They did it.
At the end of an afternoon of anxious anticipation in Berlin, Gavi, the Vaccine Alliance CEO Seth Berkley announced that his organization had reached its fundraising target of $7.5 billion.
To his elation — and, perhaps somewhere in there, to his relief — he revealed that they had exceeded this goal by $39 million, news that brought the room to its feet. The news conference afterward also had an unmistakably triumphant air, and understandably so, for this success was by no means a sure thing.
In 2011, the last time Gavi had sought pledges on this scale, they were looking for just under half this amount. Then, it had asked for $3.85 billion, but four years later, with the world’s economy further withered by the effects of the financial crash, it was making a request that even Berkley referred to as “ambitious.”
If Gavi had ever doubted the scale or importance of its task, then there would have been no shortage of people to remind them. As many of the delegates arrived at the Berlin Conference Center, striding briskly through the morning drizzle, they were greeted by a cluster of protesters bearing an array of banners, urging them to pledge generously. “World leaders, save 6 million lives today!” they read, or variations of the same.
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These were dramatic words, but no less grand than the aims of the day’s proceedings: to secure funds, as Bill Gates would tell his audience, that could help halve child mortality within the next 15 years. And so inside the conference center, past security checks that you’d more readily associate with an airport terminal, the representatives of dozens of countries prepared their promises.
In hindsight, Gavi ran the day just right. A little like a marathon runner who knows that his best chance of winning is to sprint to the front of the pack early and stay there, they structured the program so that most of the truly rousing moments came before lunch.
To sandblast away any skepticism, we heard stories of communities and entire countries whose health systems had been transformed by Gavi’s work: from Nigeria, where vaccines were kept fresh by solar-powered cells along village rooftops, to Burkina Faso, which since rolling out a vaccine program in 2010 had not experienced a single further meningitis epidemic.
The ‘Gates effect’
And, of course, we heard from the biggest name on the billboard. It was notable that Bill Gates, accompanied by his wife and fellow foundation strategist Melinda, was frequently on hand throughout the day. He set the tone early in his remarks, speaking of the “injustice” that children who most needed the rotavirus vaccine were those least likely to have access to it.
From that bleak tale he pivoted toward one of hope, lauding the work of Bangladesh, Rwanda and Tanzania, which he thought showed best practice in the delivery of Gavi’s objectives. Indeed, he seemed particularly fond of Tanzania, inviting President Jakaya Kikwete to join him on a panel at that afternoon’s news conference — the only head of state to accompany him there.
It was also apparent why Gates finds immunization such a rewarding focus for his funding. Rather like some of the challenges that he once faced in the corporate world, it is a field where the correct strategy and infrastructure can very quickly lead to extraordinary results. As Donald Kaberuka, president of the African Development Bank Group, told Devex at a press point, “I can’t think of investment that gives return so great as vaccination.”
The figures produced by Gavi to date justify their faith: Since its inception in 2000, it has helped administer vaccines to more than 500 million children, preventing 7 million fatalities. The emphasis in Berlin was on accelerating that progress, with the intention of immunizing a further 300 million children and preventing 5 million to 6 million deaths. This urgency was apparent in Gates’ pledge of $1.55 billion, the largest by any donor on the day, and which raised his total commitment to Gavi so far to $4 billion.
Gates does not seem like one to rest on his laurels, but if there was triumphalism anywhere else in the room then a number of participants that spoke with Devex were quick to dispel it. Jasmine Whitbread, CEO of Save the Children International, congratulated Gavi on its work thus far but noted the substantial task ahead. She pointed out that much of the distribution of the vaccines was still inequitable, with coverage of only 16 percent of children in some of the world’s poorest communities. To this end, she encouraged Gavi to use its new purchasing power to cause greater competition in the vaccine market.
Civil society concerns
Whitbread’s concerns were expressed more forcefully elsewhere among civil society. In many eyes, including those of Médecins Sans Frontières, the cost of the pneumococcal vaccine virus — manufactured by just two companies, Pfizer and GlaxoSmithKline PLC — remained stubbornly high. On the eve of the conference, Pfizer announced a 6 percent (20 cents) price cut for this vaccine, while GSK stated that it would freeze its prices for 10 years.
In a strongly worded response, Kate Elder, vaccines policy adviser for MSF’s Access Campaign, described these measures as “inadequate.” Elder said the two pharma giants should take “bolder steps” to cut down vaccine prices for developing countries. In some places, Pfizer and GSK offer the vaccine at $21 per child for all three doses.
MSF further noted that Serum Institute, a pharmaceutical manufacturer in India, has laid out plans to offer a similar version of this vaccine for just $6 per child.
“We’re assuming they will still be making a profit at that price, so we think Pfizer and GSK can afford to slash their prices a whole lot more,” Elder said. “We repeat our call to Pfizer and GSK: make the pneumococcal vaccine available for $5 per child for [children] in developing countries.”
A cautionary tale
The greatest cautionary tale of the day, though, was struck by Kaberuka. He described how the recent Ebola epidemic had highlighted dysfunctional public health care in parts of Africa, and that with better infrastructure in the region it could have been contained.
This was a theme echoed by several of his fellow delegates, who explicitly mentioned this shortly before making their own pledges. When asked by Devex how much the thought of another Ebola-style outbreak had influenced their giving, Dagfinn Høybråten, chair of Gavi’s board, said that while he did not think it had been a decisive factor, he admitted it had been “a wake-up call.”
Following Kaberuka’s call to action, the morning’s session was galvanized further by four very large pledges in quick succession: from the United Kingdom ($1.57 billion), the United States ($800 million), Norway ($969 million) and Germany ($720 million). The last announcement, made by Chancellor Angela Merkel, was greeted with rapturous applause, and was in one sense a very clever set piece. Not only did Merkel assuage any fears that Germany would punch far below its weight, she also cleverly applied some extra pressure to those pledging in the afternoon, stating that she was confident Gavi would reach its target. The message was subtle but clear: We have already promised the bulk of the bill (by that point, some $5.6 billion of a total $7.5 billion), and so now it’s down to you to bring it home.
The afternoon pledging session, though a more circumspect affair, still had its own intriguing features.
The Netherlands, given recent cuts to its foreign aid budget, was expected by some commentators to scale back its commitment to Gavi, yet it produced a pledge of $300 million. China, which had once been a recipient of Gavi funds, became a donor itself for the first time with a contribution of $5 million: a moment identified by Høybråten as “historic,” in that China was the last of the BRICS countries to have done so.
In the Middle East, another area earmarked for potential growth, Qatar dipped its toe in the water for the first time, offering a pledge of $10 million as the beginning of a further discussion of how much more they could help.
Australia, France, Italy and Canada made hundred million dollar pledges, Japan reaffirmed its support but declined to name a figure on the day, and Sweden — in a somewhat proud pronouncement — said that it would donate $206 million, which would make it “the third-biggest donor per capita.”
Inching over the line
If there is any sense that the donors inched their way toward the milestone of $7.5 billion, then that is accurate: As Bill Gates would reveal later in the day, negotiations over pledges had continued right up until the very last minute.
Adrian Lovett, the Europe executive director of ONE Campaign, told Devex that he was “really thrilled and relieved” that Gavi had succeeded in its aim, and gave some indication of the activity behind the scenes during those crucial final stages.
Lovett said that with 24 hours to go “there was a little bit of a gap [in what they needed] and they were so close that it would be tragic to not get all the way.” By going back to speak with their long-standing partners in Europe and North America, and by working with the Bill & Melinda Gates Foundation, Lovett said, “we were able to persuade just enough to say, look, we’ll do the extra $10 million, the extra $30 million, and we’ll get over the line.”
And so, after many months of planning and untold flasks of late-night coffee, Gavi finally got there, to the beginning of its stiffest challenge yet: the delivery of its vaccines to those groups of children most at risk. These, though, were concerns for tomorrow. For today, there was euphoria and hope, in the words of President Kikwete of Tanzania, that “the children will now be safe from diseases that otherwise would have killed them.”
Now that Gavi has secured its $7.5 billion replenishment goal, what is the single biggest challenge faced by the organization and its partners in disbursing the funds to the communities that need them most? Have your say by leaving a comment below.
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