In 2008, some 10 years after high-income countries crossed the 50% coverage line, Haemophilus influenzae type b (Hib) vaccines had been introduced in half of all low-income countries.
By the end of 2014, all Gavi-supported countries had introduced Hib vaccine as part of the pentavalent vaccine. Coverage with a third dose of the pentavalent vaccine across Gavi-supported countries averaged 80% in 2017.
The average number of country introductions per year increased by more than 10-fold post-Gavi.
Second Gavi Evaluation 2011
According to Gavi's second evaluation report, the Vaccine Alliance played a critical role in facilitating the shift in market conditions to create high demand for Hib vaccine.
First, the Hib Initiative allowed health ministries in developing countries to establish the exact disease burden of Hib and make evidence-based arguments in favour of introducing a suitable vaccine.
Critically, it also secured a global recommendation from WHO for the introduction of Hib vaccines into national immunisation programmes.
Second, Gavi's subsidisation of pentavalent vaccine for countries interested in introducing vaccines against Hib has encouraged manufacturers to invest in developing new versions of the vaccine.
The long-term predictability and large-scale nature of Gavi support for pentavalent, coupled with the guaranteed supply at a diminishing price, has given low-income countries confidence to include Hib vaccine in their long-term plans.Pentavalent vaccine support
Haemophilus influenzae type b is the third vaccine-preventable cause of death in under-fives
By 1999, 10 years after being licensed, Hib vaccine was only available in one low-income country
Spread through sneezing and coughing, in the pre-vaccine era Haemophilus influenzae type b (Hib) was the leading cause of childhood meningitis – inflammation of the membranes covering the brain and spinal cord. Many survivors suffer paralysis, deafness, mental retardation and learning disabilities.
Even today, more than 20 years since safe and effective Hib conjugate vaccines were first licensed in the early 1990s, Hib remains an important cause of pneumonia and meningitis, mainly in children. Globally, the disease accounts for approximately 200,000 child deaths every year, most of them in low-income countries.
Hib can be treated with antibiotics, but lack of access to adequate medical facilities and increasing levels of antibiotic resistance lead to high mortality rates.
After Canada became the first country to introduce Hib vaccines in 1986, uptake was fast and, by 1998, 50% of high-income countries had introduced the vaccine into their immunisation programmes leading to dramatic declines in the incidence of Hib disease.
However, high costs meant low-income countries could not afford the vaccine. The Gambia was the lone exception, becoming the only developing country to introduce Hib vaccine thanks to a manufacturer's donation in 1997.
In 2006, WHO issued a powerful recommendation for Hib vaccines, urging that it be included in all routine immunisation programmes around the world.
In 2000, Gavi offers support for Hib vaccine as part of the pentavalent vaccine
Gavi-funded Hib Initiative aims to raise profile of Hib vaccine among developing countries and donors
When Gavi set out to catalyse the adoption of new vaccines in poor countries in 2000, Haemophilus influenzae type b (Hib) was top of its priority list. The vaccine had existed since the early 1990s but by 2000, only one low-income country had introduced the vaccine into its national immunisation programme.
As a result, subsidisation for routine immunisation against Hib was immediately made available through Gavi.
The Vaccine Alliance encouraged the administration of Hib through the combination pentavalent vaccine. This five-in-one vaccine, administered in a three-dose schedule, offered low-income countries the opportunity to provide protection from Hib at the same time as protecting their children against four other diseases: diphtheria, tetanus, pertussis (DTP) and hepatitis B.
Initially, Gavi-eligible countries were slow to take-up the offer of support for Hib vaccine, both because of a poor understanding of Hib's disease burden and concerns about the cost. By 2004, four years after the Hib vaccine had become part of Gavi's vaccine portfolio, only 15 countries out of the 74 eligible countries had been approved for Hib vaccine support.
In response, in July 2004, the Gavi Board established the Hib Task Force to explore how the Vaccine Alliance could fill the knowledge gap and lay the political foundations for large-scale Hib vaccine introduction. Following the 2005 recommendation of the Task Force, the Board allocated a four-year US$ 37 million grant to set up the Hib Initiative.
By bringing together the knowledge of the Johns Hopkins Bloomberg School of Public Health, the London School of Hygiene & Tropical Medicine, and the Centers for Disease Control and Prevention (CDC), the Hib Initiative used a combination of collecting and disseminating existing data, research and advocacy to help countries build a case for adopting the Hib vaccine.