Photograph: Daniel Chetroni/Getty Images/EyeEm
Since it was founded in 2000, the Gavi Alliance has brought immunisation to approximately 90% of households globally. Set up by the Bill & Melinda Gates Foundation in collaboration with agencies such as the World Bank and World Health Organization (WHO), and a host of vaccine manufacturers, it now works with 58 of the world’s poorest countries and has helped to protect more than 700 million children from diseases such as measles, whooping cough and pneumonia.
More recently it has delivered the first ever cholera vaccination campaign in Yemen, and helped Senegal introduce the HPV vaccine into its routine immunisation programme, protecting 200,000 nine-year-old girls a year against cervical cancer.
This June – in one guise or another – the third Gavi replenishment pledging conference will take place in London, bringing together governments, civil society, public and private donors and vaccine manufacturers, and generating what Gavi hopes will be pledges of $7.4bn to fund their activities over the next five years.
“Each dollar of investment in vaccinations brings benefits of $54 in broader societal benefits – immunisation really is a great investment,” says Laetitia Bigger, director of vaccines policy at the IFPMA.
“I hope that countries will see the need to invest long-term in not only epidemic management but also in how we continue to vaccinate children routinely to avoid the resurgence of disease.”
Even the poorest countries contribute financially towards each vaccine delivered by Gavi and, as they become wealthier, they put more of their own money into vaccine programmes. Since its last replenishment in Berlin in 2015, which raised US$7.5bn, Gavi has helped 15 countries to become completely self-funded.
“What Gavi has achieved is to create a vaccine infrastructure that gives manufacturers greater visibility on vaccine demand and financing, and improves access to vaccines for the poorest countries of the world,” says Thomas Breuer, chief medical officer of GSK vaccines, adding that this is ending the old processes whereby new vaccines were first used in high-income countries long before reaching developing nations.
“Vaccines are one of the greatest public health success stories in history,” says Joan Benson, executive director of public health partnership at MSD (Merck Sharp & Dohme).
Much is made of the Gavi model, which is based around a public-private partnership that pools demand from the world’s poorest countries, driving down the price of vaccines so that Gavi-supported countries pay less than $28 for a full course of 11 vaccines that would cost more than $1,100 in the US. It has also helped accelerate access to vaccines, with coverage growing from 60% to 80% in Gavi-supported countries since 2000.
“There’s a lot about the Gavi model that makes it special within global health,” explains Lindsey Dietschi, global health partnerships lead at Pfizer. “For us, that long-term commitment and that predictability of what’s on the horizon in the way of demand and supply is incredibly helpful.”
It means vaccine manufacturers can factor in the potential needs of different countries into their planning and then pass on the efficiencies from delivering at scale in the way of price reductions, she adds.
Isabelle Deschamps, head of global vaccines public affairs at Sanofi Pasteur, says the model provides clarity to R&D manufacturers, particularly when it comes to making early investment decisions on the development of new vaccines.
“Through its long-term forecasts and innovative financing mechanisms, the model enables market stimulation and provides better predictability of vaccine demand – one of the factors that influence vaccine development and production,” she says.
The other option, she adds, would be striking deals on a country-by-country basis, which would be time-consuming and complicated.
While reaching out to the 20% of children who are still not fully vaccinated – especially the so-called “zero-dose children” – remains a Gavi priority, over the next five years the alliance is expanding its work on life course immunisation.
“Prevention of infectious diseases is important at all stages of life to promote healthy living and healthy ageing,” says Benson. “Our vaccine pipeline reflects this continued ambition to develop vaccines that advance public health across age groups.”
“It’s not just about the numbers of doses we are distributing, but genuinely what are the public health impacts that we are seeing play out in the real world,” says Dietschi.
“We all know that when people stay healthy they can keep going to work and school. The impact on the economy over the long run is really substantial.”
Currently Gavi is helping some of the world’s poorest countries cope with the Covid-19 pandemic. An initial $29m has been provided to supply personal protective equipment (PPE) and fund diagnostic tests, while Gavi is confident that the immunisation infrastructure it has helped to create will ultimately play a key role in rolling out a vaccine for the disease.
There are other new vaccines on the horizon, too. According to Unicef, malaria still kills one child every 30 seconds and at GSK the development of the world’s first malaria vaccine is currently in a pilot phase. Pfizer is looking at a new vaccine that can protect against 20 different pneumococcal diseases and is also developing a respiratory syncytial virus (RSV) vaccine, while scientists at MSD are targeting diseases such as RSV, dengue and cytomegalovirus (CMV).
Sanofi is working on a new hexavalent vaccine, says Deschamps, which will help simplify vaccinating infants by adding polio to a combination which already includes diphtheria, tetanus, hepatis B, Hib and pertussis.
Another exciting area of work is maternal vaccination. Previously, it had been thought too dangerous to include pregnant women in clinical trails, but following the 2009 swine flu pandemic, the WHO changed its thinking and now advocates vaccination against seven diseases.
Once vaccinated, says Dietschi, the mothers pass on antibodies to the unborn baby through the placenta, giving the child extra protection during those first crucial days of life. “We really do feel this is the next frontier in scientific innovation and vaccines,” she says.
