Partnering with

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Tore Godal GAVI Executive Secretary Email tgod
al_at_unicef.org
Website www.vaccinealliance.org
Partnering with
14th GAVI Board Meeting 4-5 December 2004, Abuja,
Nigeria
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PRESENTATION OVERVIEW

• In the beginning . mission and goals
• What have we achieved?
• Programmatic impact
• Innovation problem-solving
• Where have realities not met expectations?
• Where have we surpassed expectations?

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IN THE BEGINNING
The mission "To save children's lives and
protect people's health through the widespread
use of vaccines."

• The goal to address three gaps
• The number of children who do not have access to
  any vaccines
  
• The number of vaccines used in the rich world
  compared to those provided in the poor countries
  
  
• Investment in research and development for those
  diseases that are prevalent in the poor
  countries, but for which no market exists in the
  industrialised world

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PROGRAMMATIC IMPACT COVERAGE IS RISING
DTP3 coverage rates, 1980-2003
Global
100
100
90
90
80
80
78
77
76
70
70
75
74
74
74
73
75
72
73
72
70
71
69
60
60
64
56
50
50
52
49
45
40
40
38
30
30
26
24
20
20
20
10
10
0
0
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
SOURCE WHO/UNICEF Estimates
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PROGRAMMATIC IMPACT COVERAGE IS RISING
DTP3 coverage in 2000
DTP3 coverage change
100
80
60
COVERAGE
40
20
Nigeria
Chad
Angola
Niger
Afghanistan
Congo
Somalia
CAR
DRC
Mali
Mauritania
Sudan
Guinea-Bissau
Haiti
Sierra Leone
Guinea
Djibouti
Cambodia
Senegal
Cameroon
Lao
Liberia
Madagascar
Ethiopia
Korea
Burkina Faso
Papua New Guinea
Uganda
Pakistan
Togo
India
Mozambique
Comoros
Côte d'Ivoire
Nepal
Burundi
Kenya
Malawi
Indonesia
Timor-Leste
Yemen
Zimbabwe
Zambia
Benin
Tanzania
Bolivia
Georgia
Lesotho
Sao Tome
Myanmar
Solomon Islands
Gambia
Tajikistan
Bangladesh
Ghana
Bosnia
Eritrea
Guyana
China
Rwanda
Moldova
Bhutan
Nicaragua
Armenia
Cuba
Honduras
Mongolia
Uzbekistan
Viet Nam
Albania
Turkmenistan
Azerbaijan
Kyrgyzstan
Ukraine
Sri Lanka
SOURCE WHO/UNICEF Estimates
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IMMUNIZATION PERFORMANCE IN ELIGIBLE COUNTRIES
90
80
70
60
coverage
50
40
30
20
10
1999
2000
2001
2002
2003
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CHILDREN NOT REACHED WITH DTP3

24.3m children
90 COVERAGE
DTP3
HepB3
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CHILDREN NOT REACHED WITH HEPB3

55.6m children
90 COVERAGE
DTP3
Others 21
India 42
HepB3
Sudan 2
Indonesia 2
Bangladesh 3
Pakistan 3
DR Congo 4
China 10
Ethiopia 5
Nigeria 8
9
PROGRAMMATIC IMPACT RESOURCES DELIVERED TO
COUNTRIES
250
200
150
millions of US
millions of US
100
50
0
2001
2002
2003
2004
SOURCE GAVI Secretariat
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PROGRAMMATIC IMPACT VACCINES DELIVERED
160
160
140
140
120
120
100
100
millions of doses
millions of doses
80
80
60
60
40
40
20
20
0
0
2001
2002
2003
2004
SOURCE GAVI Secretariat
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PROGRAMMATIC IMPACT AD SYRINGES DELIVERED
1000
800
600
Millions of ADsyringes
400
200
0
2001
2002
2003
2004
SOURCE GAVI Secretariat
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INNOVATIONS BOTTOM-UP APPLICATION PROCESS
75
70
Approved for any support
65
Approved for new vaccines
60
55
Approved for immunization services support
50
45
Approved for injection safety
40
Number of countries
35
30
25
20
15
10
5
0
1999
2000
2001
2002
2003
2004
SOURCE GAVI Secretariat
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INNOVATIONS COUNTRIES CO-FINANCING VACCINES
30
23
25
20
15
11
4
11
10
8
8
5
4
3
2
0
mono hepB
DTP-hepB
DTP-hepB-Hib
Yellow fever
SOURCE GAVI Secretariat
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INNOVATIONS IMPROVING INFORMATION SYSTEMS
With introduction of Data Quality Audit (DQA),
health data are becoming more reliable in all
countries
100
90
Average DQA verification factor (80passing
score)
80
70
60
50
40
2002
2003
2004
SOURCE GAVI Secretariat
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INNOVATIONS REWARDING ACHIEVEMENTS
Example Uganda
US
4,500,000
4,360,640
4,000,000
3,500,000
3,000,000
2,500,000
2,000,000
1,500,000
1,000,000
1,074,360
910,000
500,000
455,000
455,000
0
1st investment
2nd investment
3rd investment
1st reward
2nd reward
Based on plans to reach more children
Based on of children actually reached
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INNOVATIONS REWARDING ACHIEVEMENTS
Of the 33 countries eligible for
performance-based grants
Eligible for two, but only receiving one reward
Receiving two rewards
SOURCE GAVI Secretariat
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UNEXPECTED PROBLEMS
28 out of 75 countries have faced difficulty
wars, insurgencies, civil strife, natural
disasters
SenegalSierra LeoneSolomon IslandsSomaliaSri
LankaSudanTajikistanTanzaniaTimor
LesteTogoTurkmenistanUkraineUgandaUzbekistan
Viet NamYemenZambiaZimbabwe
Lao PDRLesothoLiberiaMadagascarMalawiMaliMau
ritaniaMoldovaMongoliaMozambiqueMyanmarNepal
NicaraguaNigerNigeriaPakistanPapua New Guinea
Rwanda São Thomé
Congo, RepCôte dIvoireCubaDjiboutiEritreaEth
iopiaGambiaGeorgiaGhanaGuineaGuinea-BissauGu
yanaHaitiHondurasIndiaIndonesiaKenyaKorea,
DPRKyrgyz Republic
AfghanistanAlbaniaAngolaArmeniaAzerbaijanBang
ladeshBeninBhutanBoliviaBosnia
HerzegovinaBurkina FasoBurundiCambodiaCameroon
Central African RepublicChadChinaComorosCongo
, Dem Rep
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UNEXPECTED PROBLEMS

• Poor data quality
• If immunization is gold standard, other health
  data extremely poor
  
• Country immunization plans not comprehensive
• Have not succeeded in overcoming piecemeal
  approach to programming and funding
  
• Difference between rhetoric and reality in
  large partner institutions, including bilaterals
  
• Decentralization means that top-level commitment
  hasnt always translated to all levels of
  agencies
  

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CERTAIN EXPECTATIONS NOT MET

• Country-level coordination (ICC) has not reached
  its potential
  
• Expertise and know-how in partner institutions
  in countries not reflected in ICC
  deliberations
  
• Distinct roles of partners not sufficiently
  defined
  
• Is there too much of everybody being involved
  in everything?
  
• Workplan a good tool to make progress
• Capacity building opportunities not realized

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SURPASSED EXPECTATIONS

• Created market competition

SOURCE UNICEF Supply Division
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SURPASSED EXPECTATIONS

• New vaccine pipeline

14
14
13
13
12
12
11
11
10
10
Number of vaccines
9
9
Number of vaccines
8
8
7
7
6
6
5
5
1975
1985
1995
2005
2015
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SURPASSED EXPECTATIONS

• Government accountability
• Developing country governments took ownership of
  goals, challenges and successes
  
• GAVI and immunization at center of development
• New financing (IFFIm)
• Innovations
• Results
• Implementation of an alliance concept

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GAVI IN A BROADER DEVELOPMENT PERSPECTIVE
Bilateral budget support
Loans and credits
Qualities of effective aid
Global Fund
GAVI

• Focus on the poorest countries and the poorest
  groups within countries
  
• Timely scale up with the most cost-effective
  interventions and easy-to-use technologies
  
• Increase predictability
• Tie funding to performance
• Include a strong monitoring and evaluation
  component
  
• Build on country priorities and harmonize with
  other types of health funding and programs
  
• Promote sustainability

P
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P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
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THE BOTTOM LINE WHAT YOU HAVE ACHIEVED

• With the 230 million of Vaccine Fund resources
  received in countries by the end of 2003
  
• 6 million more children were reached with basic
  vaccines
  
• 45 million more children were reached with new
  vaccines
  
• Nearly 700,000 future deaths have been prevented

SOURCE WHO Department of Immunization, Vaccines
and Biologicals (IVB) Estimates
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THANKS FOR THE MEMORIES !