Health

• Basic childhood immunisation rebounded in 2022, as lower-income countries committed historic levels of domestic funding to immunisation programmes.

• Data on outbreaks, population growth, geographic equity highlights challenges ahead, as countries seek to recover immunisation to pre-pandemic levels and expand progress while dealing with multiple threats

A year of recovery for routine immunisation services across 57 lower-income countries supported by Gavi, the Vaccine Alliance in 2022 was underpinned by historic levels of investment by these countries, according to Gavi’s 2022 Annual Progress Report published today.  

In 2022, lower-income countries collectively contributed US$ 162 million to co-finance Gavi-supported vaccines, the highest amount in Gavi’s history. This brings the total amount contributed by lower-income countries since 2008 – when country co-financing began – to US$ 1.5 billion. The report shows that, despite a period of economic turmoil, and with the exception of three waivers due to humanitarian crises, all countries met their vaccine co-financing targets in 2022. This data highlights that immunisation remains a top priority on the political agenda as well as a challenge, with country co-financing projected to substantially increase again, by more than 30%, in 2023. 

This sustained commitment from countries has been key to programmatic impact: In 2022, the percentage of children receiving all three doses of diphtheria, tetanus and pertussis (DTP3) – a key benchmark for basic protection – rose 3 percentage points to 81% across 57 Gavi implementing countries. Country ownership and sustainability are essential pillars of the Vaccine Alliance’s approach, which aims to support country systems on the pathway to self-sufficiency as economies develop and grow. Underpinning this are the economic returns from vaccination itself: the report highlights that immunisation programmes in lower-income countries supported by Gavi have generated more than US$ 220.5 billion in economic benefits since 2000.  

Alongside these promising results, Gavi’s 2022 Annual Progress Report also sounds a strong note of caution of the challenges lower-income countries face in sustaining this progress. While moving in the right direction, routine immunisation coverage in Gavi implementing countries remains 2 percentage points lower than in 2019, the last year before the pandemic took its toll – and progress across countries and regions is uneven. Similarly, while the number of zero-dose children (those who have not received a single vaccine shot) dropped to 10.2 million in 2022, it is still higher than the estimated 9 million there were in 2019. 

While acknowledging the multiple priorities countries are facing, the report also highlights that the toll of failing to consistently reach the most vulnerable communities will only get higher – warning that the impacts of climate change, conflict, migration and deforestation are already being felt, through an increasing number of infectious diseases outbreaks as well as a higher risk of future pandemics.  

“Gavi-supported countries have made a huge effort to restore immunisation, broaden coverage, and mobilise domestic resources for long-term sustainability,” said José Manuel Barroso, Chair of the Gavi Board. “As an Alliance, our priority is to help them maintain this trajectory and work collaboratively to prepare for the new opportunities and challenges that we face. The prospect for immunisation to deliver transformative societal and economic benefits is greater than ever, but only if we are collectively able to navigate the path ahead.” 

“The data reported in this year’s Annual Progress Report shows that immunisation really is a global success story in terms of the unprecedented levels of collaboration we are seeing to expand vaccinations, drive equity and build a long-term pathway towards sustainability,” said David Marlow, CEO of Gavi, the Vaccine Alliance. “At the same time, we must not lose sight of the challenges ahead, as countries face a very uncertain future as a result of deteriorating economic conditions, an uncertain geopolitical outlook and the impact of climate change among other factors. The need for continued collaboration and innovation, today, is greater than ever.” 

Other highlights relating to Gavi’s 4 strategic goals of the 2021-2025 period include: 

Goal 1: Introduce and scale up vaccines – With the addition of COVID-19 and malaria vaccines during the current strategic period, the Gavi portfolio now offers countries vaccines against 19 infectious diseases. Alongside the rebound in DTP3 vaccination, Gavi countries also saw strong gains in coverage of the third dose of pneumococcal conjugate vaccine (PCV3), which climbed to 70% in 2022 after stagnating for three years at 56%. Coverage of the last dose in the schedule of human papillomavirus vaccine (HPVC) also reached 10%, as five more countries adopted it into their national immunisation plans. 

Warning sign: The increasing occurrence of outbreaks of infectious diseases in countries where they have not been detected for many years, if ever, is making detection and response much more challenging. In 2022, only 18% of all globally supported outbreak responses were judged to have met the criteria for timely detection and response, down from 28% in 2021.  

Goal 2: Strengthen health systems to scale up equity in immunisation – With DTP3 coverage increasing and number of zero-dose children reducing (see above), the direction of travel when it comes to equity is encouraging. Health systems have also been incredibly effective in making the best of limited resources: in 2022, health systems reached 68 million unique children with Gavi-supported routine vaccines, administering 9% more routine doses than in 2019. Importantly, children in Gavi-supported countries are now better protected than children in other countries against ten preventable diseases (56% versus 53%) — Gavi’s measure of “breadth of protection”, an important metric guiding the Alliance’s work. 

Warning sign: While Gavi implementing countries reached roughly the same number of children with routine vaccines as in 2019, coverage did not fully return to 2019 levels due to population growth, particularly in Africa. 9 million more babies are being born each year in Gavi implementing countries than in 2000. This population growth highlights the scale of the challenge facing health systems if they are to restore coverage levels to and beyond pre-pandemic levels. The report also highlights that coverage also remains uneven across and within countries. Gavi tracks “geographic equity” by looking at DTP3 coverage rates in the lowest coverage districts in each country – in these areas DTP3 held steady in 2022 at 62%, but this is still lower than in 2019, where average coverage was 67%.  

“The global rebound in immunisation is encouraging, and a tribute to those who have worked so hard to restore life-saving immunisation services with now three years of lower coverage compared to pre-pandemic levels,” said Tedros Adhanom Ghebreyesus, World Health Organisation, WHO, director-general. “But global and regional averages don’t tell the whole story, and they mask severe and persistent inequities. When countries and regions lag, children pay the price. We are proud to work with Gavi to make sure that every child benefits from the life-saving power of vaccines.” 

“Countries have worked hard over the past year to reverse the historic backsliding in routine immunisation, but the job isn’t done yet,” said UNICEF executive director Catherine Russell. “There are still many countries that have yet to recover the ground they lost during the pandemic, leaving vulnerable children at the mercy of preventable diseases such as polio and HPV. In some low-income contexts, we are even seeing a decline in coverage rates, especially for measles vaccination. We must double down on our efforts to reach every child. The recovery has started, now let’s make sure it’s equitable and durable.” 

Goal 3: Improve sustainability of immunisation programmes – The Alliance model is built to be catalytic – leveraging and strengthen country systems through supporting country ownership of immunization programs. Despite having to contend with rising debt levels as well as the impact of climate change, the war in Ukraine and other global shocks, in 2022 Gavi countries continued to demonstrate strong commitment to sustainability and country ownership of vaccination programmes. Alongside the record US$162 million in co-financing contributions in 2022 (see above), the number of vaccine programmes originally introduced with Gavi funding that are now fully self-financed reached 54 in 2022, up from 40 in 2018.  

Warning sign: With countries facing challenges on multiple fronts – pandemic recovery, inflation, debt, conflict, climate, and population growth to name a few – even relatively stronger economies at the final stages of transition out of Gavi support may struggle to co-finance programs. In order to reduce the risk of unsuccessful transition for those countries on a pathway towards becoming fully self-sufficient, the Gavi Board in December 2022 agreed to extend the accelerated transition phase from five to eight years, alongside other measures.  

Goal 4: Ensure healthy markets for vaccines and related products – Healthy immunisation programmes require healthy vaccine production ecosystems to support them. In 2022, Gavi met its target of having at least ten of its vaccine markets assessed as “healthy”. Meanwhile, Gavi’s pipeline of innovative new products grew from two to nine in 2022, including five using microarray patch (MAP) technology – a needle-free means of vaccine delivery that could bring huge benefits in terms of usability.  

Warning sign: While the number of manufacturers supplying pre-qualified Gavi-supported vaccines has grown from 5 in 2001 to 19 in 2022, some regions – in particular, Africa – remained critically under-served. Gavi published a white paper in 2022 outlining plans to expand sustainable vaccine manufacturing in Africa and has begun urgently working with the African Union, Africa Centres for Disease Control (CDC), donors, and partners to address this imbalance. 

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September 29, 2023 @ 6:44 GMT|

Tags: Catherine Russell. Tedros Adhanom Ghebreyesus