In November 1998, shortly after making their first large financial commitment to children’s vaccines, Bill and Melinda Gates hosted a dinner at their home for a dozen leading scientists. Around a single table, they spent two-and-a-half hours discussing immunology and what could be done to overcome the barriers that were preventing nearly 30 million children from receiving basic vaccines every year. Bill and Melinda challenged their guests to come back with proposals for “breakthrough solutions.” As the dinner was winding down, Bill said, “Don’t be afraid to think big.”
A Timely Hint
By all accounts, Bill and Melinda’s challenge came at the right moment. It gave pharmaceutical companies, health ministers, international agencies, and non-governmental organizations (NGOs) new incentive to restart failed discussions on how these entities could join together in an international alliance to strengthen the system for getting vaccines to where they are needed most.
In July 1999, key players from all these sectors came together for two days at the Port of Seattle and left with a blueprint for the Global Alliance for Vaccines and Immunization (GAVI) and the seeds of an idea for a sister entity that would raise money to support GAVI’s work (now known as the GAVI Fund). The goal was to radically improve access to established and underused vaccines and to accelerate the development and introduction of new ones.
One Excuse Gone
By the end of the year, the foundation pledged $750 million over five years to fund these efforts. In the words of the GAVI Fund’s president, "Lack of money could no longer be the excuse for not getting children vaccinated.”
The blueprint for GAVI called not for a large new international bureaucracy but rather for a lean secretariat housed within UNICEF’s offices in Geneva, administered by widely respected Norwegian immunologist Tore Godal, and governed by a 12-member board. These 12 members represented all the major partners in the alliance, including developing-world governments, the World Health Organization, UNICEF, the World Bank, pharmaceutical companies, NGOs, research institutes, and the Gates Foundation. The strategy was to create an inclusive decision-making body to bring new coordination to a disjointed, inefficient marketplace.
How GAVI Works
GAVI invites the 75 poorest countries in the world to develop plans and submit proposals for increasing vaccine coverage and use of newer vaccines. An independent committee made up largely of developing-country public health experts then reviews and makes recommendations on the proposals. GAVI’s board then meets to review the recommendations. Once the board approves a proposal, it requests that the GAVI Fund release payment.
To increase the efficiency of the market, GAVI looks across all the approved plans to forecast how many doses of each vaccine will be required overall. This demand-forecasting helps guarantee an adequate supply of vaccines. We hope that over the long term it will also reduce unit prices.
Two Shots in the Arm
In January 2005, the foundation announced a second $750 million grant to support GAVI’s work. This time, the grant will spread out over 10 years, rather than five. In the alliance’s first five years, the foundation’s funding accounted for half of GAVI’s resources. In its next 10 years, we hope our funding will account for less than 20 percent.
One promising approach to bringing in new and more-predictable funding for immunization through GAVI is the International Finance Facility for Immunization (IFFIm), an idea developed by economists and health experts and championed by Gordon Brown, chancellor of the British treasury. The IFFIm will collect pledges from donor governments, turn these pledges into bonds, sell the bonds in capital markets (just like a standard corporate or government bond), and use the proceeds to provide a large infusion of money for immunization. IFFIm has already collected $3.5 billion in pledges from eight middle- and high-income countries, including greatly expanded commitments from two countries (the U.K. and France) that have already supported GAVI and four countries that have not contributed to GAVI previously.
Next: Results