What We Do

Vaccine Delivery

Strategy Overview

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Children at a launch ceremony for a new meningitis vaccine in Ouagadougou, Burkina Faso. (Photo © PATH / Gabriel Bienczycki)

our goal:

to eliminate vaccine-preventable diseases worldwide.

The Challenge

At A Glance

Vaccines are among the most cost-effective investments in global health, saving about 2.5 million lives each year. But every 20 seconds, a child dies from a vaccine-preventable condition such as diarrhea or pneumonia.

Nearly 200 countries have endorsed a shared vision—known as the Decade of Vaccines—to extend the benefits of vaccines to every person by 2020.

The foundation works to ensure that existing life-saving vaccines are delivered where they are needed most. We also support development of new vaccines and new delivery technologies and approaches.

The foundation has committed US$2.5 billion to the GAVI Alliance, a global public-private partnership that has been instrumental in expanding access to existing vaccines and speeding the introduction of new vaccines in developing countries.

Our Vaccine Delivery strategy, updated in 2012, is led by Orin Levine, director, and is part of the foundation’s Global Development Division.

Vaccines save millions of lives a year and are among the most cost-effective health interventions ever developed. Immunization has led to the eradication of smallpox, a 74 percent reduction in childhood deaths from measles over the past decade, and the near-eradication of polio.

Despite these great strides, there remains an urgent need to reach all children with life-saving vaccines. One in five children worldwide does not receive even the most basic vaccines. As a result, an estimated 1.5 million children die each year—one every 20 seconds—from vaccine-preventable diseases such as diarrhea and pneumonia. Tens of thousands of other children suffer from severe or permanently disabling illnesses.

Vaccines are often expensive for the world’s poorest countries, and supply shortages and a lack of trained health workers are often challenges as well. Unreliable transportation systems and storage facilities also make it difficult to preserve high-quality vaccines that require refrigeration.

The Opportunity

Global immunization coverage has never been higher. More than 100 million children are immunized each year against tuberculosis, polio, measles, diphtheria, tetanus, pertussis, hepatitis B, Haemophilus influenzae type B, and, in some countries, yellow fever. These vaccines save an estimated 2.5 million lives each year.

The benefits of vaccines go beyond protecting children from disease. One recent study in the Philippines showed that children who received vaccines were not just healthier throughout childhood but also scored significantly higher on language, math, and verbal reasoning tests.

Nearly 200 countries around the globe have endorsed a shared vision—known as the Decade of Vaccines—to extend the benefits of vaccines to every person by 2020 and thereby save more than 20 million lives. The eradication of polio is an early and important priority. This international collaboration has generated the Global Vaccine Action Plan (GVAP), a roadmap for extending the delivery of a basic package of vaccines, making vaccines that are available in richer countries accessible in the developing world, and supporting vaccine research and development.

Our Strategy

At the Bill & Melinda Gates Foundation, all of our investments in vaccines and immunization contribute to the goals of the Decade of Vaccines. As one entity within the greater vaccine community—which includes national governments, other donors, international organizations, the private sector, academia, civil society organizations, faith-based organizations, and local communities—we are working to ensure that existing life-saving vaccines are introduced into countries where people need them most, and we support the innovation needed to develop new vaccines and delivery technologies and approaches.

Areas of Focus

Routine Immunization

Ultimately, all of our vaccine-related work depends on strong systems within countries. We therefore invest in partners whose programs strengthen and provide support for these systems; such partners include the World Health Organization (WHO), UNICEF, the GAVI Alliance, and civil society organizations.

A nurse in Accra, Ghana, prepares a vaccine that protects against multiple diseases.

We also invest in tools and research, including initiatives to improve the collection and analysis of vaccine-related data, measure the progress of vaccination efforts, and develop new diagnostic tools to help health workers assess immunity to disease.

Strengthening supply chains and logistics is another priority. We support the development of new tools and approaches that can help countries improve the transportation, delivery, and management of vaccines. This is particularly crucial as countries prepare to deliver newer, more expensive vaccines to a greater number of people. Many vaccines are temperature-sensitive and require special storage, transport, and handling to be delivered safely and effectively.

A child receiving a vaccination in Silte, Ethiopia.

In the area of routine immunization, we believe that measles control deserves greater attention. We advocate for stronger routine systems to deliver the measles vaccine along with well-planned and well-run education campaigns. We focus particular attention on selected countries—including India, Nigeria, and Ethiopia—that have large numbers of unvaccinated children and where we have strong relationships with governments and a wide range of other investments.

In India, our strongest focus is in the states of Bihar and Uttar Pradesh. In Bihar, we are building on successful efforts to increase immunization coverage and are supporting programs to test and evaluate a variety of innovations, including technologies for vaccine registration, tracking, and mapping. We also invest in new ways to generate demand for and awareness of immunizations among healthcare providers and families.

Vaccine Introduction

One of our most important collaborations is with the GAVI Alliance, a global public-private partnership of scientists, health experts, government leaders, businesspeople, and philanthropic organizations whose goal is to vaccinate all the world’s children. GAVI provides funding to buy vaccines for and provide technical support to countries with the greatest needs. Since 1999, the foundation has committed US$2.5 billion to the GAVI Alliance.

Health workers at a launch event for the MenAfriVac meningitis vaccine in Ouagadougou, Burkina Faso. (Photo © PATH / Gabriel Bienczycki)

GAVI is helping countries introduce vaccines against pneumococcal disease and rotavirus, the main causes of pneumonia and severe diarrhea, respectively. These are among the leading causes of child deaths in developing countries. GAVI also supports pilot projects to plan for the introduction of the HPV vaccine, which helps protect against cervical cancer, a leading cause of cancer-related mortality among women in developing countries.

Historically, it has taken as long as 15 to 20 years for vaccines available in wealthier countries to make their way to the world’s poorest nations. That timeframe is shortening, in part due to GAVI’s work with industry, which has helped bring down the price of vaccines.

Innovative and Market-Based Approaches

To get the most promising new vaccines to the people who need them, we participate in innovative partnerships that span the continuum from discovery to development to delivery. For example, we supported a major partnership between PATH, WHO, the Serum Institute of India, and African governments to develop an affordable vaccine to prevent meningitis A. MenAfriVac is the first vaccine designed specifically for use in Africa, and within a year of its introduction it led to a dramatic drop in meningitis A infections. Promising vaccines to prevent malaria and dengue are currently in late-stage development and could have a major impact in the fight against those diseases.

Workers at the Serum Institute of India, a major producer of affordable vaccines used in the developing world.

The foundation also invests in research and development to improve existing vaccines. Improvements include the use of new adjuvants that strengthen immune response and could reduce the amount of antigen needed per dose, thereby lowering the cost of immunizations. Other improvements reduce the number of doses required and make vaccines easier to administer. We also support research to simplify vaccine delivery through innovations such as needle-free delivery systems and heat-stabilized vaccines that don’t require refrigeration.

Along with supply and demand, price is a critical element in the successful launch and sustainable use of any new vaccine. Without a clear idea of the demand for a vaccine and how it might be delivered, manufacturers have little incentive to invest in product development and manufacturing. We are addressing this challenge by working with private industry on innovative, market-based financing mechanisms to ensure that vaccines are developed at the lowest possible cost.

These financing mechanisms have lowered prices for rotavirus and pneumococcal vaccines as well as pentavalent vaccine, which protects against five deadly diseases through one injection. We are working to ensure sufficient supplies of these vaccines to meet the demand from countries around the world.

New competition will also make vaccines more affordable. We support development of manufacturing facilities and new entrants to the marketplace to ensure that quality vaccines can be produced in sufficient quantities and at a lower cost. Vaccine manufacturers in Brazil, India, and China have steadily increased the quality of their products and will help bring prices down internationally.

Evidence-Based Decision Making

Officials in developing countries must consider a number of factors before deciding which new vaccines to introduce and when.

The first infant in India to receive a pentavalent vaccine introduced by the GAVI Alliance. (Photo © GAVI Alliance)

They must study the impact of the disease in their country, whether a new vaccine will be effective in a given population, and what its benefits will be compared to other health interventions.

We invest in providing reliable information and analysis to help officials review new vaccines and thereby speed up their decision making. Accurate data on the financial burden of disease is essential to accurately calculating the cost-effectiveness of immunizations. Countries also need accurate price and product information to purchase the best product at the lowest possible price. Our partners can then assist decision makers in planning for vaccine introduction.

Advocacy

We work at the international, national, and local levels to make sure that vaccination remains a priority. We are committed to supporting and strengthening the GAVI Alliance and our other partners that work to improve and expand immunization.

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