Gavi Board starts framing Alliance's approach to 2021-2025 period

Geneva, 29 November 2018 – The Gavi Board has made a series of decisions that will help shape the Alliance’s approach for the period 2021-2025 during a two-day meeting in Geneva’s Global Health Campus. The Board will adopt the 2021-2025 strategic goals at its next meeting in June 2019.

“The Board had extensive discussions on Gavi’s future direction which will lead to intense work over the coming months to develop a strategy for the 2021-2025 period – the fifth in Gavi’s existence,” said Dr Ngozi Okonjo-Iweala, Gavi Board Chair. “The global landscape has changed fundamentally since Gavi was created in 2000 and the Alliance is changing with it. While for Gavi the core focus remains on its current mission of accelerating access to vaccines and increasing equitable coverage in the world’s poorest countries, Gavi is also adapting to meet the challenges of the future.”

As part of its Vaccine Investment Strategy (VIS), the Gavi Board approved a future investment in six new and expanded vaccine programmes, contingent on the final parameters of Gavi’s 2021-2025 strategy (Gavi 5.0) and sufficient funding being made available after Gavi’s next replenishment. Following a thorough evaluation of current and future vaccines, the final VIS prioritised:

• hepatitis B birth dose – to prevent chronic hepatitis B virus (HBV) infection, which develops in as many as 90% of infants infected with HBV at birth or in the first year of life and can lead to liver cancer,
• diphtheria, pertussis & tetanus containing boosters - given at 12-24 months, 4-7 years and 9-15 years, these three boosters offer continued protection from those diseases beyond the primary series administered in the first year,
• oral cholera vaccine (OCV) – to proactively reduce incidence of a disease that mainly affects poor and marginalised people,
• human rabies vaccine for post-exposure prophylaxis - to provide equitable access to human rabies prevention following a suspected dog bite,
• meningococcal conjugate vaccine - multivalent A,C,W-containing vaccine to expand serogroups protection beyond meningitis A,
• and respiratory syncytial virus (RSV) - to prevent one of the most common causes of bronchiolitis and pneumonia in children under 1 year of age.

“Unlike previous vaccine investment strategies, these vaccines will involve building new delivery platforms which will strengthen primary healthcare as a whole,” said Dr Berkley. “This life-course immunisation approach can help lay the foundation for strengthening primary healthcare as a whole by providing more moments in which a child, adolescent or adult is in contact with health workers.”

The decision includes approval for investment in studies to address gaps in knowledge and enhance the impact of the six new and expanded vaccine programmes. Support for use of the global stockpile of cholera vaccines was also extended until 2020 by the Board.

This approval is in line with a resolution adopted by the World Health Assembly in May on cholera prevention and control, which committed to the Ending Cholera: A Global Roadmap to 2030. With this resolution, which recognises the role of immunisation as part of an integrated strategy, the Global Task Force on Cholera Control (GTFCC) partners will support countries to reduce by 90% deaths from the disease by 2030, including through the use of the global vaccine stockpile.

“Cholera is often an indicator of inequity and poverty,” said Dr Ngozi Okonjo-Iweala. “Outbreaks of this disease are currently on the rise, devastating families, communities and countries. Extending support for this cholera vaccine stockpile has the potential to help end this, reducing the threat cholera poses to public health, both at the local level and globally.”

Gavi’s support for the creation of the global OCV stockpile in 2014 has led to skyrocketing demand for the vaccine. In 2017 alone, almost 10 million doses were used, from Sierra Leone to Somalia to Bangladesh. In the first ten months of 2018 over 14 million doses have already been used worldwide, mostly for outbreak response.

The Gavi Board also requested the Gavi Secretariat to assess, with WHO, the feasibility and impact of routine influenza immunisation of health care workers to support epidemic and pandemic influenza preparedness. Moreover, the Gavi Board approved support for strengthening yellow fever diagnostic capacity in Africa through a diagnostics procurement mechanism.

“Investment in yellow fever diagnostics has the potential to save lives by enabling a quicker response to outbreaks of yellow fever, which is a deadly, incurable disease,” said Dr Berkley. “Due to similarities in symptoms with other diseases, only a fraction of yellow fever cases identified are actually yellow fever, which is why robust diagnostic laboratory capacity is needed. Many African countries have limited capacity due to the lack of a commercially available test kit.”

The Gavi Board approved support for Inactivated Poliovirus Vaccine (IPV) post-2020, depending on the availability of funding for the 2021-2025 period and subject to alignment with the final parameter setting for Gavi 5.0 at the June 2019 Board meeting. The Gavi Board emphasised that this investment must be additional to other Gavi investments while recognising the full programmatic integration of IPV into Gavi’s immunisation approach. The Gavi Board stressed the importance of close collaboration between Gavi, the Global Polio Eradication Initiative (GPEI) and polio partners and requested GPEI to include IPV costs within its 2019-2023 programmatic strategy.

“With polio eradication so close to being achieved, IPV is a global health priority,” said Bill Roedy, Vice Chair of the Gavi Board. “It can ensure that the world remains polio-free for generations to come. Any slip in our efforts could lead to a dramatic resurgence of this horrific disease.”

Wild polio virus remains endemic in three countries – Afghanistan, Nigeria and Pakistan and significant challenges still remain to stop transmission. With a concurrent increasing in the number of vaccine-derived poliovirus outbreaks, eradication timelines have been delayed. Based on current data, the earliest that polio eradication could be certified is 2022, which will be followed by the cessation of the use of bivalent oral polio vaccine (bOPV) in 2024. The GPEI is therefore updating the Endgame Strategy for 2019-2023 and will take it to the World Health Assembly in 2019. The Strategic Advisory Group of Experts (SAGE) on Immunization recommends that IPV be used for 10 years after the removal of bOPV in countries that do not maintain polio essential facilities.

As part of the future IPV support, the Gavi Board approved in-principle support for hexavalent vaccine – which includes IPV and also protects against diphtheria, tetanus, pertussis, Hepatitis B and Haemophilus influenzae type b. The vaccine is forecasted to become available in sufficient quantities for country introduction late in the next strategic period, around 2024. The Gavi Board also approved support for India to mitigate the increased costs of IPV for 2019-2021. The cost-sharing arrangement ensures continued country ownership for the IPV programme while minimising the risks to the global polio endgame agenda. 

Lastly the Gavi Board commended the government of Nigeria and the leadership of the Minister of Health, who joined the Board meeting from Abuja by videoconference, for developing a robust accountability framework which will enable Alliance partners to monitor the progress of the immunisation programme.

For the first time, the Gavi Board met in Gavi’s headquarters at the Global Health Campus, a building shared with the Global Fund, RBM Partnership to End Malaria, Stop TB and Unitaid. Gavi moved into the building in July 2018.