Ensuring the World's Poorest Children Benefit from Lifesaving Vaccines

WHAT WE’RE LEARNING Ensuring the World’s Poorest Children Benefit from Lifesaving Vaccines “Supporting children’s immunization is undoubtedly the best investment we’ve ever made.” —Bill and Melinda Gates Program Area pertussis) vaccine. When GAVI was The Challenge launched, 71 percent of the world’s Global Health Most people in rich nations do not children were receiving DTP vaccine. realize how difficult it is simply to By 2004, the rate had increased to survive early childhood in many parts Our Goal 78 percent. of the world. Every year, more than Prevent needless deaths in the world’s GAVI has concentrated the greatest 10 million children are buried before poorest countries by increasing access percentage of its resources on speeding they reach their fifth birthday. Of these, to basic vaccines and speeding the the introduction of newer, more about 1.4 million die from diseases that introduction of new vaccines. expensive vaccines, including those for existing vaccines can prevent—including hepatitis B, Haemophilus influenzae B measles, pertussis, and tetanus. Another Our Progress in Brief (Hib), and yellow fever. The vaccine 1.1 million die from diseases for which The Global Alliance for Vaccines for hepatitis B, for example, had been we will soon have vaccines. Because and Immunization (GAVI), which widely used in rich countries for childhood death is so frequent, parents the foundation helped to launch in 20 years but was severely underutilized in some countries in Africa and Asia 1999, has made significant progress. in the developing world because of a don’t even name their babies until they Children’s immunization is no longer a lack of political will and the vaccine’s reach several months of age. neglected area, and immunization rates relatively high cost. Today, 90 million are once again on the rise after a decade children in the developing world have A Father’s Grief of stagnation. One of the best indicators received the vaccine because of the Neonosa Muhani is a manioc farmer of immunization coverage is the alliance’s efforts. The progress on Hib and community leader in the southern percentage of the world’s children and yellow fever has been slower—an African nation of Mozambique, one of who receive DTP (diphtheria, tetanus, additional 14 million children have the most beautiful countries on Earth. received Hib and yellow fever vaccines. He lives in a thatched-roof, mud-walled house in the rural village of Metoro, near the country’s border with Tanzania. Information accurate as of June 2006 www.gatesfoundation.org/whatwerelearning WHAT WE’RE LEARNING PAGE 2 ENSURING THE WORLD’S POOREST CHILDREN BENEFIT FROM LIFESAVING VACCINES Three years ago, health workers to invest more heavily in supplying In July 1999, key players from all these affiliated with the innovative nonprofit vaccines to the developing world. sectors came together for two days at VillageReach brought polio, BCG, the Port of Seattle and left with a These problems undermined efforts measles, and DTP vaccines to Metoro blueprint for the Global Alliance for even to provide established, basic for the first time. Vaccines and Immunization (GAVI) vaccines to the world’s children. Newer, and the seeds of an idea for a sister But that was too late for two of Mr. more expensive, vaccines routinely entity that would raise money to support Muhani’s children. In 2000, his 2-year- given to infants in the rich world—such GAVI’s work (now known as the old son, Maulana, took ill with fever, as those for Haemophilus influenzae B GAVI Fund). The goal was to radically skin eruptions, red eyes, and diarrhea. (Hib) and hepatitis B—were reaching improve access to established and Within weeks, he was dead from almost no children in the poorest underused vaccines and to accelerate measles. Two years later, another countries. the development and introduction of measles outbreak swept the village new ones. and took with it Neonosa’s 4-year-old The Response daughter, Marina. Neonosa’s grief and In November 1998, shortly after making One Excuse Gone suffering are incalculable. The price their first large financial commitment By the end of the year, the foundation of the vaccine that could have saved to children’s vaccines, Bill and Melinda pledged $750 million over five years to his children is not: The measles vaccine Gates hosted a dinner at their home for fund these efforts. In the words of the costs pennies a dose. It has been in a dozen leading scientists. Around a GAVI Fund’s president, “Lack of existence since 1963. single table, they spent two-and-a-half money could no longer be the excuse hours discussing immunology and what for not getting children vaccinated.” Vaccine Progress Stalls could be done to overcome the barriers In the 1970s and 1980s, the world made The blueprint for GAVI called not for that were preventing nearly 30 million dramatic progress in expanding access a large new international bureaucracy children from receiving basic vaccines to basic vaccines, thanks in great but rather for a lean secretariat housed every year. Bill and Melinda challenged measure to the leadership of the World within UNICEF’s offices in Geneva, their guests to come back with Health Organization and UNICEF. administered by widely respected proposals for “breakthrough solutions.” Sadly, the progress ground to a halt Norwegian immunologist Tore Godal, As the dinner was winding down, Bill in the 1990s. and governed by a 12-member board. said, “Don’t be afraid to think big.” These 12 members represented all the Child immunization had dropped on the major partners in the alliance, including priority list of the world’s major donors, A Timely Hint developing-world governments, the and developing countries were left By all accounts, Bill and Melinda’s World Health Organization, UNICEF, struggling to maintain access for their challenge came at the right moment. the World Bank, pharmaceutical children. HIV/AIDS was beginning to It gave pharmaceutical companies, companies, NGOs, research institutes, devastate the world’s poorest countries health ministers, international agencies, and the Bill & Melinda Gates and absorb a large share of health-care and nongovernmental organizations Foundation. The strategy was to dollars. Bureaucratic struggles between (NGOs) new incentive to restart failed create an inclusive decision-making international agencies had set in. discussions on how these entities could body to bring new coordination to a Wars, civil unrest, and famine in poor join together in an international alliance disjointed, inefficient marketplace. countries took their toll on vaccination to strengthen the system for getting campaigns. Pharmaceutical companies vaccines to where they are needed most. did not have consistent market incentives that would enable them www.gatesfoundation.org/whatwerelearning Information accurate as of June 2006 WHAT WE’RE LEARNING ENSURING THE WORLD’S POOREST CHILDREN BENEFIT FROM LIFESAVING VACCINES PAGE 3 How GAVI Works GAVI invites the 75 poorest countries in the world to develop plans and submit proposals for increasing vaccine coverage and use of newer vaccines. An independent committee made up largely of developing-country public health experts then reviews and makes recommendations on the proposals. GAVI’s board then meets to review the recommendations. Once the board approves a proposal, it requests that the GAVI Fund release payment. To increase the efficiency of the market, GAVI looks across all the approved plans to forecast how many doses of each vaccine will be required overall. This demand-forecasting helps guarantee an adequate supply of vaccines. We hope that over the long term it will also reduce unit prices. Two Shots in the Arm In January 2005, the foundation experts and championed by Gordon Results announced a second $750 million grant Brown, chancellor of the British • The GAVI Alliance estimates that its to support GAVI’s work. This time, treasury. The IFFIm will collect pledges work has helped prevent approximately the grant will spread out over 10 years, from donor governments, turn these 1.7 million deaths and that it is poised rather than five. In the alliance’s first pledges into bonds, sell the bonds in to help prevent well over 5 million five years, the foundation’s funding capital markets (just like a standard deaths during the next 10 years. accounted for half of GAVI’s resources. corporate or government bond), and use In its next 10 years, we hope our the proceeds to provide a large infusion • More than 115 million additional funding will account for less than of money for immunization. IFFIm has children have been reached with new 20 percent. already collected $3.5 billion in pledges vaccines, including those for hepatitis One promising approach to bringing from eight middle- and high-income B, Hib, and yellow fever. countries, including greatly expanded in new and more-predictable funding • 15 million additional children have commitments from two countries (the for immunization through GAVI been reached with basic vaccines. is the International Finance Facility United Kingdom and France) that for Immunization (IFFIm), an idea have already supported GAVI and • Since 2000, the funding for developed by economists and health four countries that have not contributed immunization in the countries that to GAVI previously. GAVI focuses on has more than doubled—from $1.1 billion to $2.5 billion a year. Information accurate as of June 2006 www.gatesfoundation.org/whatwerelearning WHAT WE’RE LEARNING PAGE 4 ENSURING THE WORLD’S POOREST CHILDREN BENEFIT FROM LIFESAVING VACCINES Key Lessons hoped would lend support have operating expenses is vital for getting redirected vaccine funds to other new entities up and running, for • Sometimes you have to be the first pressing health needs. As a result, attracting donors that have greater dollar in.

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