In a nutshell
Currently, only 85% of children worldwide, and 77% of children in Africa, receive the recommended set of childhood vaccines.1
Because of (a) the strong evidence that expanding access to vaccinations for children in the developing world is an effective way to save lives, and (b) the potential for it to do so cost effectively, we sought to answer the question: what giving opportunities would increase immunization coverage globally?
In order to answer this question, we spoke with the organizations working on this program. This page details our impressions from these conversations; most statements are supported by quotes from the conversations and not by detailed analysis.
We have not yet found promising funding opportunities to directly support the expansion of routine immunization activities.
Published: November 2012
Organizations work on three different types of vaccination programs:
- Routine vaccine delivery systems. Vaccinations delivered primarily through health facilities to children at ages that are specific to each vaccine. These vaccines include measles, polio, and DTP (diphtheria, tetatnus, and pertussis), among others. (More)
- Vaccination campaigns provide additional opportunities for children to receive a few key vaccines, as a way to reach children missed by the routine vaccination system and to provide additional doses to increase immunity to the targeted diseases. Campaigns are periodic events in which all people in a specified demographic in an area are vaccinated in a short time period. Vaccination campaigns are also called Supplementary Immunization Activities (SIAs). (More)
- Eradication initiatives seek to eradicate single diseases. The Global Polio Eradication Initiative seeks to eradicate polio. (More)
Routine vaccine delivery systems
- Developing country governments are generally responsible for paying for and delivering a set of inexpensive "traditional" vaccines through governments' existing health systems. Though governments are expected to pay for the vaccines, they are purchased through UNICEF's procurement service.2 Governments can pay for "traditional" vaccines because they are inexpensive.3
- UNICEF (www.unicef.org) provides technical assistance to governments for their vaccine delivery programs and runs support programs such as social mobilization initiatives, implementation support, and vaccine market shaping; it is considering expanding its work in these areas.4
In May 2012, UNICEF told us that it was seeking to focus on reaching the approximately 20% of children in the developing world who do not receive routine immunizations. UNICEF told us that specific activities will need to be tailored to the country's needs, and it is working with countries on plans and implementation to strengthen immunization. A representative stated that "Funding is mainly needed in areas such as improving outreach, upgrading and modernizing the cold chain and the supply system, and social mobilization. While in most instances governments pay for the 'traditional' vaccines (BCG, Polio, DTP, Measles), most of the funding for new vaccines (Hepatitis B, Haemophilus Influenzae B, pneumococcal, rotavirus etc) in the poorer countries is provided by the international community through the GAVI Alliance, with recipient governments paying a small part."5
UNICEF is a large diverse organization and we have not investigated how it funds its immunization work or how it prioritizes among its many different activities.
- GAVI Alliance (www.gavialliance.org) was created in the year 2000 to expand access to new and underused vaccines in the developing world. These vaccines are often much more expensive than the traditional vaccines that have been on the market longer,6 and include vaccines that help to prevent diseases such as hepatitis B, meningitis, pneumonia, and diarrhea, which are responsible for a significant number of child deaths.7 In addition to providing financing for vaccines, which represents the bulk of its support to countries,8 GAVI provides cash support to governments to strengthen the health systems that are responsible for delivering vaccines.9
GAVI has also provided some support for traditional vaccines, including supporting immunization campaigns and outbreak response for measles (see below), providing one-time grants to the Global Polio Eradication Initiative and the Maternal and Neonatal Tetanus Elimination Initiative, and purchasing pentavalent vaccines, which include the DTP vaccine, a traditional vaccine.10
Though GAVI primarily funds vaccines that are delivered through routine vaccination systems, it has also supported vaccination campaigns for meningitis A,11 yellow fever,12 and, as noted above, measles, maternal and neonatal tetanus, and polio. In the future, it plans to support combined measles and rubella vaccination campaigns.13
In June 2011, donors pledged $4.3 billion to GAVI for 2011-2015, exceeding GAVI's fundraising target of $3.7 billion.14 As a result of this successful fundraising effort, GAVI told us that additional funding would be used if pledges are not paid and to begin filling the funding gap for 2016 and beyond.15
GAVI receives 76% of its funding from governments (largest donors include U.K., Norway, U.S., France, and Italy), and another 18% from the Gates Foundation.16 GAVI expects to have $7.6 billion available for the period 2011-2015 or an average of $1.5 billion per year.17
(We previously considered GAVI: 2009 review of GAVI.)
- World Health Organization (www.who.int) describes its role in vaccination as "activities including standard-setting, research and development, vaccine regulation and quality, vaccine supply and immunization financing, and immunization system strengthening."18
According to WHO's website, as of January 2012, it had a funding gap of $224 million for its immunization work in 2012-2013, including $86 million for "measles control and surveillance" and $31 million for "meningitis control and surveillance."19
We have contacted WHO for more information but have not produced publicly available information from this investigation.
- Doctors Without Borders (Medecins Sans Frontieres, or MSF): MSF's work on vaccination was mentioned to us by multiple people we spoke to as part of this investigation. We spoke to MSF about its work in this area. MSF told us:
- It would like to have vaccination teams who actively screen all children who visit its health centers and provide vaccinations to those who have not received them. It does not currently have sufficient funding or staff to provide vaccination screening to every child who visits.20
- Its work also includes outbreak response, preventative vaccination campaigns, advocacy and policy, and operational research. MSF has been part of the introduction of the meningitis A vaccine and is a member of the Measles and Rubella Initiative.21
- MSF largely sets its priorities within the organization, rather than being driven by donors' preferences. We asked MSF, "If we direct funding to MSF and request that the funding be used for vaccination, how will MSF's programs change (if at all)?" MSF replied that it "can and will accept restricted funds for vaccinations, but a restricted gift for this project may not mean that we do 'more.'"22
- Measles and Rubella Initiative (www.measlesinitiative.org), formerly the Measles Initiative, funds national vaccination campaigns in which all children in a specified age range in an area are vaccinated for measles, and more recently, with a combined measles and rubella vaccine, regardless of whether they have received one or more doses of the vaccine previously.23 In June 2012, GAVI announced that it would provide additional funding for measles campaigns and measles outbreak response.24 The funding from GAVI fills the Measles and Rubella Initiative's expected funding gap for measles campaigns and outbreak response for 2013-2015.25 The Measles and Rubella Initiative notes that funding gaps may exist in the future for (a) including older children in campaigns in countries where disease surveillance data shows that there are gaps in vaccination coverage for this age group; and (b) investing in disease surveillance to work toward measles eradication. The Measles and Rubella Initiative expects to have information on 2013 funding gaps for (a) after September 2012.26
In 2012, the Measles and Rubella Initiative expects to receive about 60% of its funding from developed country governments (excluding the CDC, a U.S. government agency) and 40% from the five partners that run the initiative (UNICEF, WHO, American Red Cross, CDC, and the United Nations Foundation) as well as from other contributors, such as Lions Clubs International.27 Its budget for 2012 is $234 million.28
In addition to the funding for measles campaigns and outbreak response discussed above, GAVI has pledged support to the Measles and Rubella Initiative for combined measles and rubella vaccination campaigns in countries that have not yet introduced rubella vaccination.29 The Measles and Rubella Initiative estimates that this support will total $335 million in 2013-2015. In 2013 to 2015, the Measles and Rubella Initiative's anticipates that more than half of the funding for its work will come from GAVI.30 GAVI has not committed to fund measles vaccination campaigns once initial combined measles and rubella campaigns have been completed.31
- Maternal and Neonatal Tetanus Elimination Initiative (www.unicef.org/health/index_43509.html) is a partnership between UNICEF, WHO, and the United Nations Population Fund (UNFPA).32 Vaccination campaigns target women of childbearing ages in high-risk areas with the aim of preventing tetanus in mothers and future newborns. Each campaign consists of three rounds of vaccination with tetanus-containing vaccines.33
UNICEF leads the MNT elimination effort at the global level, while national governments are the main implementers of the campaigns. UNICEF provides funding, vaccine procurement, technical support, assistance with planning, and monitoring/supervision of the program.34 In the past ten years UNICEF has raised $200 million for MNT elimination; it is seeking to raise another $100 million by mid-2014. Potential funders include Kiwanis International, Proctor and Gamble, GAVI, U.S. Fund for UNICEF, and the Bill and Melinda Gates Foundation.35
- Introduction of meningitis A vaccine: GAVI has pledged $370.4 million to introduce a new meningitis A vaccine in 25 countries in 2011-2015.36 It expects the remaining $571 million needed for the program to be funded by implementing governments.37
In the first stage, the program will conduct vaccination campaigns targeting 1 to 29 year olds with one dose of vaccine. After the initial campaigns are completed, the program will transition to delivery of the vaccine through routine immunization services and/or follow up campaigns targeting children age 1 to 4.38
The website of the Meningitis Vaccine Project (www.meningvax.org), which developed the vaccine, notes, "Groups or individuals interested in helping meet the funding gap for large-scale introduction of the meningococcal A vaccine in sub-Saharan Africa can contact email@example.com for additional information."39 We have done some investigation into this funding gap but have not produced publicly available information from this investigation.
We include information about the Global Polio Eradication Initiative (GPEI) for the sake of completeness but do not currently plan to pursue it. While eradicating polio may be a cost-effective use of funds, we feel that the polio eradication effort has reached a stage where the focus is on eradicating the relatively few cases remaining,40 an endeavor that is likely distinct from other immunization campaigns in terms of its high upfront costs and potential long-term benefits. While we have high confidence in the impact of protecting individuals from contracting diseases by providing them with vaccinations, we have not fully investigated the expected benefits and risks of eradicating a small number of remaining cases of one disease. We would guess that, unlike vaccinating individuals for common diseases, an eradication campaign is likely to have high potential impact and high risk of failure. In addition, with eradication, the size of the donation may be important, because conducting the effort at less than full scale could result in failure to accomplish the goal of eradication and thus loss of future gains.
We have not contacted GPEI to discuss what the effect additional funding would have on its activities.
Reported funding needs
In its 2011 annual report, GPEI notes that it has a pressing need for additional funds for 2012-2013.41 GPEI has published details of its 2012-2013 budget and funding commitments and prospects. As of May 2012, it reported a funding gap for this period of $956 million. 42
We believe that GPEI likely has strong prospects for raising the funds it needs because polio eradication is a major focus of the Gates Foundation, which has spent over $1.5 billion on the effort,43 and because polio eradication is one of Bill Gates' "top personal priorities."44
Current sources of funding
In 2011, GPEI raised $1.1 billion for a budget of $0.98 billion; it started the year with a $0.36 billion funding gap.45 About 30% of funding in 2011 came from the Gates Foundation, 30% from developed country governments, 27% from countries at risk of polio, and the remainder from other foundations, non-profits, and other private funders.46
- Elder, Kate. Doctors Without Borders (MSF) Vaccines Policy Advisor. Phone conversation with GiveWell, July 13, 2012.
- Ferreira, David, and Alex Palacios. GAVI Managing Director for Innovative Finance and Special Representative. Phone conversation with GiveWell, February 2, 2012.
- Gates Foundation. Grant search. http://www.gatesfoundation.org/grants/Pages/search.aspx (accessed June 6, 2012).
- Gates Notes. Creating a polio-free world requires action now. http://www.thegatesnotes.com/Topics/Health/Creating-a-Polio-Free-World-R... (accessed June 7, 2012. Archived by WebCite® at http://www.webcitation.org/68Eub0LtK.
- GAVI Alliance. Annual financial report (2010) (PDF).
- GAVI Alliance. CEO report to board (June 2012) (PDF).
- GAVI Alliance. Donor profiles. http://www.gavialliance.org/funding/donor-profiles/ (accessed on June 6, 2012). Archived by WebCite® at http://www.webcitation.org/68DqMRcJK.
- GAVI Alliance. First year results - IFFIm provides US$ 1 billion to prevent disease. http://www.gavialliance.org/library/news/press-releases/2007/first-year-results---iffim-provides-us$-1-billion-to-prevent-disease/ (accessed August 24, 2012). Archived by WebCite® at http://www.webcitation.org/6AA5x3onq.
- GAVI Alliance. Haemophilus influenzae type B vaccine support: The issue. http://www.gavialliance.org/support/nvs/hib/ (accessed September 18, 2012). Archived by WebCite® at http://www.webcitation.org/6Alzo8p2P.
- GAVI Alliance. Hepatitis B vaccine support. http://www.gavialliance.org/support/nvs/hepb/ (accessed September 18, 2012). Archived by WebCite® at http://www.webcitation.org/6AlzivgtP.
- GAVI Alliance. Meningitis A vaccine support. http://www.gavialliance.org/support/nvs/meningitis-a/ (accessed August 3, 2012). Archived by WebCite® at http://www.webcitation.org/69eO1QQoD.
- GAVI Alliance. Options for enhancing GAVI’s investment in measles prevention (presentation) (PDF).
- GAVI Alliance. Options for enhancing GAVI’s investment in measles prevention (report) (PDF).
- GAVI Alliance. Pledging conference (June 2011). http://www.gavialliance.org/funding/resource-mobilisation/process/gavi-p... (accessed June 6, 2012). Archived by WebCite® at http://www.webcitation.org/68DqC3Cvz.
- GAVI Alliance. Pneumococcal vaccine support: The issue. http://www.gavialliance.org/support/nvs/pneumococcal/ (accessed September 18, 2012). Archived by WebCite® at http://www.webcitation.org/6AlzqHkOU.
- GAVI Alliance. Review of board decisions (June 2012) (PDF).
- GAVI Alliance. Rotavirus vaccine support. http://www.gavialliance.org/support/nvs/rotavirus/ (accessed September 18, 2012). Archived by WebCite® at http://www.webcitation.org/6AlzwXrKO.
- GAVI Alliance. Rubella vaccine support: GAVI's response. http://www.gavialliance.org/support/nvs/rubella/ (accessed on August 24, 2012). Archived by WebCite® at http://www.webcitation.org/6AACvZfOn.
- GAVI Alliance. What we do. http://www.gavialliance.org/about/mission/what/ (accessed June 6, 2012). Archived by WebCite® at http://www.webcitation.org/68Dq5gNds.
- GAVI Alliance. Yellow fever vaccine support: GAVI's response. http://www.gavialliance.org/support/nvs/yellow-fever/ (accessed August 3, 2012). Archived by WebCite® at http://www.webcitation.org/69eNy6U1I.
- Gay, Andrea. Measles and Rubella Initiative representative. Email to GiveWell, May 24, 2012.
- Gay, Andrea. Measles and Rubella Initiative representative. Email to GiveWell, August 2, 2012.
- Gay, Andrea. Measles and Rubella Initiative representative. Email to GiveWell, August 9, 2012.
- Gay, Andrea, and Steve Cochi. Measles and Rubella Initiative representatives. Phone conversation with GiveWell, May 22, 2012.
- Global Polio Eradication Initiative. Annual report (2011) (PDF).
- Global Polio Eradication Initiative. Financial resource requirements (2012-2013, as of May 1, 2012) (PDF).
- Global Polio Eradication Initiative. Polio this week (May 30, 2012). http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx (accessed Juen 5, 2012). Archived at http://www.webcitation.org/68BCqpuy7.
- GiveWell. Gates Foundation polio grants (XLS).
- GiveWell. Summary of phone conversation with UNICEF regarding the Maternal and Neonatal Tetanus Elimination Initiative (June 22, 2012) (DOC).
- Measles and Rubella Initiative. Contributions and costs (2012-2015 as of April 11, 2012). We have not received permission to publish this document.
- Measles and Rubella Initiative. The strategy. http://measlesrubellainitiative.org/portal/site/mi/menuitem.49e657516233... (accessed August 7, 2012). Archived by WebCite® at http://www.webcitation.org/69k3ZR8Zz.
- Meningitis Vaccine Project. Funding. http://www.meningvax.org/funding.php (accessed on August 6, 2012). Archived by WebCite® at http://www.webcitation.org/69j0ER91e.
- Meningitis Vaccine Project. Vaccine introduction strategy. http://www.meningvax.org/vaccine-introduction.php (accessed August 6, 2012). Archived by WebCite® at http://www.webcitation.org/69izc7SjH.
- UNICEF. Annual report (2010) (PDF).
- UNICEF. DTP prices (2001-2011) (PDF).
- UNICEF. DTP-HepB-Hib prices (2001-2011) (PDF).
- UNICEF. PCV prices (2010-2011) (PDF).
- UNICEF. Immunization summary (data through 2010) (PDF).
- Vandelaer, Jos. UNICEF Chief of Immunization. Phone conversation with GiveWell, May 25, 2012.
- World Health Organization. Global immunization work 2012-13 (January 2012) (PDF).
- World Health Organization. Immunization, vaccines and biologicals: About us. http://www.who.int/immunization/aboutus/en/ (accessed August 6, 2012). Archived by WebCite® at http://www.webcitation.org/69jFP8ZQx.
- World Health Organization. Maternal and neonatal tetanus (MNT) elimination. http://www.who.int/immunization_monitoring/diseases/MNTE_initiative/en/i... (accessed June 6, 2012). Archived by WebCite® at http://www.webcitation.org/68Dr39XAu.
Globally in 2010, UNICEF estimates that 85% of children received 3 doses of DTP vaccine (a common indicator of "vaccination coverage"). In the World Health Organization's African and South East Asian regions, the figure was 77%. UNICEF, "Immunization Summary (Data through 2010)," Pg xiii.
"Routine immunization with traditional vaccines is largely paid for by national governments, including both purchasing vaccines and running the cold chain and logistics. With support from partners, it still largely functions in the way it was set up in the 1980s. The traditional vaccines are procured through UNICEF (which purchases more than half of all vaccines doses globally, allowing it to negotiate lower prices), or directly by governments, and delivered by government health staff." Jos Vandelaer, phone conversation with GiveWell, May 25, 2012.
"These vaccines are inexpensive; they cost about $0.10 to $0.25 per dose." Jos Vandelaer, phone conversation with GiveWell, May 25, 2012.
According to Jos Vandelaer, UNICEF believes that a larger effort is needed to raise immunizations rates further and is beginning to explore with countries how it can help them reach the hard-to-reach. It sees three main areas in which it could contribute going forward:
- Support logistics: Setting up systems to improve supply management (reduce stock outs) and track spoilage of vaccines. UNICEF has traditionally worked on this in-country.
- Social mobilization: UNICEF works to encourage people to access vaccines currently, but Dr. Vandelaer thinks that more is needed.
- Better data on the unimmunized: In-depth analysis to determine why pockets of children aren't being vaccinated in order to inform program planning so that unvaccinated children can specifically be targeted.
It could also contribute by:
- Market shaping: Obtaining vaccines at reduced prices while ensuring a stable and healthy market.
- Advocacy: Convincing governments to devote more resources to vaccination.
UNICEF has historically been involved in the areas above, but now thinks that it needs to focus more directly on scaling up its efforts and fundraising to focus on the above.
Jos Vandelaer, phone conversation with GiveWell, May 25, 2012.
"The approximately 20% of children who are not vaccinated tend to also lack access to other services and are therefore more likely to get diseases (e.g., due to poor nutrition or lack of water and sanitation) and more likely to die if they get sick (due to lack of access to healthcare).
Funding is mainly needed in areas such as improving outreach, upgrading and modernizing the cold chain and the supply system, and social mobilization. While in most instances governments pay for the 'traditional' vaccines (BCG, Polio, DTP, Measles), most of the funding for new vaccines (Hepatitis B, Haemophilus Influenzae B, pneumococcal, rotavirus etc) in the poorer countries is provided by the international community through the GAVI Alliance, with recipient governments paying a small part...
UNICEF has historically been involved in the areas above [see previous footnote], but now thinks that it needs to focus more directly on scaling up its efforts and fundraising to focus on the above.
Initially, UNICEF will focus this 'scale up' in 13 priority countries, where many of the unimmunized children live, including Uganda, Chad, and DRC. Once plans are finalized, there will be a process to determine if the government or existing funders can fund the additional activities. If there is still a gap, which is likely, additional funders will be sought." Jos Vandelaer, phone conversation with GiveWell, May 25, 2012.
For example, the DTP vaccine cost between $0.14 and $0.42 per dose in 2011, while the "pentavalent" vaccine, which contains DTP plus Hepatitis B and Hib vaccines, cost between $1.75 and $3.20 per dose in 2011. The pneumococcal vaccine cost $3.50 per dose in 2011.
UNICEF, "DTP Prices (2001-2011)."
UNICEF, "DTP-HepB-Hib Prices (2001-2011)."
UNICEF, "PCV Prices (2010-2011)."
- "Thanks to GAVI's new and underused vaccine support (NVS), many other low-income countries quickly introduced the vaccine, spurring a spectacular acceleration of hepB immunisation coverage." GAVI Alliance, "Hepatitis B Vaccine Support."
- "In the pre-vaccine era Haemophilus influenzae type b (Hib) was the leading cause of childhood meningitis - inflammation of the membranes covering the brain and spinal cord. Many survivors suffer paralysis, deafness, mental retardation and learning disabilities. Even today, almost 20 years since safe and effective Hib conjugate vaccines were first licensed in the early 1990s, Hib remains the second most common cause of bacterial pneumonia deaths in children aged under five and the third vaccine-preventable cause of death in children aged under five." GAVI Alliance, "Haemophilus influenzae Type B Vaccine Support: The Issue."
- "Streptococcus pneumoniae, commonly known as pneumococcal disease, is the leading cause of pneumonia – the world’s number one killer of under fives." GAVI Alliance, "Pneumococcal Vaccine Support: The Issue."
- "Diarrhoea is one of the leading child killers in the world - an estimated 751,000 children die from diarrhoeal diseases each year, accounting for 11% of under five deaths in GAVI-eligible countries. Rotavirus is the leading cause of severe childhood diarrhoea in both developed and developing countries and results in more than 450,000 deaths each year." GAVI Alliance, "Rotavirus Vaccine Support."
Total program expenses (2010): $910 million
New and underused vaccines programme disbursements (2010): $506 million
Health system strengthening program disbursements (2010): $78 million
Funding for "activities related to Alliance programmes undertaken by Alliance partners UNICEF, WHO, the World Bank, the Program for Appropriate Technology in Health (“PATH”) and Johns Hopkins University" (2010): $66 million
GAVI Alliance, "Annual Financial Report (2010)," Pgs 11-12.
"GAVI currently offers the following portfolio of programme support:
- vaccines against: pneumococcal, rotavirus, Haemophilus influenzae type b (Hib), hepatitis B (hepB), yellow fever, measles second dose and meningitis A. GAVI also supports pentavalent vaccine, which offers protection from diphtheria, tetanus, pertussis (DTP), hepB and Hib;
- vaccine stockpiles of meningitis A and yellow fever vaccine;
- health system strengthening support: cash payments to strengthen the capacity of a country's health system to deliver immunisation services;
- civil society organisation (CSO) support: in many countries, CSOs are the backbone of the health system, delivering up to 60% of immunisation services, especially to remote and vulnerable populations;
- injection safety support: three-year funding to national immunisation programmes for autodisable syringes, safety boxes for syringe disposal and activities to support widespread safe injection practices;
- immunisation services support: aims to increase basic immunisation coverage by offering countries US$ 20 for each additional child vaccinated with three doses of diphtheria, tetanus and pertussis (DTP3). DTP3 is the standard measure of the strength of routine immunisation programmes.
GAVI Alliance, "What We Do."
"GAVI Alliance which distributes the funds raised by IFFIm…
Of the US$ 912 million being given to countries in 2007: …
- US$ 181 million is being spent on securing supply of the combination 5-in-1 pentavalent vaccine. This pentavalent vaccine immunises children against five diseases: diptheria, pertussis, tetanus, hepatitis B and Haemophilus influenzae type b (Hib), a cause of severe infections including meningitis and pneumonia. With additional supply of this vaccine, the number of countries applying for GAVI support for Hib vaccine has almost doubled in a year to 44.
- US$ 139 million is for strengthening measles campaigns. IFFIm's funding represents about 80% of the total amount of external funding for measles available to high-burden countries in 2007, amounting to life-saving measles immunisation for 194 million children in 32 countries.
- US$ 191.3 million of the funds are being fast-tracked into pre-existing polio eradication efforts and vaccine stockpiles. In June 2007, IFFIm provided US$ 105 million for intensified polio eradication activities, helping to immunise more than 100 million children under the age of five, averting a set-back to a 20-year effort to eradicate the disease…
- US$ 51.4 million to support campaigns against maternal and neonatal tetanus (MNT). There is a projected doubling, to 26 million, in the number of women targeted with tetanus vaccine in 2007 and early 2008. IFFIm is providing 90% of funding resources for the 2007 MNT global elimination campaign."
"First Year Results - IFFIm Provides US$ 1 Billion to Prevent Disease."
"GAVI’s funding includes three components:
- the introduction of MenAfriVac for both catch-up and routine immunisation;
- epidemic response, including the stockpile of vaccines;
- other activities such as capacity building, surveillance, and impact assessment.
- GAVI will provide US$ 0.30 per capita for the target population to cover operational costs of catch-up campaigns -- equivalent to approximately 50% of the total cost. The support is provided in cash through WHO and UNICEF;
- Countries are expected to meet the remaining half of the operational expenses, although no co-financing of the vaccine is required for campaign support."
GAVI Alliance, "Meningitis A Vaccine Support: GAVI's Response."
"Countries at risk can apply for GAVI support for preventive campaigns, which can significantly reduce the risk of yellow fever disease and the occurrence of epidemics." GAVI Alliance, "Yellow Fever Vaccine Support: GAVI's Response."
"GAVI anticipates introducing MR [measles-rubella] vaccine into 30 countries by the end of 2015 and by 2018 we expect to support at least a further 20 developing countries." GAVI Alliance, "Rubella Vaccine Support: GAVI's Response."
"Donors committed US$ 4.3 billion at the first pledging conference held by the GAVI Alliance. This exceeded an initial target of US$ 3.7 billion." GAVI Alliance, "Pledging Conference (June 2011)."
"GiveWell: It sounds like funding is not a constraint to expanding immunization coverage in the next couple of years.
GAVI: Given what we have said about ensuring delivery of pledges, our forward planning and forecasting, in terms of being able to make commitments to countries, we do not expect funding to be a critical issue through 2013. Our need for new resources – above those already pledged – arises in 2014 when we must secure new money for the 2016-2020 period."
David Ferreira and Alex Palacios, phone conversation with GiveWell, February 2, 2012.
GAVI Alliance, "Donor Profiles."
"The pledges bring GAVI’s total available resources for the period 2011 to 2015 to US$ 7.6 billion." GAVI Alliance, "Pledging Conference (June 2011)."
World Health Organization, "Immunization, Vaccines and Biologicals: About Us."
World Health Organization, "WHO Global Immunization Work 2012-13 (January 2012)."
Kate Elder, phone conversation with GiveWell, July 13, 2012.
Kate Elder, phone conversation with GiveWell, July 13, 2012.
"MSF creates its operational budgets based on operational needs and priorities. The operations/finance team then checks with the fundraising departments internationally that funding can be raised to meet the goals outlined. So far the goals have been achievable. 90% of the funds raised are unrestricted, so what that means is that funds are directed to priority medical projects first and foremost, not to specific project envelopes (such as vaccinations)…
We can and will accept restricted funds for vaccinations, but a restricted gift for this project may not mean that we do 'more.' Our vaccination budget is huge, tens of millions of dollars every year. So, unless we were awarded an extraordinarily large grant (we are talking something like $50 million+ here) for a specific purpose like vaccines, we would not necessarily do 'more.' Even then we would have to determine if we have the human resources or medical tools available to do more than we already are doing."
Jennifer Tierney, email to GiveWell, September 6, 2012.
"The Measles & Rubella Initiative supports mass vaccination campaigns as an effective strategy to ensuring nationwide coverage and reaching the un-immunized.
A measles vaccination campaign (also referred to as 'Supplementary Immunization Activity' or SIA in countries) refers to the process of vaccinating all children in a defined age range in a short period of time, often in just a few days or weeks. Campaigns are usually countrywide but may take place in multiple phases." Measles and Rubella Initiative, "The Strategy."
GAVI Alliance, "Review of Board Decisions (June 2012)."
Expected GAVI contributions in GAVI Alliance, "Options for Enhancing GAVI’s Investment in Measles Prevention (Presentation)," Pg 7. Contributions for 2012-2015 for measles campaigns: $105 million; contributions for outbreak response for 2012-2015: $35 million.
Measles and Rubella Initiative funding gap from Measles and Rubella Initiative, "Financial Resource Requirements (2012-2015)." Funding gap for 2012-2015 excluding outbreak response: $72.4 million; budget for outbreak response for 2012-2015: $40 million ($35 million per year if the first half of 2012 is excluded).
Note that the GAVI funding for outbreak response will go to the Measles and Rubella Initiative, while the additional funding for measles campaigns will flow directly to implementing governments, rather than through the Measles and Rubella Initiative. However, these funds will cover costs that the Measles and Rubella Initiative planned to fund, and therefore, they reduce the Measles and Rubella Initiative's funding gap. From GAVI Alliance, "Options for Enhancing GAVI’s Investment in Measles Prevention (Report)," Pgs 2-3 and 9:The Secretariat recommends that support for outbreaks be provided through a grant to the MR Initiative directly...
With regard to providing support for planned campaigns, three options are proposed, as summarized below...Option 2: Utilize GAVI's application and review processes. For those country applications approved by the Board, funds for vaccines would flow to UNICEF Supply Division and funds for operational costs would flow to countries, or WHO and/or UNICEF (if requested by the countries)... The Secretariat proposes that option 2 be used to support planned campaigns...
A decision by the Board to fund additional measles activities will offset much but may not offset all of the MR Initiative's shortfall. In addition, there is a risk that GAVI support could lead current MR Initiative donors to discontinue support. In order to mitigate against this, donors and other board members could consider continuing contributing directly to the MR Initiative, or advocating on behalf of the MR Initiative, to ensure current donors don't decrease support for the remaining parts of its shortfall.
Andrea Gay, email to GiveWell, August 2, 2012.
"We also will have received almost $15M from Lions." Andrea Gay, email to GiveWell, August 9, 2012.
Measles and Rubella Initiative, "Contributions and Costs (2012-2015 as of April 11, 2012)."
"The board opened a new window for support for the Measles-Rubella (MR) vaccine, and we are working with the (recently renamed) Measles Rubella Initiative to produce strategies to reach children with the combined vaccine through campaigns in countries that introduce MR into their routine immunization programmes." GAVI Alliance, "CEO Report to Board (June 2012)."
As of early 2012, the Measles and Rubella Initiative projected a budget of $677 million for 2013-2015. In this budget, the Measles and Rubella Initiative projected $335 million in revenues from GAVI for combined measles and rubella vaccination campaigns. Measles and Rubella Initiative, "Contributions and Costs (2012-2015 as of April 11, 2012)."
In June 2012, GAVI estimated that it would contribute an additional $134 million in 2013-2015 to measles campaigns and outbreak response. GAVI Alliance, "Options for Enhancing GAVI’s Investment in Measles Prevention," Pg 7.
Andrea Gay, email to GiveWell, August 9, 2012.
"The Maternal and Neonatal Tetanus Elimination Initiative was launched by UNICEF, WHO and UNFPA in 1999, revitalizing the goal of MNT elimination as a public health problem." World Health Organization, "Maternal and Neonatal Tetanus (MNT) Elimination."
"The program targets women of childbearing age to protect both them and their future newborns. If women are adequately vaccinated during pregnancy, their newborns are protected for 2 months after birth, after which children should receive additional tetanus immunizations through the routine immunization system... The MNT Elimination Initiative supports vaccination campaigns in which government takes lead and government health workers vaccinate all women of childbearing age (usually 15- 45 years old) in targeted high-risk areas. Campaigns consist of three rounds. A single dose of tetanus vaccine is ineffective." GiveWell, "Summary of Phone Conversation with UNICEF Regarding the Maternal and Neonatal Tetanus Elimination Initiative (June 22, 2012)."
"UNICEF leads the MNT elimination effort at the global level. Governments are the main implementers of the program. UNICEF provides funding for vaccine procurement, technical support, assistance with planning, and monitoring/supervision of the program." GiveWell, "Summary of Phone Conversation with UNICEF Regarding the Maternal and Neonatal Tetanus Elimination Initiative (June 22, 2012)."
"The program has raised more than $200 million over the past 10 years. The main funders to date have been GAVI, Bill and Melinda Gates Foundation, UNICEF Natcoms, Proctor and Gamble, Becton, Dickenson and Company, and, more recently, Kiwanis International. UNICEF seeks to raise an additional $100 million by mid-2014 in order to reach elimination by the target date of 2015...
Current and potential funders include:
- Kiwanis International. It has started an initiative called "The Eliminate Project."
- Proctor and Gamble donates a set amount of money for each pack of Pampers sold.
- The U.S. Fund for UNICEF
- Bill and Melinda Gates Foundation"
GiveWell, "Summary of Phone Conversation with UNICEF Regarding the Maternal and Neonatal Tetanus Elimination Initiative (June 22, 2012)."
"GAVI has budgeted US$370.4 million to help rid the 'meningitis belt' of meningitis A. For its 2011-2015 programme, GAVI plans to support immunisation all 25 countries in the region." GAVI Alliance, "Meningitis A Vaccine Support."
"The remainder of the US$571 million budget to eliminate group A meningitis in Africa will come mostly from the countries themselves." GAVI Alliance, "Meningitis A Vaccine Support."
"Mass immunization campaigns: Comprehensive mass immunization campaigns of 1- to 29-year olds with a single dose of MenAfriVac™ are a cornerstone of the meningococcal A conjugate vaccine introduction plan...
Protection of birth cohorts: After mass vaccination campaigns have been conducted among 1- to 29-year olds, the main challenge will be protecting birth cohorts throughout infancy. The strategy used will depend on the results obtained in the infant study currently taking place in Ghana and on Expanded Programme on Immunization (EPI) coverage rates in the involved countries.
- In countries where EPI coverage is high (>80% DTP3), MenAfriVac™ could be integrated into the existing EPI calendar. Two schedules are being evaluated: a single dose during the second year of life or two doses at 14 weeks and 9 or 12 months of age (concomitantly with measles or yellow fever).
- In countries where EPI coverage is low (<60% DTP3), follow-up single-dose campaigns targeting children aged 1 to 4 years could be organized every 5 years."
Meningitis Vaccine Project, "Vaccine Introduction Strategy."
Meningitis Vaccine Project, "Funding."
"In 2011, there were 650 cases of polio worldwide." Global Polio Eradication Initiative, "Polio This Week (May 30, 2012)."
"Compounding this emergency is a 50% gap in financing needed to fully carry out the necessary activities in 2012−2013 (as of April 2012). In the first quarter of 2012, this has already dictated the scale-back of activities in 24 countries in Asia and Africa, increasing the risk of unchecked spread if poliovirus from endemic areas enters these countries." Global Polio Eradication Initiative, "Annual Report (2011)," Pg 4.
Note that the budget does not specify which activities will be cut if the funding gap is not filled. Global Polio Eradication Initiative, "Financial Resource Requirements (2012-2013, as of May 1, 2012)."
Gates Foundation, "Grant Search." Data recorded in GiveWell, "Gates Foundation Polio Grants."
Three of the Gates Foundation's ten largest grants over its history have gone to fight polio (same source, sorted by amount).
"Ending polio is one of my top personal priorities and a big focus of our foundation’s work in global health." Gates Notes, "Creating a Polio-Free World Requires Action Now."
"2011 was a year of unprecedented political and financial support, despite a bleak beginning marked by a US$ 335 million funding gap in January against a US$ 982 million budget. The gap had been reduced to US$ 125 million at the start of the fourth quarter when, by a combination of new and forward funding targeted particularly at west, central and east Africa, the total of contributions for 2011 suddenly rose to over US$ 1.1 billion, the largest amount ever received by the GPEI." GPEI, "Annual Report (2011)," Pg 35.
Global Polio Eradication Initiative, "Annual Report (2011)," Pg 36.