Message from the Chief Executive Officer of the GAVI Alliance
Looking back on 2012, I see a pivotal year in GAVI’s history. Across our strategic goals, milestones were met and foundations laid. New vaccine introductions accelerated; cash grants for health system strengthening were realigned and by year’s end significant funds were flowing; the framework for our next replenishment cycle was already taking shape; and we were closing in on new agreements with manufacturers to secure supply of key vaccines at more sustainable prices.
This year, as in the past, the GAVI Alliance showed itself to be greater than the sum of its parts. Country demand for GAVI support increased rapidly. Most gratifying is the number of countries strengthening their routine immunisation programmes. Cumulatively, 70 countries now use the five-in-one pentavalent vaccine. Pneumococcal vaccine is in routine use in 24 countries and rotavirus vaccine in 12. Ghana became the first African country to simultaneously launch the two vaccines and the United Republic of Tanzania followed soon after. Yemen became the first GAVI-supported country in the Middle East to introduce rotavirus vaccine. From Haiti to Zimbabwe to Cambodia and the Democratic People’s Republic of Korea, new vaccines were embedded in routine national programmes. Children will benefit for generations to come.
Despite these achievements, we face challenges in vaccine supply and country readiness. And improving data quality and technical support as well as strengthening supply chains are fundamental to achieving better results. For that is our clear goal – to deliver results that can be measured in improvements to the lives of children and their families and, ultimately, to national prosperity in the world’s poorest countries.
While firmly focused on increasing access to immunisation, we are demonstrating our commitment to development effectiveness. We provide predictable, long-term support to countries that is aligned with their national plans. We harmonise our efforts with other partners, for example with joint financial management assessment missions. A 2012 assessment by the Australian Government ranked GAVI among the top multilateral performers in delivering results that matter.
The Global Vaccine Action Plan was adopted by the World Health Assembly in 2012. It was an affirmation of the centrality of vaccines to global health. Successfully implementing the endgame to eradicate polio and using the legacy of polio and measles campaigns to strengthen routine immunisation are critical elements in ensuring the long-term sustainability of global immunisation efforts.
Since the Expanded Programme of Immunization was launched in 1974, the list of vaccines recommended by WHO has grown and so has the number of vaccines that GAVI supports. Our job will not be complete until every boy and every girl in the developing world can be confidently called “a fully immunised child”.
I thank each and every one of you who partner with us to take forward this incredible mission. As always, feel free to contact me with your ideas and suggestions.
Message from the Chair of the GAVI Alliance Board
2012 was a year of remarkable encounters with amazing people in different corners of the world. I met community members, government officials, civil-society and private-sector leaders, health workers and others, and I was struck by how so many people with such diverse interests are committed to realising the GAVI mission.
In Myanmar, I saw the enthusiasm of health workers for the introduction of pentavalent vaccine. In Haiti, I attended the launch of a vaccination campaign against measles, rubella and polio. And in a Tanzanian village, I spoke with a group of parents, telling them that two vaccines would soon be available at their health clinic to protect their children against pneumonia and severe diarrhoea. I saw the relief on their faces. As a father and a grandfather, I know that there is no greater sorrow than the death of a child. And death from a vaccine-preventable disease is not just a tragedy, it is a moral outrage.
The potential to end such tragedy is why I am so proud to lead a dedicated Board that unites committed people from many different walks of life. Our decision to allocate additional funds for measles vaccination programmes was a critical step in controlling this highly infectious disease. The resurgence of measles outbreaks this year in some low- and also high-income countries reminds us of the need to maintain high rates of vaccination coverage.
GAVI’s capacity to make a difference to the lives of millions of children around the world is rooted in the power of partnership. I am particularly encouraged by our expanding network of civil-society and private-sector partners. This year we welcomed the increasingly active engagement of faith-based organisations.
Just 18 months after the launch of the GAVI Matching Fund, there is a fresh wave of interest from the CEOs of leading companies and foundations. They deliver to our Alliance not just additional funds but new sets of business skills and powerful new advocates.
In December, over 650 guests were generously welcomed to Dar-es-Salaam, Tanzania, by President Kikwete to join the GAVI Alliance Partners’ Forum. It was a great honour for me to discuss our challenges and celebrate our shared achievements with so many committed partners.
2012 was a year of acceleration: more children vaccinated, more national vaccine introductions and more lives saved. Our work will continue to scale up next year. I begin my second term as Chair, strong in the belief that there is no cause more powerful than ensuring that all girls and boys, wherever they live, have access to life-saving vaccines.
We have made a promise to the governments and people of developing countries who want their children to grow up healthy, happy and productive – as well as to our generous donors – that we will work tirelessly to achieve our ambitious goals. I am pleased to be able to share this Progress Report, which illustrates that through the power of partnership, the GAVI Alliance is delivering on the promise.
What GAVI does
GAVI’s mission, to save children’s lives and protect people’s health by increasing access to immunisation in poor countries, is supported by four strategic goals.
Accelerate the uptake and use of underused and new vaccines by strengthening country decision-making and introduction.
Increase predictability and sustainability
Increase the predictability of global financing and improve the sustainability of national financing for immunisation.
Contribute to strengthening the capacity of integrated health systems to deliver immunisation.
Shape the market
Shape vaccine markets to ensure adequate supply of appropriate, quality vaccines at low and sustainable prices for developing countries.
GAVI’s 2011–2015 strategy also includes three cross-cutting areas:
- Monitoring and evaluation
- Advocacy, communication and public policy
- Policy development
Where GAVI works
GAVI supports the world’s poorest countries. In 2012, countries with a gross national income less than US$ 1,520 per person could apply for new funding.
Recipients of GAVI support,
AS OF 31 DECEMBER 2012
GAVI disbursements, 2000–2012
(includes all types of GAVI support):
Note: Pentavalent, pneumococcal and rotavirus vaccines represent GAVI’s main areas of support. In 2012, GAVI also provided support for measles (second dose), meningitis A and yellow fever vaccines, as well as for health system strengthening and civil society involvement in immunisation.
In 2012, 57 countries were eligible to apply for new support from GAVI. In addition, 16 graduating countries were receiving ongoing support for vaccines and health system strengthening programmes.
Not all GAVI-eligible countries can apply for all types of support. For instance, in order for a country to qualify for new vaccine support, its coverage for three doses of diphtheria-tetanus-pertussis vaccine (DTP3) must be at least 70%.
This requirement does not apply to meningitis A and yellow fever vaccine support.
GAVI’s investments are intended to be catalytic. New vaccine support is therefore not provided to countries that are already self-funding that particular vaccine.
The GAVI Alliance relies on three indicators, each with specific targets, to measure progress towards fulfilling its mission.
Under-five mortality rate in GAVI-supported countries (per 1,000 live births)
The under-five mortality rate measures the probability of a child born in a specific year dying before reaching the age of five years. GAVI’s target for 2015 is a 10-point decrease in child mortality rate compared with 2010. This would bring the child mortality rate down from 91 per 1,000 children to 81 per 1,000 children.
Given the scheduled number of introductions of pneumococcal, pentavalent and rotavirus vaccines, and increasing vaccination coverage, the child mortality rate during the 2011–2015 period is expected to decrease year on year. The 2012 data for this indicator will be available in late 2013.
Under-five mortality rates are derived from population-weighted estimates of child mortality rates for the 73 GAVI-supported countries.United Nations Population Division, Department of Economic and Social Affairs, World Population Prospects: The 2010 Revision
Number of additional future deaths averted (millions)
Data for 2011 and 2012 do not include estimates of future deaths averted resulting from vaccination against measles, yellow fever and meningitis A.
WHO estimates indicate that by the end of 2012, countries had prevented more than 5.5 million future deaths with the help of GAVI-supported vaccines.
The calculation of the number of future deaths averted takes account of nine vaccines funded by GAVI in the 73 GAVI-supported countries. Estimates of the number of future deaths averted 2000–2010 were revised by WHO in October 2012 based on revised immunisation coverage and burden of disease data.WHO Department of Immunization, Vaccines, and Biologicals, based on the most up-to-date data and models available as of 30 September 2012
Number of additional children fully immunised with GAVI support (millions)
According to WHO estimates, more than 370 million children had received one or more GAVI-supported vaccines by the end of 2012. This is an additional 46 million children reached in 2012.
GAVI expects to meet its target of an additional 243 million children immunised between 2011 and 2015 across all of its approved vaccine programmes.
The calculation of the number of children immunised includes the total number of children who have received the full course of any of the GAVI-supported vaccines in the 73 GAVI-supported countries.WHO Department of Immunization, Vaccines, and Biologicals, based on the most up-to-date data and models available as of 30 September 2012
2012: a year of acceleration
The year 2012 was a year of accelerated efforts.
GAVI supported more introductions and more vaccines than ever before, and helped developing countries to immunise an estimated 46 million children.
GAVI-supported vaccine introductions and campaigns in 2012
By the end of 2012, GAVI had:
supported the immunisation of an estimated 370 million children in more than 70 developing countries.
contributed to the prevention of more than 5.5 million future deaths caused by Haemophilus influenzae type b, hepatitis B, measles, pertussis, pneumococcal disease, polio, rotavirus diarrhoea and yellow fever.
committed US$ 7.5 billion to new and underused vaccines and health system strengthening programmes in developing countries.
Commitments to Countries by type of Support, 2000–2012
Donor contributions and commitments to the GAVI Alliance
Cash received by GAVI (in US$ millions) as of 31 December 2012
Click the table heading to reorder items: first-click = low-high second-click = high-low third-click = reset
Donor governments and the European Commission 2012 Total 2000–2012 Australia 56.5 133.9 Canada 15.1 187.6 Denmark 4.4 41.1 European Commission (EC) 12.5 70.4 France 20.1 73.3 Germany 34.7 65.3 Ireland 3.5 38.2 Japan 9.1 18.4 Luxembourg 1.1 8.8 Netherlands 14.2 256.4 Norway 106.9 705.8 Republic of Korea 0.3 1.0 Spain 0.0 43.2 Sweden 0.0 215.2 United Kingdom 206.9 429.4 United States of America 130.0 866.5 Sub-total (Donor governments and EC) 615.2 3,154.6 Private contributions Absolute Return for Kids (ARK) 1.6 1.6 Anglo American plc 1.0 2.0 Bill & Melinda Gates Foundation 268.8 1,745.7 Comic Relief 3.2 3.2 His Highness Sheikh Mohamed bin Zayed Al Nahyan 8.8 22.9 J.P. Morgan 0.0 2.4 «la Caixa» Foundation 2.8 21.6 LDS Charities 1.5 1.5 The Children’s Investment Fund Foundation (UK) 4.3 4.3 Other private 0.8 13.9 Sub-total (Private contributions) 292.8 1,819.1 IFFIm to GFA transfers 100.0 2,275.7 AMC funds 223.5 394.5 Total contributions 1,231.5 7,644.0
Donations are recorded on a cash basis.
Note: As GAVI’s financing mechanisms enable the innovative use of donor contributions over time, the amount of donor contributions (as detailed in Annex 2) may differ from the amount of cash received by GAVI (as detailed above) in a given year.
Innovative finance mechanisms: AMC and IFFIm
Innovative finance mechanisms: AMC and IFFIm
AMC commitments 2009–2020 (US$ millions) Italy 635 United Kingdom 485 Canada 200 Russian Federation 80 Bill & Melinda Gates Foundation 50 Norway 50 Total 1,500
IFFIm commitments* Length of commitment Amount (in millions) Total (equivalent in US$ millions** United Kingdom 20 years £ 1,380.0 2,979.9 20 years £ 250.0 France 15 years € 372.8 1,719.6 19 years € 867.2 Italy 20 years € 473.5 635.0 15 years € 25.5 Norway 5 years US$ 27.0 264.5 10 years NOK 1,500.0 Australia 20 years A$ 250.0 256.1 Spain 20 years 189.5 240.4 Netherlands 7 years 80 114.4 Sweden 15 years SEK 276.2 37.7 South Africa 20 years US$ 20.0 20 Total 6,267.6
* The UK and Brazil made new pledges to IFFIm in 2011. Negotiations are currently under way to formally sign these grant agreements.
** IFFIm pledges by donors in US$ and US$ equivalent amounts of national currency pledges calculated using prevailing exchange rates around the time of signing of the grant agreement.