The biggest success story in global health you’ve never heard of

A shot at life
A shot at life

Vaccines are boring, or if you’re getting one kind of unpleasant. And their health impact is basically invisible.

These all sound like minor side issues, but they amount to a big problem. A deadly problem.

It partly explains why you have either never heard of GAVI, the Global Alliance for Vaccines and Immunization, or, if you have, you may not think it’s nearly as important to global health as all the other high-profile efforts going on in the fight against other killers like AIDS, malaria or maternal mortality.

Yet vaccines clearly are saving more lives worldwide than any other single health intervention.

“Over the last 10 years, we’ve immunized about 288 million children and saved about 5 million lives,” said Helen Evans, interim director of GAVI and an Australian health expert. “It’s absolutely extraordinary.”

Expanding and improving child vaccination rates is also the top-funded mission, and arguably the most successful initiative to date, of the world’s biggest philanthropy, the Bill & Melinda Gates Foundation.

“It’s one of our highest priorities and our biggest investment,” said Rajeev Venkayya, director of global health delivery at the Gates Foundation.

The Seattle philanthropy, which basically launched GAVI (with partners like UNICEF, WHO and others) as one of the first things it did in global health, has given about $4.5 billion to this effort over the last decade and plans to give another $10 billion over the next.

But it’s not enough. And children who don’t need to die will, if something doesn’t change.

This global initiative created to prevent many of the leading — mundane, boring — causes of death in children is at risk of losing its momentum, of stalling.

The global economic downturn has dampened the enthusiasm of donors for many of these grand projects and new funds — even promised funding — aren’t keeping up with the needs. There are always competing government funding priorities, even within the global health agenda.

The much higher-profile Global Fund to Fight AIDS, TB and Malaria, for example, has a much more powerful political constituency and advocacy. Yet the Obama Administration and other donors have scaled back funding for that fund despite clear evidence of benefit to the poor and a boatload of political and celebrity muscle.

GAVI has no celebrity spokesfolks. It has little public name recognition. And as these two charts indicate, the U.S. has given much less than its share to this life-saving effort:

GAVI donor funding responsibilities based on GDP
Country funding commitments to GAVI

To keep moving forward, GAVI needs $3.8 billion more just to add two vaccines against pneumonia and a deadly form of diarrhea caused by a bug known as rotavirus.

These two diseases alone, which prior to this did not have vaccines effective or inexpensive enough to be used in poor countries, account for more than a third of all deaths in children under age 5 worldwide.

Bill Gates has described GAVI as a means to address a “market failure” — an innovative, humanitarian effort to get over the hurdle of drug industry disinterest in developing and manufacturing vaccines that have to be cheap enough to distribute to the poorest of the poor.

By making this such a massive effort, creating economies of scale, vaccines for poor children are now a going concern for industry.

But now, the hurdle could be described as a marketing failure.

Rajeev Venkayya
Gates Foundation

The Gates Foundation’s Venkayya acknowledged that GAVI has fairly low name recognition, but said he didn’t see that as a problem since funding comes not from the public but from major donors and governments.

“The average person on the street doesn’t need to know about GAVI,” said Venkayya. “All they need to know is that these vaccines that we take for granted here in the U.S. are these amazing, life-saving tools that should be available to children anywhere in the world.”

Evans, who only recently took the helm at GAVI (after the previous CEO Julian Lob-Levyt left to take another job, and under a bit of a cloud due to concerns about his management), isn’t so sanguine.

“I think the situation has changed,” Evans said.

Helen Evans

Lack of public awareness of GAVI hadn’t been a problem before, she said, because governments and donors recognized the inherent value of expanding childhood immunizations.

Now, with funding tight, pressure on governments to justify foreign aid and intensified competition for resources, Evans believes it will be critical to gain more awareness and public support for what she says is the “most powerful and cost-effective health intervention out there.”

To be clear, GAVI is still making progress and saving lives. PATH recently received $100 million from GAVI in support of its innovative meningitis vaccination campaign in Africa. Kenya and Congo have rolled out new vaccine programs.

A very detailed (and kinda wonky) symposium on GAVI recently held at the Center for Global Development noted the initiative’s amazing success in terms of lives saved but also in how it has succeeded in addressing Gates’ concerns about market failure by significantly bringing down the price of many vaccines — an achievement that, in a world of limited resources, translates into many more lives saved.

But if a “marketing failure” means donors don’t step up with more money to support GAVI and build on the progress made to date, millions more children will die.


About Author

Tom Paulson

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom[at] or follow him on Twitter @tompaulson.