|Seth Berkley, Dagfinn Høybråten, Ngozi Okonjo-Iweala, Anuradha Gupta|
GAVI, officially Gavi, the Vaccine Alliance (previously the GAVI Alliance, and before that the Global Alliance for Vaccines and Immunization) is a public–private global health partnership with the goal of increasing access to immunisation in poor countries.
GAVI brings together[clarification needed] developing country and donor governments, the World Health Organization, UNICEF, the World Bank, the vaccine industry in both industrialised and developing countries, research and technical agencies, civil society, the Bill & Melinda Gates Foundation and other private philanthropists. GAVI has observer status at the World Health Assembly.
Along with Global Health Initiatives (GHI) in general, GAVI has been described[by whom?] as innovative, effective, and less bureaucratic than multilateral government institutions like the WHO. GAVI programmes can often produce quantified, politically appealing, easy-to-explain results within an election cycle, which is appealing to parties locked in an election cycle.
It currently supports the immunization of almost half the world's children, giving it power to negotiate better prices for the world's poorest countries and remove the commercial risks that manufacturers faced in serving this market. It also provides funding to strengthen health systems and train health workers across the developing world. To date Gavi has helped immunize over 760 million children, preventing over 13 million deaths worldwide, helping increase DPT (DTP3) vaccine coverage in supported countries from 59% in 2000 to 81% in 2019, contributing to a halving in child mortality.
GAVI has been criticized for giving private donors more unilateral power to decide on global health goals, prioritizing new, expensive vaccines while putting less money and effort into expanding coverage of old, cheap ones, harming local healthcare systems, spending too much on subsidies to large, profitable pharmaceutical companies without reducing the prices of some vaccines, and its conflicts of interest in having vaccine manufacturers on its governance board. GAVI has taken steps to address some of these concerns.
GAVI's approach to public health has been described[by whom?] as business-oriented and technology-focused, using market-oriented measures, and seeking quantifiable results. This model, termed the "Gates approach" or US-type approach, GAVI is taken to exemplify. It contrasts with the approach typified by the Alma Ata Declaration, which focuses on the effects of political, social, and cultural systems on health.
GAVI runs in five year funding cycles which enables it to negotiate long-term deals with manufacturers, secure in the knowledge that funding will be available.
Following the latest Global Vaccine Summit in June 2020 hosted in the UK, $8.8 billion (USD) was raised for the funding cycle 2021 to 2025; exceeding the target of $7.4billion. This included $2billion from the UK, $1.6billion from the Gates Foundation and $1billion from Norway.
It is hoped[by whom?] that this round of funding will mean that 300 million more children in lower-income countries are immunized for diseases including measles, polio and diphtheria by the end of 2025. Additionally, the funding will support health systems to withstand the impact of coronavirus and maintain the infrastructure necessary to roll out a future COVID-19 vaccine on a global scale.
In the period of 2016–2020 over which US$9.3 billion had been received by GAVI, the UK was the largest donor, providing around 25% of total funding, with the Bill and Melinda Gates Foundation (BMGF), the US and Norway close behind.
Industrialised countries are GAVI's principal donors, providing approximately three-quarters of the total funding. All donor governments are represented on the GAVI Board through a constituency system (i.e. one donor country will represent several donors in their constituency).
History and programs
GAVI was awarded the 2019 Lasker-Bloomberg Public Service Award for ‘providing sustained access to childhood vaccines around the globe, thus saving millions of lives, and for highlighting the power of immunization to prevent disease’.
CEO Seth Berkley commented that the global response to the COVID-19 pandemic had started off remarkably well. However he cautioned that there was a need for a co-ordination of production at a global level. He advocated that the pandemic needed a global response whereby the best global facilities for separate parts of the processes should then be integrated into a global process. He said he hoped that the G20 countries should work together with a budget of tens of billions of dollars, and that individual countries should be prepared for finished vaccines to be allocated according to greatest need.
In September 2020, GAVI was announced as one of the organisations leading the COVAX vaccine allocation plan, created to ensure that any new COVID-19 vaccine would be shared equally between the world's richest and poorest countries.
The following month, Gavi announced the approval of up to $150 million to help 92 low- and middle-income countries prepare for the delivery of future COVID-19 vaccines, including technical assistance and cold chain equipment.
Later that month, Gavi backed Team Halo; a TikTok centered campaign from scientists in UK, US, South Africa, India and Brazil aimed at improving understanding of Coronavirus vaccine research.
In January 2021, Seth Berkley announced that Gavi hoped to deliver 145 to 150 million doses of COVID-19 vaccines in the first quarter of 2021 and 500 million doses in the second quarter, and then 1.5 billion in the second half of the year.
Leadership and positioning
Julian Lob-Levitt was GAVI's CEO between 2004 and 2010. He was rumoured to have left over conflicts around his support for health system strengthening. Seth Berkley has been the CEO of GAVI since 2011, as of 2020[update].
In August 2014, GAVI changed its name from "GAVI Alliance" and rebranded itself with a new logo deliberately reminiscent of UN organization logos, but using green as a mark of difference.
Health systems strengthening debate
In the 20-naughts, GAVI had intense internal debate about its role in vaccinations and in health systems strengthening (HSS). Some argued that vaccination could not be effectively carried out and sustained without strengthening healthcare, citing experiences in GAVI's vaccination programmes, where availability of staff, training, transport, and funds had hindered vaccination and reporting of vaccination coverage and stocks. There were also worries that GAVI was undermining and paralyzing health care systems. Others argued that HSS was a distraction from GAVI's single-minded focus on vaccines, and HSS was a nebulous concept that could not be defined and quantified.
In 2005, a narrow vote brought GAVI to endorse an HSS goal. Up to a quarter of GAVI's funding was dedicated to "strengthening the capacity of integrated health systems to deliver immunisation", in practice it's been around 10%. After 2010, this funding went through a joint-venture Health Systems Funding Platform. GAVI's funding for this platform was conditional on the platform meeting vaccine coverage goals.
As of the mid-2010s, few in GAVI were working on HSS, most of the former pro-HSS people had left, and some at GAVI dismissed HSS as PR to gain support from pro-HSS donors and counter criticisms that GAVI was harming healthcare systems.
Public-sector workers and academics public health have criticized GAVI, and other global health initiatives (GHIs) with private-sector actors, saying that they have neither the democratic legitimacy nor the capacity to decide on public health agendas. Private donors often find it easier to exert influence through public-private partnerships like GAVI than through the traditional public sector. There is also criticism that staff at GHIs are often recruited directly from elite educational institutions, and have no experience in health care systems, especially those in poorer countries. Some WHO officials have privately criticized GAVI for infringing and weakening the WHO's mandate.
Vaccine pricing and market shaping
In 2012, the first MSF "The right shot" report criticized GAVI for focussing on funding expensive new vaccines and neglecting to give children cheap old ones. "Twenty percent of the world’s children aren’t even getting the basic vaccines", MSF's vaccine policy adviser said. MSF criticized the Global Vaccine Action Plan (GVAP), a WHO global collaboration of which GAVI is listed as a leader, as flawed for failing to help those 20%, which is some 19 million children.
In 2011 GAVI added "shape the market for vaccines and other immunisation supplies" to its strategic goals. It spent 15 years (2005-2020) with a program for shaping the pentavalent vaccine market to be more stable and competitive. The vaccine price fell with increased competition, and price discrimination declined. Whether GAVI met quantitative goals will be assessed in 2020.[third-party source needed]
The number of manufacturers making certified pentavalent vaccine increased, making the market more competitive. Graph by GAVI; manufacturers are not named.[clarification needed]
All pentavalent vaccine prices fell and price discrimination almost vanished. Graph by GAVI; non-UNICEF prices not shown
In 2011, Doctors without borders (MSF) recommended that GAVI change the ways in which it buy vaccines. They criticized the pneumococcal vaccine Advance Market Commitment, which means that GlaxoSmithKline (GSK) and Pfizer get a subsidy as well as a per-unit payment for supplying doses of pneumococcal vaccine, as "corporate welfare that is scandalously expensive to donors and taxpayers" (in return, the companies committed to sell at least 30 million doses annually for ten years).
In January 2015, MSF also called upon GSK and Pfizer to cut the price of the pneumococcal vaccine to US$5 per child in developing countries, a price they estimated as competitive.
In August 2019, MSF asked GAVI to stop giving Advance Market Commitment subsidies to GSK and Pfizer, whom they called a duopoly, and instead buy vaccine from a new third manufacturer, the Serum Institute of India, which offered the vaccine at 2/3 of the price then offered by the two. As the pneumococcal vaccine made up 40% of GAVI's vaccine purchasing costs, a 33% price drop would save GAVI billions (13% of its total vaccine purchasing costs).
In January 2020, MSF repeated the appeal for GAVI to bulk-buy the cheaper pneumococcal vaccine and vaccinate more of the 55 million children who are not vaccinated with it. They also appealed to the World Health Organization, UNICEF, and the Gates Foundation, and said that GAVI could have done more to lower vaccine prices.
GAVI supports the following vaccine programs:
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- one-third of 40% is 13.3333...%
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