ONE's Vaccine Policy Pitch

Why Childhood Vaccines?

Childhood vaccines are one of the most cost-effective ways to save lives and prevent disease for a lifetime. Unlike many other health interventions, vaccines help healthy people stay healthy. Not only do vaccines help protect against preventable death from disease, but they also help significantly reduce the likelihood of future illness and disability. Doing so generates savings in reductions in clinic visits and hospitalizations, and allows children and adults to participate in school and work as productive members of society. For these reasons, vaccines are often called a “best buy in public health”; they are inexpensive, easy to administer, and effective.

Vaccines are powerful tools, helping to prevent more than 2.5 million deaths each year that would otherwise occur without vaccination (WHO estimation). Thanks in large part to vaccines and other simple health interventions, under-5 childhood mortality rates were halved between 1960 and 2005, and have been reduced even further in the years since. Smallpox is the only disease in history to be eradicated, and that eradication was achieved through global vaccination efforts. In 1988, polio was widespread in 125 countries and paralyzed an estimated 350,000 children every year. Today, the poliovirus remains endemic in only four countries and thanks to reenergized vaccination campaigns, fewer than 1,000 cases occurred in 2010. Measles is another success story: between 2000 and 2008, widespread vaccination reduced the number of measles deaths in Africa by 92%. 

Why now?

In spite of much progress in reducing child mortality, 8.1 million children under the age of 5 died in 2009. The vast majority of these deaths occurred from preventable and treatable causes.

The two leading disease killers of children in the developing world are pneumonia and diarrheal disease. Together, these two killers account for an estimated 36 percent of child mortality—more than HIV/AIDS, malaria, and tuberculosis deaths in children combined. 

Pneumonia is the largest disease killer of children globally, causing an estimated 1.5 million deaths annually—roughly one child death every 20 seconds. In addition to these deaths, each year there are more than 150 million episodes of pneumonia in young children in developing countries, and more than 11 million children require hospitalization. Of pneumonia deaths, roughly 800,000 are caused by pneumococcal disease.

Diarrhea is the second largest disease killer of children globally, causing an estimated 1.3 million deaths annually. Rotavirus is the leading cause of severe diarrheal disease and dehydration in infants and young children; each year, more than half a million children under 5 die because of rotavirus, and millions more are hospitalized.  The greatest burden is felt in developing countries of Africa and Asia where more than 85 percent of rotavirus deaths occur; deaths are most common in areas where access to clean water, sanitation, and urgent medical care may be limited.

Pneumonia and diarrhea also exist in the developed world, but medical systems are in place to treat these diseases, and vaccines for pneumococcal disease and rotavirus have existed for years to prevent severe cases that can lead to death. Yet vaccines for these two diseases suitable for the developing world’s health systems and children were not developed, made available, and made affordable until 2010. So now, the world has a huge opportunity: starting this year, countries across the developing world will be able to access these two new vaccines to fight pneumonia and diarrhea and to significantly reduce child illness and mortality.

Why GAVI?

In order to get new and underutilized vaccines out to the children who need them, it is critical that national governments, donors, delivery mechanisms, and the private sector all work together toward the goal of reducing preventable child deaths. The Global Alliance for Vaccines and Immunization (GAVI) is a unique and innovative public-private partnership with impressive results. Since its launch in 2000, GAVI and its partners have averted an estimated 5.4 million future child deaths and have supported the immunization of more than 288 million children. 

They have done this by:

• increasing access to underutilized vaccines
• incentivizing the development of vaccines appropriate for the developing world
• utilizing innovative finance to generate additional sources of revenue for vaccines
• pooling demand to drive down the cost of vaccines

Key partners of the GAVI Alliance include: The Bill & Melinda Gates Foundation, civil society organizations, developing country governments, donor country governments, research and technical health institutes, UNICEF, the vaccine industry, World Health Organization and The World Bank Group. This diverse group of partners works together to provide funding for immunization; offer technical assistance; support research and development; set normative guidelines for vaccine safety and quality control; deliver vaccines; and develop sustainable financing for health systems.

GAVI currently finances the purchase of vaccines in the 72 poorest countries in the world. New eligibility criteria stipulate that to qualify for GAVI support, these countries must have a gross national income (GNI) per capita less than US$ 1,500 and coverage levels of at least 70% with three doses of the diphtheria, tetanus, pertussis (DTP3) vaccine. GAVI’s funding to-date has gone toward the purchase of key childhood vaccines including hepatitis B, Hib (a form of pneumonia), pertussis, measles, yellow fever and polio. Through the introduction of Hib vaccine, Hib meningitis has been virtually eradicated in many sub-Saharan countries and the Hepatitis B vaccine is now part of routine immunization programs in almost all low-income countries.

Although the risk of theft of GAVI-supported vaccines is quite low compared to cash payments or other medicines for which there is a secondary market, GAVI upholds a zero tolerance policy for misuse of its funds. GAVI regularly holds Financial Management Assessments (FMAs) of programs and independent, annual audits of its cash-based programs (which represent approximately 15% of total GAVI expenditures). If GAVI suspects misuse, all cash disbursements to the program in question are halted and funds in-country are frozen pending investigation by GAVI. If misuse is confirmed, GAVI’s funding agreement with a partner government requires it to repay any missing funds.  Even when cash programs are suspended, however, vaccines support ordinarily remains uninterrupted in order to ensure that children do not unnecessarily suffer.

The Need

Between 2011 and 2015, the GAVI Alliance expects to disburse a total of US$ 6.8 billion to poor countries to support immunization plans—nearly half of which will go toward the purchase of new vaccines for pneumococcal disease and rotavirus. Of this total funding challenge, US $3.1 billion is already assured from donor governments and philanthropic groups. Therefore, GAVI’s overall 2011-2015 funding challenge is US $3.7 billion. This funding will help immunize an estimated 243 million children across the developing world. 

If GAVI can secure sufficient funding to finance the demand for new and underutilized life-saving vaccines, an additional 3.9 million future deaths could be prevented by 2015. Doing so would make significant progress toward Millennium Development Goal 4, aimed at reducing child mortality.

ONE is building support toward three primary objectives in 2011:

1.    Assist the GAVI Alliance in garnering adequate funding pledges from donors to fill a $3.7 billion funding gap through 2015
2.    Raise awareness about the impact of child vaccines, as well as about specific investment opportunities outside of GAVI that could have a particular impact (such as polio eradication)
3.    Build a foundation of policymaker support for other aspects of the maternal, newborn and child health continuum

As we work toward these public-facing objectives, we will also work diligently to promote the lowest possible prices for critical child vaccines and transparency around vaccine funding and delivery.