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Friday, 20th of December 2013 Print
Dear Friends of GAVI
As I always do at this time of year, I am writing to share with you the highlights of 2013 for the GAVI Alliance and the progress we’ve made over the last year. More than halfway through our 2011-15 funding cycling it is fair to say that we are now in the midst of an unprecedented acceleration of our mission to get new and improved vaccines to those living in poor countries, with on average more than one vaccine launch every five days! So what better time to take stock and reflect on how far we have come, and to look ahead at what needs to be done in 2014.
For me 2013 will stick in my memory as the year in which we saw a dramatic shift in vaccines for women’s health. Not only did the new low price of human papillomavirus (HPV) vaccines open the door for poor countries to vaccinate millions of girls against a devastating women’s cancer, but we also saw significant progress in preventing congenital rubella syndrome by bringing the measles - rubella (MR) vaccine to countries with four catch-up campaigns. Measles also continues to be an issue. Following a resurgence of outbreaks in recent years, in 2013 GAVI stepped up its efforts to prevent the disease, working with the Measles - Rubella Initiative to carry out supplementary immunisation activities in three large countries at high risk of outbreaks. The Alliance has also provided other forms of measles support to countries. In 2013, we supported three countries to roll-out a second dose of measles vaccine, bringing the total to 11 countries that have rolled out routine measles second dose with GAVI support.
A very welcome development this year was the publication of the long awaited Hib Initiative Supplement in The Journal of Pediatrics, which provided fresh evidence of the impact of Hib vaccines on reducing the burden of disease. Funded by GAVI this comprised 13 research articles by 115 researchers working in seven different countries over eight years. With all but one of the GAVI-eligible countries now using Hib vaccines, as part of the routine five-in-one pentavalent vaccine, the supplement has provided answers to strategic questions about Hib and filled important gaps in our knowledge. In places where there is active surveillance, we can see the dramatic reductions in Hib disease in the population. For some countries, particularly in Asia and Eastern Europe where data was either not available or interpretation of previous studies was unclear, this research has provided valuable new assurances of the impact and cost effectiveness of Hib vaccines.
Polio has also seen some significant and exciting developments. Just this month guidelines on how to apply for inactivated poliovirus vaccine (IPV) went live on the GAVI website, two weeks after the GAVI Board’s decision in November to begin supporting it in all 73 GAVI countries. Introducing IPV is a critical step in the phased removal of oral polio vaccines to eliminate the risk of vaccine-associated polio outbreaks, as laid out in the Polio Eradication & Endgame Strategic Plan 2013-2018, which was endorsed by the World Health Assembly in May. Equally, continued transmission of wild polio virus and fresh outbreaks, most recently in Syria and the Horn of Africa, only reinforce the importance of ensuring robust routine immunisation programmes. With the Board’s decision, GAVI will play a critical complementary role to the Global Polio Eradication Initiative, supporting routine immunisation strengthening and IPV introduction.
We have also seen important developments in malaria, with the first proof of protection from vaccination for a parasitic infection. Results from trials showed that when used in combination with insecticide-treated bed nets the RTS,S vaccine can almost halve the number of malaria cases in children vaccinated between five and 17 months of age. Its early days and we are awaiting further data – expected in 2014 – on duration of protection and booster doses. GAVI will follow these developments closely and consider possible support for the vaccine once this data is available and technical review and regulatory processes have been completed.
We continue to see acceleration in GAVI’s programmes. By December 31st, we expect to have supported more than 40 vaccine introductions and campaigns, compared to 22 in 2011 and 30 in 2012. At this point, nearly 80% of eligible countries have now applied for pneumo, more than 70% for rota and nearly 50% for HPV demonstration projects. South Sudan is expected to be the final GAVI country to introduce penta next year. It’s a similar story with GAVI’s health system strengthening support with $US 64 million disbursed in the first three quarters of 2013 alone – that’s more than three times the spend for the same period in 2012 when we were undergoing a change in our HSS programming. This progress means that by the end of this year, we will have vaccinated 145 million additional children since January 2011 and averted 2 million future deaths. This is what we are all about and has played a direct role in helping to reduce child mortality in GAVI countries from 78 per 1,000 live births to 73 in just two years. Cumulatively since GAVI was created in 2000, we will have reached a total of 440 million children and averted approximately 6 million deaths.
But it’s not all plain sailing. On average coverage for rota and pneumo vaccines remains behind target due to supply shortages and readiness issues. As we reported in October at our Mid-Term Review in Stockholm, we have also not seen adequate improvements in average immunisation coverage and drop-out rates between first and third doses across the GAVI-eligible countries. And while we are close to meeting our target on equity (which measures wealth-related inequities), we know this masks broader equity challenges that need addressing. Indeed we took away a strong message from MTR participants that we need an even greater focus on equity. We also heard calls for GAVI to do more to ensure sustainability, with more than 20% of GAVI-eligible countries having entered graduation.
Looking forward, we will continue to accelerate our efforts with more than 200 launches in 2014 and 2015. 2014 will also be the year in which we determine our strategy for 2016-20, and in which we launch our second Replenishment to secure the resources needed for that strategy. Given our current trajectory, we are on track to increase the number of children immunised 2016-20 by 24% to 301 million, and to raise the number of future deaths averted by more than half, to 5.9 million. However, we believe there is scope to increase our impact further and – building on the message on equity we received at the MTR – that we should strive to reach and fully immunise every last child in GAVI countries. Moreover – again echoing the discussion at the MTR – we also recognise that our next strategy must focus even further on ensuring the sustainability of immunisation programmes and demonstrating the success of GAVI’s graduation model.
According to The Lancet’s “Global Health 2035 Commission” we now, for the first time in human history, have the financial and technical capacity to eliminate health disparities between poorer and wealthier nations within a single generation. Published earlier this month to mark the 20th anniversary of the World Development Report Investing in Health, with myself as one of the co-authors, it concludes that by 2035 we can achieve a “grand convergence” by bringing preventable infectious, maternal and child deaths in all countries down to levels currently seen in best-performing middle-income countries. It’s an ambitious and noble vision, and one in which GAVI – through its next strategy – can play a vital role.
Of course, we will not be able to deliver our 2016-20 strategy without securing the resources to fund our work. We have already begun planning our second Replenishment and will be asking donors to repeat the generosity they showed in London in 2011. We have already seen encouraging signs with several existing donors increasing their commitments since 2011 and new donors continuing to join GAVI. Nonetheless, we do not underestimate the challenge in the current fiscal environment and know that we cannot rely on donors alone – countries and industry also need to do their part. We have seen good progress on both these fronts. Countries continue to increase their investment with co-financing payments projected to reach approximately US$ 180 million 2011-2013. This represents more than 8% of GAVI non-campaign vaccine support and we expect co-financing to grow to more than $1 billion 2016-20. We have also made substantial progress in bringing down the cost of fully vaccinating a child with penta, pneumo and rota, with a reduction of 35% 2010-2012 and further progress this year, including a substantial reduction for HPV and a new lowest price for penta.
Since 2000 the GAVI Alliance has been making the difference between life and death for millions of families. We now have a generation of six million children who would not be with us if it weren’t for the efforts of the Alliance partners and continuous support from donors. The Holiday Season is the moment to celebrate this achievement with the knowledge that there are many more to come!
Thank you all for your continued engagement and support. Best wishes to you and your family for a happy, healthy and peaceful 2014.
Dr Seth Berkley
CEO of the GAVI Alliance