Gavi grapples with replenishment at crucial moment for vaccine funding

LONDON — Gavi is grappling with how to handle its upcoming replenishment amid the pressures of the coronavirus pandemic, as experts call for it to be delayed.

The vaccine alliance’s replenishment conference is still scheduled for early June in the U.K., but with the country in the grip of a severe outbreak and other development gatherings canceled, it seems unlikely to go ahead as planned.

The event aimed to raise at least $7.4 billion for 2021-25 to vaccinate children in low-income countries against infectious diseases such as measles, but Gavi’s calculations of how much it could raise were made before the pandemic, which has absorbed huge amounts of public resources.

At the same time, the organization would be expected to play a critical role in distributing a potential COVID-19 vaccine, with some arguing it needs to raise the amount of money it is asking for to meet that challenge.

“Countries will need a lot of support to get the products out there,” said Kalipso Chalkidou, director of global health policy at the Center for Global Development. “Gavi has a significant role to play. … But they have to rethink everything.”

Among the civil society organizations working with Gavi, the issue of whether the replenishment will be postponed is the “$100,000 question,” according to a source who spoke anonymously to preserve professional ties. NGOs have not yet received any information from Gavi about when and how the event will go ahead, the source added.

“The difficulty we see with the pandemic is how to secure pledges from the main [global north] donors. … All efforts are going to be needed to secure pledges, and this is challenging, given the current circumstances,” the source said.

Now, Gavi appears uncertain on how to proceed. A spokesperson told Devex that discussions about the replenishment summit, and the extent to which it would be held virtually, were “ongoing.”

Global health experts have called for Gavi to delay the summit as donors deal with the new coronavirus and to request more money so that the vaccine alliance can maintain its vital, routine immunization work.

“It's likely that Gavi would need more funding than was originally foreseen when they did the calculations for the ask for the replenishment,” said Amanda Glassman, executive vice president at CGD.

“I do think it's probably worth waiting a couple of months to see what happens, to understand the true magnitude of economic recession and then to recalculate the ask,” she added.

Gavi, which has already loosened restrictions on funding and approved $29 million to help the front-line response to the pandemic in low-income countries, is expected by many to play a key role in the distribution of any future vaccine against COVID-19.

The U.K. government’s development chief, Anne-Marie Trevelyan, recently wrote that the “expertise and global reach of Gavi … will be critical” in ensuring vaccine accessibility in low- and middle-income countries. To prevent profiteering, civil society groups this week called for safeguards against patents on any vaccine developed with public funds.

Experts warned that, despite the attention given to COVID-19, Gavi’s routine work on infectious diseases should not fall behind.

“The rise in excess death is just marginal compared to the potential lives we save from routine immunization programs every day,” Glassman said. A recent study by the London School of Hygiene & Tropical Medicine estimated that the amount of deaths from the interruption of routine immunization services would be 128 times greater than the number of COVID-19 fatalities that would result from the continuation of such services.

Glassman also warned that vaccines “can only deliver on their health impact and value-for-money promise if herd immunity is attained and sustained.”

David Salisbury, associate fellow of Chatham House’s Global Health Programme, said there were “real concerns about the ability to maintain existing programs” and about the development of new vaccines for diseases other than COVID-19.

“Campaigns such as the polio vaccination campaign, which are of huge importance to try to get on top of … are being put at risk because of social distancing and the need not to put health providers and the public at additional risk,” he said.

Another source close to Gavi told Devex that this is “already happening” and that “2020 will not be a good year for immunizations.”

The current challenges of the pandemic for donor governments could be a problem for Gavi’s fundraising, according to Salisbury. He said, however, that a delay to the replenishment could help.

“Maybe waiting six months, so the world is a little clearer, might be a better time. … I would favor delaying because everyone's priorities in the next two months will be fixed elsewhere than Gavi replenishment. The risk is higher of trying to do it in June than delaying for six months,” he said.