With increasing number of vaccine-preventable disease outbreaks, urgently tackling glaring childhood immunisation shortfalls must be priority for Gavi and Board
Geneva, 4 December 2023 – Ahead of Gavi, the Vaccine Alliance’s December 6 Board Meeting, Doctors Without Borders/Médecins Sans Frontières (MSF) called for Gavi to use funds leftover from the pandemic COVAX Facility to pay in full for all catch-up vaccines for children up to at least five years old, so that every child who has missed out on some or all of their routine childhood vaccines has the opportunity to catch-up and receive protection against vaccine-preventable diseases.
From 2019-2021 an historic backslide in childhood vaccination fuelled by disruptions to health systems during the COVID pandemic saw 67 million children – of whom 48 million were ‘zero-dose’* children – miss out on routine vaccination. Although 2022 WHO and UNICEF estimates showed vaccination coverage recovery in some countries, most – 60% – had still not recovered even back to pre-pandemic levels. This significant gap in childhood vaccinations comes at a time when we are witnessing an increasing number of vaccine preventable disease outbreaks, including measles and diphtheria. To prevent further outbreaks and to save more lives, ‘zero-dose’ and under-immunised children need to be caught up on their routine childhood vaccinations fast. In addition, Gavi should consider going beyond the currently supported vaccines for catch-up** to include other critical vaccines for childhood survival such as rotavirus and pneumococcal conjugate vaccine (PCV). Ensuring sufficient funds are available to close these gaps will be crucial.
“It is very concerning to see that in some of the countries where we work, a lot of children have not received their routine vaccinations and are now too old to be eligible because countries often can only afford to pay for routine vaccines for children up to age one,” said Dr Louis Massing, MSF Medical Intersectional Coordinator, Democratic Republic of Congo (DRC). “We recently conducted a mass vaccination campaign in close collaboration with the Ministry of Health in the DRC where we reduced the number of ‘zero-dose' and under-immunised children, but to reach every child, there simply needs to be more financial support for countries. While there are of course several factors that limit catching up children on their vaccines, financial constraints at country level are a key issue that Gavi can address by temporarily waiving co-financing for all catch-up vaccines for children up to age five so that countries that have the bandwidth to do so can close these worrying gaps in child vaccination without eroding their health budgets.”
Gavi, an international partnership set up 20 years ago to improve access to vaccines for children living in the world’s poorest countries, has a ‘co-financing’ policy wherein countries contribute to the cost of Gavi-supported vaccines by financing some of the required vaccine doses. This policy is currently an unnecessary financial barrier to getting more children caught up on the vaccines they need. This is because Gavi reportedly has US$2.6 billion remaining COVAX funds*** which, if sufficiently allocated to funding routine childhood vaccinations could make a significant impact without further depleting many countries’ already fragile health systems. This is why, with the upcoming Board Meeting set to explore the various areas in which Gavi can put the remaining COVAX funds to use, we urge catch-up vaccination – along with the necessary technical assistance – to be Gavi’s number one allocation priority.
“Gavi has stated that reaching ‘zero-dose’ and under-vaccinated children is currently its main strategic priority, and with nearly $2 billion leftover from COVAX, Gavi certainly has the means to make this possible for many children,” said Victorine de Milliano, Vaccines Policy Advisor, MSF Access Campaign. “If the Gavi board wants to truly reach its ambition to ‘leave no one behind with immunisation’ then they should vote to fully fund all catch-up vaccine doses requested by countries for children up to 5 years of age and ensure financial barriers are not a limiting factor. With childhood vaccination coverage in such a dire place, fully funding catch-up vaccination doses should be a no-brainer for Gavi especially considering that all catch-up vaccination plans will go through a thorough review. So there’s really no excuse to not fully support the efforts of countries with the capacity to achieve their catch-up ambitions: the money seems to be there, now the Gavi Board needs to show its willingness,” said de Milliano.
* ‘Zero-dose’ children are children who haven’t received a single dose of diphtheria, tetanus and pertussis-containing vaccine.
** The current vaccines listed for catch-up are the Pentavalent vaccine which provides protection to a child from 5 diseases – diphtheria, pertussis, tetanus, hepatitis B and Hemophilus influenza type B (Hib)., and Yellow Fever, Meningitis A, Measles/Rubella, and Inactivated Polio.
*** With around $700 million of this already allocated to COVID-19 vaccination integration, there should be around $2 billion left for re-allocation.