Original Article

December 9, 2022

After two days of heavy discussion in Geneva, Switzerland, the Gavi Board has voted its approval of a bold suite of strategy decisions – a plan of action that prompted Chair of the Gavi Board José Manuel Barroso to hail 2023 as a "Year of Renewal".

If that phrase rings with determined confidence, it might be because these last pandemic years have brought with them both hard-won successes and worrying setbacks.

The Board agreed, in principle, to explore integrating the COVID-19 jabs into Gavi’s core programming. The aim here is to help lift the burden on country health programmes of running specialised emergency immunisation programmes, and move towards a sustainable new normal.

In 2021, Gavi-supported countries delivered a larger volume of life-saving vaccines than ever before, with more than 65 million children reached with routine vaccines in addition to the more than two billion COVID-19 vaccines administered in Gavi-supported countries.

And yet, in consequence of COVID-19's many disruptions, the world entered 2022 with millions more vaccine-unprotected "zero-dose" children than it had in 2019. Global coverage with three doses of diphtheria, tetanus and pertussis-containing vaccine (DTP3) – the conventional measure for vaccine coverage in general – fell by four percentage points in 2020 and a further one percentage point in 2021.

This is ground that must be regained. 'Renewal', then, means both catching up losses and pressing ambitiously forward. Here are six ways Gavi will be doing that in 2023:

1. Doubling down on essential immunisation

Making sure children have access to life-saving routine vaccines no matter where they live has been at the heart of Gavi's mission since the organisation was founded at the turn of the millennium. The upshot of its efforts so far? An estimated 16.2 million future deaths averted and child mortality halved in 73 lower-income countries.

But there's a lot more to do. And, since the pandemic hobbled many national immunisation programmes, the world is now engaged in an urgent game of catch-up – the stakes of which are spotlit by the aberrant numbers of large-scale, life-threatening measles outbreaks the world has recorded this year alone.

A renewed focus on routine immunisation and reaching zero-dose children, new vaccine introductions, a strengthened Alliance role in outbreak and pandemic preparedness and response, alongside continued COVID-19 vaccinations in lower income countries, is the basis of Gavi's next-period strategy, the Board has reaffirmed.

2. Finding missed-out zero-dose children

Renewing core commitments doesn't mean business as usual. Finding completely unvaccinated, hard-to-reach zero-dose children and bringing them under the shelter of the immunisation umbrella has been a core priority of Gavi's fifth strategic period, inaugurated in 2021, and which will reach its halfway point in 2023 (the evolution of the Gavi 5.0 strategy just endorsed by the Board is being called 5.1).

The urgency of this work couldn't be clearer: Pre-pandemic analyses suggest nearly 50% of vaccine preventable deaths occur among zero-dose children. Two-thirds of these children live in extremely poor households suffering from multiple deprivations, including lack of access to reproductive health services, water and sanitation.

It's a workstream that – in making vaccination blind spots its target – runs on innovation. The Zero-Dose Immunization Programme, or ZIP, a programme that launched this year, which serves kids in some of the most fragile cross-border zones on the planet, offers one example of the kinds of fresh approaches and partnerships that will channel Gavi's transformative efforts into 2023.

3. Driving new vaccine introductions: HPV and more

The human papillomavirus (HPV) vaccine has the power to prevent 70–90% of cervical cancer cases – a disease which currently finds about 90% of its more than 340,000 annual victims in lower and middle-income countries (LMICs). Today, just 12% of people worldwide, and 9% of people in Gavi-supported countries, have been immunised against the cancer-causing virus.

That's about to change. This week, the Board has green-lit an injection of US$ 167 million for the relaunch of Gavi's HPV vaccine programme, for a total investment of more than US$ 600 million. By 2025, the Alliance is planning to reach more than 86 million girls with the vaccine, which will translate to an estimated 1.4 million future deaths averted.

Other vaccines that will receive beefed-up Gavi support in the next period include the world's first generation of malaria vaccines, and the inactivated polio vaccine (IPV), a critical component of the global polio end-game.

4. In principle, mainstreaming COVID-19 vaccines into Gavi's core programmes

Other potential additions to the Gavi stable of vaccines are the COVID-19 jabs that have been saving lives worldwide for the past two years. While COVAX has a plan to cover the worst-case scenario – a major worldwide resurgence of the pandemic, including associated deaths – the Board agreed, in principle, to explore integrating the COVID-19 jabs into Gavi's core programming. The aim here is to help lift the burden on country health programmes of running specialised emergency immunisation programmes, and move towards a sustainable new normal.

This approval in principle by the Board will help Gavi engage with countries and partners on what shape a future programme would take, while also remaining flexible in case of further developments in 2023.

5. Helping grow vaccine manufacturing outside the Global North – especially in Africa

The pandemic made it clear: concentrating the capacity to make vaccines in just a couple of global regions leaves the rest of the world at elevated risk. Gavi's Board has voted 'yes' on a plan to step up and support regional institutions to create sustainable vaccine-manufacturing hubs in, particularly, Africa, which currently fulfils just 0.1% of global supply.

The African Union has declared an intention that the continent should develop, produce and supply more than 60% of its own vaccine needs by 2040. For both global health equity and resilience, Gavi has pledged to help.

6. Preparing for the next pandemic

You've heard it by now: the question isn't if, it's when. Amid climate change, population growth, urbanisation, pressure on wildernesses and human migration, the chance of a COVID-19 scale pandemic breaking out has increased to an estimated 2% in any given year. At this very moment, the world is faced with no fewer than three WHO-declared Public Health Emergencies of International Concern (PHEICs): polio, mpox and COVID-19.

If it wasn't clear before, it has certainly became evident during the COVID-19 pandemic that Gavi's decades of experience in responding to outbreaks gives the organisation an important position in the global landscape of pandemic preparedness and response (PPR). The Board voted this week to prioritise strengthening health systems in readiness for a major epidemic threat and working towards equitable access to outbreak and pandemic vaccines.