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Vaccination remains a challenge in Africa

Daniel Pelz
April 26, 2018

Donors pledged $7.5 billion to the global vaccine alliance GAVI in 2015 to immunize millions of people worldwide. Ahead of a review conference in December, GAVI says its on track. But challenges remain.

A child receives a cholera vaccination in South Sudan's capital Juba
Image: Imago/ZUMA Press

When members of the GAVI Vaccine Alliance met in Berlin in 2015, German chancellor Angela Merkel personally drummed up support for the global vaccine alliance. In the end, the meeting even raised slightly more than the $7.5 billion (€6,19 billion) that were asked for. Pledges totaled $7.539 billion. The alliance aims to use the funds to vaccinate some 300 million children worldwide until 2020. Three years down the line, GAVI CEO Seth Berkley told DW that the initiative was making good progress. 

"We were able to raise full funding, which allows us to immunize three million additional children and prevent another 5 to 6 million deaths," Berkley told DW during a visit to Berlin.

GAVI is a public-private partnership that consists of international bodies such as the World Health Organization, private donors, as well as, governments and pharmaceutical companies. GAVI currently supplies developing countries with 13 vaccines, including those against pneumonia, polio, measles and hepatitis amongst others. The alliance, founded in 2000 with the support of Microsoft's Bill Gates, says it will have helped to vaccinate some 700 million children by the end of this year.

Philantropist Bill Gates, Norwegian prime minister Solberg, Tanzania's president Kikwete and Chancellor Merkel at the 2015 replenishment conference in Berlin
Global leaders pledged massive support for GAVI in 2015Image: Reuters/F. Bensch

Lack of infrastructure and conflict hamper immunization efforts 

"There have been dramatic changes in diseases in Africa. One of the most successful ones was a specific campaign using vaccines for meningitis A," CEO Seth Berkely told DW. "We have also seen reductions of diseases like measles, where we have seen a 95 percent reduction of cases globally, although there are pockets of low coverage in Africa where we are still seeing a fair amount of disease."

But plenty of challenges remain. In 2016, nearly one in ten children worldwide did not receive a single vaccine, according to medical charity Doctors without Borders (MSF). In Africa, a lack of critical infrastructure and civil strife in some areas still make it difficult to deliver vaccines to people in need. Public health systems in many countries are heavily underfunded. "There is a huge shortage of health workers, not just doctors, but also nurses and community health workers. It does not just affect immunization, but all diseases. It cannot be solved by external agencies, but only by local governments themselves," Berkley said.

A health worker vaccinates a child at a health centre in Kano, northern Nigeria
A lack of qualified health workers makes it difficult to vaccinate those in need Image: AFP/Getty Images

Even critics appreciate GAVI's efforts, but say there are shortcomings that need to be addressed. The alliance aims to reduce the price of vaccines by buying large quantities of them. GAVI officials insist that they've made great progress in bringing prices down. But the medical charity MSF says more needs to be done. "The vaccine that protects children against pneumonia is still only made by two companies. GAVI gets the lowest global price, but it is still high and has only marginally decreased over the past years," MSF's Vaccines Policy Advisor Kate Elder told DW. "There is more that GAVI could be doing to stimulate competition and to bring in more manufacturers. Because as we see it with many products in other markets, the prices go down when there is more competition."

Review conference scheduled for December

Some civil organizations also demand a critical review of the criteria used to determine the eligibility of countries for support. Currently, countries only receive vaccines through the alliance if their gross national income is below $1580 per capita. For that reason, Congo and Angola are set to loose support. GAVI officials point out that countries can still benefit from reduced vaccine prices for lengthy transition periods that can last for up to ten years.

But that does not satisfy MSF's Kate Elder. "We think of a more sophisticated look at a country's progress rather than this one economic indicator," she said. MSF suggests that health indicators, such as the performance of the health sector in a given country or improvements in the field of vaccination coverage should also be included.

Discussions about this and other issues are expected to feature at an official mid-term review conference scheduled in the United Arab Emirates in December. A new funding conference is likely to take place in 2020.

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