Now to spend it equitably
Joint blog for World Immunisation Week from Simon Wright, Head of Child Survival at Save the Children and Donna Altenpohl, Vice-President Communications and Government Affairs, Vaccines, GSK
This week is World Immunisation Week: an opportunity to celebrate the importance and impact of life-saving vaccines worldwide and reflect on the challenges that remain in making sure that every child has access to the vaccines they need.
Immunisation is one of the most powerful tools that exist to improve health – a low-cost and high-impact service second only to clean water in terms of mortality impact. There has been huge investment in vaccines which has helped increase global basic immunisation coverage to 84%, and helped to ensure 17,000 fewer child deaths every day.
Three months ago, Gavi, the Vaccine Alliance received pledges of a remarkable $7.5 billion from international donors to fully fund the next five years of its strategy. This was no easy feat. Save the Children and GSK supported this replenishment with GSK committing to price freezes for countries after their Gavi support stops, building on previous price reductions.
GSK and Save the Children welcome this commitment to funding and are committed to supporting Gavi to define how this money should be used to reduce the global immunisation access gap.
The Gavi replenishment placed equity of access and universal coverage at the centre. The replenishment banner was ‘Reach Every Child’ and speaker after speaker at the replenishment event called for the next Gavi strategy to leave no child behind and make immunisation more equitable. Equity is a theme of World Immunisation Week, an issue Save the Children has been drawing attention to since our 2012 report Finding the Final Fifth. While global vaccine coverage is at 84%, this masks great inequalities within countries. For example, we show that in Nigeria the poorest children are eight times less likely to receive vaccinations than the rich.
Gavi’s next strategy also gives it a mandate to strengthen health systems and provides the opportunity to build the technical skills required in countries to support independent, sustainable national immunisation programmes post graduation and ensure a sustainable and healthy vaccine market. The recent Ebola crisis has highlighted that strengthening the whole health system for all conditions, including the ones we don’t know are coming, is critical.
When it comes to Gavi’s new strategy, we believe there is an opportunity to make sure the framework drives positive improvements.
What gets measured, gets done?
Soon, the Gavi board will agree on the targets against which Gavi can measure its impact.
Gavi’s inclusion of health system strengthening as a strategic goal is welcome. Gavi, like all multilaterals, needs to be able to show how it is strengthening health systems generally. If there is a very narrow definition of how this will be measured, there is a risk this could limit achievements – for example, immunisation may achieve universal coverage while other vital services continue to languish.
Gavi also needs to be focused on achieving universal coverage of immunisation. Midway through the Decade of Vaccines, the World Health Organization’s expert group on immunisation has just reported that vaccination coverage is stagnating, and the world is failing in the targets to get basic immunisations to all populations. While progress is being made on one target (the introduction of new and underutilised vaccines largely thanks to the work of Gavi), there is a risk that we are neglecting the basics.
Coverage of the most basic vaccines (DPT3) is flatlining with no major improvements seen for the past four years. The number of unvaccinated children has remained constant at around 22 million. Gavi’s targets and indicators need to show that it is putting building universal and fair coverage at the top of its priorities.
Making vaccine gains sustainable is key. As their economies have grown, a number of countries are now transitioning out of Gavi support and will face challenges in sustaining their immunisation programmes. GSK’s price freeze will give these countries stability in pricing and will enable governments to better plan for financing the full cost of immunisation. However, it is crucial is that while under Gavi support, all countries develop the necessary capacity to continue their vaccination programmes after graduation so that the significant progress made is not undone.
Gavi’s strategy should tackle inequalities, especially in graduating countries, focusing on in-country capacity-building in technical areas such as surveillance, supply chain and procurement of vaccines at sustainable prices. It needs to ensure political commitment to maintain vaccine programmes.
GSK and Save the Children welcome Gavi’s objective to strengthen civil society and private sector engagement in immunisation, and think a strategic approach to measuring this should be applied right across the Gavi strategy. We believe maximising the combined expertise of different partners is the best route to overcoming barriers and bottlenecks in health systems to increase vaccination coverage and provide more equitable access to immunisation.
We will be working together to make sure that the Gavi strategy achieves the ambitions expressed at the replenishment meeting. This will require meaningful indicators for coverage, equity, health system strengthening and market shaping so that Gavi can help play its part in the Global Vaccine Action Plan, and help to build comprehensive health services and universal health coverage.
Note – about GSK and Save the Children
GSK and Save the Children have an innovative five-year partnership that aims to help the world prevent 1 million under five deaths. We are working together to support development of new products, pilot new ways of working and putting our voices together to support change.
 Levels and Trends in Child Mortality, 2014 report.
Achieve >90% national coverage, and >80% in every district by end 2020.