Global vaccine coalition unveils ambitious plan to immunize 300 million children

Helen Branswell

Gavi, the Vaccine Alliance, has unveiled an ambitious plan to expand the number of doses it helps developing countries purchase, aiming to vaccinate an additional 300 million children from 2021 to 2025.

The Geneva-based organization revealed to donors it needs $7.4 billion for its five-year period at an event in Japan on Friday (local time) to launch its replenishment drive.

Gavi CEO Dr. Seth Berkley said donors and donor countries need advance notice to be able to work contributions into their budgeting processes, especially as several other major global health programs — the Global Polio Eradication Initiative and the Global Fund to Fight HIV, Tuberculosis and Malaria among them — are also undertaking funding drives.

Donors will announce their contributions at Gavi’s pledging conference next summer in Britain.

“We will now have to meet individually with countries and discuss their willingness to provide financing,” Berkley told STAT in an interview. “But they want to see first of all what’s the overall plan. What’s the money going to be spent on? What type of impact is it going to have? How cost-effective are you in what you’re doing? And it gives them a notice of what this looks like.”

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Created in 2000, Gavi is a public-private partnership that works to ensure even the world’s poorest countries have the capacity to buy vaccines. Countries must contribute a portion of the cost of the vaccines and, over time, their contribution increases until they reach the point where they must take over the full cost themselves. At the moment, 55 countries are eligible for Gavi’s assistance.

In the current five-year period, recipient countries contributed $1.6 billion towards the cost of the vaccines they used; in the next five-year round that figure more than doubles to $3.6 billion — 41% of the cost of the vaccines, Berkley explained.

When the organization was founded, it helped countries purchase six vaccines; by 2025 the alliance will be helping countries buy 18 different vaccines.

Gavi estimates that since its inception it has helped to immunize more than 760 million people, saving an estimated 13 million lives. By the end of the next five-year period, those figures will have risen to 1.1 billion vaccinated children, and 22 million deaths averted, the organization said.

In addition to its traditional vaccine work, Gavi is taking on more responsibilities, the costs of which are reflected in the replenishment request, Berkley explained.

It needs an additional $150 million to maintain a stockpile of Ebola vaccine, a continuation of work Gavi began after the devastating West African Ebola outbreak of 2014-2016, when vaccines were tested in the field for the first time. One, made by Merck, was proven to be protective; clinical trials involving two others concluded without results because the outbreak ended. The stockpile of Merck vaccine is being used in the current Ebola outbreak in the Democratic Republic of the Congo.

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As the drive to rid the world of polio reaches its final stages, Gavi also plans to spend $800 million to help countries buy inactivated polio vaccine, the injectable type used in the United States. This is a program the organization is running at the request of the Global Polio Eradication Initiative.

Many low-income countries use oral polio vaccine almost exclusively. Though the oral vaccine is much cheaper, its use will have to be discontinued at a point because the live but weakened viruses it contains can transmit from child to child, regaining virulence in the process. These vaccine-derived polioviruses, as they are called, can on occasion paralyze children.

Adding inactivated polio vaccine to Gavi’s portfolio will help safeguard the gains made by the polio eradication program through its tricky endgame period, Berkley said.

Gavi’s funding request for the 2021-2025 period is slightly less than the current five-year budget of $7.5 billion. Berkley said the organization knew donors were hoping for a bigger decrease in cost — and without the extra responsibilities, the decrease would have been greater.

The cost of its core function, the vaccine assistance program, has actually decreased, he said, noting that though Gavi will actually buy more vaccine in the coming five-year period — 3.2 million doses, up from 3.1 million — the cost of the vaccine will decline because of organization’s ability to achieve savings through bulk purchasing.