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.
58% of the global birth cohort live in the 57 Gavi-supported countries. As a global alliance, we help protect nearly half the world’s children through vaccination.
From 2000 through 2021, Gavi helped vaccinate more than 981 million children in 77 countries through routine immunisation and supported more than 1.4 billion vaccinations through campaigns.
With more than 1.2 million future deaths averted in 2021 alone, Gavi has helped lower-income countries to prevent more than 16.2 million future deaths through its support for routine immunisation programmes and vaccination campaigns since 2000. More than 59 million future DALYs were averted by Gavi-supported vaccinations in 2021. DALYs measure healthy years lost due to disability or premature death.
In Gavi-supported countries, coverage with three doses of diphtheria-tetanus-pertussis-containing vaccine (DTP3), included in pentavalent vaccine, was 77% in 2021 – just 4 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 2021 than in 2000; and coverage with the first dose of measles-containing vaccine (MCV1) was also 77% in 2021 – also 4 percentage points below the global average.
Countries immunised more than 65 million unique children with Gavi-supported vaccines in 2021. (Of this number, each child is protected against approximately six infectious diseases.) This brings the cumulative number of children immunised since 2000 to more than 981 million.
By preventing illness, death and long-term disability, Gavi-supported vaccines helped generate more than US$ 185.3 billion in economic benefits from 2000–2021.
From 2000–2021, Gavi supported 561 vaccine introductions and campaigns. In 2021, the number of routine introductions and preventive campaigns increased to 39 from 21 in 2020. (These figures exclude COVID-19 vaccination.)
The year 2021 saw a record number of cold chain equipment (CCE) fridge/freezer procurements through UNICEF Supply Division, including 12,861 from Gavi’s Cold Chain Equipment Optimisation Platform (CCEOP); and 5,243 from COVAX (in addition to ultra-low temperature CCE).
Increasing immunisation sessions is a key desired output of health system strengthening (HSS) investments and an intermediate result in the causal pathway to increasing vaccine coverage. In 2021, 6.3 million immunisation sessions were conducted in the 25 Gavi-supported countries that reported: 4.9 million in fixed-site facilities; and 1.4 million in outreach facilities.
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.
A testament to increasing country ownership and long-term financial sustainability, countries contributed a record US$ 161 million towards co-financing of Gavi-supported vaccines in 2021 – despite ongoing fiscal challenges of the COVID-19 pandemic – bringing to US$ 1.3 billion their total contribution since the co-financing policy was introduced in 2008.
By end 2022, 19 countries had transitioned to fully self-financing their vaccine programmes (including 3 in 2022), bringing to 54 the number of countries eligible to apply for new vaccine support from Gavi. The number of vaccine programmes originally introduced with Gavi funding, but which are now self-financed by countries, increased from 40 in 2018 to 49 in 2020 and 2021.
Data sources for this document, unless otherwise stated: Gavi, the Vaccine Alliance; World Health Organization (WHO); UNICEF; CDC vaccine price list; UN Department of Economic and Social Affairs. For more information on activities and performance, please visit Gavi’s 2021 Annual Progress Report
1 The updated study also looked at the investment return in the world’s 94 lowest-income countries. For every US$ 1 spent on immunisation in these countries, US$ 20 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 investment return is estimated to be US$ 52.
By end 2021, Gavi supported 561 routine introductions and campaigns across 17 infectious diseases, and funded more than 195 million vaccine doses through global stockpiles – in addition to nearly 1 billion COVID-19 vaccine doses shipped through COVAX.
Gavi led efforts to fund and deploy the world’s first Ebola vaccine, launching a global stockpile in 2021 with more than 300,000 WHO-prequalified doses made available by the end of the year. In its inaugural year, 4,800 doses were shipped from the stockpile to Democratic Republic of the Congo (DRC).
In 2021, 3 more countries introduced human papillomavirus (HPV) vaccine into their routine immunisation programme, for a total of 24 countries by end 2021 – of which eight also introduced with multi-age cohort (MAC) vaccination (including 3 in 2021).
Although there were no new launches in 2021, more than 6.4 million children have been immunised against Japanese encephalitis with Gavi support through routine service deliveries; and more than 18.1 million children through catch-up campaigns.
Since 2007, countries have immunised over 136 million children with a first and/or second dose of measles or measles-rubella (MR) vaccine through Gavi-supported routine immunisation programmes. The pandemic continued to disrupt planning for measles and MR activities: four introductions and seven campaigns were launched in 2021 (an increase from six activities in 2020); and two introductions and three campaigns were postponed until 2022.
By end 2021, more than 339 million people had been vaccinated against meningococcal meningitis A through Gavi-supported preventive mass and catch-up campaigns in the African “meningitis belt”. Over 39 million were reached through routine immunisation. By end 2021, 13 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 2009–2021, the stockpile was accessed 54 times by 16 countries, shipping over 24.82 million doses. Three requests were approved in 2021 to respond to Neisseria meningitidis C and W outbreaks in Benin, DRC and Niger, targeting 600,922.
Since its creation in 2013 to support emergency response, humanitarian crises and preventive vaccination in countries with endemic cholera, the stockpile has been accessed 102 times by 22 countries, with approximately 97 million doses shipped by end 2021.
All Gavi-supported countries have introduced the five-in-one pentavalent vaccine against diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type b (Hib). By end 2021, more than 661 million children had been immunised with Gavi support.
By end 2021, 614 countries had introduced pneumococcal conjugate vaccine (PCV), and immunised more than 315 million children against pneumococcal disease with Gavi support. Since 2016, PCV coverage in Gavi-supported countries has been the same or higher than the worldwide average.
All 73 eligible countries have introduced one dose of inactivated polio vaccine (IPV) into their routine immunisation schedules, vaccinating more than 323 million children.5 Meeting the 2021 target, 12 countries conducted catch-up campaigns, targeting more than 11 million children who were not protected against poliovirus type 2. Nineteen countries introduced the second dose of IPV (IPV2) into their routine immunisation schedules – a significant number, considering it was the first year of Gavi support for the second dose – vaccinating an estimated 61 million.
By end 2021, 536 countries had introduced rotavirus vaccine with support from the Vaccine Alliance – immunising more than 201 million children. Since 2018, Gavi-supported countries had higher rotavirus vaccine coverage than the rest of the world.
In 2019, Pakistan became the first country to introduce the new typhoid conjugate vaccine (TCV) into its routine immunisation programme; Liberia and Zimbabwe introduced in 2021. By end 2021, more than 3 million children had been reached through routine immunisation, and an additional 36 million children aged up to 15 through catch-up campaigns.
Since 2011, Gavi-supported mass campaigns in 16 countries have reached more than 215 million people, while routine introductions in 18 countries have reached over 146 million people. The Gavi-supported yellow fever vaccine stockpile has saved countless lives; over 747 million doses have been shipped through end 2021.
2 Historical review of data and indicators is in progress.
3 All 73 Gavi-eligible countries have introduced pentavalent vaccine. Six of the 73 countries introduced pentavalent vaccine independently of Gavi support.
4 Includes Bhutan, Indonesia and Mongolia, which are fully self-financing and accessed the Pneumococcal AMC price for pneumococcal vaccines.
5 Two of the 73 countries introduced IPV independently of Gavi support.
6 Includes Kiribati, which introduced rotavirus vaccine independently of Gavi support.
7 Historical review of data and indicators is in progress.
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.
25 million children worldwide miss out on basic vaccines. 69% of these children live in Gavi-supported countries.
Only 29% 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 23% of children are under-immunised – they have not received all three doses of the essential childhood vaccine containing DTP. Of this group, 72% are “zero-dose” children – they have not received even a single dose of DTP-containing vaccine. In Gavi-supported countries in 2021, there were 12.5 million zero-dose children – down from 18.6 million in 2000.
Pneumonia and diarrhoea remain major killers of young children. Together, these diseases accounted for over 1.2 million deaths of children aged under five years in 2019 – including ~370,000 children from rotavirus diarrhoea.
Due to gender norms, it is often women’s responsibility to bring children for vaccination; yet women in lower-income countries often face gender-related barriers to doing so, including: time constraints due to high workload; limited funds for transport; and lack of access to information on disease prevention. In many countries, vaccinators are predominantly women, and they may face barriers in delivering vaccine services due to gender norms, unsafe working conditions, poor or irregular pay, and heavy workload.
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.
In 2021, the number of markets exhibiting acceptable levels of healthy market dynamics for vaccines and immunisation products improved from 10 to 11, exceeding the target for the year. This outcome was driven by an improvement in demand in the typhoid conjugate vaccine (TCV) market.
In 2001, five vaccine manufacturers produced prequalified, appropriate Gavi vaccines, with only one based in Africa. In 2021, 18 vaccine manufacturers produced prequalified, appropriate Gavi vaccines, with 11 based in Africa, Asia and Latin America.
In August 2021, Gavi, GlaxoSmithKline (GSK) and MedAccess announced an innovative financing agreement to guarantee continued production of the antigen for the world’s first malaria vaccine – nearly 35 years in development. In December 2021, the Gavi Board made history by approving funding to support the roll-out of the vaccine in sub-Saharan Africa. The first application deadline was September 2022.
Innovation-related market shaping indicators are on track. The number of innovative products within the pipeline of commercial-scale manufacturers increased by two in 2021. Two measles-rubella micro-array patch (MAP) phase 1 studies were initiated.
Because of Gavi’s market shaping efforts, the cost of fully immunising a child against 11 antigens now costs about US$ 28 in Gavi-supported countries, compared with approximately US$ 1,300 in the United States of America public sector – or US$ 24 and US$ 1,100, respectively, if one-dose schedule for HPV vaccine.
Amid the economic, political and social challenges of the COVID-19 pandemic in 2021, Vaccine Alliance partners and countries made progress towards achieving our six mission indicators for the 2021–2025 strategic period. We remain on track to reach our Mission target of immunising 300 million additional children during the 2021–2025 strategic period and are set to exceed 1.1 billion children vaccinated through routine systems by end 2025.
In 2021, despite the COVID-19 pandemic, routine immunisation reached 86% 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).
Before the COVID-19 pandemic, a study published in Health Affairs in 2018 showed that vaccines administered between 2016 and 2030 could have prevented 24 million people in 41 of the world's poorest countries from falling into poverty.
In December 2022, the Gavi Board approved an evolution of its current five-year programme strategy that will see renewed focus on routine immunisation and reaching zero-dose children, new vaccine introductions, a strengthened Alliance role in outbreak and pandemic preparedness and response, alongside continued COVID-19 vaccinations in the 92 lower income countries supported by the Gavi COVAX Advance Market Commitment (AMC).
Data sources for this document, unless otherwise stated: Gavi, the Vaccine Alliance; World Health Organization (WHO); UNICEF; CDC vaccine price list; UN Department of Economic and Social Affairs. For more information on activities and performance, please visit Gavi’s 2021 Annual Progress Report.