A mid-term review of Gavi’s progress

On 10-11 December 2018, Germany participated in Gavi’s mid-term review meeting, hosted by the United Arab Emirates

Gavi MTR Meeting 2018, Abu Dhabi, United Arab Emirates

More than 300 leaders attended a high-level meeting in Abu Dhabi to critically review progress against Gavi’s 2016-2020 commitments. Together they took stock of achievements - 700 million people immunised and 10 million lives saved since 2000, and planned how best to meet the immunisation needs of the world’s poorest countries.

Three years into Gavi’s 2016–2020 programme cycle and 18 years after the Alliance was established in 2000, a mid-term review (MTR) meeting was held in Abu Dhabi on 10 and 11 December. The primary meeting objective was to examine results and report back to donors and other stakeholders on progress. It also provided opportunities for Gavi-supported countries to showcase their achievements and share lessons, and for representatives of the pharmaceutical and other industries to demonstrate their contributions to delivering innovative vaccine-related solutions.

In January 2015, during Germany’s presidency of the G7 group of countries, German Chancellor Angela Merkel hosted a Gavi replenishment conference in Berlin where 31 public and private sector donors pledged more than USD 7.5 billion for the 2016 – 2020 programme. Germany itself pledged EUR 600 million. At the meeting, Gavi signed up to the ambitious goal of immunising an additional 300 million children, saving an estimated 5 - 6 million lives and contributing economic benefits of USD 80 – 100 billion.

Also during this programme cycle, Gavi aims to ensure all countries are co-financing their vaccine programmes, and to assist more than 20 countries to fully fund their programmes. Finishing the introduction of pneumococcal and rotavirus vaccines in lower-income countries, and strengthening vaccine markets and supply-chains are further important objectives.

Gavi’s top-line achievements

Gavi is on course to deliver on the Berlin commitments for 2016 – 2020. At the close of 2017, 127 million children had been immunized, thereby helping to prevent more than 2.5 million ‘future deaths’ that would otherwise be lost to vaccine-preventable diseases. These achievements reflect Gavi’s support for vaccine manufacture, pricing and delivery, as well as activities to strengthen the underlying health systems which support the delivery of the vaccines in supported countries.

Record levels of domestic resources are being channeled to immunisation, reflecting strong political commitment and wide recognition of the clear impact of immunisation on broader development goals. By early 2018, 16 of the target 20 countries had transitioned to fully self-finance all their vaccines introduced with Gavi support.

Gavi also continues to focus on innovative private sector partnerships to make life-saving vaccines and other immunisation products more accessible and affordable, particularly in low-income countries. It has proven adept at exploiting the economies of scale to successfully drive down vaccine prices and secure future economic benefits.

Germany supports introduction of blockchain technology

At MTR Meeting: Ngozi Okonjo-Iweala, Chair of the Gavi Board, Reem Al Hashimy, Minister of State for International Cooperation, United Arab Emirates, Seth Berkley, CEO, Gavi

In keeping with Gavi’s emphasis on innovation, the MTR meeting provided an excellent platform to announce a new collaboration between Gavi and the German Development Bank KfW, to explore the application of blockchain technology to Gavi’s cash support and supply chain management systems. The TruBudget application will be introduced and trialed with the aim of building trust among Gavi partner organisations, and of reducing wastage and addressing fiduciary risk. Harriet Ludwig, the German Board Member of Gavi from the Federal Ministry for Economic Cooperation and Development said, ‘The new blockchain technology could significantly improve transparency and accountability of allocated funds and commodities along the supply chain.’

Prior to the MTR meeting, the preparation of a mid-term review report afforded the opportunity for Gavi stakeholders jointly to look back over the past three years, discuss the key challenges and, critically, to identify areas for improvement.

Strengthening health systems

Germany has been at the forefront of calls for Gavi to integrate its traditionally disease-centred approach into a broader approach to strengthening health systems. In line with Gavi’s new strategic focus areas, this means developing the capacities of people working in the health system; strengthening supply-chains and improving infrastructure and equipment, supporting more robust leadership and governance, and enhancing the availability of data and information needed to plan, monitor and improve service delivery.

Strong and robust systems for health will pave the way to greater coverage and equity in immunisation - areas that have seen weaker progress to date. Together with systematic, post-transition engagement in Gavi-supported countries, this will lead to a more sustainable transition to country-funded, nationally-owned and led immunisation programmes.

Improving alignment and coordination

Greater harmonisation and coordination of activities among global health partners represent further areas for enhancement by Gavi and its partner organisations. At the request of Germany, Ghana and Norway, and with support from the United Nations Secretary-General, 12 multilateral organisations including Gavi united to endorse the Global Action Plan for Healthy Lives and Well-being for All. This framework aims to accelerate progress towards achieving nearly 50 health-related targets across 14 SDGs.

Leveraging the full potential of the multilateral system, the Global Action Plan will set out ways to improve alignment and coordination - both globally and at country level in consultation with in-country stakeholders, scale-up and accelerate impact, and to focus on results and link them more closely to investments. Not only will this reduce the considerable duplication among global health partners, it will enable greater efficiencies and support innovation.

Shaping Gavi’s post-2020 agenda

The complex and interrelated issues of population growth, migration and urbanisation, climate change, and conflict and fragility in many parts of the world, present important challenges for increasing effective immunisation coverage. Anti-microbial resistance also poses an increasingly urgent challenge.

Against this context, Gavi must adjust its approach in order to find and immunise the final 20% of children missing a full course of basic vaccines. These children often go under the radar, living in hard-to-reach rural and urban slum areas with little or no access to the most basic services. Reaching them requires a more flexible and tailored approach, particularly in fragile and emergency settings. Solutions will entail the targeting of specific areas and population groups with lower coverage and the development of innovative approaches both to generate demand for immunisation services and to deliver vaccines more efficiently.

As discussions on the post-2020 agenda continue, it is clear that reaching these children will remain Gavi’s top priority. Strengthening health systems is a critical enabler to reach the so-called ‘fifth child’ and achieve greater immunisation coverage and equity. That is why there is a need for a robust and timely evaluation of Gavi’s health systems strengthening activities to be better informed about what works and where adjustments should be made to support countries transition to sustainable, nationally-owned and financed programmes.

Further information

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