GAVI ALLIANCE: UPDATE AND FUTURE DIRECTIONS FOR GLOBAL VACCINES AND IMMUNISATIONS
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1 GAVI ALLIANCE: UPDATE AND FUTURE DIRECTIONS FOR GLOBAL VACCINES AND IMMUNISATIONS Ranjana Kumar International Rotavirus Symposium Istanbul, 3 4 June 2008
2 The GAVI Alliance Public-private partnership bringing together all the major stakeholders in immunization Launched in 2000 Mission: Save children s lives and protect people s health by increasing access to immunization in poor countries Vaccines and funding to strengthen immunization and health services to 70+ of the poorest countries 2
3 GAVI partners
4 GAVI support The GAVI Alliance provides support to countries with a Gross National Income (GNI) per capita below US$1,000 i.e. 72 eligible countries that can apply for: Immunisation services support (ISS); New and underused vaccines support: Hepatitis B vaccine / Haemophilus influenzae type b vaccine / Pneumococcal vaccine / Rotavirus vaccine / Yellow fever vaccine Combined vaccines with DTP: Pentavalent / Tetravalent Injection safety support (INS); and Health system strengthening (HSS) Civil society organisation support
5 Other GAVI Activities Non Country-Specific Programmes Measles o Five year global programme ( ) o Campaigns Tetanus o o Target 19 countries with tetanus toxoid vaccine campaigns Validate tetanus elimination in target countries
6 Cumulative number of eligible countries with approved proposals
7 Coverage of DTP3 Hepatitis B and Hib immunisation in GAVI-eligible countries Projections Source WHO Report on GAVI Progress & Projected Achievements , 15 November 2007
8 Co-financing Levels Poorest Group Intermediate Group Least Poor (starting level) ** Fragile Group First Vaccine $0.20 $0.30 $0.30 $0.10 Second Vaccine $0.15 $0.15 $0.15 $0.15 Third vaccine $0.15 $0.15 $0.15 $0.15 ** The «group of the least poor» will be requested to increase 15% annually 8
9 Other GAVI Activities New Vaccines Accelerated development and introduction plans (ADIPs) for Pneumococcal and Rotavirus o o Designed to address the significant challenges involved in making available new vaccines that are used primarily in developing countries. Rotavirus ADIP hosted at Path, Pneumococcal ADIP hosted at Johns Hopkins Bloomberg School of Public Health. Hib Initiative o o supported by a 4-year grant from GAVI/The Vaccine Fund aims to guide countries in making informed decisions regarding introduction or continuation of Hib vaccine programs in the context of other health priorities 9 9
10 Funds committed by January 2008 Injection safety; $ Health system strengthening incl CSO (from 2007); $ Immunisation services support; $ New vaccines; $
11 Results to date Health services Additional children reached Hepatitis B: 126 million Hib: 20 million Yellow fever: 17 million DTP3: 28 million Dramatic immunisation coverage increase DPT3: 63% in 1999 to 77% in % in 1999 to a 73% in 2006 in Africa Safe (auto-disable) syringes uptake 1.2 billion syringes
12 Innovative Financing IFFIm Commitments secured from 7 governments. (UK, France, Italy, Spain, Sweden, Norway, South Africa) Brazil underway Generate up to $4 billion in funding for GAVI Expected to help prevent five million child deaths between 2006 and 2015, and more than five million future adult deaths by protecting more than 500 million children in campaigns against measles, tetanus, and yellow fever To date, $927 million in Programmes have been approved for funding by IFFIm, of which $674 million have been distributed M&E Technical Advisory Group 22 May
13 Advance Market Commitment Launched in February 2007, first AMC is for next generation pneumoccocal vaccines Provides assurance of a future market with a guaranteed and credible resource envelope to pull the development of new products Stimulates competition & encourages lower prices USD 1.5 billion committed by Italy, UK, Canada, Norway, Russia, Bill & Melinda Gates Foundation Will prevent 5.4 million deaths by 2030
14 The vaccine pipeline HIV/AIDS Future Underutilized Vaccines Traditional EPI 3 million premature deaths from vaccine preventable diseases YF Pertussis Influenza Tetanus Polio JE Rubella Measles Cholera HepB Typhoid Hib (conj) Malaria Dengue Mening (conj) HPV Rotavirus Pneumo (conj) TB 7 million premature deaths from diseases for which vaccines not yet widely available Diphtheria // // Vaccine Development Pipeline Halos represent current deaths being averted, and solid circles represent deaths estimated to occur.
15 WHO Disease Prioritization (Nov. 2007) Consensus Assessment of Relative Importance (n=27) Malaria.160 Pneumococcal.102 Influenza (seasonal).076 Meningococcal ACWY.068 Cervical Cancer (HPV).066 Cholera.066 Rabies.066 Japanese Encephalitis.065 Yellow Fever.064 Rotavirus.055 Typhoid Fever.054 Dengue.043 Meningococcal B.031 Rubella.021 Varicella.017 Hepatitis A.016 Hepatitis E.016 Mumps Medium Priority High Priority Highest Priority
16 Initial Strategy Themes STRATEGY THEME Maximize Access to New & Underused Vaccines Focus on Infants Maximize Contribution to MDG 4 Reduce Overall Mortality Rollout New While Strengthening Underused OBJECTIVE Support all GAVI-relevant vaccines in the pipeline Provide complete flexibility and let countries decide which vaccines they want and when Minimize immunization program impact by focusing on diseases that can be added to existing EPI immunization schedule Maximise impact on MDG 4 (reducing < 5yo mortality) Select vaccines which have the highest under-5 mortality Maximise impact on overall mortality Prioritise high mortality or high mortality rate vaccine-preventable diseases Recognize country capacity constraints and avoid flooding countries with too many new vaccines Optimize roll-out of vaccines in the GAVI portfolio Focus on increasing coverage of existing underused vaccines (mumps, rabies, rubella) 16
17 Next steps Independent Review Committee May (Chair Prof. R. Black) to Presentation of recommended vaccine portfolio option(s) to GAVI Board June Over the summer timing and types of investments for each vaccine will be set Presentation of final strategy with budget implications to October Board In 2012, GAVI will carry out a new strategy to consider lessons learned and new vaccines that are in the pipeline for the next five years
18 Accelerated vaccine introduction project How can partners best provide additional support to countries for decision making and vaccine introduction? By building on the experience of the Hib Initiative and transitioning the activities of the PneumoADIP and the Rotavirus Vaccine Program to countries and partners WHO, UNICEF, the World Bank, and other partners will scale up support in their areas of expertise Strategic focus on key activities will be complemented by an integrated pneumococcal and rotavirus vaccine introduction programme similar to the existing Hib Initiative. Ongoing consultation to develop a costed proposal for the GAVI board in mid-2008.
19 Continued support Communications and Advocacy to increase the support and financing of new vaccines and to support global, regional and country level decision making Special Studies scientific and economic studies to support decision making and assess health impact Strategic Vaccine Supply--managing the strategic supply and demand dynamic
20 GAVI prospects and priorities A long-term vaccine investment strategy Roll out of current commitments, e.g. Rota/ pneumo until 2015 Ensuring effective implementation of scaled up resources Strengthened CSOs participation in GAVI policy-making and programme implementation Linking GAVI in with developments in international health architecture and in particular health systems work Maintaining GAVI s position as a leading innovative Global Health Partnership
21
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