Q&A: Gavi alliance talks immunising 300 million people

Abi Millar: Gavi, a Vaccine Alliance, recently launched a major fundraising drive, with a view to raising $7.4bn. How do you intend to raise these funds and who are your primary donors likely to be?

Aurelia Nguyen: We’re entering quite an exciting period, which will culminate in a replenishment event in London in June 2020. The $7.4bn we’re looking for will be from a combination of contributions – we have government donors and sovereign entities, we have foundations and regional funds, and we also have partnerships with the private sector. Another important part is the contributions we have through innovative financing mechanisms, such as the International Finance Facility for Immunisation.

In this upcoming replenishment, of course we’re going to be making a case to our current donors, but we’re also very interested in reaching out and diversifying our donor base, whether they be sovereign donors or the private sector.

Developing country governments will invest $3.6bn in their own vaccine programmes in 2021-2025, compared to $1.6bn in 2016-2020. What do you think lies behind this increase in investment, and how do you support countries in their transition to self-financing?

That’s one of the things we’re extremely proud of. Gavi has embraced the principles of being country-driven, and for us, country-driven also means country-funded. So when these countries request an investment programme, we ask them to make a contribution to the cost of each vaccine.

We understand we’re servicing the poorest countries in the world so they don’t have the money to be able to fully fund their programmes, but it’s important that they have some ownership in it right from the start. What happens is that as the country grows economically, the share of the money they put in increases.

Because we’ve had a very intense engagement with the ministers of health and finance, we’ve been able to increase the amount that countries spend on their vaccine programme over time. That’s led to the $3.6bn you’re referring to.

What’s not counted in here is another huge amount, $6.3bn, which the countries are funding themselves in terms of delivering the vaccines. So really it’s those two numbers together – the $3.6bn and the $6.3bn – that show the incredible commitment that developing countries have made towards immunisation.

The investment will support 18 basic vaccines. Which are the priorities and which vaccines are new to the 2021-2025 Investment Opportunity?

That’s a bit like trying to name your favourite child – you’re not allowed to do that! Joking aside, it’s difficult to single out a single vaccine because each one has a unique role in terms of being a lifesaver and preventing a disease that causes raises in mortality and morbidity.

A lot of our focus has been on rolling out the newer vaccines - for example HPV, rotavirus and pneumococcal. We’ll be focusing on making sure that all the countries that need those vaccines are taking them up.

But as you alluded to, an important and exciting part of this next strategy is that we are expanding our portfolio quite a bit. And so on top of these existing vaccines we’re going to be adding boosters for diphtheria, tetanus, and pertussis. We’re going to be adding a hepatitis B birth dose, we’re going to be adding a new vaccine in our meningococcal programme that addresses more strains of the disease, and we’re going to be expanding our cholera programme into a routine programme. We’re also going to be looking at rabies, and as and when we get a good vaccine for respiratory syncytial virus hopefully we’ll be supporting that.

One thing I should mention is the work we’re doing on Ebola. In the Democratic Republic of Congo, we’ve been supporting the response to Ebola with an investigational vaccine – 230,000 people have been vaccinated thanks to a deal between Gavi and the manufacturer. As soon as that vaccine gets licensed, we’ll be looking for support from our board so as to have a regular Ebola programme. That’s one of my key projects.

Can you comment on some of the work the Vaccine Alliance has done so far? What do you consider to be your main accomplishments?

When Gavi was created in 2000, only 59% of children in the developing world were receiving the basic vaccinations, and usually when a new vaccine became available it was ten years in between when high-income countries could introduce the vaccine and developing countries could introduce it. Today, 81% of children receive the basic course of vaccines, and we’ve really narrowed the gap between what’s happening in the developing world and what’s happening elsewhere.

In some instances, we’ve even superseded other countries. So if you take a vaccine like rotavirus or pneumococcal, the coverage that we have in countries supported by Gavi is actually higher than in some other countries. That is a key accomplishment.

And then to put it in terms of the magnitude of the work, we’ve vaccinated 760 million children since the inception of Gavi, which means we’ve averted 13 million deaths. Over this period of time, child mortality in the countries we work in has halved, and our vaccination programmes have been a key driver.

So a lot of work has been accomplished so far, and there’s a lot of work still to do. The world is becoming a more difficult place in terms of population displacement, climate change fragility, disease outbreaks etc, so that’s where we’ll be focusing our attention next.

What do you aim to achieve with this next round of funding? How will you ensure the vaccines go to those most in need?

In the past 20 years, we’ve managed to vaccinate 760 million children, and now with the 2021-25 round of funding, we’re going to be aiming to cover 300 million more. That equates to seven to eight million additional lives saved. So, by the end of 2025, we’ll have vaccinated 1.1 billion children and saved 22 million lives altogether if we’re successful in our funding and implementation.

The strategy we have in place for this period is to focus on the communities where immunisation is currently not taking place and children are being missed. With growing urbanisation there’s a lot of work for us to do in urban slums, as well in reaching remote areas, stigmatised populations and conflict settings.

What are Gavi’s next steps?

Our next step will be our replenishment event next year. What we’re doing at the moment is galvanising all the Alliance members, to be able to show the success that Gavi has had so far and the opportunity we have for further progress. That includes the pharmaceutical industry as a key partner, as well as all the implementation partners and the countries themselves.

In January at the World Economic Forum at Davos, we’re going to be celebrating our 20 years and it’s apropos since Gavi was launched at Davos 20 years ago. So that will be a key moment to build momentum towards a successful replenishment.

One of the things we need to come back to is just how amazing an investment immunisation is. If you invest $1 in immunisation in the countries we work in, you get $54 of return in wider societal benefits. That’s really a best buy as far as I’m concerned.