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 prevent more than 11 million deaths, 3.9 million disabilities, and 264 million illnesses by 2020 through high, equitable, and sustainable vaccine coverage and support for polio eradication.

The Challenge

At A Glance

About 1.5 million children die each year from vaccine-preventable diseases.

More than 70 percent of the world’s unvaccinated children live in 10 countries with large populations and weak immunization systems.

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.

We have 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 team is led by Orin Levine, director, and is part of the foundation’s Global Development Division.

Vaccines save millions of lives each 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 are not fully protected with 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 challenges as well. Unreliable transportation systems and storage facilities also make it difficult to preserve high-quality vaccines that require refrigeration.

The Opportunity

Decade of Vaccines: the global vaccine Action Plan

The Global Vaccine Action Plan (GVAP), endorsed by the 194 member states of the World Health Assembly (WHA) in 2012, provides a framework for achieving the vision of the Decade of Vaccines—delivering full access to immunization by 2020 and extending the full benefits of immunization to all people, regardless of where they are born, who they are, or where they live.

The GVAP sets out strategic objectives, recommends actions and stakeholder responsibilities for achieving the objectives, and provides for monitoring and evaluation of the plan’s implementation. All WHA countries now report annually on progress against GVAP indicators.

The plan was the result of a global collaboration involving governments and elected officials, health professionals, academic institutions, vaccine manufacturers, nongovernmental organizations, and civil society organizations.

If the global community meets the plan’s objectives, childhood mortality around the world will be reduced below the targets set by the United Nations Millennium Development Goals.

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.

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. This international collaboration has generated the Global Vaccine Action Plan (GVAP), a framework for preventing millions of deaths by 2020 through more equitable access to existing vaccines for people in all communities.

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 to support the innovation needed to develop new vaccines and new delivery technologies and approaches.

Areas of Focus

Country Programs and Partnerships

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

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

One of our most important collaborations is with the GAVI Alliance, a global public-private partnership of scientists, health experts, government leaders, businesses, and philanthropic organizations whose goal is to save children’s lives and improve health through increased access to immunization in 73 of the world’s poorest countries. 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 GAVI.

A child receiving a vaccination in Silte, Ethiopia.

GAVI is helping countries introduce an array of vaccines, including 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.

In addition to our commitments to GAVI, we make direct investments with partners in India, Nigeria, and Ethiopia, which together account for a significant proportion of the world’s unvaccinated and undervaccinated children and where we have strong relationships with governments and a wide range of other investments.

Our efforts to support polio eradication are an integral part of our country-based approach in the remaining polio-endemic countries— Nigeria, Pakistan, and Afghanistan—as well as in countries that have experienced polio outbreaks.

Immunization Systems

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

We work to strengthen country immunization systems by supporting the collection, analysis, and use of high-quality vaccine-related data, improving the measurement and evaluation of vaccination efforts, and developing new diagnostic tools to help health workers assess population immunity to disease.

Another priority is strengthening vaccine-related supply chains and logistics. We support the development of new ways to help countries improve the storage, transportation, and distribution of vaccines. This is particularly crucial as countries prepare to deliver a greater volume of vaccines to a greater number of people. Many vaccines are temperature-sensitive and require special storage, transport, and handling to ensure that they maintain their potency.

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

In the area of routine immunization, we advocate for stronger, fully financed systems to deliver routine vaccines along with well-planned and well-run education campaigns.

One example of how we work to strengthen immunization systems is in Bihar, India’s most densely populated state. We are building on successful efforts in Bihar to increase immunization coverage and are supporting programs to test and evaluate innovations such as technologies for vaccine registration, tracking, and mapping. We are also investing in new ways to generate demand for and awareness of immunizations among healthcare providers and families.

Vaccine Introduction and Market Dynamics

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.

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

We also invest 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.

Advocacy

We work at the international, national, and local levels to ensure that immunization remains a global health 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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