Anuradha Gupta, Gavi DCEO, Mid-term review presentation
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A deep dive into the 2016-2020 results of Gavi, the Vaccine Alliance, during the 2018 Gavi mid-term review in Abu Dhabi.
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Anuradha Gupta, Gavi DCEO, Mid-term review presentation
- 1. Deep dive into our results: 2016-2020 Got vaccines? Got life! Anuradha Gupta, Deputy CEO, 10-11 December 2018, Abu Dhabi, UAE
- 3. Gavi’s impact at scale 2000 2005 2010 2015 Pentavalent Inactivated polio Measles 2nd dose Pneumococcal 3rd dose Rubella Rotavirus 80% 2017 Gavi 1.0 Gavi 2.0 Gavi 3.0 Gavi 4.0
- 4. Closing the gap between low and high income countries at pace Coverage rates between Gavi and non-Gavi countries 36% 80% 46% 60% 2010 2017 Haemophilus Influenza Type B 1% 43% 24% 46% 2010 2017 Pneumococcal 0% 28% 18% 27% 2010 2017 Rotavirus Gavi Non Gavi
- 5. Close to making immunisation the stepping-stone to UHC 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2000 2002 2004 2006 2008 2010 2012 2014 Family planning Antenatal Care Immunisation (DTP3) HIV treatment TB treatment Bed nets Sanitation Median coverage of key interventions in Gavi-supported countries 2017
- 6. Berlin replenishment: key promises 6 Reach more children & avert more deaths 1 Transition countries out of Gavi support 2 Ensure healthy vaccine markets 3 Generate economic benefits 4
- 7. Progress on track after two years 7 PROMISE 1: Reach more children & avert more deaths Number of additional children immunised with Gavi support (millions) Number of additional future deaths averted (millions)
- 8. 8 0 10 20 30 40 50 60 70 80 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Numberofsurvivinginfants(millions) UNDER-IMMUNISED VACCINATED WITH DTP3 More children being immunised… but also more children to be immunised PROMISE 1: Reach more children & avert more deaths
- 9. 9 0 10 20 30 40 50 60 70 80 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Numberofsurvivinginfants(millions) UNDER-IMMUNISED VACCINATED WITH DTP3 UNDER-IMMUNISED More children being immunised… but also more children to be immunised PROMISE 1: Reach more children & avert more deaths
- 10. 0 10 20 30 40 50 60 70 80 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Numberofsurvivinginfants(millions) FRAGILE NON-FRAGILE UNDER-IMMUNISED 10 Countries with fragile systems are struggling to accelerate PROMISE 1: Reach more children & avert more deaths • High birth rates • Conflict & displacement • Compounded vulnerabilities • Weak state capacity FRAGILE COUNTRIES • Subnational disparities • Urbanisation • Growing vaccine hesitancy • Hosting refugee populations NON FRAGILE COUNTRIES
- 11. Progress on track 11 PROMISE 2: Transition countries out of Gavi support Countries transitioned out of Gavi support Percentage of countries meeting their co-financing commitments
- 12. Spurring domestic financing of vaccines PROMISE 2: Transition countries out of Gavi support 11% 27% 35% 2015 2016 2017 Domestic financing of Gavi vaccines Country contribution as a percentage of Gavi’s routine vaccine expenditure 2015 2016 2017 Co-financing Self-financing Self-financing (India) $125m $298m $238m 12
- 13. 4 8 16 20 2016 2017 2020 (end) 2018 Number of countries transitioned from Gavi support Programmatic risks are evolving PROMISE 2: Transition countries out of Gavi support Sustained or improved coverage rates: 6 countries having coverage ≥ 90% Fully funding vaccine programmes Avg. investment per child increased >400% 4 countries have introduced HPV with one-time catalytic funding from Gavi Strong performance after more than one year without Gavi support 13
- 14. 4 8 16 20 2016 2017 2020 (end) 2018 Sustained or improved coverage rates: 6 countries having coverage ≥ 90% Fully funding vaccine programmes & investment per child increased 428%, on average 4 countries have introduced HPV with one-time catalytic funding from Gavi Strong performance after more than one year without Gavi support Programmatic risks are evolving PROMISE 2: Transition countries out of Gavi support Weak institutional capacities, decreasing GNI per capita, declining DTP3 coverage Tailored country approaches underway Angola Congo Rep. PNG Timor Leste 14 Some countries facing programmatic challenges Number of countries transitioned from Gavi support
- 15. Progress on track after two years 15 PROMISE 3: Ensure healthy vaccine markets Vaccine markets classified as having moderate or high healthy market dynamics Weighted average price of immunising a child with three key vaccines
- 16. Number of antigens, doses and manufacturers continues to increase 715m doses 564m doses 183m doses98m doses50m doses 2001 2005 2010 2015 2017 PROMISE 3: Ensure healthy vaccine markets 6 antigens 5 suppliers 18 17
- 17. Three vaccine markets showing healthy market dynamics, three others challenging PROMISE 3: Ensure healthy vaccine markets PENTA YELLOW FEVER PNEUMOCOCCAL High/ Moderate Low 17 No market health CHOLERA JE MENIGITIS A MR MEASLES ROTAVIRUS HPV IPV
- 18. Progress on track after two years PROMISE 4: Generate economic benefits 2016-2017 2018-2020 projected 0 20 40 60 80 100 120 140 2001-2005 2006-2010 2011-2015 2016-2020 Avertedcosts(inbiillionsofUS$) Economic benefits by strategic period Economic benefits due to Gavi-supported vaccines 18
- 19. Treatment costs Productivity lost due to death & disability Lost caretaker wages Transport costs Immunisation disproportionately benefits poorer households and vulnerable populations PROMISE 4: Generate economic benefits 24 million households saved from medical impoverishment, between 2016-2030 Catastrophic health costs are the highest among poorest quintiles 19
- 20. While we should celebrate success, we must neither rest on our laurels nor become complacent in this long journey…
- 21. Breakout sessions: Progress, challenges and lessons learnt from across the Alliance 2. Innovative solutions for vaccine delivery 3. Building resilient systems for coverage and equity 1. Healthy markets in action 4. Sustainable transition
Editor's Notes
- Background information: Note: Self-financing amounts are estimated country cost for co-financed vaccines after having transitioned out from Gavi support; Transitioned countries include former Gavi countries that have formally transitioned out of Gavi support (have become fully self-financing) Transitioned countries include former Gavi countries that have formally transitioned out of Gavi support and become fully self financing In 2018, 16 transitioned have transitioned (excluding Ukraine): 8 before 2017 (ex Ukraine): Bhutan (HPV), Honduras (HPV), Mongolia, Sri Lanka (HPV), Guyana (HPV), Indonesia, Kiribati, Moldova, [Ukraine] 8 at the end of 2017: Angola, Armenia, Azerbaijan, Bolivia, Congo Rep., Cuba, Georgia, Timor Leste 8 countries in accelerated transition (in addition to Nigeria): 4 expected to transitioned by 2021: Nicaragua, Papua New Guinea, Uzbekistan, Vietnam, 4 expected to transition after 2021: India, Lao, Sao Tome, Solomon Islands By December 2018, the 16 transitioned countries will be fully self-financing a total of 33 vaccine programmes Challenges/risks 4 countries at high risk of successful transition (out of the 20 due to transition by 2020) In addition, Nigeria: but not included in the 20 countries to transition Based on the eligibility decision of 2009, Angola, Congo Rep. and Timor-Leste shifted groupings from Fragile Country to Transition Country. We didn’t include a “consolidation phase”. This should be an important lessons for 5.0. (these 3 were the only countries that did that shift) Narrative Financial sustainability has previously been the focus for Gavi and can see clear success here with all co-financing obligations being met, and transitioned countries continuing to fund their vaccine programmes and increase their domestic resource allocation to immunisation However, programmatic sustainability has not been such a focus and we are seeing some challenges here Need to ensure we are engaging early, targeting HSS funding to ensure programmatic sustainability All 5 countries identified by the Board have seen their GNI per capita decline from 2016 to 2017, and their DTP3 coverage either decline (Angola, Congo and PNG) or remain stagnant (Timor Leste and Nigeria) Bolivia is experiencing a data challenge due to uncertainties in the recently revised denominator Lao PDR is not meeting the programmatic criteria of three consecutive years of increased DTP3 coverage, the trend is encouraging as coverage increased by three percentage points between 2016 and 2017 (2015: 88%, 2016: 76%, 2017: 82%). Lao PDR transition plan has also recently been approved and conversations on support to service delivery are ongoing with the World Bank From MTR Deepdive Of the 16 countries that have transitioned out of Gavi support, 8 have already been fully self-financing their vaccines for more than year (see figure 5). Importantly, over the same period, they have also managed to maintain or increase coverage (see figure 6). However, both Indonesia and the Republic of Moldova report coverage rates below 90%, despite a steady increase in the number of children reached with three doses of pentavalent vaccine. In all of these countries, domestic resources for vaccines increased significantly between 2010 and 2017. This excludes Cuba, which has not introduced any vaccines with Gavi support.