Child immunisation to avert 4 million deaths by 2015, says Gavi report

Global Alliance for Vaccines and Immunisation to achieve target of 243 million children immunised in four years. The Global Alliance for Vaccines and Immunisation (Gavi) says it is on track to enable developing countries to immunise an additional quarter of a billion children by 2015, but acknowledges that it needs to improve on equity.

Mark Tran

In its mid-term review, Gavi said in addition to reaching its goal of helping developing countries immunise 243 million children between 2011 and 2015, it was also on target to help avert nearly 4 million deaths during the same period.

Gavi, set up in 2000 to expand immunisation in poor countries, will assess its progress in Stockholm, Sweden, on Wednesday. Specifically, it will examine the extent to which it has met the goals established at the 2011 pledging conference, where donors committed $4.3bn (£2.7bn) to immunisation.

About 150 participants are expected to gather in the Swedish capital, including Gavi's partners (WHO, Unicef, the World Bank, the Bill & Melinda Gates Foundation), donors and potential donors, implementing countries, the private sector, civil society, members of parliament and vaccine manufacturers.

Since 2011, about 100 million additional children have been immunised, averting some 1.2 million deaths. Gavi says it will bolster its vaccination campaigns (48 this year) to meet its targets.

Immunisation has contributed to a big reduction in child mortality worldwide, from 12.6 million deaths of under-fives in 1990 to 6.6 million. However, many countries remain off-track to achieve a target of millennium development goal (MDG) 4 – a two-thirds reduction in child mortality rates by 2015.

In a midpoint report on Gavi's 2011-15 strategy, Save the Children said the alliance had some success in bridging the gap in coverage between rich and poor countries, for example by shortening the time lag between vaccine introductions in developed and developing countries and raising average immunisation in the latter.

But the charity pointed out that inequalities persisted between, and within, countries. In 2012, coverage was below 50% in Chad, Central African Republic, Equatorial Guinea, Nigeria, Somalia and Syria. Save the Children urged Gavi to develop a broader equity policy.

Dr Seth Berkley, chief executive of Gavi, said equity was a "core part of what we're trying to do". Specifically, the alliance has a target of ensuring that immunisation coverage for the poorest section of the population is no more than 20 percentage points lower than among the richest families.

Berkley said Unicef, one of Gavi's partners, was prioritising several countries with the largest inequities in coverage, including India, Pakistan, Vietnam and Yemen. "It will be working with local governments to enhance coverage," he said. "But the data systems aren't very good so you are trying to work with the best that you have."

Save the Children said it was important to see this work progress through implementation and monitoring and evaluation of the equity plans, as well as extending support to other countries.

In its review, Gavi reported progress in funding new vaccine campaigns. Since 2011, it has funded 67 introductions and campaigns. By 2014, all 73 Gavi-supported countries will have introduced five-in-one pentavalent vaccines, including Burma, Haiti, Somalia and South Sudan.

On prices, Gavi said it had helped to produce more predictability and competition in the vaccine market. This had led to a reduction in the cost of fully innoculating a child with three priority vaccines – pentavalent, pneumococcal and rotavirus – from $35 in 2010 to $23 in 2012.

With more vaccines being added to recommended immunisation schedules, the total cost of innoculating a child has risen from about $1.50 10 years ago for the prevention of six diseases to nearly $40 today for the prevention of 11. Save the Children said pharmaceutical companies must work harder to lower vaccine prices to affordable levels.

Gavi has secured total funding of $7.4bn for 2011-15, but has yet to begin planning for after 2015. "There is very little after 2015," Berkley admitted. "There are no donor commitments as we haven't asked them yet, but informally they're happy … we are confident we will get support." (http://www.theguardian.com/global-development/2013/oct/30/child-immunisation-avert-4-million-deaths-gavi-vaccines?CMP=twt_fd)