Overcoming challenges to sustainable immunization financing: early experiences from GAVI graduating countries

Abstract

Over the 5-year period ending in 2018, 16 countries with a combined birth cohort of over 6 million infants requiring life-saving immunizations are scheduled to transition (graduate) from outside financial and technical support for a number of their essential vaccines. This support has been provided over the past decade by the GAVI Alliance. Will these 16 countries be able to continue to sustain these vaccination efforts? To address this issue, GAVI and its partners are supporting transition planning, entailing country assessments of readiness to graduate and intensive dialogue with national officials to ensure a smooth transition process. This approach was piloted in Bhutan, Republic of Congo, Georgia, Moldova and Mongolia in 2012. The pilot showed that graduating countries are highly heterogeneous in their capacity to assume responsibility for their immunization programmes. Although all possess certain strengths, each country displayed weaknesses in some of the following areas: budgeting for vaccine purchase, national procurement practices, performance of national regulatory agencies, and technical capacity for vaccine planning and advocacy. The 2012 pilot experience further demonstrated the value of transition planning processes and tools. As a result, GAVI has decided to continue with transition planning in 2013 and beyond. As the graduation process advances, GAVI and graduating countries should continue to contribute to global collective thinking about how developing countries can successfully end their dependence on donor aid and achieve self-sufficiency.

Challenges to sustainable immunization systems in Gavi transitioning countries

“…Gavi documents focus exclusively on transitioning countries, while peer-reviewed articles include analyses of Gavi-ineligible MICs. However, both Gavi publications and peer-reviewed literature focus heavily on appraising financial challenges for countries [3], [9], [13], [14], [15], [16], [17].…”

“…There are two exceptions: a Gavi document [14] and a peer-reviewed article [16] that review the transition experience of six countries (Angola, Bhutan, Republic of Congo, Georgia, Moldova, and Mongolia). Nonetheless, while these two articles offer a useful view on country procurement practices, national regulatory authorities and country capacity for immunization planning and advocacy, they provide examples of issues rather than a comprehensive review of countries’ challenges.…”

Pneumococcal conjugate vaccine implementation in middle-income countries

“…This case underscores the difficulty in determining what is a “fair” price for MICs.Philippe et al [13]GlobalLimited access to international support is resulting in LMICs beginning to lag behind the poorest countries in protecting their populations from vaccine-preventable diseases using newer vaccines and combination vaccines. Strong disease surveillance and programme monitoring systems are required.• to seek more suitable formulations and presentations of new vaccines• surveillance of diseases targeted by new vaccines including enhanced laboratory networks and centres of excellence• supporting the establishment/strengthening of National Immunization Technical Advisory Committees• to ensure evidence-based decision at country level, which is particularly needed in view of the complexity of the immunization programs and cost of new vaccinesSaxenian et al [19]GAVI graduating countries: Indonesia, Sri Lanka, Angola, Bolivia, Azerbaijan, Honduras, Georgia, Congo, Moldova, Armenia, Mongolia, Guyana, Bhutan, KiribatiCountries had not carried out detailed financial projections of vaccine costs by funding source.• Ministry of Health should ensure that vaccine procurement methods result in competitive prices for high quality products• need to build specialised market knowledge and skills• a well-functioning national regulatory agencies (NRA)• to maximise the commitment and support of existing advisory bodies in the country (NITAG)Shen et al [15]Developing countries(list of countries not specified)(1) policy, standards, and guidelines;(2) governance, organization and management;(3) human resources;(4) vaccine, cold chain, and logistics management;(5) service delivery;(6) communication and community partnerships;(7) data generation and use;(8) sustainable financing.An enabling environment, even in the poorest countries, depends on the political will of decision-makers.• a strong routine immunization platform to benefit the overall health system by generating policy and skilled human resources• NITAGs is to guide the development of national immunization policies, guidelines, and standards• NRAs are necessary if countries are to self-procure and ensure a reliable supply of quality vaccines• to improving governance, organization, and management of routine immunization include• to invest to build the capacity and professional development of an appropriately trained health care• educating and mobilising the public to support immunization and to use immunization services is central to EPI• the generation of high-quality immunization data is important to informing programmatic decisions• sustainable financing …”

World Health Organization perspectives on the contribution of the Global Alliance for Vaccines and Immunization on reducing child mortality

“…In counting down towards the MDG's deadline in 2015, countries need to accelerate both introduction of these high-impact vaccines and create the budgetary and fiscal space to sustain these vaccines in their national immunisation programmes against the backdrop of competing health priorities and limited resources 30 31…”