Fragile environments, insecurity, conflict and emergencies create both disruption to vaccination uptake and inequitable service provision. In these settings, it is particularly challenging for large parts of the population, including displaced communities, to access routine immunisation services – leaving many unprotected against vaccine-preventable diseases. Countries experiencing chronic fragility comprise a growing share of Gavi’s portfolio, challenging Gavi’s vision of achieving equity in immunisation and reaching zero-dose children. To address this, the Gavi Board approved the Fragility, Emergencies and Displaced Populations Policy in June 2022.
WHAT IS THE PURPOSE OF THE POLICY?
The policy enables Gavi to prioritise countries affected by chronic fragility, acute emergencies and hosting large numbers of displaced populations. Populations in these settings can benefit from flexible and differentiated support to maintain and strengthen immunisation coverage. Through tailored support, bespoke interventions can be adopted to systematically identify and reach zero-dose children and missed communities with the full course of vaccines as a critical step towards integrated primary health care.
HOW DOES THE POLICY ENABLE GAVI’S VISION TO REACH ZERO-DOSE CHILDREN?
The policy recognises the complexity of three key settings that are not mutually exclusive and can occur at the same time. These settings include: long-term, protracted state of fragility; acute emergency events; and settings with large numbers of internally or externally displaced populations. The policy enables differentiated support and models of engagement for countries with these contexts in order to ensure immunisation services are maintained and zero-dose children are systematically reached. The policy places great emphasis on partnerships, understanding there are situations where there is a disputed or non-recognised government, or the national government is unwilling to or unable to reach populations at risk. Thus, the policy enables direct support to an array of Vaccine Alliance and Expanded Partners to ensure missed populations in such areas can be reached – not just by immunisation, but also with an integrated package of essential services.
WHEN IS THE POLICY APPLIED AND HOW DOES IT WORK?
Chronic fragility: the policy identifies countries facing protracted breakdown of health systems due to prolonged conflict, volatile political situations, macroeconomic instability and persistently low institutional capacity. The criteria to identify such countries include:
- Is the country globally recognised as facing fragility? This is indicated by international classifications including Fund for Peace Fragile States Index, OECD States of Fragility Report, World Bank Fragile and Conflict-Affected Situations and presence of humanitarian response plans in the Global Humanitarian Overview.
- Is the country facing immunisation programme performance challenges? This is indicated by low immunisation coverage or recurrent outbreaks of vaccine-preventable diseases.
- Does the country have other contextual challenges that may limit progress of immunisation programmes? These can include, but are not limited to, negative economic projections, rising political tension, weakened health system, mounting sub-national challenges or limited resilience to global challenges such as climate change.
These sub-set of countries are eligible for additional support for the entire Gavi 5.0 strategic period (2020–2025), enabling predictable, multi-year support and focused engagement. Gavi will aim for a participatory process in the development of support, involving the participation of a wide range of stakeholders, including: national and local governments; civil society organisations; Alliance and Expanded Partners; and other relevant in-country partners, such as humanitarian coordination mechanisms, as relevant.
Acute emergencies: In acute emergencies that adversely impact immunisation programmes, the policy helps to provide rapid, flexible and time-bound support. For a period up to one year, Gavi will work in a coordinated manner with the humanitarian response coordination mechanism to sustain routine immunisation services and prevent an increase in vaccine-preventable diseases and outbreaks.
Displaced populations: The policy puts a laser focus on displaced populations and enables Gavi to provide suitable support to ensure comprehensive and sustainable provision of immunisation services to such populations within Gavi-eligible countries, independent of their residency and legal status. Gavi encourages governments to ensure comprehensive and sustainable provision of immunisation services to displaced populations, and to integrate displaced populations into their national vaccination programmes. Gavi can provide additional support based on need and in collaboration with the humanitarian mechanism in country, through Alliance partners and civil society organisations.
WHEN WAS THE CURRENT POLICY APPROVED AND WHEN WILL IT BE UPDATED?
The current policy was approved by the Gavi Board on 23 June 2022 and will come into effect on 1 July 2022. It replaces the Fragility, Emergencies and Refugees Policy approved in June 2017. Regular updates of the policy will be proposed based on new learnings, approaches or policy bottlenecks surfaced in its operationalisation.