The GAVI Alliance: immunization as a key component of primary health care Marc Hofstetter
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The GAVI Alliance: immunization as a key component of primary health care
Marc Hofstetter
Action for Global Health ConferenceBerlin, 11 February 2009
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Why GAVI?
9.2 million annual child deaths 25% vaccine-preventable MDG 4
Vaccines: life-saving, simple and highly cost-effective:
Harvard economists: “the economic impact and benefits of immunization have been greatly underestimated; GAVI programmes could earn a rate of return of 18%”
North-South inequity in access to vaccines
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The response: private-public alliance
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GAVI programmes: New and under-used vaccines
GAVI supported vaccines:
Hepatitis B Hib Yellow fever Pneumococcal disease Rotavirus diarrhoea Meningitis 4 new vaccines prioritized:
HPV, Japanese Encephalitis, Typhoid, Rubella
Leading causes of vaccine-preventable death in children under 5 years old:
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Using pentavalent vaccine to reach MDG 4 (2000)
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Using pentavalent vaccine to reach MDG 4 (2008)
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Elimination of Hib meningitis in Uganda 2002-2007
H. Influenzae meningitis cases, Mulago Hospital, Kampala, Uganda
Source/credits: Lewis R, et al Action for child survival: Elimination of meningitis due to Haemophilus influenzae type b following introduction of Hib vaccine in Uganda. WHO Bulletin. April 2008
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Overall results
Source: WHO
Measuring impact: future deaths averted through GAVI vaccine support (hepatitis B, Hib and pertussis vaccines)
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World Health report 2008 – Revitalizing primary health care
Key role for immunisation
Too many children still miss out on vaccinations
Goal: universal coverage, equitable access
Strengthening health service delivery platforms
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GAVI Programmes:Health Systems Strengthening Support
Why? GAVI’s outcome-based immunisation programmes revealed system
weaknesses, bottlenecks for further progress Infrastructure, human resources, service delivery, constraints at
peripheral level, organization and management, etc.
How? Use principles outlined in DAC Paris declaration: alignment, country
ownership, accountability, managing by results Active involvement of CSOs in implementation
How much? $800 million -2015 Evaluation in 2009 to guide direction
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HSS example: Ethiopia
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Aid effectiveness: Paris and Accra
GAVI business model based on Paris principles, active role in aid effectiveness debates, pioneering new models
Predictability: long-term commitments to countries
Ownership: countries apply for the support they need and contribute financially, countries define indicators for HSS monitoring
Alignment: GAVI support must be in line with countries’ existing national health plans and not replace existing funding
Performance-based funding to reward results
H8 - Health Leaders of 8 organisations collaborating for better and measurable outcomes
IHP: strengthen GAVI business model to start IHP implementation in Ethiopia and Mozambique
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Moving forward - the funding gap
Expenditures reflect known and estimated country demand for vaccines that can shift the needle on MDG4
Key donors: USA: $70 m/year – Norway: $75 m/year – Netherlands: €25 m/year - UK: $2 b through IFFim - France: $1.5 b through IFFim – Italy: $1.2 b through IFFIm and AMC – BMGF: $1.5 b over 15 years.
Germany: €4 million in 2009
Estimates as at January 2009
2009 - 2015 Per annum (average)
Projected expenditure $ 9.54 b $ 1.36 b
Projected available resources (historical trend)
$ 5.45 b $ 0.78 b
GAP $4.04 billion $0.58 billion
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WHO/Christopher Black
Danke
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