Lebanon and Venezuela are now eligible to receive support from Gavi, the Vaccine Alliance for their immunization programs, a Gavi spokesperson told Devex. This could help the two countries sustain routine immunizations and introduce missing important childhood vaccines amid economic crises that are affecting health care, including their populations’ access to critical vaccines.
The support will include technical assistance, catalytic financing to introduce new vaccines and help in obtaining “sustainable prices” for vaccines introduced in the country. If they meet the conditions Gavi has set for lower-middle-income countries experiencing fragility, they can receive dedicated, time-limited support from the organization to maintain their routine immunization programs. These could include vaccine financing for existing routine vaccines, technical assistance, and/or access to vaccines at Gavi-negotiated prices.
The support is part of Gavi’s middle-income countries approach, approved by the board in December 2020. It aims to prevent the “backsliding” of vaccine coverage in middle-income countries that formerly received Gavi support and introduce key vaccines for children, such as the pneumococcal conjugate vaccine.
The support includes lower-middle-income countries not previously eligible for Gavi support, but whose gross national income per capita is below $4,000 as per World Bank data, or those eligible for support under the International Development Association, the bank’s concessional lending arm for the poorest countries.
Last month, the board also approved a proposal to include countries reclassified by the World Bank as lower-middle-income until 2024. Currently, that means Lebanon is eligible to receive support as it was the only country that was reclassified from an upper-middle-income to an LMIC for the year 2022. In addition, the Gavi board agreed to include Venezuela, despite its current lack of World Bank income classification, to address the current immunization challenges in the country.
According to a board document on the decision seen by Devex, six of the 19 countries that have already transitioned from Gavi support are missing the pneumococcal conjugate vaccine in their routine immunization programs; eight are missing the rotavirus vaccine, and nine are missing the human papillomavirus vaccine.
Meanwhile, 71% of lower-middle-income countries that were never eligible for Gavi support were also missing these three key vaccines in their immunization programs, or they’re only available in the private sector, making them inaccessible for those who can’t afford them.
The immunization impact of Lebanon’s economic crisis
This month, the World Bank reclassified Lebanon as a lower-middle-income country, as the country’s per capita GNI fell below the bank’s threshold for upper-middle-income countries. As of July 1, Lebanon’s GNI per capita was $3,450, a 37% drop from the previous year.
This made Lebanon eligible for Gavi support under the MICs approach. It joins 14 other lower-middle-income countries and territories that were previously not eligible for Gavi support, which includes Algeria, Belize, Cape Verde, Egypt, El Salvador, Eswatini, Iran, Micronesia, Morocco, the Philippines, Samoa, Tunisia, and the West Bank and Gaza, according to a list of eligible economies that Gavi shared with Devex.
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“Lebanon is going through the worst economic crisis in modern times and there is a direct impact on entire healthcare specially on preventive and promotive services like immunization. The constant drop in immunization coverage from the onset of [the] economic crisis and COVID-19 pandemic is creating [a] large cohort of unvaccinated children,” Ettie Higgins, UNICEF Lebanon deputy representative, told Devex in an email.
According to the latest immunization estimates released last week by the World Health Organization and UNICEF, 33% of children in Lebanon in 2021 did not receive three doses of the vaccine against diphtheria, tetanus, and pertussis, a 4 percentage point drop from 2020. The same number of children didn’t receive their measles vaccines, and 12% or nearly 12,000 children born in 2021 did not receive any vaccine at all.
UNICEF and other partners are helping support the government in continuing immunization services in the country amid the economic crisis, Higgins said, but “with the shrinking effective Government budget due to loss of currency value, there are multiple immunization domains requiring urgent support from partners like Gavi.”
That includes the continuation of immunization services in communities, maintenance of vaccine quality, and cold chain management, she said.
Venezuela’s unique case
The board also decided to include Venezuela as eligible under the MICs approach, even if it’s unclear if the country is a lower-middle-income country. Venezuela was previously an upper-middle-income country, but since 2021, the World Bank has been unable to determine the country’s income classification due to lack of data.
“Noting that there is a national and regional threat to immunization coverage, and in light of consultations with relevant partners on a best estimate of GNI, the Gavi Board agreed that Venezuela be treated as eligible under the MICs Approach,” a Gavi spokesperson told Devex via email.
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Venezuela’s efforts to obtain vaccines and release a vaccination plan have been caught in a power struggle between President Nicolás Maduro and opposition leader Juan Guaidó.
According to the latest childhood vaccinations data published by UNICEF and WHO, only 56% of children in Venezuela received three doses of the vaccine against diphtheria, tetanus, and pertussis in 2021, the lowest across Latin American countries. Only 68% received the first dose of a measles vaccine, and just 37% received a second dose. Meanwhile, no data is available for pneumococcal and rotavirus vaccine coverage.
The political and economic crisis in the country has had a huge impact on child vaccinations. According to a recent story by The Associated Press, low vaccination rates have led to a resurgence of vaccine-preventable diseases in the country, such as measles. Some vaccines are not available in public hospitals, and families are often asked to get them in private clinics — if they can afford it — or cross to neighboring countries to get them for free.
“Gavi is engaging in discussions with the Government of Venezuela as well as a coalition of partners to better understand the situation and the needs in country and whether there is a potential role for Gavi support,” according to a Gavi spokesperson.
About the author
Jenny Lei Ravelo@JennyLeiRavelo
Jenny Lei Ravelo is a Devex Senior Reporter based in Manila. She covers global health, with a particular focus on the World Health Organization, and other development and humanitarian aid trends in Asia Pacific. Prior to Devex, she wrote for ABS-CBN, one of the largest broadcasting networks in the Philippines, and was a copy editor for various international scientific journals. She received her journalism degree from the University of Santo Tomas.
