At the 7th Tokyo International Conference on African Development conference at the end of last month in Japan, Gavi launched its third call for funding – presenting a financial ask of at least US$7.4 billion to immunise 300 million people by 2025, leaving no one behind, and saving up to 8 million lives over its 2021–25 strategic period. This officially kicked off its replenishment period.
A smart investment
Immunisation saves lives and is one of the most successful and cost-effective health interventions, with far-reaching benefits. Improved coverage has contributed to significant reductions in child deaths – saving 2–3 million lives a year and protecting millions more from disease and disability.
The return on investment from immunisation turns $1 into $21. This increases 2½ fold to a return of $54 when considering wider societal benefits. A fully funded Gavi replenishment is anticipated to deliver up to US$100 billion in economic benefits by 2025.
Universal coverage of life-saving vaccinations is also a critical component of strengthening primary health care and can help drive progress on universal health coverage (UHC) and the Sustainable Development Goals (SDGs).
However, beyond the economics of it all is the most important argument for investing in immunisation – it is everyone’s right, as part of their right to health.
Not all children are being reached
Nevertheless, for nearly 20 million this right is not being fulfilled. Global immunisation coverage has stalled at 85% and coverage across Gavi countries has only increased one percentage point between 2015 and 2017.
Inequalities in coverage across and within countries mean that children from the poorest families, the most remote areas and marginalised groups are left behind. Around half of Gavi countries with available disaggregated data (29 out of 55) show poor performance in terms of equity.
These children are left exposed to deadly diseases, like pneumonia, the biggest infectious killer of children globally. While largely preventable through vaccination, the vaccines that can help protect children from many types of pneumonia are not always available to those children who need them most. In 2018, nearly 30% of children globally didn’t receive the recommended three doses of Hib vaccine and over 50% didn’t receive the pneumococcal vaccine.
Countries must do much more to ensure immunisation services reach all children, as part of comprehensive primary health care. However, for many low-income countries, they still rely on support from donors and development partners to achieve this. This is why an investment in Gavi is so critical.
Beyond the money
The pledging conference for Gavi’s next replenishment will take place in the UK in June 2020. This is an opportunity to invest in driving improved and more equitable immunisation coverage. Save the Children is calling for donors to step up to the plate and ensure a successful replenishment to support Gavi to deliver on its 2021–25 strategy.
But these pledges must go beyond the money. They must drive a strong policy agenda and be a transformative investment in building stronger health systems and mobilising domestic resources.
Gavi’s next strategic period must focus on supporting countries to strengthen primary healthcare systems that can equitably and sustainably improve immunisation coverage, while building capacity for countries to successfully transition from Gavi support. It must also have a sharper focus on reaching the most deprived and marginalised children, including children affected by conflict.
Gavi must also play a stronger role in shaping the vaccines markets, using its extensive market-shaping expertise, leverage and purchasing power, so that prices are affordable in the long term, including for middle-income countries that have transitioned from Gavi support or those that have never been eligible.
Commitments from all stakeholders
The success of Gavi’s replenishment should not be measured solely by reaching funding targets. Wider commitments from Gavi-recipient countries and the private sector are just a critical to achieving immunisation goals.
We are also calling for Gavi-recipient countries to make their own commitments during Gavi’s replenishment – including commitments to achieve universal immunisation coverage, turning political commitments into action to accelerate progress. And countries must take action to increase domestic investment and strengthen their primary healthcare systems to equitably and sustainably deliver immunisation services.
Manufacturers must make financial commitments as part of Gavi replenishment, including through innovative financing such as matching funds. Critically they must make commitments to lower vaccine prices so that they are more affordable for Gavi and middle-income countries and commit to supplying vaccine volumes needed to meet demand and fulfil supply commitments. This is where they have most impact in helping to immunise more children.
As we enter into Gavi’s next replenishment period, we must work together to make sure vaccination delivery isn’t just one jab, but is a transformative investment in building stronger health systems for children in the poorest countries, with the potential to save millions of children’s lives.