Gavi replenishment 2015: 5 key issues

The great and the good of the international development scene descended on Berlin, Germany, this week for the 2015 Gavi, the Vaccine Alliance replenishment conference.

This meeting was important for a number of reasons: for the German government, it was the inaugural event of an ambitious agenda for their holding of the rotating G-7 presidency. In particular, global health has been identified as a key issue for its presidency, which will culminate at the G-7 meeting in June.

The Gavi conference was also one of the opening events of what will be a defining year for international development policy and for the fight against extreme poverty around the world. Given the outstanding commitment shown in Berlin this week toward the global betterment of child health, this event will set the stage for upcoming debates on financing for development in July and for the final stages of the negotiations of the post-2015 sustainable development agenda.

Finally, the meeting was an opportunity to take stock of the achievements of Gavi and the global health community in fighting against child mortality in the 15 years since the organization’s founding.

But what were the key issues raised by the replenishment conference, and what did we learn about the work of Gavi both past and future? Here are five key takeaways and upcoming issues.

1. Vaccines work.

One of the recurring themes in the presentations by all the speakers was the impact that immunization and vaccination programs have had in the past decade. Since its inception, Gavi has been delivering on its promises of saving lives through immunization. The organization has helped more than 70 of the world’s poorest countries immunize at least 440 million children since the year 2000. This means 6 million lives have been saved, and economic growth in these countries has increased.

2. There is no room for complacency.

Significant gaps remain in vaccine coverage around the world, however. An estimated 20 million children in Gavi-supported countries did not receive a full course of even the most basic vaccine in 2012. Access to more powerful vaccines is even worse: more than 70 million children are not immunized.

In addition, only 1 percent of girls living in low and middle-income countries received a human papillomavirus vaccine — resulting in an estimated 32 million girls at risk of contracting cervical cancer.

The Ebola crisis in West Africa has shown what can happen when there is no readily available vaccine for a deadly disease and where health systems are unable to cope with the impact. This also comes against the backdrop of the fast-approaching deadline for the MDG target for child mortality (reduction by two-thirds by 2015), which is likely to be achieved since between 1990 and 2013 child mortality has been halved.

3. Donors have bought into the Gavi model.

The headline news coming out of the conference in Berlin was that Gavi had exceeded its target of $7.5 billion for donor pledges for the period 2016 to 2020. The final total of $7.54 billion reflected significant increases in funding pledges from donors including the United States, the United Kingdom and the European Commission (which doubled its support to $240 million), as well as private philanthropic groups like the Bill & Melinda Gates Foundation.

Germany, as the host of the replenishment conference, increased its contribution from 420 million euros to 600 million euros ($720 million) over the next five years, exceeding  everyone’s expectations. For the first time, donation pledges also came from former Gavi program countries such as China, as well as from countries in the Middle East.

What does this commitment mean for the work of Gavi?

Practically speaking it means that they can lock in the gains already achieved by the roll out of vaccines by increasing the number of children that will be immunized over the next five years by 300 million. This single action would prevent an estimated 5 million to 6 million deaths by 2020. Investing in public health is also an investment in economic development — families and communities can become healthier and stronger, more children are able to remain in school and complete their education, and opportunities for girls and mothers are improved. Added together, this could result in a $100 billion economic benefit for the world’s poorest countries — a more than tenfold return on investment.

4. Gavi graduates — how will they be affected?

While the amount that Gavi has to spend in the coming five years has increased, the number of program countries it works with will reduce. An estimated 22 countries will graduate from Gavi support by 2020, and how their immunization programs will continue to operate at a sustainable level without Gavi support is one of the key questions facing the organization in the future.

In advance of the conference, several of the industry partners that work with Gavi to produce vaccines committed to price reductions or price freezes on their products for countries graduating from Gavi-supported programs.

5. Where will the next vaccines come from?

Gavi has made huge progress in supporting and rolling out vaccines for rotavirus, diarrheal diseases and pneumonia, which have saved millions of lives. Still, however, there are many diseases that continue to wreak havoc on children and young women for which there is no vaccine in production or on the horizon — diseases such as malaria and HIV and AIDS.

A vaccine that would protect against malaria or HIV would make a huge dent in child and maternal mortality figures in the world’s poorest countries. There was little talk, and less urgency, at the meeting in Berlin about how we make this next giant leap in global health. Chancellor Angela Merkel said, “We must invest more in prevention and research,” and the response to the Ebola crisis has shown what can be achieved when enough attention and funding is made available.

For this to happen though, we need the same donor governments who have upped their support for existing vaccines to commit political and financial capital to global health research efforts to create the next generation of vaccines. For its part, DSW and its partners — through the “Let’s Save Lives” campaign — have been advocating for the European Union and its member states to invest in research for new prevention, diagnostics and treatment for poverty-related and neglected tropical diseases.

If we are ambitious now, and we can make this a central part of the global health agenda, by the time the next Gavi replenishment meeting comes around we could be talking about securing funding for a malaria or a HIV vaccine.

It is possible — we only have to aim for it together.

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