Columbia International Affairs Online: Policy Briefs

CIAO DATE: 05/2015

Refocusing Gavi for Greater Impact

Sarah Dykstra, Amanda Glassman, Charles Kenny, Justin Sandefur

February 2015

Center for Global Development


Gavi, the Vaccine Alliance, pools donor funds to increase immunization rates in developing countries. Vaccines have saved millions of lives. [1] Results from new research at the Center for Global Development suggest Gavi could save more lives by shifting support away from lower-cost vaccines provided to middle-income countries toward more underused vaccines and support to the poorest countries. Since 2000, Gavi has disbursed $5.3 billion worth of vaccines and $1.7 billion in financing to 77 countries with a combined population of 4.5 billion. [2] In 2014, Gavi shipped 169 million doses of the pentavalent vaccine (a combined vaccine against diphtheria, pertussis, tetanus [DPT], Haemophilus influenza type B [Hib], and hepatitis B [hep B]), enough to provide a full course of the vaccine to 79 percent of infants in participating countries. [3] The Alliance has also funded performance-based payments for increased DPT immunization coverage ($20 per additional infant covered), though this program was discontinued starting in 2013. The Alliance employs an income-based eligibility criterion for its support that initially excluded all countries with a per capita gross national income (GNI) in excess of $1,000 in 1998 at market exchange rates and currently excludes countries above $1,570. Countries with per capita income that crosses this threshold are no longer eligible to apply for new vaccine support, but can continue receiving support for existing vaccines for five years. During this period, countries pay an increasing share until 100 percent of vaccine costs are covered by domestic sources. Gavi recently completed a $7.5 billion replenishment process to raise funds for the period 2016 to 2020. As part of the replenishment, Gavi is considering changes to its model, including modifying the types and targets of support. This brief builds on research presented in a companion paper ("Are Vaccines Fungible? Regression Discontinuity Evidence from a Large Aid Program") to provide policy suggestions to help inform these discussions.