An Analysis Of How The GAVI Alliance And Low- And Middle-Income Countries Can Share Costs Of New Vaccines

Abstract

Immunization is one of the "best buys" in global health. However, for the poorest countries, even modest expenditures may be out of reach. The GAVI Alliance is a public-private partnership created to help the poorest countries introduce new vaccines. Since 2008 GAVI has required that countries cover a share of the cost of vaccines introduced with GAVI support. To determine how much countries can contribute to the cost of vaccines--without displacing spending on other essential programs--we analyzed their fiscal capacity to contribute to the purchase of vaccines over the coming decade. For low-income countries, external financing will be required to purchase vaccines supported by GAVI, so co-financing needs to be modest. Relatively better-off "intermediate" countries could support initially modest but gradually increasing co-financing levels. The countries soon to graduate from GAVI can generally afford to follow a rapid path to self-sufficiency. Co-financing for these countries needs to ramp up so that national budgets fully cover the costs of the new generation of vaccines once GAVI support ends.

Matching Grants for New and Underutilized Vaccines in Resource-poor Settings: Determinants of Generation of New Money

“…Cofunding levels were set based on fiscal space analysis among the recipient low-income countries [14] and as the economies of these countries have continued to grow, there was the expectation that they should be able to contribute more to their immunization costs [28]. However, findings show that the recipients were only able to meet their basic co-funding obligations, and could not rise to the challenge of progressively taking over the full cost of immunization.…”

“…Initially Gavi, a non-profit organization dedicated to increasing access to immunization in low-income countries, provided general or non-matching grants to national immunization programs [12], but due to lack of progress in sustainable self-financing among the recipient countries [3,13], a co-financing form of matching grant was introduced in 2008 with the aim of stimulating an increase in budgetary allocations from local revenue, and funding from other donors [14]. Under co-financing arrangements, grant recipients contribute to the total cost of new and underutilized vaccines from domestic revenue based on a mutually agreed upon formula [14].…”

“…Under co-financing arrangements, grant recipients contribute to the total cost of new and underutilized vaccines from domestic revenue based on a mutually agreed upon formula [14].…”

Vaccine Marketing

“…Donor fi nancing of vaccines is particularly important in low-income countries, where total per capita government spending on health averaged about $15 in 2008 (Saxenian et al 2011 ), while the cost of vaccinating a child fully through age 18 at the US federal contract price amounted to $1,105 for boys and $1,407 for girls ). Vaccine expenditures without donor contributions in lowincome countries would have accounted for 4.2 % of government spending on health in 2010, rising to 6.3 % in 2015.…”

“…Vaccine expenditures without donor contributions in lowincome countries would have accounted for 4.2 % of government spending on health in 2010, rising to 6.3 % in 2015. By comparison, spending on vaccines in Latin American countries, which tend to be early adopters of new vaccines, amounts to slightly less than 1 % of government spending on health (Saxenian et al 2011 ).…”