Devex CheckUp: Gavi falls around $2.9 billion short

Gavi, the Vaccine Alliance now has a total of more than $9 billion in pledges to fund its work for the next five years. However, it’s still about $2.9 billion short of its total need.

Not all of the pledges are new money, which the organization was aiming for at its much-anticipated replenishment summit on Wednesday in Brussels. The total includes new pledges made by world leaders and philanthropists in the lead-up to and during the event, but also leftover COVID-19 funds, among other funding streams — although there are no details yet on the breakdown of which funds are new, my colleague Sara Jerving explains.

Some of Gavi’s top donors either maintained or sustained their strong levels of support, despite the difficult fundraising climate.

The United Kingdom pledged £1.25 billion ($1.7 billion), keeping its status as Gavi’s top country donor, although that amount was less than in previous years. The Gates Foundation, which rallied for support for Gavi’s replenishment, committed $1.6 billion — the same amount it promised the organization for the 2020-2025 period. The European Union — which co-hosted the summit — and its member countries pledged a combined €2 billion ($2.33 billion).

However, the United States, Gavi’s third largest donor, said it’s not contributing any more resources to Gavi, until it’s able to “re-earn the public trust.” In a video message, U.S. Secretary of Health and Human Services Robert F. Kennedy Jr., a known vaccine skeptic, accused the organization of neglecting vaccine safety and ignoring the science — which Gavi refuted.

But in response to Kennedy’s announcement, there were questions about whether the Trump administration can do this. The U.S. government pledged $1.58 billion to Gavi in 2024, during former President Joe Biden’s administration, and Congress has always had a final say on how much to allocate to Gavi.

Without U.S. funding and additional pledges coming through, Gavi may face difficulties in meeting its goals of vaccinating at least 500 million children, stockpiling on critical vaccines to prevent disease outbreaks, and rolling out malaria vaccines. Gavi needed a total of $11.9 billion to follow through on all of its goals.

“Gavi will now face tough choices about how to allocate its available resources—without compromising on its impact,” Janeen Madan Keller, deputy director of global health policy at the Center for Global Development, said in a statement.

Read: Gavi pledges fall short about $2.9B as US pulls out

Read more: Robert F. Kennedy Jr. says the US is cutting funding for Gavi

ICYMI: Price of first malaria vaccine to be slashed by more than half

A taxing affair

I’m in Dublin this week for the World Conference on Tobacco Control, which, after much delay (no thanks to COVID-19), finally happened after seven years. It’s not April 25, but I can say, borrowing from Ms. Rhode Island, that the weather here is “not too hot, not too cold. All you need is a light jacket.”

Weather aside, concerns persist regarding tobacco industry advertising and interference at the conference, and how that is evolving and becoming even more challenging in the wake of digital media, which, as one expert noted, is a bottomless pit to monitor.

One running theme is the need for governments to raise their taxes on tobacco. This could give their coffers much-needed revenue for health and social protection programs, including tobacco control, at a time of diminished resources due to aid cuts.

But the big question is, why aren’t governments doing this? After all, it could provide critical funding. Advocates blame industry influence, noting how it can be persuasive in getting governments to keep taxes low or to raise them in small increments.

The latest report from the World Health Organization on the tobacco epidemic reveals just how real this is. Only 40 countries have raised their tobacco taxes to 75% or more as recommended by WHO. That means cigarettes remain quite affordable — and therefore accessible — in many parts of the world.

Amid the concerns, billionaire philanthropist Michael Bloomberg provided a bit of a respite when — against a backdrop of a full-on production akin to a Broadway musical, complete with song and dance — he announced a new $20 million fund for tobacco control, and recognized countries and organizations that have done well in implementing control measures. The philanthropist also said he’s not backing off from global health, “not an inch,” at a time of significant donor funding cuts to health.

But that still leaves some outstanding questions, such as how control efforts can win against an industry that spends billions of dollars a year on tobacco advertising and promotion alone? WHO says $9.6 billion is needed to implement tobacco control programs globally, but only $1.2 billion is currently available.

Read: Low-income countries are missing out on tobacco tax gains amid aid cuts 

Plus: Michael Bloomberg announces new $20M fund for tobacco control

Stick with me

Stay with me on taxes for a bit, as there’s A LOT of talk and push for that at the conference this week. But tax discussions are, well, tricky.

One concern that has come up is that raising taxes on tobacco could lead to illicit trade. Experts said this is another tobacco industry tactic to undermine control measures. But even if there’s illicit trade, Chile’s former finance minister, Andrés Velasco, said the problem can be tackled by new technologies, such as satellite photographs and drones. Another solution: public shaming.

“If somebody is caught not paying VAT or corporate tax, we shame that person. … If the person is rich, the shaming will be even more intense. But if we find somebody on a boat smuggling a cigarette into a country, then somehow that is untouchable,” he said. “I think that what we need to do is extend the shame that we adjudicate to anybody avoiding tax to those set of people.”

But his one piece of advice to health professionals is, don’t lecture about morality.

“There's nothing that economists dislike more than being lectured by health professionals from a higher moral ground. I sat in rooms in which that conversation took place many times: ‘We doctors do good, you economists keep us from doing good.’ That narrative, guys, is not going to fly,” he said.

Nothing lasts forever

We’re in the age of changes, and one institution facing an uncertain future is the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR. It’s the world’s largest bilateral HIV program, but it is now facing unprecedented budget threats.

But institutions such as PEPFAR were never meant to be permanent — and that’s coming straight from one of its architects, Dr. Mark Dybul. Even so, he says there needs to be a gradual reduction of support in collaboration with countries.

But one challenge is that several governments do not appear to fully acknowledge the scale of their HIV epidemics and embrace the necessary solutions, one veteran AIDS activist says.

“If indeed we were just looking at science and just looking at the accountability of a prime minister or president to their own people. PEPFAR would have transitioned long ago,” says Asia Russell, executive director of Health GAP.

“But in reality, many countries are unwilling to accept the epidemics they have, unwilling to embrace science, unwilling to embrace human rights, and to step aside from colonial artifacts of criminalization of LGBTQ and other highly vulnerable populations,” she adds.

Read: What should a responsible PEPFAR transition look like? (Pro)

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What we’re reading

How U.S. aid funding cuts are threatening the rollout of a game-changing HIV prevention drug. [The New York Times]

Indonesia’s health minister says the country aims to be “self-sufficient” in vaccine production by 2037. [The Telegraph]

Over 40 people, including children and health workers, were killed in an attack on a hospital in Sudan, WHO says. [Reuters]