By the end of 2019, 16 countries had transitioned to fully self-financing their vaccine programmes.2
Through routine immunisation programmes, preventive campaigns and emergency stockpiles, the Vaccine Alliance supports vaccines against 17 infectious diseases. By the end of 2019, Gavi had supported 495 routine introductions and campaigns, and funded more than 135 million vaccine doses through global stockpiles.
In July 2014, South Sudan became the final Gavi-supported country to introduce the five-in-one pentavalent vaccine against diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type b (Hib). By the end of 2019, over 517 million children had been immunised with pentavalent vaccine with Gavi support.
Our support has contributed to immunising more than 125 million children against rotavirus diarrhoea.
By the end of 2019, 48 countries had introduced the vaccine with support from the Vaccine Alliance.
By the end of 2019, more than 332 million people had been vaccinated against meningococcal meningitis A through Gavi-supported preventive mass campaigns, as well as through catch-up campaigns, in the African “meningitis belt.” In addition, more than 16 million were reached through routine immunisation. By the end of 2019, 10 out of the 26 countries in the belt added the vaccine to their national schedules.
Gavi funds a stockpile of multivalent vaccine to prevent outbreaks of meningococcal meningitis A, C, W and Y. From 2009 through the end of 2019, the stockpile had been accessed 47 times by 13 countries, with over 22 million doses shipped. In 2019, the stockpile was accessed by Burkina Faso, Chad and Togo to help manage outbreaks of the disease.
Pakistan became the first country to introduce typhoid conjugate vaccine (TCV) into routine immunisation with Gavi support, and in 2019 more than 9.8 million children were vaccinated in a catch-up campaign. In the same year, Gavi supported the first use of TCV in Africa for an outbreak response campaign in Harare, Zimbabwe, vaccinating over 318,000 people.
Gavi led efforts to bring forward the world’s first vaccine against Ebola virus disease (EVD), helping protect more than 260,000 people in the Democratic Republic of the Congo as of December 2019. In 2021, Gavi announced its support for a global emergency stockpile of 500,000 doses of Ebola vaccine to be made available to all countries for outbreak response.
By the end of 2019, 60 countries had introduced pneumococcal conjugate vaccine (PCV) and immunised more than 215 million children against pneumococcal disease with Gavi support.
In 2019, eight countries introduced human papillomavirus (HPV) vaccine into their routine programme, of which two also introduced a multi-age cohort (MAC) vaccination. In total, 18 countries have successfully launched their HPV national programmes, including 3 countries with MAC.
Since 2007, countries have immunised over 95 million children with a second dose of measles or a first and/or second dose of measles-rubella vaccine through Gavi-supported routine immunisation programmes. 2019 was an active year for measles and measles-rubella vaccines: 32 Gavi-supported activities took place (9 vaccine introductions and 23 campaigns), immunising over 149 million children.
Since 2011, Gavi-supported mass campaigns in
14 countries have reached more than 158 million people, while routine introductions in 17 countries have reached over 122 million people. The Gavi-supported yellow fever vaccine stockpile has saved countless lives; over 55 million doses were shipped from its launch through the end of 2019.
Since its creation in 2013 to support emergency response, humanitarian crises and preventive vaccination in countries with endemic cholera, the stockpile has been accessed 80 times by 22 countries, with over 58 million doses shipped. In 2019, 23.7 million doses were shipped, including for the first time to Ethiopia and Sudan – an increase of 37% since 2018 and more than 1,000% since Gavi support began in 2013.
In April 2015, the Lao People’s Democratic Republic became the first country to introduce Japanese encephalitis (JE) vaccine with Gavi funding. By the end of 2019, over 2.9 million children had been immunised against JE through Gavi-supported routine programmes, while over 16 million had been reached through vaccination campaigns, resulting in over 18.9 million children in total being vaccinated.
As of April 2019, all Gavi-supported countries provide at least one dose of inactivated polio vaccine (IPV) as part of their routine immunisation programmes, which have reached more than 160 million children.
While we continue to help countries introduce new vaccines, our focus is expanding. Reaching every child is at the heart of Gavi’s next five-year plan, helping to deliver vaccines to people who need them everywhere, regardless of their gender, ethnic or social identity.
Over the past two decades, Gavi has helped protect a generation against some of the world’s deadliest diseases. However, 1.5 million people are still dying from vaccine-preventable diseases, while climate change, conflict and urbanisation are combining to make it easier for outbreaks to spread.
19.7 million children worldwide miss out on basic vaccines. 77% of these children live in Gavi-supported countries.
Only 17% of children in Gavi-supported countries receive the last recommended dose of each of the 11 antigens currently recommended by the World Health Organization (WHO) for all infants worldwide by their first birthday.
In Gavi-supported countries, nearly 20% of children are under-immunised – they have not received all three doses of the essential childhood vaccine containing DTP. Of this group, almost 70% are “zero-dose” children – they have not yet been reached with a single dose of DTP-containing vaccine. In Gavi-supported countries, there are still 10.6 million zero-dose children – down from 18.9 million in 2000.
In Gavi’s 2016–2020 strategic period, we intensified our efforts in 20 priority countries. In 2019, eight of these countries – Afghanistan, Chad, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria and Pakistan accounted for the most “zero-dose” children in Gavi-supported countries, so improving their immunisation coverage is critical.
During 2016–2020, we prioritised an additional 10 countries facing severe inequities or crises: Central African Republic, Haiti, Madagascar, Mozambique, Myanmar, Niger, Papua New Guinea, Somalia, South Sudan and Yemen.
Pneumonia and diarrhoea remain major killers of young children. Together, these diseases account for 29% of all deaths of children aged under five years and result in the loss of two million young lives each year.
A WHO study found no significant difference in immunisation coverage rates for boys and girls at the global level. Yet in some countries and communities, gender discrimination means that boys have greater access to vaccines than do girls. In others, the opposite is true – girls have greater access. In societies where women have low status and therefore lack access to immunisation and other health services, both girls and boys are less likely to be immunised.
Globally, one woman dies of cervical cancer approximately every two minutes. With more than 300,000 deaths a year, it kills more women than complications during and following pregnancy and childbirth. Approximately 90% of these deaths occurred in low- and middle-income countries. Human papillomavirus (HPV) vaccines protect against the main causes of cervical cancer.
Rubella is the leading vaccine-preventable cause of birth defects. Every year, 100,000 babies are born with severe birth defects known as congenital rubella syndrome because their mothers were infected with rubella during pregnancy – the vast majority in Gavi-supported countries. The combined measles-rubella vaccine, which Gavi supports, can prevent this devastating disease.
By the end of 2019, the cost of fully immunising a child with pentavalent, pneumococcal and rotavirus vaccines reached US$ 15.57. This represents a reduction of 22% relative to the 2015 baseline figure of US$ 20.01 and 3% drop from the previous year.
The weighted average price per dose of the five-in-one pentavalent vaccine against diphtheria, tetanus, pertussis, hepatitis B and Hib dropped from US$ 1.68 in 2015 to US$ 0.86 in 2019.
Continuing high global demand for human papillomavirus (HPV) vaccine – while extremely positive news – has created significant challenges for Gavi and the countries we support. Due to the successful introduction of the vaccine in countries around the world, suppliers are not currently able to meet high and rising demand. However, we expect the supply situation to improve significantly in Gavi’s next strategic period (2021–2025), both from existing suppliers and new manufacturers expected to enter the market.
After two difficult years, global supply of inactivated polio vaccine (IPV) has steadily increased and is now adequate to meet the needs of all countries providing a single dose IPV. Countries have also started catch-up campaigns for children who missed due to earlier supply shortages. The next challenge is to ensure adequate supply for countries to introduce a second dose of IPV into their routine immunisation schedules, as recommended by the Strategic Advisory Group of Experts (SAGE) on Immunization.
Through the Pneumococcal Advance Market Commitment (AMC), pneumococcal conjugate vaccines (PCV) are available to Gavi countries at no more than US$ 3.50 per dose – less than 5% of the public price in the United States of America. By 2020, Gavi had secured a lowest price offer from one of its PCV suppliers of US$ 2.00 per dose. This could contribute additional savings of up to US$ 50 million. In 2019, for the first time, pneumococcal vaccine coverage in Gavi-supported countries was higher than the worldwide average.
In 2001, five vaccine manufacturers produced prequalified, appropriate Gavi vaccines, with only one based in Africa. In 2019, 17 vaccine manufacturers produced prequalified, appropriate Gavi vaccines, with 11 based in Africa, Asia and Latin America.
Supply constraints had disrupted the efforts of some governments to introduce the vaccine in 2018–2019; however, extensive Alliance collaboration helped mitigate the issue, and a key manufacturer resolved bulk production challenges and increased supply capacity to reach previously forecasted levels. The market’s resilience is also improving with the prequalification of new vaccine products, with three manufacturers now offering a total of six presentations. Greater competition in the market led to a decrease of 5% in the weighted average price for this vaccine.
In 2019, an additional three vaccine products with improved characteristics were procured by UNICEF for Gavi-supported countries, bringing the total to ten since 2015 – meeting our 2020 target one year ahead of schedule. These new products reflect Gavi’s continued efforts to procure products that offer countries more flexibility and help reduce cold chain footprint.
By the end of 2019, Gavi was on track to help countries immunise an additional 300 million children in the 2016–2020 strategic period, preventing 5–6 million future deaths.
In 2019, routine immunisation reached 85% of the world’s children. It is the only intervention that brings the vast majority of families into contact with the health system multiple times during the first year of a child’s life. If we expand this reach further, we have a solid platform for universal health coverage.
According to a study published in Health Affairs in 2018, vaccines administered between 2016 and 2030 will prevent 24 million people in 41 of the world's poorest countries from falling into poverty.
In June 2019, the Gavi Board approved a new five-year strategy with a vision to ‘leave no one behind with immunisation and a mission to save lives and protect people’s health by increasing equitable and sustainable use of vaccines. Gavi 5.0 began on 1 January 2021.