GAVI AND THE EU: A PARTNERSHIP FOR THE FUTURE
On the 3rd and 4th of June 2020, the UK will host the next replenishment of Gavi, the Vaccine Alliance, providing an opportunity for the EU, and the international community, to realign with the ambitious Agenda 2030 by scaling up immunisation efforts and “reaching those left furthest behind”. At a time when the world is off track to reach the Sustainable Development Goals (SDGs) by 20301, immunisation is not only a chance to achieve SDG3’s aspiration of healthy lives and the promotion of well-being for all, it is also essential to reach most of the SDGs. Having recently hosted the first Global Vaccine Summit in Brussels, the EU has shown itself to be a supporter of immunisation worldwide. Now is the time for the EU to turn words into actions and maintain immunisation gains by continuing its support for the Vaccine Alliance. This initiative aligns fully with forthcoming European priorities, such as the European Green Deal and a meaningful partnership with Africa.
In the next investment cycle, the Alliance intends to reach 300 million more children, saving an additional 7-8 million lives2. Global Health Advocates France, ONE and Save the Children, a group of child and global health advocates and implementers, are calling on the EU to support this life saving initiative by making a robust, increased, and unearmarked commitment, through grant funding, to the Vaccine Alliance of €300 million for the years 2021-2025.
Why the EU must invest in Gavi
As a strong supporter of Gavi since 2003, the investment made by the EU has had a deep and lasting impact on millions of children living in low-income countries. Increasing access to vaccines changes lives; protecting children from infectious diseases which may prevent them from attending school, result in life-long injury or illness, or even fatality.
Gavi’s progress has been impressive. Since its inception in 2000, Gavi has supported countries to protect 760 million
children, thereby reducing vaccine-preventable deaths by as much as 70%3. Gavi is among the best performing global health initiatives, due to its high societal return on investment, and it receives top scores in multilateral reviews with regards to transparency of internal processes, and fiduciary and operational risk management.
For every US$ 1 invested into immunisation, we see a return of US$ 54 in broader societal benefits4.
In its upcoming strategic period (from 2021 to 2025), Gavi has laid out a comprehensive strategy, vowing to reach the last unvaccinated child, and reaffirming a foundational dedication to equity.
Furthermore, Gavi’s partnership model complements the importance placed on sustainable, equal partnerships by the new European Commission. Gavi takes a strategic approach to sustainability, and encourages countries to transition towards self-financing through domestic investment. Over the 2021-2025 period, Gavi will help the transition of 10 countries into self-financing, and continue to engage with the 18 other countries that have already transitioned.
The eradication of poverty depends on healthy populations. Communities or individuals that face health setbacks can easily fall back into the poverty from which they struggled to escape. Gavi’s renewed emphasis on gender is exemplified by the Alliance’s plans to accelerate the roll out of the new human papillomavirus (HPV) vaccine, which serves to protect women and girls from cervical cancer. These targeted equity initiatives allow Gavi’s impact to go beyond SDG3, affecting a plethora of the Sustainable Development Goals. Additionally, the EU is increasingly recognising the role that climate change will play in the future of health including for vulnerable communities. Immunisation strengthens the health systems of communities most at risk from the climate crisis.
Why should the EU increase its investment in Gavi?
Even with the number of countries transitioning from Gavi support, the reality is that Gavi’s 2021-2025 strategy will be more ambitious, due to the inclusion of inactivated polio vaccine (IPV) within the co-financing of Gavi and the increased docket of vaccines and focus on equity. As a result, Gavi will need at least US$ 7.4 billion in additional resources.
There are a number of reasons why the EU should increase its investment in Gavi:
- Partnership with Africa: If the EU is serious about a genuine and equal partnership with Africa, one that creates opportunities for local populations, it should prioritize investments in immunization and public health, as the foundation for healthy societies. Gavi’s 2021-2025 strategy allocates 69% of support for vaccine programmes to Africa, supporting the EU’s commitment to a renewed partnership that empowers the continent’s children and youth.
- Reaching under vaccinated and unvaccinated children is harder and more expensive: In order to reach the increasing number of underimmunized children in low-income urban communities and the most remote rural areas, Gavi will need to implement new tools and approaches that adapt to local challenges.
- Increasing coverage means doing more: Gavi is continuing to expand its portfolio of vaccines, and during the next period will provide protection against 18 diseases, compared with just 6 in 2000. This includes taking on polio eradication through implementing routine inactivated polio vaccine (IPV) programmes across Gavi countries. We must also keep in mind that Gavi’s hard-earned gains are increasingly threatened by the combined impacts of climate change, population growth and displacement, and vaccine hesitancy so increasing coverage in places that face these issues will be more challenging.
- Universal Health Coverage/ Health System Strengthening: Gavi delivers more than vaccines. By helping countries extend their capacity to deliver immunisation where most health services are also unavailable, it strengthens local health systems and supports the primary health platform through which other essential health services can be delivered. The EU has been a long time supporter of health system strengthening (HSS) and if they want Gavi to do more in this area, it is essential to ensure that Gavi can deliver in the area of HSS programming.
- Preventing tomorrow’s emergencies: The Gavi funded stockpile has already been instrumental in battling health emergencies and will be increasingly crucial in ending ebola and tackling the rise of climate sensitive-diseases ie dengue fever, cholera etc.
- Market-shaping innovations: With every investment cycle, Gavi’s market shaping tools increase the impact of donor investments by improving the availability and pricing of vaccines. Gavi’s market shaping model will result in savings of over US $900 million between 2021-2025.
When making the commitment, we are asking the EU to fully leverage their donor role on the Gavi Board and seek the following promises from Gavi linked to the EU pledge:
1. Enhance transition preparedness and capacity support: There is a need to strengthen and deliver on comprehensive country transition plans early on, going beyond ability to pay and take into account programme readiness. These transition plans must be developed with full transparency and alignment with other Global Health Initiative transitionary frameworks to avoid burdening transitioning countries with overlapping or simultaneous transitions.
2. Sustainability and strong primary healthcare systems: Currently, a large portion of Gavi support is funnelled through UN programmes (such as UNICEF and the WHO). To help countries strengthen primary healthcare systems in the long term, Gavi support for health system strengthening should increasingly be provided to or in partnership with the government, moving beyond cash-based support, and should be extended to local NGOs that have strong ties to communities and access to remote areas.
3. Equity: We welcome the equity focus in the new investment case with a prioritisation of undervaccinated children and the implementation of a new gender policy. In order to reach the most marginalised, Gavi will need to continue to sharpen its focus, including on children affected by conflict. This can be done by developing an Equity Policy to provide an overarching strategic framework, give oversight to, and drive Gavi’s equity agenda.
4. Vaccine affordability: Market shaping is an important tool for ensuring vaccine affordability. Gavi has extensive market-shaping expertise and could use this expertise more strategically to influence markets, so that prices are affordable in the long term for all countries. Gavi should be encouraged to use all its tools to the fullest to expand supplier base, such as maximising the use of Advanced Market Commitments (AMC)5 to support new vaccine producers, including for the PCV vaccine (which is currently one of the most expensive vaccines in the Gavi Portfolio).
5. Accountability: While the move to simplify the funding models is commended, transparency and accountability mechanisms should be strengthened by creating a strong accountability framework for the Secretariat of the Alliance and its partners. CSO engagement is key to fostering accountability. Gavi should commit to further fostering meaningful civil society engagement in immunisation and Gavi planning and processes, through independent support to civil society.
Get in early, invest in Gavi
During the last replenishment, the EU’s early pledge set the level of ambition for a successful replenishment. Gavi has a proven track record of delivering on its promise. Now, the partnership wants to run the last mile, to reach the communities who have been left out of the benefits reaped through immunisation. This last mile will be the hardest and most expensive, because the road needs to be built to the most marginalised and furthest behind - those in difficult to reach rural settings, the urban poor, people facing conflict, instability and displacement.
Additionally, Gavi has been asked to do more with less, while shouldering more responsibility in the fight to eradicate polio. As a vaccine champion, the EU can lead the way to a successful replenishment with an early pledge, catalyzing support from EU Member States. For these reasons, we call on the European Commission to live up to its reputation as a champion of vaccination and global health by making a robust, increased, and unearmarked commitment, through grant funding, to the Vaccine Alliance of €300 million for the years 2021-2025.
2 GAVI, 2019. Prevent, Protect, Prosper: 2021-2025 Investment Case, page 4. Available here.
4 John Hopkins University - International Vaccine Access Center (IVAC), 2019. Methodology Report: Decade of Vaccines Economics (DOVE) Return on Investment Analysis. Available here.
5 An AMC is a legally-binding agreement for funds to subsidize the purchase, at a given price, of an as yet unavailable vaccine against a specific disease in developing countries. The establishment of AMCs encourages the development of future generations of vaccines and accelerate the development and availability of priority new vaccines to developing countries.
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