When Gavi, the Vaccine Alliance announced last week in Berlin that it had reached its target of $7.5 billion in pledges for the organization's 2016-2020 replenishment, many global development actors were relieved.
But one stakeholder now warns that even if the funds have been committed, actually implementing the programs and achieving global vaccination goals will be no easy task. It's “not going to be a walk in the park,” Save the Children International CEO Jasmine Whitbread said in an interview with Devex.
Gavi confirmed last week during its second replenishment conference in Berlin that it plans “to immunize an additional 300 million children between 2016 and 2020, helping to save an estimated 5 to 6 million lives.” The question now is who will be left out and how can Gavi and its implementing partners scale up efforts to ensure that no child is left behind?
Back in 2011, UNICEF chief Anthony Lake described how 4 out of 5 children would receive the third dose of diptheria-tetanus-pertussis — or DTP3 — vaccine. “But what of the fifth child,” he asked, “the child we don’t reach?”
With up to 22 million children worldwide living in countries where only 5 percent of them receive new vaccines against known child killers like rotavirus or pneumococcal disease, what does Gavi need to do over the next five years to serve the “fifth child”?
“Gavi can only be successful in its mission if it prioritizes equity of coverage before the introduction of new vaccines," the Save the Children executive said. “To do so, Gavi must develop an equity policy in line with the 2016-2020 strategy. ... If we do not ensure that all populations and geographic regions in each country are covered, we are not building a sustainable model.”
Whitbread’s words are particularly relevant in light of the 2014 Assessment Report of the Global Vaccine Action Plan, prepared by the World Health Organization’s Strategic Advisory Group of Experts — or SAGE — which concluded that of six key immunization targets with deadlines at the end of 2014 or 2015, only one is on track to be met, and some have been missed multiple times before.
“It is not acceptable that the plan is failing to deliver at the scale that is required,” the report noted.
More technology to overcome logistical hurdles
Whitbread noted that success for Gavi would entail “organizing and overcoming logistical hurdles to enable vaccines to be taken to very remote places, either across very hot, dry areas or across flooded areas.”
How can such obstacles be overcome in practice? Technology can be a game changer, according to Dagfinn Høybråten, chair of the board of the vaccine alliance.
“We are involved in different processes to see how the cold chain itself can be developed, so that it can be less dependent on cold,” he told Devex, referring to the current need to keep vaccines in cold storage during their journey. “We are also developing devices for keeping the right temperature [of vaccines] that are not dependent upon the input of new energy. More independence of local positions is the key.”
Given the rapidly growing use of mobile phones in many of Gavi’s partner countries, Høybråten said that Gavi is looking into mobile technology — not only for immunization programs, but also for follow-up schedules “within the public health package.” And of course, along with these practical issues, Gavi would likewise need further engagement with the private sector.
“On the business side, it’s great to see companies such as GlaxoSmithKline PLC agreeing to keep their prices down,” he said. “But actually, we think that the sustainable answer to this is to have more competition, by increasing the number of companies that are producing the vaccine, including companies in the developing countries themselves.”
On this issue, Whitbread pointed out that the organization now has far greater leverage than it did before.
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“This bigger pledge also means that Gavi has quite enormous purchasing power, so it signals to the market and the private sector that there’s money to be made here, but they’re going to have to compete for it and drive those prices down,” she said. “The challenge is not necessarily to rely on charitable donations and goodwill, but actually to get it sustainable, because the market’s working properly.”
As for immediate Gavi priorities, Whitbread stressed that one should definitely be strengthening health systems, as has been demonstrated by the impact of the Ebola crisis in West Africa.
“Just focusing on immunization, on just going in and immunizing the child and going away again, misses the wider issue about every child having a health worker within reach,” she said. “A health worker does not only do vaccinations, but is also there to provide advice on nutrition, to prescribe antibiotics if needed — just to be available to provide health services.”
Whitbread also emphasized the need for a holistic approach.
“We’re not talking about fancy hospitals everywhere, but just a basic health care system,” she said. “The Ebola virus would still have hit, but we saw in some countries that if you have got a decently functioning health system you can control [it.]”
Høybråten agreed that strengthening health systems is a must, but argued that Gavi can’t force the issue on its partner countries.
“There is no ‘go’ if the country is not in the driver’s seat,” he said. “How we strengthen the health systems will vary from country to country.”
In broader terms, he did not anticipate a radical reallocation of expenditure. “About 85 percent of our resources have historically been [spent] on vaccines, and the rest — more or less — on systems, so I don’t expect that to change,” he said. “But, of course, that is subject to our assessments going forward about the best use of the resources.”
Whitbread does believe that Gavi’s 2016-2020 strategy “is a great step in the right direction” and has “great potential to broaden Gavi’s alliance model,” especially if more pharmaceutical companies come on board and the organization is able to get more expertise and outreach on the ground. Community organizations and civil society can play an important role too, she said, particularly to help vaccines reach displaced people and those living in conflict zones.
Shift in strategy toward faith-based groups
One question on everyone’s mind is surely which new partners will be joining Gavi in the forthcoming period. Høybråten noted this would depend upon the specific context of each country, though he anticipated that civil society would continue to be crucial, particularly after graduation, when firm advocacy would be needed to make immunization a priority in the relevant countries.
The Gavi chair also mentioned one intriguing shift in strategy.
“We are refining our approach to the faith-based community, because sometimes they are seen as a part of the problem — sometimes they actually are — but most of the time they can be a part of the solution,” he explained. “We need to identify those areas, and work closely with those organizations, not only in-country but also globally.”
The most immediate next steps for Gavi are now to secure the pledges from donors via legal agreements, and then press on with their “all-time high” introduction of vaccines.
Notably, Høybråten said, “we are running the introduction of the new polio vaccine into in-country programs, as part of the overarching eradication [of the disease].”
Furthermore, the organization wants to double down on efforts “to secure … investments with the graduating countries,” and assist them so that five years from moving into the graduation phase they would have “the fiscal space” to take over their own vaccine programs.
“If we don’t do that well”, he said, “we risk the results we have already achieved.”
Will Gavi’s 2016-2020 strategy achieve its goals? And what will be the impact of engaging with faith-based groups? Please let us know your thoughts by leaving a comment below.
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