The GAVI Alliance: immunization as a key component of primary health care

Marc Hofstetter

Action for Global Health ConferenceBerlin, 11 February 2009

Why GAVI?

9.2 million annual child deaths 25% vaccine-preventable MDG 4

Vaccines: life-saving, simple and highly cost-effective:

Harvard economists: “the economic impact and benefits of immunization have been greatly underestimated; GAVI programmes could earn a rate of return of 18%”

North-South inequity in access to vaccines

The response: private-public alliance

GAVI programmes: New and under-used vaccines

GAVI supported vaccines:

Hepatitis B Hib Yellow fever Pneumococcal disease Rotavirus diarrhoea Meningitis 4 new vaccines prioritized:

HPV, Japanese Encephalitis, Typhoid, Rubella

Leading causes of vaccine-preventable death in children under 5 years old:

Using pentavalent vaccine to reach MDG 4 (2000)

Using pentavalent vaccine to reach MDG 4 (2008)

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Elimination of Hib meningitis in Uganda 2002-2007

H. Influenzae meningitis cases, Mulago Hospital, Kampala, Uganda

Source/credits: Lewis R, et al Action for child survival: Elimination of meningitis due to Haemophilus influenzae type b following introduction of Hib vaccine in Uganda. WHO Bulletin. April 2008

Overall results

Source: WHO

Measuring impact: future deaths averted through GAVI vaccine support (hepatitis B, Hib and pertussis vaccines)

World Health report 2008 – Revitalizing primary health care

Key role for immunisation

Too many children still miss out on vaccinations

Goal: universal coverage, equitable access

Strengthening health service delivery platforms

GAVI Programmes:Health Systems Strengthening Support

Why? GAVI’s outcome-based immunisation programmes revealed system

weaknesses, bottlenecks for further progress Infrastructure, human resources, service delivery, constraints at

peripheral level, organization and management, etc.

How? Use principles outlined in DAC Paris declaration: alignment, country

ownership, accountability, managing by results Active involvement of CSOs in implementation

How much? $800 million -2015 Evaluation in 2009 to guide direction

HSS example: Ethiopia

Aid effectiveness: Paris and Accra

GAVI business model based on Paris principles, active role in aid effectiveness debates, pioneering new models

Predictability: long-term commitments to countries

Ownership: countries apply for the support they need and contribute financially, countries define indicators for HSS monitoring

Alignment: GAVI support must be in line with countries’ existing national health plans and not replace existing funding

Performance-based funding to reward results

H8 - Health Leaders of 8 organisations collaborating for better and measurable outcomes

IHP: strengthen GAVI business model to start IHP implementation in Ethiopia and Mozambique

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Moving forward - the funding gap

Expenditures reflect known and estimated country demand for vaccines that can shift the needle on MDG4

Key donors: USA: $70 m/year – Norway: $75 m/year – Netherlands: €25 m/year - UK: $2 b through IFFim - France: $1.5 b through IFFim – Italy: $1.2 b through IFFIm and AMC – BMGF: $1.5 b over 15 years.

Germany: €4 million in 2009

Estimates as at January 2009

2009 - 2015 Per annum (average)

Projected expenditure $ 9.54 b $ 1.36 b

Projected available resources (historical trend)

$ 5.45 b $ 0.78 b

GAP $4.04 billion $0.58 billion

WHO/Christopher Black

Danke