Independent evaluation finds GAVI funding to poor countries can boost childhood vaccine coverage

But countries with initial coverage greater than 65% showed no effect

Boston, MA -- The Global Alliance for Vaccines and Immunization (GAVI) was created in 1999 with the goal of enabling even the poorest countries to provide vaccines to all children. A study by researchers associated with the Harvard Initiative for Global Health set out to measure the extent to which GAVI funding had succeeded in raising the percentage of children who received the combined diphtheria, tetanus and pertussis vaccine (DTP3) and whether the cost had been close to GAVI's original estimates of $20 per additional child immunized.

Their analysis appears in advance online in the September 21, 2006 issue of the Lancet, www.thelancet.com.

GAVI is a public-private global health partnership that was created when vaccine coverage in many countries was dropping. Countries with a gross national income of less than US$1000 per capita per year and with coverage under 80% were eligible to receive financial support from GAVI to develop immunization services, including personnel, infrastructure and supplies, as part of their national health system. Decisions on how resources are spent are left to the individual countries, but continued authorization of funding is tied to meeting yearly immunization coverage targets set by the countries.

Research Associate Chunling Lu and colleagues from the Harvard School of Public Health (HSPH) analyzed the relationship between DTP3 coverage for GAVI recipient countries from 1995 to 2004 and immunization services spending (ISS) per surviving child in 53 countries. The analysis revealed that in countries with DTP3 coverage of 65% or less at the start of the program, ISS spending had a significant positive effect on DTP3 coverage, raising coverage from under 50% in many countries to close to 65%.

However, in countries with initial DTP3 coverage of more than 65%, GAVI spending did not translate into increased immunization coverage.

The estimated cost per additional child immunized was less than $14. But if non-ISS expenditures are included, such as for new and underused vaccine and safe injection equipment, the cost per child approaches $20, close to GAVI's original estimates.

Between 2000 and 2005, total GAVI disbursements were $760.5 million, of which $124-125 million (16%) were for immunization services spending.

Based on their analysis, the researchers recommend that GAVI consider redistributing its resources to countries with the lowest immunization coverage.

"Assessment of the effect of GAVI is important not only because of the alliance's mission and the resources devoted to this effort," write the researchers, "but also because the project represents an important innovation in global health. Together with Stop TB and Roll Back Malaria, GAVI was one of the first major global health initiatives designed to create new public-private partnerships to tackle major health problems."

Unlike these other global health initiatives, however, for which there is no reliable indicator of effect on health, GAVI afforded an opportunity for concrete measure of public health improvement.

"This is the first time that there is hard evidence that one of the major global health programs is having a real impact; the world desperately needs similar analyses for AIDS, tuberculosis, malaria and other initiatives," said senior author Christopher J. Murray, Richard Saltonstall Professor of Population Policy at HSPH and director of the Harvard Initiative for Global Health.

Said Lu: "Our research shows conclusively that GAVI, as an experiment to provide financial help to countries with poor performance in DTP3 coverage, is effective in bringing vaccine protection to the world's most disadvantaged children."

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Other authors on the paper include Catherine M. Michaud, Emmanuela Gakidou and Kashif Khan.

Research funds were provided by the Harvard Initiative for Global Health and the Grand Challenges in Global Health Initiative.

Harvard School of Public Health is dedicated to advancing the public's health through learning, discovery, and communication. More than 300 faculty members are engaged in teaching and training the 900-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children's health to quality of care measurement; from health care management to international health and human rights. For more information on the school visit: www.hsph.harvard.edu


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