Memorandum by GAVI Alliance
INTRODUCTION
1. This submission includes a brief background
on GAVI and addresses four of the issues listed in the Committee's
Call for Evidence: points 1, 5, 6, 18 and 19.
BACKGROUND
2. The Global Alliance for Vaccines and
Immunisation was established in 2000. GAVI's mission is to save
children's lives and improve people's health by increasing access
to immunisation in poor countries. GAVI has quickly established
itself as a significant actor in global health: by the end of
2007, total support committed to poor countries in the period
2000 to 2015 was $3.5 billion and we had received funds and long-term
pledges from donors exceeding US$7.5 billion. Our largest donors
are the United Kingdom, France, Norway, Italy and the Bill and
Melinda Gates Foundation.
3. The World Health Organization (WHO) estimates
that in the first seven years of our existence, GAVI support has
averted 2.9 million future deaths. Major successes include reversing
the falling coverage rates of basic childhood vaccines, introducing
immunisation safety practices and accelerating the uptake and
use of new and under used vaccines, such as vaccines against hepatitis
B and yellow fever. GAVI also offers vaccines against Haemophilus
influenzae type b and pneumococcal disease (against pneumonia)
and rotavirus (against diarrhea) thereby protecting children against
the two biggest infectious disease killers.
4. Recognising poor health service delivery
systems as an impediment to rolling out immunisation programs,
in 2006 GAVI launched a Health Systems Strengthening (HSS) programme.
GAVI's HSS has attracted the attention of WHO, the World Bank
and others who see it as a potential model approach for supporting
developing country's national health plans.
5. A feature of GAVI's success has been
in developing and piloting innovative approaches to development
financing. For example, the International Finance Facility for
Immunisation (IFFIm) has seen donors make long-term (up to 20
year) commitments, and leveraged the strength of the capital markets
to frontload assistance.
6. A less quantifiable success is reflected
in GAVI's business model and approach to development assistance.
GAVI represents a new model for international development cooperation
in global health that positions developing countries at the centre
of decision-making and draws on the relative strengths of both
the public and private sectors. GAVI is currently restructuring
its governance arrangements and the two main Boards are being
brought together in a single governing body. This will include
representatives of all of the major players relevant to the success
of our mission: the developing countries, the donor governments,
the main multilateral agencies (WHO, UNICEF, World Bank), the
Gates Foundation, civil society and the vaccine industry; critically
it will also include a significant number of non-affiliated individuals
with private sector backgrounds.
7. There are not yet any licensed and available
vaccines for the four infectious diseases that are the particular
focus of the Committee's inquiry. The lessons that GAVI has learned
and the approaches that we have put in place for introducing and
accelerating vaccine supply and uptake will be useful and can
be put into action when vaccines for malaria, tuberculosis and
AIDS become available.
8. More information on GAVI, including details
of our most recent performance results are available at www.gavialliance.org
SPECIFIC COMMENTS
AGAINST THE
COMMITTEE'S
IDENTIFIED ISSUES
Point 1: status of global progress against
communicable diseases
9. After some initial successes (eg smallpox
and polio) routine vaccination in resource poor settings became
a neglected issue and coverage fell in the early 1990s. GAVI was
created in 2000 in response to falling coverage and the recognition
of potential benefits in new and emerging vaccines. GAVI's early
results demonstrate how a deteriorating situation can be addressed.
For example, coverage rates for the basic childhood vaccines of
diptheria, tetanus and pertussis in Africa have risen from less
than 50% in 1999 to over 70% today; and an additional 158.6 million
children have been immunised against hepatitis B liver disease
in the past seven years.
10. In regard to vaccines against the diseases
that are the focus of the Committee's inquiry, a recent preliminary
study conducted for GAVI by WHO ranked malaria as the highest
public health priority in terms of a disease for which a vaccine
is likely to be available in the near term. HIV/AIDS and second
generation tuberculosis fell into the category of diseases for
which vaccines are under development but unlikely to be licensed
or available in the near future.
Point 5: blockages to achieving progress
11. GAVI's experience increasing access
to immunisation demonstrates that more financial resources are
needed for the research and development of new vaccines and that
the right incentives need to be in place to spur development.
That said there remains a basic lack of scientific knowledge that
needs to be overcome if the world is to develop a vaccine against,
for example, HIV/AIDS.
12. There are a relatively small number
of established vaccine manufacturers but a growing number in the
developing world. Vaccine production is a complex and expensive
operation (relative, for example, to drugs) and better demand
forecasting is an important ingredient in ensuring plant capacity.
It is therefore essential that a long-term focus is maintained
on market dynamics to ensure adequate supply.
13. Innovations in vaccines are insufficient
if there is neither the finance nor the delivery platform to ensure
that they reach the people who need them. A historic and long-standing
neglect of basic health service systems (by the national governments,
bilateral donors and the international development institutions)
has left a legacy of failing and dramatically under-resourced
health systems in many of the world's developing countries. Recent
international initiatives, such as the International Health Partnership
launched in London in September 2007, are commendable and demonstrate
a high-level recognition of the problem but urgent and long-term
action including a significant scaling up of resources will be
required to overcome it.
Point 6: role of GAVI in combating the four
diseases
14. GAVI brings together the relevant actors
in vaccine and immunisation, plus effective non-affiliated private
sector expertise, in a collective effort to leverage skills and
attributes to accelerate action against vaccine preventable diseases.
Lessons from our public-private partnership business model could
be useful to others working to fight the diseases that are subject
of the Committee's focus.
15. GAVI has also broken new ground with
innovative financing approaches to development aid and can contribute
experience and ideas to the broader effort required to increase
financial resources and the predictability of aid.
16. HIV/AIDS related organisations, such
as the International AIDS Vaccine Initiative, have shown strong
interest in GAVI's experience as they recognize that having the
vaccine technology is not enough—there are significant challenges
in introducing and accelerating the uptake of new vaccines. GAVI's
work is seen as a pathfinder in this regard.
17. GAVI is very engaged in advancing the
broader global health development agenda, in particular pursuing
efforts with other global health organizations to better coordinate
our collective work and to ensure international efforts are aligned
with developing countries own priorities. In addition to our alliance
partners we work increasingly closely with the Global Fund to
Fight AIDS, Tuberculosis and Malaria.
Point 18. potential other infectious diseases
18. Diseases such as measles, polio and
yellow fever could all require global control strategies that
must be sustained. With increasing movement of people, outbreaks
in any part of the world could have global implications.
Point 19. resources committed by the UK Government
19. The UK Government was one of GAVI's
founding donors and has committed significant funds. Direct contributions
to GAVI from UK total over US$115 million and in addition the
UK has committed £1.38 billion over twenty years for the
International Finance Facility for Immunisation. GAVI has valued
the UK Government's policy engagement with GAVI as well as both
the quantum of funding and the long-term nature of the commitments.
25 January 2008
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