Historically, these countries housed most under-vaccinated children and struggled with the most severe resource constraints, offering a natural target for immunization support. In its first 20 years, Gavi targeted its support to the 68–77 countries meeting its income-based eligibility criteria over the period-specifically, GNI per capita under or equal to a threshold ($1,580 as of 2018, averaged over a three-year period since 2015). Ĭountry eligibility and transition criteria don’t fit with mission and expected results. While there are important success stories, there are just as many cases of stagnation and several egregious cases of very low coverage more than a decade after a vaccine is introduced.ĭrivers of under-immunization vary but are linked in the literature to the distribution and training of health workers, high staff turnover, and salary payment delays shortfalls in funding created by macroeconomic changes, weak demand forecasting, or lack of budget priority to immunization procurement and supply chain issues (e.g., global shortages of IPV and high wastage rates) and low demand, in part driven by parental beliefs or economic constraints as well as unfounded fears about vaccine safety and the intent behind immunization efforts, among others. Too often, the new vaccines reach the same children that already receive services and actually increase inequities as the same vulnerable populations are missed by more interventions and services. In Ethiopia, for example, the pneumococcal conjugate vaccine was introduced in 2011 but coverage of a third dose of PCV among children 12–23 months had only reached half of children as of 2016, and less than 40 percent of children had received all basic vaccinations. Yet coverage rates of Gavi-funded vaccines are highly variable, particularly among those countries with the largest birth cohorts that are poised to or have already transitioned away from eligibility. Increasing immunization coverage and equity have been part of Gavi’s mission since its founding. Immunization coverage remains low in too many places. This overview note lays out five challenges and summarizes some of our ideas to address them backing up each is a standalone note that provides greater detail and options for action. Gavi 5.0 needs a new model to deliver on its laudable mission. ![]() ![]() Vaccines can only deliver on their health impact and value-for-money promise if herd immunity is attained and sustained. A country crossing an income threshold does not signal mission accomplished for an organization that aims to save lives and protect health with vaccines. ![]() These global realities require a new approach. New or dormant threats are also a new reality-newly vaccine-preventable diseases like Ebola or virulent flu strains can spread swiftly and lethally in an interconnected world. Yet the effects of under-immunization anywhere can have global implications everywhere, as recent outbreaks illustrate. Gavi and partners have also contributed to increased coverage immunization rates are higher in Burundi and Rwanda, for example, than in many places in the United States and Europe. Gavi and its partners have made enormous progress towards increasing equity in the introduction of vaccines children living in the lowest-income countries now have access to the same set of vaccines as those living in high-income countries. Gavi’s mission-saving children’s lives and protecting people’s health by increasing equitable use of vaccines-remains highly relevant. ![]() In a highly contested funding environment where priorities must be set for the allocation of scarce concessional resources, investment in expanding the availability and coverage of cost-effective vaccination must come at the top of the list. Child vaccination remains among the most cost-effective uses of public and aid monies.
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