The evidence is clear: vaccines are one of the most cost-effective investments in health and development in history. Established in 2000, Gavi’s mission is to 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 2020, Gavi helped vaccinate more than 888 million children in 77 countries through routine immunisation and supported more than 1.19 billion vaccinations through campaigns.
With approximately 1.2 million future deaths prevented in 2020 alone, Gavi has helped lower-income countries to prevent more than 15 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 78% in 2020 – just 5 percentage points below the global average. This represents an increase of 19 percentage points since 2000. Over 50% more children were immunised with DTP3 in 68 of the world’s lowest-income countries in 2020 than in 2000.
Countries immunised an additional 64 million children with Gavi support in 2020, often with more than one vaccine. Due to the impact of the COVID-19 pandemic, this represents a decrease from the 66 million children reached in 2019; but we exceeded our target of 300 million for the 2016–2020 period, helping countries immunise over 324 million unique children.
Gavi has supported more than 521 vaccine introductions and campaigns since 2000. In 2020, 21 introductions and campaigns took place with Gavi support, a decrease from 60 in 2019 due to the impact of the COVID-19 pandemic.
Gavi disbursed a record US$ 383 million in health system support in 2020, for a total of US$ 1.42 billion for the 2016–2020 strategic period. Part of this support facilitates the introduction of more modern and environmentally friendly cold chain equipment to make sure that vaccines can safely reach everyone who needs them.
The Vaccine Alliance has helped strengthen health systems and immunisation services in 70 countries, and 52 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$ 230 billion in economic benefits from 2000–2020.
By end 2019, 16 countries had transitioned to fully self-financing their vaccine programmes.4 By end 2020, 88% of countries in the accelerated transition phase were on track to transition successfully – an increase from 67% in 2019, exceeding the 2020 target of 75%.
Through routine immunisation programmes, preventive campaigns and emergency stockpiles, the Vaccine Alliance supports vaccines against 17 infectious diseases. By end 2020, Gavi had supported 521 routine introductions and campaigns, and funded more than 165.5 million vaccine doses through global stockpiles.
All Gavi-supported countries have successfully introduced the five-in-one pentavalent vaccine against diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type b (Hib). By end 2020, more than 569 million children had been immunised with pentavalent vaccine with Gavi support.
Our support has contributed to immunising more than 159 million children against rotavirus diarrhoea. By end 2020, 51 countries had introduced the vaccine with support from the Vaccine Alliance. For the third year in a row, Gavi-supported countries had higher rotavirus vaccine coverage than the rest of the world.
By end 2020, 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 27 million were reached through routine immunisation. By end 2020, 11 out of the 26 countries in the belt had added the vaccine to their national schedules.
Gavi funds a stockpile of multivalent vaccine to respond to outbreaks of meningococcal meningitis A, C, W and Y. From 2009 through 2020, the stockpile had been accessed 48 times by 13 countries, with over 22.6 million doses shipped. In 2020, Benin was the only country that applied to use the stockpile.
In 2019, Pakistan became the first country to introduce typhoid conjugate vaccine (TCV) into routine immunisation with Gavi support; by end 2020, more than 10 million children had been vaccinated in Sindh province – achieving a TCV coverage rate of more than 70%. In 2019, Gavi supported the first use of TCV in Africa for an outbreak response campaign in Harare, Zimbabwe, vaccinating over 318,000 people.
More than 300,000 people in the Democratic Republic of the Congo had been protected against Ebola virus disease (EVD) with Gavi support by end 2020. 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 end 2020, 60 countries had introduced pneumococcal conjugate vaccine (PCV) and immunised more than 255 million children against pneumococcal disease with Gavi support. For the third year in a row, PCV coverage in Gavi-supported countries remains slightly higher than the worldwide average.
In 2020, three countries introduced human papillomavirus (HPV) vaccine into their routine programme, of which one also introduced a multi-age cohort (MAC) vaccination. In total, 21 countries have successfully launched their HPV vaccine national programme with Gavi support, including 5 countries with MAC.
Since 2007, countries have immunised over 117 million children with a first and/or second dose of measles or measles-rubella (MR) vaccine through Gavi-supported routine immunisation programmes. Activities were heavily impacted by the pandemic: in 2020, only 1 routine introduction and 5 campaigns took place, compared with 32 activities in 2019.
Since 2011, Gavi-supported mass campaigns in 15 countries have reached more than 158 million people, while routine introductions in 17 countries have reached over 129 million people. The Gavi-supported yellow fever vaccine stockpile has saved countless lives; over 72 million doses have been shipped through the end of 2020.
Since its creation in 2013 to support emergency response, humanitarian crises and preventive vaccination in countries with endemic cholera, the stockpile has been accessed 87 times by 22 countries, with approximately 70 million doses shipped by end 2020.
Although there were no new launches in 2020, by the end of the year more than 3.9 million children had been immunised against Japanese encephalitis through routine service deliveries. In addition, over 16.6 million had been reached through catch-up campaigns, resulting in more than 20.5 million children in total being vaccinated.
Despite global supply shortages during the Gavi 4.0 strategic period, by April 2019 all 73 eligible countries had introduced one dose of inactivated polio vaccine (IPV) into their routine immunisation schedules.4 Overcoming challenges of the COVID-19 pandemic, 6 countries (out of 17 expected) implemented IPV catch-up vaccination activities in 2020 – including Angola, which integrated bivalent oral polio vaccine (bOPV) outbreak response and measles-rubella National Immunization Days (NIDs).
After more than two decades of progress, Gavi is now focused on protecting the next generation, above all the “zero-dose” children who have not received even a single vaccine shot.
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.
22.7 million children worldwide miss out on basic vaccines. 78% of these children live in Gavi-supported countries.
Only 28% 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, more than 20% of children are under-immunised – they have not received all three doses of the essential childhood vaccine containing DTP. Of this group, more than 75% are “zero-dose” children – they have not received even a single dose of DTP-containing vaccine. In Gavi-supported countries in 2020, there were 13.7 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 2020, seven of these countries – Afghanistan, 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 also prioritised ten 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 accounted for over 1.1 million deaths of children aged under five years in 2019.
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.
About 90% of these deaths occurred in low- and middle-income countries. Human papillomavirus (HPV) vaccine protects against the main causes of cervical cancer.
Rubella is the leading vaccine-preventable cause of birth defects. It is estimated that every year approximately 100,000 babies are born with severe birth defects known as congenital rubella syndrome (CRS) 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 end 2020, the cost of fully immunising a child with pentavalent, pneumococcal and rotavirus vaccines reached US$ 15.20. This represents a reduction of 24% relative to the 2015 baseline figure of US$ 20.01 and 2% 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 2020.
By end 2020, 10 out of 11 vaccine markets were assessed as having sufficient and uninterrupted supply – up from 8 in 2019. Five markets were judged to have moderate health, up from three in 2019, as supply security for inactivated polio vaccine (IPV) and oral cholera vaccine (OCV) improved.
Global demand for human papillomavirus (HPV) vaccine continues to outpace available supply, despite manufacturing capacity expansion efforts of a major supplier to Gavi. Countries were unable to scale up as originally envisioned, with multi-age cohort (MAC) vaccination deferred until supply availability improves. This translated into more than 7.1 million girls vaccinated by end 2020 compared to the original target of 40 million. In Gavi 5.0, Gavi’s fifth strategic period (2021–2025), we expect increased HPV vaccine supply from both existing and new manufacturers.
Through the Pneumococcal Advance Market Commitment (AMC), which reached its conclusion on 31 December 2020, pneumococcal conjugate vaccines (PCV) are available to Gavi countries at a new lower price of US$ 2.00 per dose, with the entry of the first vaccine from a Developing Countries Vaccine Manufacturers Network (DCVMN) member, Serum Institute of India (SII). The impact of this ten-year supply agreement is estimated to yield US$ 50–100 million in additional savings for Gavi and Gavi countries.
In 2001, five vaccine manufacturers produced prequalified, appropriate Gavi vaccines, with only one based in Africa. In 2020, 18 vaccine manufacturers produced prequalified, appropriate Gavi vaccines, with 11 based in Africa, Asia and Latin America.
In 2020, one additional vaccine product with improved characteristics was procured by UNICEF for Gavi-supported countries, bringing the Gavi 4.0 total to 11 since 2015 – exceeding our 2020 target of 10. These new products reflect Gavi’s continued efforts to procure products that offer countries more flexibility and help reduce cold chain footprint.
By end 2020, countries had immunised an additional 324 million children through routine systems with Gavi support during the 2016–2020 strategic period, meaning that, despite the COVID-19 pandemic, we exceeded our mission target of at least 300 million children.
In 2020, despite the COVID-19 pandemic, routine immunisation reached 83% 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 (UHC).
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 of “Leaving 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.