Pentavalent vaccine
Number of countries

Pneumococcal vaccine
Number of countries

Pentavalent vaccine, 3rd dose
Coverage (%)

Pneumococcal vaccine, 3rd dose
Coverage (%)

During the year, developing countries, with support from GAVI, continued to accelerate access to immunisation against the three vaccine-preventable diseases that cause the largest number of under-five child deaths: pneumococcal disease, rotavirus infection and infection with Haemophilus influenzae type b (Hib).1

Five African countries conducted preventive vaccine campaigns against meningococcal disease while yellow fever immunisation campaigns were rolled out in Côte d’Ivoire, Ghana and the Sudan – protecting millions against these deadly and debilitating diseases.

In November, the GAVI Board took steps to open new funding

windows for vaccines against human papillomavirus (HPV) and rubella, which will have a direct benefit on the health of women and children.

Increasing demand

Applications to GAVI for new and underused vaccine support hit a record high in 2011. Countries made a total of 74 applications in the June application round, more than in any previous round.

In 2011, the GAVI Board approved 55 vaccine applications from 38 countries. Eighteen applications were approved for pneumococcal vaccine, 16 for rotavirus vaccine, 5 for pentavalent vaccine and 16 for other types of vaccines.

Accelerating access to pneumococcal and rotavirus vaccines

Pneumonia and diarrhoea are the two leading causes of death among children under the age of five.

Pneumococcal vaccines help to prevent pneumonia, and also provide protection against meningitis and sepsis. The rapid introduction by countries of pneumococcal vaccine offers the potential for a significant reduction in the number of child deaths, especially from pneumonia. In 2011 alone, GAVI-supported programmes helped to immunise an estimated 3.3 million children against pneumococcal disease.

By the end of 2011, 16 developing countries had already started to introduce the vaccine with GAVI support, while another 21 had had their applications for support approved. As a result, the vaccine will soon be part of routine immunisation programmes in more than half of all GAVI-eligible countries.

Over 20 GAVI-eligible countries have thus far been approved for support for vaccines against rotavirus, the main cause of deadly diarrhoea in children. July 2011 marked a milestone for rotavirus control in Africa, as the Sudan became the first African nation to introduce rotavirus vaccine with GAVI support.

While these new vaccines can save millions of lives in their own right, their introduction provides additional opportunities to promote complementary ways of preventing and treating pneumonia and diarrhoea. This includes encouraging behaviours such as exclusive breastfeeding, hand-washing and care-seeking, and use of antibiotic (for pneumonia) and oral rehydration therapies (for diarrhoea).

Pentavalent vaccine boosts protection against Hib and hepatitis B

By the end of 2011, GAVI-supported countries had immunised 296 million children against hepatitis B, one of the main causes of liver cancer and cirrhosis later in life. This has helped to prevent 3.7 million future deaths caused by both the chronic and acute effects of hepatitis B infection.

Infection with Hib causes some 3 million cases of serious illness and more than 380,000 deaths per year, mainly through meningitis and pneumonia. The vast majority of Hib-related deaths occur in children, in particular among those aged between 4 and 18 months. By providing countries with vaccines to immunise close to 124 million children against Hib, GAVI has contributed to the prevention of 697,000 future deaths.

Most GAVI-eligible countries have introduced hepatitis B and Hib vaccines as part of the easy-to-administer pentavalent vaccine, which protects against five diseases: hepatitis B, Hib, diphtheria, pertussis (whooping cough) and tetanus.

Protecting women and girls against cervical cancer and rubella

Cervical cancer claims the lives of some 275,000 women every year – the vast majority of whom live in developing countries. If left unchecked, this number could rise to more than 400,000 women per year by 2030.

New HPV vaccines, which can prevent approximately 70% of all cervical cancer cases, have recently been introduced in many wealthy countries. Making these vaccines available to girls in developing countries is vital, as they often lack access to cancer screening and treatment services.

Following a 2008 assessment of the potential impact of 18 vaccines, in 2011 GAVI took its first steps towards supporting the introduction of the HPV vaccine in developing countries. Countries will be invited to apply for support provided that GAVI can secure acceptable price commitments from manufacturers and countries can demonstrate their ability to deliver the vaccines. The aim is to immunise over 28 million women and girls by 2020.

The introduction of HPV vaccines will be challenging for many developing countries. WHO recommends that girls aged 9–13 years, many of whom

do not have routine contact with health services, are immunised. At the same time, HPV vaccines offer an exciting opportunity to help countries integrate vaccine delivery with other important interventions for girls such as adolescent reproductive health, HIV prevention, nutrition, family planning and maternal health.

On the basis of the 2008 impact assessment, the GAVI Board also decided to invite countries to apply for measles-rubella vaccine support in 2012. Rubella infection early in pregnancy can cause severe congenital defects in children and may result in stillbirth and miscarriage in pregnant women. It is estimated that of the 112,000 children born with rubella-related birth defects every year, 90,000 are in GAVI-eligible countries. GAVI’s support will help to fight this disease and protect both mothers and babies from its effects.

GAVI will build on the success of measles control activities by supporting the combined measles-rubella vaccine. Beginning in 2012, GAVI will fund catch-up campaigns of measles-rubella vaccine for countries, on the condition that they introduce the vaccines into their routine immunisation programmes at their own cost.

Meningococcal A vaccine dramatically reduces meningitis cases

Meningitis epidemics periodically sweep through central Africa, leaving thousands of people dead or disabled in its wake. MenAfriVac, a new meningococcal A vaccine licensed in 2010, has the potential to eliminate a leading cause of meningitis epidemics. Between 2011 and 2015, GAVI intends to support the roll-out of the vaccine in all 25 countries in the “meningitis belt”, a string of countries stretching from Senegal to Ethiopia.

So far, six countries have successfully rolled out the new meningococcal vaccine. In early 2011, GAVI approved new applications for meningococcal vaccine support from Cameroon, Chad and Nigeria, accelerating the process so that the vaccine could be introduced before the start of the epidemic season.

Later in the year, applications from four other countries were approved. During 2011, an estimated 32.6 million people were vaccinated against meningitis A.

The new meningococcal A vaccine has proved to be highly effective. Burkina Faso, which introduced the vaccine in 2010, reported just four cases of meningitis A in the 2010–2011 epidemic season – the lowest number ever recorded. All the reported cases were in unimmunised people.