"Thanks to the power of immunisation, the number of childhood deaths from vaccine preventable diseases has fallen by 70% since 2000" -- Dr Sania Nishtar, CEO of Gavi, The Vaccine Alliance at the Global Forum for Vaccine Sovereignty and Innovation
The exponential benefits of vaccines cannot be underestimated. As Chris Elias, President of Global Development at the Bill & Melinda Gates Foundation, aptly puts it, "vaccines mean more families celebrate their children's 5th birthday". In the past 50 years, vaccination has saved 154 million lives and prevented the long-term adverse effects of severe diseases, with the majority of lives saved being children under the age of five years.
Reaching the most vulnerable with vaccines
Vaccines are the cornerstone of public health, protecting people from infectious diseases and outbreaks. This is the core of Gavi, The Vaccine Alliance's mission to ensure that people have equitable access to life-saving vaccines, pushing to increase vaccine uptake, especially among zero-dose children who are most in need.
Nigeria has a high prevalence of zero-dose children, with many missing access to even basic immunisations. The COVID-19 pandemic further disrupted vaccination programmes, making it harder to reach these vulnerable populations. So far, catch-up campaigns have been implemented by various development partners, supporting the National Primary Health Care Development Agency (NPHCDA) to bring Nigeria back on track to achieve the Immunization Agenda 2030. However, work still needs to be done to sustain these efforts and ensure no child is left behind in the fight against vaccine-preventable diseases.
Prevalence of Zero-Dose Children, MICS/NICS 2021 National Immunisation Coverage Survey (NICS)
Gavi 6.0: A Fresh Plan to Save Millions
Gavi, a public-private global partnership, has launched its ambitious new five-year strategy for 2026-2030, aiming to save over 8 million lives. This new strategy, approved by the board and announced on June 20th, marks the alliance's sixth strategic period (Gavi 6.0) and seeks to raise funds for the organisation's replenishment. The strategy is designed to respond more effectively to the evolving global disease burden, which is being accelerated by climate change, antimicrobial resistance, and the complexities of fragile and conflict settings, as well as increasing humanitarian crises. Throughout, Gavi will continue to focus on its core mission of providing life-saving vaccine access.
however, there have been calls for Gavi to incorporate more direct input from the countries it serves, empowering them to tailor vaccine programmes to better suit their socio-economic contexts. By doing so, Gavi would ensure that its efforts reflect the real-world needs and priorities of those on the ground. Therefore, in its sixth strategic period, Gavi 6.0 must ensure and promote greater country ownership and prioritisation, fostering more inclusivity ensuring that programme designs are country-driven, and representing local voices and perspectives.
During a panel session titled "A New Era at Gavi: Ensuring the Organisation Remains Fit-for-Purpose," organised by Devex on the sidelines of the 77th World Health Assembly, the Coordinating Minister for Health and Social Welfare, Professor Muhammad Ali Pate, stated that "country contexts differ; one solution does not apply in all countries equally." He additionally pointed out that it might be necessary to consider "flipping the model, to think of countries at the centre, organising global health initiatives in a way that supports country priorities, using national systems, because these are the systems that have the reach, legitimacy, and can be more sustainable."
Navigating the complex transition out of Gavi funding
Nigeria depends on donor funding to bridge the gaps in its healthcare system. Since 2001, Gavi has injected over $732 million into Nigeria's health sector for the purchase of vaccines and cold chain supplies, technical support, immunisation campaigns, and the development of a stronger health system.
The country is set to transition out of Gavi's support by 2028, a development that necessitates a robust plan for domestic resource mobilisation, and programmatic and health system readiness for transition. Nigeria has been in the accelerated phase of the transition process since 2018. This transition was initiated after the country's Gross National Income (GNI) per capita -- the average income earned by the country's residents, including international earnings -- exceeded Gavi's support threshold of $1,580 GNI for three consecutive years. Under Gavi 6.0 plan, countries are categorised into three stages: rapid transformation, preparation, and initiating self-financing.
Gavi's Eligibility for Gavi Support and Transition
Nigeria's transition from Gavi funding is becoming increasingly complex due to evolving economic headwinds and fiscal challenges. The models that previously defined the transition path have shifted. Similarly, the eligibility criteria that determined country funding support from Gavi and the transition pathway may have altered.
The Centre for Global Development (CGD) developed a policy paper, titled "A New Playbook for Gavi", that suggests that Gavi's new 6.0 strategy should consider realigning with the fiscal realities of countries and their disease burdens. Failure to address these concerns could negatively impact vaccine coverage. As such, a nuanced approach, specifically tailored to Nigeria and similar low- and middle-income countries, is essential to navigate the challenging landscape they are faced with, effectively. This transition approach must establish a robust foundation and support system, strengthening capabilities to ensure a successful transition.
Accelerating vaccine manufacturing in Africa
The African continent largely relies on other regions of the world for essential vaccines. This dependency became starkly apparent during the COVI9-19 pandemic when access to vaccines significantly lagged behind that in high-income countries (HICs). It is now widely recognised that Africa imports 99% of its vaccines, with only 1% produced locally. This has served as a wake-up call on the continent, with increased discussions pushing the urgent need for the continent to boost local vaccine production and reduce dependency on external sources.
In the wake of COVID-19, various initiatives were developed to address the significant gaps in vaccine and pharmaceutical production across the African continent. These efforts include the Partnership for Vaccine Manufacturing (PAVM), the African Medicines Agency (AMA), and the most recent, the African Vaccine Manufacturing Accelerator (AVMA), a $1 billion commitment from Gavi, to incentivise local vaccine production. The initiative was approved by the Gavi Board in December 2023 and launched in June 2024, following a design process conducted over nearly two years of close collaboration between Gavi, the African Union and the Africa Centre for Disease Control and Prevention (Africa CDC). The funding is expected to act as a catalyst, offering a critical opportunity for manufacturers to embark on the path to vaccine production.
How does the African Vaccine Manufacturing Accelerator (AVMA) work?
Currently, the yearly demand for vaccinations in Africa is estimated to be worth over US$ 1 billion, and over the coming decades, this amount is expected to rise in tandem with the continent's population. Since the production of vaccines has significant initial costs, it is doubtful that the commercial sustainability needed for continuous supply security will emerge in the absence of downstream incentives. AVMA seeks to support two main goals: enhanced pandemic and outbreak vaccine supply resilience in Africa and a sustainable African manufacturing base that supports robust global vaccine markets.
The Presidential Initiative on Unlocking Healthcare Value Chains (PVAC) in Nigeria could play an important role in leveraging funds from AVMA, by stimulating private sector investment in vaccine manufacturing and other medical products in Nigeria. The initiative can also help shape markets to ensure sustainable local and international demands, with an overall goal of saving lives.
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To successfully improve their vaccine manufacturing capabilities, African countries must leverage both existing and emerging technologies, exploring innovative ways to disrupt traditional vaccine production models. An initiative such as the African Vaccine Agency (AVA) is seeking to strengthen locally-driven vaccine development capacities. Other support for regionally-led efforts includes the Coalition for Epidemic Innovation (CEPI) partnership with BioNTech_Group to develop mRNA vaccine research, development, and manufacturing capacities, both clinical and commercial-scale, at BioNTech's site in Kigali.
The ultimate measure of AVMA's success will hinge on whether procurement agencies like Gavi or government entities place sizable orders with African manufacturers, which would significantly strengthen and sustain the continent's vaccine production capacity. At the Global Forum for Vaccine Sovereignty and Innovation, Ndidi Nwuneli, CEO/President of One Campaign, emphasised that "vaccine sovereignty is critical to ensure healthy lives across Africa.". The commitment to enhance local vaccine production is not just about achieving self-sufficiency, but also to ensure long-term health security and resilience for the African continent.
This initiative not only aims at self-reliance but also at continuing the legacy of vaccines as life-saving miracles. Building on this foundation, establishing vaccine production in African represents a critical step toward taking control of our health and future. It marks a shift from dependency to independence, creating the opportunity for African countries to develop vaccines and therapeutics tailored to our unique disease landscape and public health needs, leveraging the latest innovations.
