Gavi, The Vaccine Alliance
Saving children’s lives and protecting people’s health by increasing equitable use of vaccines.
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- Vaccines: Help countries prioritize, introduce, and expand vaccinations appropriate for their context while improving outbreak response.
- Health systems: Ensure immunization services are well-managed, sustainable, innovative, and caregiver-friendly to reach under-immunized children and address gender-related immunization barriers.
- Sustainability: Increase national and subnational immunization public resource commitment and engage self-financing countries to maintain or improve immunization performance.
- Market shaping: Encourage innovation while safeguarding affordable, sustainable vaccine and immunization market dynamics.
Created in 2000, Gavi is the global vaccine alliance, bringing together public and private sectors with the shared goal of creating equal access to new and underused vaccines for children living in the world’s poorest countries. By forming strategic alliances with business and industry leaders, Gavi leverages the private sector’s financial resources, operational expertise, thought leadership, and innovation to advance vaccine coverage and equity goals.
Gavi’s five-year (2021-2025) strategy (‘Gavi 5.0’) envisions to ‘leave no-one behind with immunization’ and aims to save lives and protect people’s health by increasing equitable and sustainable use of vaccines.
Countries qualify for Gavi aid if their average GNI per capita over the past three years has been less than or equal to US$ 1,630 (according to World Bank data published in July each year). Once a country surpasses the eligibility criteria, Gavi scales down its financial support. Independent specialists in routine immunization, health system strengthening, epidemiology and disease control, cold chain and logistics, financial and budget analysis, and gender and equity analyze all applications. In 2020, 57 countries met Gavi’s vaccination support eligibility.
Key support areas for Gavi-eligible countries include:
- Health system and immunization strengthening – Strong health and immunization systems are vital to delivering vaccines to all the children who need them.
- Support vaccination campaigns against 17 infectious diseases – Cholera, COVID-19, Diphtheria, Ebola, Haemophilus influenza type b (DTP-hepB-Hib), Hepatitis B, HPV, Japanese Encephalitis, Measles and Rubella, Meningitis A, Pertussis, Pneumococcus, Polio, Rotavirus, Tetanus, Typhoid, and Yellow Fever.
- Sustainable immunization – Gavi support aims to ensure that countries can independently sustain high immunization coverage and equal access to life-saving vaccines.
- Civil society organization support – Civil society organizations play a crucial role in strengthening health systems and delivering immunization services in some of the world’s poorest regions.
Gavi is co-leading COVAX, the vaccines pillar of the Access to COVID-19 Tools (ACT) Accelerator. COVAX aims to speed up the development and manufacture of COVID-19 vaccines and ensure fair access for every country.
Pharmaceutical companies have shown continued commitment to supplying Gavi-supported nations with an appropriate provision of relevant vaccines. In 2020, the industry pledged to continue its 20-year partnership with Gavi, including:
- GSK activities: GSK is the leading vaccines company – they deliver over two million vaccine doses per day and more than 945 million vaccine doses since 2010 to people living in 158 countries. More than 70% of their vaccines are distributed to developing countries, including low- middle-income countries.
- GSK is the largest supplier of vaccines to UNICEF which purchases vaccines on behalf of Gavi.
- GSK is the only company supplying three vaccines (pneumococcal, rotavirus, and cervical cancer vaccines) at reduced prices to Gavi.
- They have committed to deliver 720 million doses of their pneumococcal vaccine, Synflorix, to Gavi through the Advance Market Commitment (AMC) at a discounted price up to 2024. In 2018, they delivered over 120 million doses of vaccines to Gavi. Eight Gavi countries are now using their new four-dose vial presentation of the Synflorix pneumococcal vaccine, designed to reduce cold chain challenges in countries.
- Their Rotarix vaccine is available in 36 Gavi countries to protect against rotavirus. In 2018, they distributed around two million doses of the vaccine Cervarix in Zimbabwe in support of its multi-age cohort vaccination program to protect over 800,000 girls against human papillomavirus and have also supported Gavi pilots of our Cervarix vaccine for human papillomavirus (HPV) in 12 countries since 2012.
- GSK is also the only company that has committed to a ten-year price freeze to support countries transitioning from Gavi financing. GSK is also developing candidate vaccines for diseases that are future Gavi targets, including malaria and TB.
- Additionally, in December 2021 and following the WHO’s recommendation for wider routine use of the GSK’s RTS,S/AS01 malaria vaccine in October 2021, the Gavi Board approved an initial investment of US$ 155.7 million to support the rollout of a malaria vaccination campaign in Kenya, Ghana and Malawi for the 2022–2025 period. The project is further supported by a US$ 56 million investment through an agreement with GSK and innovative financing partner MedAccess.
- Johnson & Johnson activities: Johnson & Johnson (J&J) supplied the first internationally-available, fully liquid pentavalent vaccine, Quinvaxem™, protecting children against five diseases (DTP-HepB-Hib) in one single shot. Over 270 million doses were distributed to Gavi-eligible countries.
- In September 2020, Johnson & Johnson, along with 15 life science companies and the Bill & Melinda Gates Foundation, signed a joint communique outlining their commitment to equitable global access to the innovations being developed to fight the COVID-19 pandemic.
- In May 2021, J&J entered into an agreement with Gavi, the Vaccine Alliance, with the goal of supplying 200 million doses of their single-shot COVID-19 to the COVAX Facility. Through these collaborations, J&J has worked tirelessly toward ending the COVID-19 pandemic globally.
- Johnson & Johnson is also a leader in Ebola-prevention efforts and has developed a preventive vaccine regimen, Zabdeno® (Ad26.ZEBOV) and Mvabea® (MVA-BN-Filo), that was approved by the European Commission in July 2020 and granted World Health Organization Prequalification in April 2021. J&J is actively working with Ebola-impacted countries to support their prevention strategies by providing access to their vaccine and developing local capacity for broad vaccination campaigns. In collaboration with global partners including WHO, Gavi, UNICEF, J&J aims to further expand access for countries to its vaccine through the global emergency stockpile.
- MSD activities: MSD offers GARDASIL® [Human Papillomavirus Quadrivalent (Types 6, 11, 16 and 18) Vaccine, Recombinant] at an access price that is significantly less than the value-based price in other countries. The access price is exclusive to the public sectors of the countries eligible for support from Gavi.
- In 2015, MSD extended current Gavi prices for GARDASIL through 2025 to Gavi-graduated countries with a per-capita gross national income (GNI) not exceeding US $3,200. This action greatly assists Gavi-transitioned countries by facilitating access to these vaccines in those countries, while also making sure they remain affordable and sustainable in the long term. In the short period of time since MSD made the price commitment to countries transitioning out of Gavi support, six countries have taken advantage of the offer to introduce or continue existing national HPV vaccination programs.
- MSD is working actively with Gavi, UNICEF, and WHO on an arrangement for supplying ERVEBO (Ebola Zaire Vaccine, Live) to help establish and build the world’s first global stockpile of Ebola virus vaccine. The company also remains actively engaged with Gavi on policy efforts to improve access to vaccines in Gavi-transitioned countries. MSD believes that this pricing approach contributes to broader access to the vaccines while taking into account the need to continue investing in vaccine research, development, and production.
- More than 56 million doses of two of these vaccines—GARDASIL and ROTATEQ® (Rotavirus Vaccine, Live, Oral, Pentavalent)—have been distributed in Gavi-eligible countries through 2019. This represents important progress toward ensuring that these vaccines reach people in low-income settings with a high burden of disease.
- Pfizer activities: In March 2010, Pfizer entered into the first of four 10-year supply agreements under the terms of the AMC to supply 300M doses of PCV 13 for pneumococcal disease (PD).
- Subsequently, Pfizer entered into three additional agreements with the AMC expanding its commitment with an additional 630 million doses, for a total commitment of 930 million doses of the first 13 valent pneumococcal conjugate vaccine until 2027. The AMC is a public-private health funding program designed to create a sustainable marketplace, ensure an affordable and stable supply of pneumococcal vaccines at a steeply discounted price, and stimulate the development and expansion of manufacturing capacity for vaccines specifically for the world’s poorest countries.
- Pfizer was proud to introduce its vaccine into the childhood immunization program of a developing country within one year of its launch in the United States and European Union — a historic precedent given the average 10-15 year lag for introducing newer vaccines into developing countries following their introduction in industrialized nations. As of December 2018, Prevenar 13 is now available in 50 Gavi eligible countries. Nicaragua, the first Gavi country to launch a PCV vaccine, has demonstrated a reduction of infant mortality by 33% just two years after launch.
- Pfizer is proud to be a continued partner in the Gavi Alliance and to contribute to the reduction of infant mortality from pneumococcal disease. Pfizer has pledged to supply up to 930 million vaccine doses to infants and young children in Gavi-eligible countries through 2027.
- Pfizer is a partner to COVAX, and In 2021, Pfizer/BioNTech shipped more than 250 million COVID-19 doses to more than 100 countries and territories.
- Sanofi activities: Sanofi Pasteur is a longstanding partner of Gavi in the supply of several
- Most recently, in light of Gavi decisions to support implementation of inactivated polio vaccine (IPV) in routine immunization as part of the eradication goal, this partnership has expanded further via the supply of unparalleled quantities of IPV.
- Collaboration to enable widespread adoption of the vaccine across 73 of the world’s poorest countries has been done hand-in-hand with the Global Polio Eradication Initiative (GPEI) – another key public-private partnership spearheaded by WHO. In 2020, Sanofi supplied 66 million polio vaccine doses to UNICEF for GAVI-eligible countries, enabling around 66 million children to be fully vaccinated.
- Sanofi Pasteur is a leading supplier of Yellow Fever vaccines, a key component of EPI in many African countries, with a huge potential to end outbreaks threatening global health security through one dose providing protection for life. Sanofi is a partner in the EYE (Eliminate Yellow fever Epidemics) supported by Gavi, delivering 27.5 million vaccine doses to Africa in 2018.
- Sanofi also supports global stockpiling for emergency response to outbreaks though the Gavi-funded International Coordination Group (ICG). Shantha biologics – a Sanofi company – supplies a well adapted fully liquid ready-to-use oral vaccine against cholera, recognized as an important tool in the control of this disease, which is estimated to kill up to 100,000 people every year, around half of whom are in Africa. Shantha’s pentavalent pediatric combination vaccine (DTP-HepB-Hib) is added to the list of pre-qualified vaccines that comprise the pillars of routine immunization and are introduced in every Gavi country.
- Looking to the future, Sanofi has engaged in discussions supporting Gavi’s new Vaccine Investment Strategy, sharing insights around more programmatically efficient combination vaccines as part of the partnership’s commitment to innovation in improving access to vaccination.
- Sanofi, together with GSK, signed a Statement of Intent to provide 200 million doses of the companies’ adjuvanted recombinant protein COVID-19 vaccine to the COVAX Facility.
- Takeda activities: Takeda as part of the worldwide polio eradication strategy, will produce at least 50 million polio doses per year to supply to more than 70 LMICs. For this vaccine, Takeda has committed to a ceiling price for Gavi-eligible countries and intends to extend Gavi-level prices to Gavi transitioning countries for several years post-transition.
Results and milestones
Just over 20 years after it was created in a small basement room of a UNICEF building in Geneva, GAVI has become a global health pioneer in delivering vaccinations to children in the world’s poorest economies with its unique public-private partnership model.
- Strengthen countries’ prioritization of vaccines appropriate to their context
- Support countries to introduce and scale up coverage of vaccines for prevention of endemic and epidemic diseases
- Enhance outbreak response through availability and strategic allocation of vaccine stockpiles
Between 2000-2020 Gavi, together with its partners, helped:
- Vaccinate 888 million children through routine programs
- HPV – 7.1 million
- Pneumococcus – 225 million
- Polio – 224 million
- Pentavalent (DTP-HepB-Hib) – 569 million
- Rotavirus – 159 million
- Yellow fever – 129 million
- Administer 1.19 billion vaccinations through vaccination campaigns
- Prevent 15 million future deaths
- Avert 700 million future DALYs (Disability-adjusted life years)
- Deliver 521 vaccine introductions and campaigns in LMICs
- All transitioned countries continued to provide all the recommended routine vaccination programs since 2016.
Together with COVAX, GAVI supported the shipment of 1.5 billion COVID-19 vaccines to 144 countries and territories.
Health system milestones
- Help countries extend immunization services to regularly reach under-immunized and zero-dose children to build a stronger primary health care platform
- Support countries to ensure immunization services are well-managed, sustainable, harness innovation, and meet the needs of caregivers
- Work with countries and communities to build resilient demand, and to identify and address gender related barriers to immunization
Despite COVID-19 setbacks, Gavi aided in increasing the effectiveness and efficiency of immunization delivery:
- Before the COVID-19 pandemic, countries increased coverage with the first dose of the pentavalent vaccine while decreasing the number of zero-dose children by 14% between 2015 and 2019.
- Gavi disbursed a record US$ 383 million in health system support in 2020, bringing the total grant amount for the 2016-2020 strategic period to US$ 1.42 billion.
- 54,000 units of cold chain equipment were purchased between 2017 and 2020, with over 14,000 in 2020 alone.
- Strengthen national and subnational political and social commitment to immunization
- Promote domestic public resources for immunization and primary health care to improve allocative efficiency
- Prepare and engage self-financing countries to maintain or increase performance
Gavi strengthened the viability of national immunization programs:
- All countries, excluding nine who received a COVID-19 waiver, paid their 2020 co-financing obligations on time
- Countries co-financed Gavi-supported vaccines with US$129,4 million
- Since the policy’s introduction, governments have contributed US$1.2 billion in co-financing
- Gavi-supported countries self-funded 49 vaccine programs, up from 47 in 2019
- In 2019, 65% of nations raised regular immunization per child spending compared to 2015
Market shaping milestones
- Ensure sustainable, healthy market dynamics for vaccines and immunization-related products at affordable prices
- Incentivize innovation for the development of suitable vaccines
- Scale up innovative immunization-related products.
Gavi was involved in shaping markets for vaccines and other immunization products:
- In 2020, the price to fully immunize a kid with pentavalent, pneumococcal, and rotavirus vaccines has dropped 24% since 2015.
- In 2020, 10 out of 11 vaccinations on the markets have an uninterrupted supply, up from 8 in 2019.
- In 2020, 50 vaccine product presentations were available, up 100% from 2015.
- Manufacturing bases have expanded from 5 to 18 since 2001 – with more than half based in Africa, Asia, and Latin America.
- Global Commitment
- Non-communicable Diseases
- Women’s and Child Health
- Infectious and Parasitic Disease
- Marginalized/indigenous people
- People with low incomes
- Rural populations
SGDs the partnership contributes to
- 3.8: Achieve universal health coverage
- 3.C: Health workforce
Ministry of Health Russia
Ministry of Health South Africa
Ministry of Health Uganda
Republic of Korea
Ministry of Health Brazil
Royal Government of Bhutan
Ministry of Health Burkina Faso
Ministry of Health Cameroon
Ministry of Health Chad
Kingdom of Saudi Arabia
Sovereign Military Order of Malta
Ministry of Health Malaysia
Ministry of Health Niger
Centers for Disease Control and Prevention (CDC)
Philippines Department of Health
Chengdu Institute of Biological Products
Gavi, The Vaccine Alliance
Aga Khan University
International Vaccine Institute
Johns Hopkins Bloomberg School of Public Health
Norwegian Institute of Public Health
Pharma (non-IFPMA member)
Biological E Limited (BioE)
Serum Institute of India
- Cervical Cancer
Women’s and Child Health
- Children's Health
Infectious and Parasitic Disease
- Hepatitis B
- Haemophilus influenzae type b (Hib)
- Human papillomavirus
- Meningococcal A, C, W, Y
- Japanese encephalitis
- Paratyphoid fever
- Pneumococcal Disease
- Yellow Fever