The evidence is clear: vaccines are one of the most cost-effective investments in health and development in history. Gavi helps save children’s lives and protect people’s health by increasing equitable use of vaccines in lower-income countries.
Whilst we reach 60% of countries, vaccination rates within those mean Gavi vaccinates 49.2% of children globally.
Since its inception in 2000, Gavi has helped low-income countries to prevent more than 13 million future deaths through its support for routine immunisation programmes and vaccination campaigns.
Since 2000, Gavi support has contributed to the immunisation of more than 760 million unique children.
Coverage with three doses of diphtheria-tetanus-pertussis-containing vaccine (DTP3), including pentavalent vaccine, in Gavi-supported countries was 81% in 2018 – just 4 percentage points below the global average. While this represents an increase of 22 percentage points since 2000, it has remained unchanged over the past two years.
In 2018, 66 million children were immunised with Gavi-supported vaccines. Between 2016 and 2018 Gavi immunised 198 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.
The Vaccine Alliance has helped to strengthen health systems and immunisation services in more than 60 countries.
Gavi has supported 433 vaccine introductions and campaigns since 2000.
An updated study by Johns Hopkins University covering the 73 Gavi-supported countries over the 2011–2020 period shows that, for every US$ 1 spent on immunisation, US$ 21 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$ 54 per US$ 1 spent.
By preventing illness, death and long-term disability, Gavi-supported vaccines have helped to generate more than US$ 150 billion in economic benefits between 2000 and 2017.
By early 2019, 15 countries had started to fully self-finance all their vaccines introduced with Gavi support.2
1Note: The study also looked at the return on investment in the world’s 94 lowest-income countries. For every US$ 1 spent in these countries, US$ 16 are saved in healthcare costs, lost wages and lost productivity. Adding the broader benefits of immunisation, this rises to US$ 44 for every dollar invested.
2 Does not include countries that have previously received Gavi support but did not transition under the current policy (Albania, Bosnia-Herzegovina, China, Turkmenistan and Ukraine). Although 16 countries were fully self-financing in 2018, the Gavi Board approved Congo to regain eligibility as of 1 January 2019.
Gavi supports 17 antigens for use in routine immunisation programmes and preventive campaigns, as well as emergency stockpiles
In July 2014, South Sudan became the final Gavi-supported country to introduce the five-in-one pentavalent vaccine. By the end of 2018, over 467 million children had been immunised with pentavalent vaccine with Gavi support.
By the end of 2018, 59 Gavi-supported countries had immunised more than 183 million children against pneumococcal disease with support from the Vaccine Alliance.
Our support has contributed to immunising over 100 million children against rotavirus diarrhoea. By the end of 2018, 45 countries had introduced the vaccine with support from the Vaccine Alliance.
By the end of 2018, 296 million people against meningitis A through Gavi-supported campaigns. By the end of 2019, 9 countries will have rolled out the vaccine, however another 17 countries in the African “meningitis belt” need to introduce the vaccine to protect people against this strain of meningococcal meningitis.
Gavi funds a stockpile of multivalent vaccine to prevent outbreaks of meningitis A, C, W and Y. By the end of 2018, over 21 million vaccine doses had been distributed through the stockpile and it was accessed by Fiji and Nigeria to help manage outbreaks of the disease.
Since the first human papillomavirus (HPV) vaccine demonstration programme in Kenya in 2013, more than 3.9 million girls have been immunised with Gavi support.
Typhoid conjugate vaccines were Board-approved in late 2017, applications opened mid-2018 and since then three countries have applied for support. One request was also approved for TCV-use in outbreak response. The first Gavi-supported introduction and catch-up campaign began in 2019.
In September 2014, Nepal became the first country to introduce inactivated polio vaccine (IPV) with Gavi support and by the end of 2018, Gavi has immunised more than 112 million children. Fourteen countries introduced IPV into their routine immunisation system in 2018 and two additional countries are doing so in 2019.
Since 2007, countries have immunised over 76 million children with a second dose of measles vaccine and over 42 million with a first and/or second dose of measles-rubella vaccine through Gavi-supported routine immunisation programmes. Gavi-funded campaigns with these two vaccines have helped to vaccinate another 524 million children in countries at high risk of outbreaks.
Since 2011, Gavi-supported campaigns have protected 133 million people while routine introductions have reached over 117 million people. Gavi has helped 17 countries introduce yellow fever vaccine through routine immunisation. The yellow fever stockpile has also saved countless lives and since its set-up over 62 million doses have been distributed.
Since its creation in 2013, the Gavi-supported global oral cholera vaccine stockpile has distributed over 35 million doses and is viewed as a critical tool to support prevention and control of cholera as part of a multisectoral strategy. A clear indication of this is that in 2018, oral cholera vaccine use increased by 75% compared to 2017 and over 17 million doses of the vaccine were shipped with Gavi support.
In April 2015, Lao People’s Democratic Republic became the first country to introduce Japanese encephalitis (JE) vaccine with Gavi funding. By the end of 2018, 1,655,362 million children had been immunised against JE through Gavi-supported routine programmes, while 16,676,510 million had been reached through vaccination campaigns, resulting in over 18 million children in total being vaccinated.
While we continue to help countries introduce new vaccines, our focus is expanding. Our task now is to reach every child with these vaccines, regardless of where they are born or how rich their families are, and whether they are boys or girls.
Over the past two decades Gavi has helped protect a generation against some of the world’s deadliest diseases. However, 1.5 million people, including over 600,000 children under the age of five, are still dying from vaccine-preventable diseases, while climate change, conflict and urbanisation are combining to make it easier for outbreaks to spread.
19.4 million children worldwide miss out on basic vaccines. 78% of these children live in Gavi-supported countries.
Only 11% of children receive the last recommended dose of each of the 11 antigens currently recommended by WHO for all infants worldwide by their first birthday.
In the 2016–2020 period we are intensifying our efforts in 20 priority countries. Ten of these – Afghanistan, Chad, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Kenya, Nigeria, Pakistan and Uganda – account for over 70% of the underimmunised children in Gavi-supported countries, so improving their immunisation coverage is critical.
We are also prioritising an additional 10 countries, which face severe inequities or crises: The Central African Republic, Haiti, Madagascar, Mozambique, Myanmar, Niger, Papua New Guinea, Somalia, South Sudan and Yemen.
Pneumonia and diarrhoea account for nearly a quarter of deaths in under-fives in Gavi-supported countries.
A WHO study found no significant difference in immunisation coverage rates for boys and girls at the global level. Yet in some societies, boys are privileged over girls. In others, the opposite is true, and girls have greater access to vaccines than boys. 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.
One woman dies from cervical cancer approximately every two minutes – or 311,000 a year – over 80% of these are in low-income countries. If current trends hold, and without changes in prevention and control, cervical cancer deaths could eventually outpace maternal deaths. HPV vaccines can prevent up to 90% of all cervical cancer cases.
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 2018, the cost of fully immunising a child with pentavalent, pneumococcal and rotavirus vaccines averaged US$ 15.90. This represents a reduction of 21% relative to the 2015 baseline figure of US$ 20.01 and 4% drop from the 2017 price of US$ 16.63.
The weighted average price of pentavalent vaccine per dose dropped from US$ 2.98 in 2010 to US$ 0.90 in 2018; however, it is expected to increase to US$ 0.93 in 2019 following the decision by some manufacturers to increase their prices.
In 2013, a price of US$ 4.50 per dose for one type of HPV vaccine was agreed – a two-thirds reduction on the previous lowest public price. The rise in country demand for the vaccine is currently outpacing supply. Gavi is working with countries to help adjust the timing of introductions and with manufacturers to scale up production capacity.
After a period of supply shortages, sufficient quantities of IPV are now available to cover routine demand in Gavi-supported countries. While an important price increase was seen in 2019 due to significant scale-up costs, the weighted average price is expected to drop with the arrival of new suppliers.
Through the Advance Market Commitment (AMC), pneumococcal vaccines are available to Gavi-supported countries at no more than US$ 3.50 per dose – less than 5% of the public price in the USA. By early 2019, Gavi had secured a lowest price offer from one of its pneumococcal vaccine suppliers of US$ 2.90 per dose.
In 2001, 5 vaccine manufacturers produced prequalified, appropriate Gavi vaccines with 1 based in Africa. In 2018, 17 vaccine manufacturers produced prequalified, appropriate Gavi vaccines with 11 based in Africa, Asia and Latin America.
Thanks to long-term supply agreements with manufacturers, Gavi has been able to secure prices below US$ 1 per dose for two types of rotavirus vaccine (US$ 0.85 and US$ 0.95 per dose). This is less than 2% of the 2019 public price in the USA (US$ 70.49 per dose). Supply constraints have disrupted the efforts of some governments to introduce the vaccine in 2018/2019; however, extensive Alliance collaboration helped mitigate the issue and the market’s resilience is improving with the prequalification of new vaccine products.
Between 2016 and 2020, Gavi will help countries to immunise another 300 million children against potentially fatal diseases, saving between 5 and 6 million lives in the long term.
Routine immunisation currently reaches 86% of the world’s children. It is the only intervention that brings the vast majority of families into contact with the health system five or more 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.
Gavi continues to help countries to build sustainable immunisation programmes. Fifteen countries have already started to fully self-finance all their vaccines introduced with Gavi funding. By the end of 2020, a total of 18 countries are expected to have transitioned out of our support.
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.
Source: Harvard University 2018