The Global Alliance for Vaccines and Immunization, GAVI, is one of the largest and arguably most successful efforts going in global health today.
Other large health initiatives like the Global Fund to Fight AIDS, TB and Malaria or PEPFAR (the President’s Emergency Plan for AIDS Relief) tend to get more attention because they are focused on some of the big disease-specific killers. GAVI, focused generally on expanding child vaccination against a number of routine and mundane killers like measles, diarrhea or pneumonia, is decidedly less sexy and so it gets less ink.
Yet in terms of lives saved per dollar spent, it is arguably unequaled as a global health initiative.
Launched in 2000 by a $750 million grant from the Bill & Melinda Gates Foundation (and originally administered by Seattle-based PATH), immunization rates worldwide have been increased by 10 percent (from about 76% to 83%) and substantially contributed to the halving of child mortality rates globally, from more than 12 million child deaths in 1990 to about 6.5 million today.
“I am pleased that our partners recognise the fantastic progress by the GAVI Alliance that has put us firmly on track to reach our goal of immunising an additional quarter of a billion children by 2015, saving four million lives,” said Seth Berkley, chief executive officer for GAVI and a long-time advocate of the power of immunization.
Berkley and others had much to celebrate at a meeting in Stockholm, Sweden, this week for the official ‘mid-term review’ of GAVI. But some of those attending also saw some chronic problems and increased future challenges for the vaccine initiative.
“While there have been significant achievements accomplished in the field of immunization … to bring new vaccines to the poorest countries, persistent gaps have revealed that immunization needs a major booster shot,” said the advocacy organization Médecins Sans Frontières (aka Doctors Without Borders).
Kate Elder, who focuses on vaccine access for MSF, said her organization applauds the efforts of GAVI to expand immunization worldwide. But some 22 million of the poorest children still are not reached, Elder said, in part because many of the new vaccines promoted by the Alliance for use against diarrhea and pneumonia are often still too expensive to be feasible in the developing world.
“We think GAVI could do a lot more to encourage affordable pricing by industry and to expand access to these vaccines,” Elder said.
Similarly, Save the Children UK said in a report on GAVI that the initiative has been quite successful in expanding immunization, but not in adequately reducing prices or in supporting the kind of health system strengthening (i.e., making sure there are enough trained personnel and basic health infrastructure) needed to ensure sustained improvement in immunization worldwide.
“A vaccine cannot inject itself; it needs to be administered by a qualified, motivated and properly remunerated health worker, supported by a well-functioning health system in reach of every person,” said the Save the Children report. The vaccine alliance – working in concert with donors and the pharmaceutical industry – must do much more to support beefing up health systems in poor countries, the organization said.