I relish access to various public institutions, including my local library, bus services, and postal system. However, upon being asked to choose a standout achievement by the US government, I would likely opt for “funding Gavi.”
Is the global health initiative, supported by affluent governments and charitable organizations, responsible for financing and coordinating the delivery of life-preserving vaccinations across the developing world? Nations can grow to become eligible for membership in international organizations if their economy, political stability and infrastructure are developed enough. It’s surprising that many countries we consider quite impoverished, such as Bangladesh or Kenya, still struggle to meet the criteria for Gavi support. Countries that consistently receive the most assistance from international organizations are typically among the poorest in the world – think Haiti, Liberia, and the Democratic Republic of the Congo, among others.
When you’ve heard of Gavi, you may know that it co-led Covax, the global initiative aimed at ensuring low-income countries gained access to COVID-19 vaccines. While it’s true that routine vaccination is a core component of its portfolio, similar to the polio vaccine or measles, mumps, and rubella (MMR) vaccines. Its groundbreaking work has had a profound impact, saving hundreds of thousands of lives worldwide.
Gavi, similar to numerous global entities, operates under a replenishment framework, where every few years it solicits commitments from high-income countries to support its efforts over a fixed period, typically spanning three to five years. The International Monetary Fund is currently seeking $9 billion in funding from wealthy nation donors to cover its budget shortfall between 2026 and 2030. A global health organisation is poised to allocate substantial funds for the procurement of vital medicines, prioritising initiatives combating malaria, a devastating disease that disproportionately affects millions living in some of the world’s most impoverished countries. Such vaccines, which offer significant advantages, further strengthen the case for benevolent funding of Gavi.
On the same time, raising $9 billion is no easy feat, and Gavi’s ask for funding coincides with a crowded landscape of global humanitarian organizations – the World Bank, World Health Organization, and others – all vying for donor support simultaneously? The concern is that the prolonged fundraising effort may lead to donor fatigue and budget constraints, potentially threatening the ability of some, if not all, teams to achieve their goals.
Fortunately, Gavi seems less likely to succumb to that dire fate. The US has allocated $9 billion to the group, which is part of the total funding they had requested. Despite Congressional gridlock on many issues, there’s actually bipartisan backing to take a more robust approach.
While vaccine hesitancy remains a persistent concern, Gavi’s efforts in purchasing and delivering immunizations have indeed been impressive. One key consideration is that reduced pricing would likely have the effect of increasing accessibility, allowing more people to receive vaccinations at a lower cost.
The company has played a pivotal role in driving the development of cutting-edge vaccines. When the Alliance launched in 2000, the sole available pneumococcal vaccine targeted serotypes predominant in wealthy countries, rather than those prevalent in GAVI-supported nations where pneumococcal disease poses a significant public health burden. By making a commitment to purchase large quantities of an effective vaccine, Gavi, the Vaccine Alliance, has pledged to support the widespread use of a vaccine that has been proven successful in improving health outcomes in low-income countries.
By the end of 2016, an initial assessment revealed that Gavi’s early efforts had resulted in approximately 9 million lives saved, with each life valued at around $118. Utilising a specific empirical technique, the estimated fee per life saved ranges from $4,265 to $17,059; although still remarkably low in the grand scheme of things? Raising Medicaid coverage in the United States would require a significant investment, potentially exceeding the number of vaccinations administered by Gavi by at least 300 times.
Distributing vaccines at an affordable price isn’t always straightforward. The study found that Gavi funding for countries like Ukraine or the Philippines, which were near its revenue threshold, essentially covered vaccines they would have purchased anyway; however, authors stressed that this was not the case for very poor nations far from the cutoff, nor for less poor nations where assistance allowed them to adopt more advanced vaccines and redirect government funds to other valuable social programs.
According to Adam Wexler, director of the global health budget project at the Kaiser Family Foundation, this observe document has fostered a prolonged historical record of bipartisan support in Congress for Gavi. During the presidencies of Barack Obama and Donald Trump, Congress consistently demonstrated a willingness to provide substantial support for the organization, often meeting or exceeding the president’s initial commitments. By 2011, NASA’s funding was expected to cease entirely by 2015; however, Congressional budget decisions ultimately spared the agency from this drastic cut. During his presidency from 2017 to 2021, the Trump administration had control of all three branches of government: the executive branch (led by President Donald Trump), the legislative branch (Congress) and the judicial branch.
That continues immediately. This spring, bipartisan resolutions have emerged in both chambers of Congress, advocating for robust funding levels for Gavi, while bicameral efforts are also underway, seeking $340 million annually to support the organization’s mission. The White House has committed to a substantial $1.7 billion allocation for this initiative, surpassing the $1.58 billion promised by the Biden administration. When announcing the budget allocation, the administration exercised caution by specifying a minimum amount of “not less than $1.58 billion,” allowing Congress to potentially exceed this figure.
The House Appropriations Committee recently passed a budget bill featuring significant cuts, including the elimination of all funding for the World Health Organization. Despite the Republican-backed package deviating from expectations, it still allocated $300 million to Gavi, aligning with President Biden’s initial commitment, albeit falling short of the $340 million advocacy groups had sought. Colin Puzo Smith, director of worldwide coverage for pro-aid advocacy group Outcomes, informed me that the $1.58 billion will be allocated as follows: $300 million in the initial year and $320 million over the subsequent four-year period, ensuring the House bill stays on track.
While final funding is still pending, it’s likely that the Home and Senate appropriators will clash over disparate aspects of the proposed legislation. However, it now seems increasingly likely that at least $300 million in Gavi funding for 2025 is all but assured.
Will global health efforts ensure that the revolutionary malaria vaccine reaches those who need it most?
I’m surprisingly revitalized whenever American politics demonstrate a genuine commitment to crucial programs, which is all it takes to spark my enthusiasm. Despite the presence of concrete instances, allocators should strive to achieve much more effectively.
Two new vaccines are set to become available for combating malaria. Despite ongoing refinement efforts, RTS,S remains a costly endeavor to distribute; conversely, R21, the second approved vaccine, should not be similarly burdened by expenses. At present prices, RTS,S costs more than R21, which is priced at $3.90 per dose. Once manufacturing scales up, GlaxoSmithKline, the manufacturer of RTS,S, anticipates producing approximately 15 million doses annually, while the Serum Institute, responsible for R21, currently forecasts an annual output. As a result, the cost being less than half its value, with the added benefit that it can be manufactured in larger quantities, R21 stands out as the most viable option.
A full course of both vaccines requires four doses, permitting the theoretical production of enough supply to immunize approximately 29 million children annually. Despite this effort, it’s still insufficient to cover every child vulnerable to the disease, but it is a substantial number. Currently, the Gavi price range falls short of achieving that focus. The initiative aims to immunize 50 million children between 2026 and 2030, equivalent to 10 million per year. Despite being below the projected figure, this represents a significant step forward in the global vaccination effort.
In the near future, the situation looks increasingly grim. The advocacy group 1DaySooner has been driving its mission forward with significant momentum in recent years, setting goals for 2024 and beyond. According to Serum’s estimates, producing that quantity would require approximately 200 million doses. While Gavi has already vaccinated around 2 million children by the end of 2025, this represents only a quarter of the potential number that could have been reached with additional financing.
The rollout of R21 has been met with skepticism from some quarters in public health, a reaction that I find bewildering. While efforts are being made to eradicate malaria, a more effective approach is needed to ultimately eliminate it, just as the smallpox vaccine successfully exhausted that disease. According to leading studies, immunity is reportedly achieved within a year of vaccination, a remarkable outcome although not quite on par with others, such as the HPV vaccine. As the malaria landscape evolves, considering RTS,S as just one tool among many, potentially upgradable with advances in vaccine technology, seems a prudent approach. In the event you’re staying near Baltimore, you can help out right away!
The R21 vaccine continues to be an exceptionally cost-effective strategy for preventing malaria infections and deaths. According to research, implementing R21 can extend a child’s life by approximately one year at a cost of around $39 per annum. Anti-malarial bednets can save nearly a year’s worth of life for approximately $38 per person. Bednets are among the most cost-effective public health interventions known to humanity, being roughly as effective as they are in saving lives. If Gavi were able to procure it at a significantly lower cost per unit, it could potentially be a more cost-effective option than bednets, making it a relatively straightforward decision.
While the bipartisan backing for Gavi is commendable, it’s essential to note that donors like the US should be committing significantly more funds to guarantee every single dose of RTS,S and R21 purchased and utilized to combat malaria is effectively supported. Ensuring timely funding for conventional vaccinations is a commendable endeavor. Every 100,000 children vaccinated with R21 results in a reduction of around 10 deaths from malaria.
“The 48-million-child disparity between 1DaySooner’s proposed vaccination goal and Gavi’s current plans for this year and beyond translates into approximately 300,000 additional child fatalities.” By securing sufficient financial support, we have the potential to preserve countless lives.
Will we, as a nation, and globally, truly permit financial constraints to stand in the way of children receiving life-saving malaria vaccinations?
