Tore Godal

When it was launched in 2000, the Global Alliance for Vaccines and Immunization (GAVI), a coalition of public and private sector entities, pioneered a new model for vaccine access. At HSPH on March 25, GAVI Executive Secretary Tore Godal discussed the challenges of global immunization. The seminar was sponsored by the Office of the Dean and the Department of Population and International Health.

In a rapid international health scale-up, the Vaccine Fund–the financing arm that helps raise and distribute funding to achieve GAVI’s goals–has supported vaccinations for hepatitis B for more than 35 million children, DTP3 (diphtheria-tetanus-pertussis) for eight million children, Haemophilus influenzae type B for six million children, and yellow fever for 2.7 million children. Several hundred million free syringes have also been donated.

"This is a good time for discussing pragmatic approaches to improving health instead of the ideological ones we usually have," said Godal.

In February, the Vaccine Fund and GAVI launched a global "Campaign for Child Immunization," with the goal of saving at least one million children from 2004 to 2006 by providing vaccines and immunization services to 30 million children in the world’s poorest countries where access to the pharmaceuticals is limited.

The Bill and Melinda Gates Foundation provided the initial grant for the Vaccine Fund. "Bill Gates said his hand was shaking a little when he signed a check for $754 million," said Godal. "This year, he said it was the best investment he ever made. Vaccination is among the most cost-effective health tools we have."

So far, GAVI and the Vaccine Fund have raised $1.3 billion of support.

Unlike past international immunization programs, GAVI has not created a new organization. Instead, the alliance has formed a coalition of existing groups and has received high-level commitments from them to carry out the work of the alliance. By using this approach, the coalition avoids spending large amounts of money simply sustaining itself and can funnel more funds to the countries in need. Approximately 98 percent of the Vaccine Fund’s resources go directly to countries, according to GAVI.

Also remarkable is GAVI’s emphasis on measuring the results of the immunization programs the alliance chooses to fund. Governments and partners, such as UNICEF and the World Health Organization, decide how to spend the funding based on local needs. Countries that fulfill target immunization rates–and have reliable tracking systems to prove their achievements–receive a bonus of $20 for each additional child immunized beyond the initial baseline rates.

"This is a new model of how to run a global overseas development program with real integrity, outcomes measures, and accountability," said HSPH Dean Barry Bloom in a discussion following Godal’s presentation. "It seems to be a complete sea change for foreign aid."

Countries must apply for funds through a rigorous review process. Some have had to resubmit repeatedly, Godal said. The program includes a strong monitoring and evaluation component. GAVI contracts with PricewaterhouseCoopers and Deloitte Touche Tohmatsu to conduct random audits to verify the results. Even then, Godal said, immunization numbers are not completely reliable–demonstrating the challenge of collecting data in countries with developing infrastructures.

GAVI’s approach to immunization accessibility and documentation gives countries a tool to identify potential barriers to development goals, such as poor political commitment, weak health care infrastructures, incomplete or non-existent information systems, and inadequate financial management. Two-thirds of all unimmunized children in the world live in seven countries with especially difficult problems, said Godal.

"The United Nations’ Millennium Development Goals will never be reached unless the issues in these countries can be solved," Godal said. Immunizations and improved health help support economic growth, better education, and other societal benefits, he said.

The Vaccine Fund now supports immunization programs in nearly 70 of the world’s poorest countries, defined as having less than $1,000 average annual income per person. By the end of 2003, the Vaccine Fund and GAVI had made five-year commitments of more than $1 billion to 69 countries.

GAVI is working with countries to develop long-term plans that extend beyond the alliance’s initial financial commitment so that immunization programs can be sustained. Decreases in vaccine prices and increases in the number of companies making vaccines are bound to help, he said.

In addition to broadening global immunization coverage, GAVI’s goals include reducing the lag time between the introduction of new vaccines and their use in the poorest countries and accelerating the development of novel vaccines. Now, GAVI is devising a 10-year strategic plan, Godal said. The alliance is considering a new metric of progress that would emphasize the reduction of vaccine-preventable deaths over the measurement of the percentage of a given population covered by immunization programs.

For more information about GAVI, visit the web site available at http://www.vaccinealliance.org/home/index.php.

-- Carol Cruzan Morton