Addressing the challenges
Since 2011, the Alliance has developed new approaches and taken a number of measures to adapt to the changing global context, respond to challenges and become more efficient.
The unprecedented demand for new vaccines, especially those protecting against pneumococcal disease and rotavirus diarrhoea, has led to supply constraints for particular products and formulations, and has highlighted issues related to country preparedness. GAVI and its partners are working together with manufacturers to secure sufficient supply and coordinating technical assistance to identify and resolve implementation issues.
To make these new vaccines available and ensure their safety and efficacy, countries need well-functioning refrigerated supply systems. Studies have shown that the cold chains in many developing countries are unreliable, and that vaccines are at risk of exposure to damaging temperatures. Discussions with companies and foundations that are interested in providing private-sector expertise and funding are informing a cross-Alliance supply chain strategy, which will be brought to the Board at the end of 2013.
Ensuring sufficient quantity and quality of immunisation data is another key challenge for the Alliance. In January 2013, GAVI held a data summit to explore ways to improve the quality of coverage data. GAVI is working with WHO, UNICEF, the Institute for Health Metrics and Evaluation, the Global Fund and other partners to help countries better assess and strengthen data quality, as well as to reduce gaps between surveys and address discrepancies between different coverage estimates.
GAVI is also enhancing its ability to adapt to local contexts in a more efficient and transparent way. A new policy, which enables GAVI to adopt a more flexible approach to funding in the case of fragile states and those in short-term emergency situations, was adopted in 2012. Tailored approaches for Afghanistan, the Democratic Republic of the Congo, Nigeria and Pakistan are under way, with Chad, Haiti and South Sudan following in the second phase.
In Pakistan, GAVI will provide technical support to strengthen the routine immunisation system, as well as to enhance the system for monitoring and evaluation to ensure better-quality data. Together with the government and partners in the Democratic Republic of the Congo, GAVI will help to support routine immunisation, increase demand for immunisation, strengthen vaccine management and the supply system, and ensure sustainable immunisation financing. Support to Nigeria will focus on supply chain management and outreach services at the local level.
One of the factors that determine if a country qualifies for tailored support is whether there are immunisation inequities, including those related to gender, income or geographic location. As reaching the unreached remains a challenge, the Alliance is strengthening its support to countries where inequities in coverage are most severe and in those where immunisation coverage is below 70%. Although all partners are involved, WHO is taking the lead in working with low-coverage countries and UNICEF with countries facing inequities in access. Furthermore, a portion of GAVI HSS support is contingent upon countries meeting specific equity targets.
Ensuring that programmes are sustainable has been a priority for the Alliance since its inception. Commencing in 2012, GAVI’s revised co-financing policy requires all countries to contribute a portion of the cost of their vaccines. This helps to help build country ownership and long-term sustainability, and to ensure that vaccine procurement is included in national budgets.
To ensure a smooth transition to full national financing, Alliance partners are providing assistance to countries that will graduate in the coming years. For example, graduating countries continue to be eligible for certain negotiated vaccine prices. All 17 graduating countries are on track in terms of fulfilling their co-financing requirements, and it is expected that the 7 countries graduating in 2015 will be able to sustain the vaccines they have introduced with GAVI support. On current projections, 30 of the 73 currently GAVI-supported countries will either have graduated or be in the process of graduating by 2020.
Since January 2011 GAVI has finalised eight evaluations, focusing on topics such as the gender policy, civil society support, and the process and design of the AMC. In addition, the Alliance is launching five full country evaluations in partnership with in-country institutes, the Institute for Health Metrics Evaluation and PATH to identify barriers to and drivers of immunisation programmes, as well as to further assess the impact of vaccines.
- Antwi-Agyej KO, Kristensen D, Lasher H et al. The imperative for stronger vaccine supply and logistic systems. Vaccine. 2013 Apr 18;31 Suppl 2:B73-80. doi: 10.1016/j.vaccine.2012.11.036. Garrrison, MM, Matthias DM, Nelson C et al. Freezing temperatures in the vaccine cold chain: A systematic literature review. Vaccine 25 (2007) 3980–3986↵