In a health clinic in a remote village in Tanzania, bright-eyed Masai babies are burrowed in their mothers' embrace, quietly nursing while waiting for their turn to be vaccinated. The fact that these Masai women, despite their nomadic lifestyles, have the chance to vaccinate their babies is testament to the success of the immunization programs of Tanzania. Perhaps it would not have been successful if not for the support of the Global Alliance for Vaccines and Immunization (GAVI), an organization that raises funds and stimulates the production of new vaccines for the developing world. It does this by bringing together several players including the World Health Organization, UNICEF, the World Bank, civil society organizations, the vaccine industry, research and technical agencies, the Bill & Melinda Gates Foundation and other private-sector philanthropists. With global immunization rates stagnating in the 1990s, GAVI was launched in January 2000 to fund vaccines for children in the world's 70 poorest countries. Speaking to Saudi Gazette, chair of the GAVI Alliance Board Dagfinn Hoybraten said the organization has made great strides in its global immunization program, with coverage increasing from 74 percent in 2000 to 83 percent in 2011, tackling deaths from illnesses like malaria diphtheria, whooping cough and tetanus. GAVI has committed more than $7.9 billion to developing countries' immunization programs. In the Arab World, it is planning to invest over $400 million in 2012–2020 to vaccinate over 52 million children with pentavalent, pneumococal, meningitis A and rotavirus vaccines to help avert 387,000 deaths in Comoros, Djibouti, Mauritania, Somalia, North Sudan and Yemen. Explaining GAVI'S mission and vision, H?ybr?ten said that it is to give every child a fair start in life by protecting him or her with essential vaccines that are quite accessible. “Our goal is to strengthen immunization as we believe that is at the core of public health, and immunization is driving the wider package of health and both sanitation and nutrition. “Everywhere in the world where we have gone with this simple message, we have had the support of leaders in the political world and private sector and it has really caught on. “People are deeply touched by it and they are really impressed by our business model which takes the best from the private sector and the public sector, making them work together.” The alliance may have achieved success with its immunization program but humanitarian organizations like Medecins sans Frontiers (MSF) say there is room for improvement. According to these organizations, humanitarian groups should be able to acquire vaccines at reasonable prices and not have to negotiate access to them on a cumbersome case-by-case basis. Dr. Manica Balasegaram, executive director of MSF's Access Campaign, said: “We need access to vaccines when we need them, where we need them and at an affordable price. “It's time for GAVI to recognize that other actors vaccinating on the ground need fast and regular access to life-saving vaccines at the lowest-possible prices.” MSF also alleged that GAVI has not played a role in the development of products that are better adapted to reach children in remote or unstable locations, including vaccines that do not require refrigeration, do not require needles, and which can be given in fewer doses. This is not being prioritized enough, according to MSF, although better products are needed to alleviate the growing number of children who are not immunized. In response, H?ybr?ten said: “Our philosophy is to accept criticism and learn from it. “But [the criticism from MSF] is unfair as GAVI has never had the ambition to support research. “We take the vaccines once they are pre-qualified by the WHO and we go to the world and finance the distribution. “We go to the country and ask for their support and their contributions; all the countries have to co-pay and we take it from there.” According to him, this does not mean GAVI is not pushing for innovation. “We are doing that constantly and we are working towards tailoring efforts in fragile states and vulnerable situations in order to reach every child. “We are looking forward to working with MSF and other civil society organizations because their efforts are critical as often times they are in countries where there are no public health structures, so that's why we also finance and support civil society efforts.” Another accusation against GAVI is that when a country's per capita income exceeds $1,520, GAVI's support stops since it considers that state to have become medically self-sufficient. But even at that threshold, some countries cannot afford the high cost of vaccines. Meanwhile, access to GAVI-negotiated prices for newer vaccines is also lost. Thus the “graduates” are caught in a double bind: they cannot afford newer medicines available in the market and their existing programs regress. H?ybr?ten refutes this argument. “That's not the case. GAVI's philosophy is to create a sustainable situation for a country's growth potential and their growing economies. “We are not there forever to take the bills on behalf of the countries that are able to finance their own vaccines; we are there to sustain weak health systems in the poorest countries.” H?ybr?ten insists GAVI is working to secure countries that are in this situation. “ “What we now pursue are solutions where GAVI prices are still available to the countries after they have graduated and that means that the GAVI price is lower than the general market price. “But they still have to pay the bill without GAVI's support once they have crossed the threshold that has been set.” The organization tries to instill a sense of responsibility in even the poorest countries, he said. “What we are committed to doing is to follow our system of copayment and graduation, not to create an eternal dependency. “What GAVI does is to help poor nations sustain and scale up vaccination programs until their economies improve and they are able to face health challenges by themselves.”
