2016-2020 Strategy: Progress, Challenges and RisksBOARD MEETING: Anuradha Gupta, 4-5 December 2019, Delhi

UNDER-5 MORTALITY

FUTURE DEATHS

AVERTED

FUTURE DALYS

AVERTED

CHILDREN IMMUNISED(WITH GAVI SUPPORT)

VACCINES SUSTAINED (AFTER GAVI SUPPORTS ENDS)

2015 BASELINE

57 per 1,00063 per 1,000

198 million

4.3 million

203 million

N/A 100%

250 million

5-6 million

300 million

2020 TARGET

Alliance on track to achieve its 2020 mission indicators

-

500,000

1,000,000

1,500,000

2,000,000

2,500,000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Pro

jecte

d U

5 V

PD

Death

s,

Gavi 68

Rota: 78% reduction in proportion of

hospitalisations due to rotavirus in Madagascar

PCV: nearly 50% reduction in proportion of

hospitalisations due to pneumonia in Nepal

Other VPDs

Pneumococcal

Hib

Rotavirus

Measles

Immunisation is succeeding in reaching more households, including the poorest

5Note: based on Gavi68 with a Demographic and Health Survey or Multiple Indicator Cluster Survey, latest

survey for each country, 2010-2017. Estimates are averages of country values weighted by appropriate

population groups to compute weighted average coverage of a given intervention

Highest coverage ……

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2000 2002 2004 2006 2008 2010 2012 2014

Median coverage of key interventionsin Gavi-supported countries

Family planning Antenatal Care

Immunisation (DTP3) HIV treatment

TB treatment Bed nets

Sanitation

2017

and most equitable

7%

28%

50%

52%

56%

0% 10% 20% 30% 40% 50% 60% 70%

Sanitation

Antenatal care

Family planning

Careseeking for Pneumonia

DTP3 vaccination

Coverage in Poorest Decile (%)

Coverage of services in the poorest decilein Gavi-supported countries

Zero dose child is a marker of acute inequity

2 out of 3 zero dose children live in households surviving on less than US$ 1.90 a day

US$ 1.90 poverty line

Opportunity for multi-agency, multi-sectoral action

SG2: Strengthen systems

SG1: Accelerate vaccines

Lim

ite

d D

ata

Flu

ctu

ati

ng

Mixed performance: challenges and risks remain

MATERNAL & WEALTH EQUITY

79%

83%81%

81%

89%18%18%

15%18% 18%

18% 18% 17% 17%14%

Wealth

Maternal

education

2015 2016 2017 2020 2015 2016 2017 2020

GEOGRAPHIC EQUITY

80% 81%

85%81%82%

DTP3

MCV1

78%80%

83%81% 81%

39%31%

42%

52%63%

2015 2016 2017 20202015 2016 2017 2020

Inc

rea

sin

g

Flu

ctu

ati

ng

BREADTH OF PROTECTIONCOVERAGE

SG 1&2: Accelerate vaccines & strengthen systems

2018

2018 2018

2018

0

20

40

60

80

100

120

2015 2016 2017 2018

Co

ve

rag

e (

%)

HIB3 IPV MCV2 PCV3 Rubella Rota YF

Significant progress in expanding breadth of protection

SG 1&2: Accelerate vaccines & strengthen systems

Not just introducing vaccines but

accelerating their uptake and coverage

HIB3

IPV

MCV2RUBELLAPCV3YFRota

>170mvaccinations

>300mvaccinations

Zero-dose

(no DTP)

Immunised

(DTP3)

Differentiation showing encouraging trends (2015-2018)

10

Surviving

infants

-11%

-16%

+1.5%PEF

TIER 1

+5%+6%

+5%

PEF Tier 1: Nigeria, India, Pakistan, Indonesia, Ethiopia, DRC, Afghanistan, Chad, Kenya and Uganda

+5%

Under-

immunised

PEF

TIER 2

+4%

PEF Tier 2 (plus fragile): Somalia, Yemen, Mali, Mozambique, Madagascar, Niger, South Sudan, Haiti, Sudan, PNG, Myanmar, CAR,

Burundi, Eritrea and Solomon Island

SG 1&2: Accelerate vaccines & strengthen systems

Progress on equity in countries where Alliance has amplified its focus

PEF Tier 1: Pakistan

SG 1&2: Accelerate vaccines & strengthen systems

Zero dose* decreased by 2%

Under-immunised decreased by 8%

Wealth equity improved by 16pp

Maternal education equity

improved by 7pp

* Defined as no DTP

Fragile: Mali

Zero dose* decreased by 24%

Under-immunised decreased by 7%

Wealth equity improved by 16pp

Maternal education equity

improved by 13pp

Forging new partnerships in fragile countries

12

SG 1&2: Accelerate vaccines & strengthen systems

SOUTH SUDAN

Health Pool Fund

(HPF3) & International

Organisation for

Migration

SOMALIA

International

Rescue Committee IFRC & Afghan Red

Crescent Society

AFGHANISTAN

SG3: Improve sustainability

2015 2016 2018

$407m

2017

Gavi continues to lead the way on sustainability

COUNTRIES INVESTMENT IN

IMMUNISATION

TRANSITION STATUSCO-FINANCING COMMITMENTS

Co

nti

nu

ed

pe

rfo

rma

nc

e

CO-FINANCING & SELF-FINANCING

Incre

asin

g

Ch

all

en

ge

sIn

cre

as

ing

100%

49% 54%

63%

75%

56%

79%

53%

2015 2016 2017 2020

$125m

85%

100% 100% 100%

2015 2016 2017 2020 2015 2016 2017 2020

$298m

$241m

N/A

(% of countries meeting their co-financing commitments excluding waivers)

(% of countries “on track” for successful transition)

(% of countries increasing domestic expenditure on RI)

SG3: Improve sustainability

2018 2018

India

Self

Financing

Co-Financing

100%

2018

60%

40

50

60

70

80

90

100

2015 2016 2017 2018

DT

P3 C

overa

ge (

%)

Viet Nam

40

50

60

70

80

90

100

2015 2016 2017 2018

DT

P3 C

overa

ge (

%)

Nigeria Papua New Guinea Solomon Islands

SG3: Improve sustainability

Focused engagement in transitioning and transitioned countries

Transitioning countries:

5 on track, 3 not yet there

14 of 15 countries have sustained

above 90% or improved coverage

All 15 countries have continued to

procure vaccines introduced with

Gavi support

15 countries have transitioned out

of Gavi support

Transitioned countries showing

strong performance

Vietnam (DTP3)

Vietnam (MCV1)

SG4: Market shaping

17

Progress on price reduction and innovation;continued challenges on supply and healthy markets

Ch

all

en

ge

sIn

cre

as

ing

Sta

ble

Imp

rovin

g

11

2015 2016 2017 20202015 2016 2017 2020

2015 2016 2017 2020

$17 $16$20 $19

N/A

(Vaccine markets where supply meets demand)(Cost of full course of Penta, PCV and Rota vaccines)

(Vaccine markets classified with moderate or high healthy dynamics) (No. vaccines & immunisation products with improved characteristics)

2015 2016 2017 2020

8 /119/11

7 /11

SUPPLY SECURITY

VACCINE INNOVATIONHEALTHY MARKET DYNAMICS

VACCINE PRICE REDUCTION

8 /11

SG4: Market shaping

2018

2018 2018

2018

6/11

12

3 3

0

3

5

7

10

Most cervical cancer deaths are in poor countries

18

SG4: Market shaping

Cervical cancer deaths,

cervix uteri (per 100,000)

Sources: GLOBOCAN 2018,

IARC (http://gco.iarc.fr/today). World Health Organization

≥ 19.9

7.1 to 11.0

4.4 to 7.1

2.2 to 4.4

0 to 2.2

11.0 to19.9

* Total unconstrained demand for countries that have been approved to introduce HPV vaccine between 2017-2020

Estimated girls to be reached by end of 2020 compared to target communicated to the Board in December 2016

Supply of ~35m doses versus country demand of ~80m*

13m girls reached versus 40m^ target

300k future deaths averted versus 900k target

www.gavi.org

THANK YOU

‘It always seems

impossible until it is done’ Nelson Mandela