Gavi is a global vaccine alliance, put together 21 years ago by public and private organisations, to boost immunisation programmes. Last year, Gavi launched the Covax Facility to widen global access to Covid-19 vaccines. Anuradha Gupta, Deputy Chief Executive Officer, Gavi, who was earlier Mission Director of India’s National Health Mission, spoke to Taru Bahl.
What has been GAVI’s role in advancing vaccines for COVID-19?
Gavi is co-leading COVAX with the Coalition for Epidemic Preparedness Innovations (CEPI) and the World Health Organization to accelerate development, manufacturing and equitable supply of Covid-19 vaccines. Our leadership on Covid-19 vaccines builds off our long track record of success in providing vaccines for over 50% of the world’s infants. As the single largest procurer of childhood vaccines, Gavi brings tremendous experience in innovative finance, global pooling of demand and incentivising development of vaccines, at highly affordable prices. Gavi’s work has helped expand and diversify the pool of vaccine manufacturers from only 5 in 2000 (of which only one was in the Global South) to 17 in 2020, of which more than half are in emerging markets, including India. These manufacturers are playing a major role in manufacturing Covid-19 vaccines at scale and at unprecedented speed.
Gavi’s innovative mechanisms such as the Advance Market Commitment – which incentivised accelerated development of pneumococcal vaccine for use in developing countries, saving millions of children from dying of pneumonia – have also proven very useful in encouraging rapid development and manufacturing of Covid-19 vaccines. For example, demand guarantees and pre-financing of US$300 million provided to Serum Institute of India has enabled creation of manufacturing capacity for billions of Covid-19 vaccine doses at an unprecedented pace, with an affordable COVAX price in the range of $3 per dose.
To ensure doses of Covid vaccines are available in time for delivery as early as possible in 2021 besides being affordable and appropriate for roll-out globally in response to the huge level of demand, COVAX is cognizant that it would need as many vaccine candidates as possible for use across a range of populations and settings. This is the reason why the COVAX Facility, of which Gavi is the legal administrator, is investing in a diverse, actively managed portfolio of vaccine candidates – and why Gavi is in discussions with numerous vaccine manufacturers to secure doses for the COVAX Facility.
This strategy has so far seen agreements put in place that secure over 2 billion doses of vaccines for the COVAX Facility, including those with manufacturers of AstraZeneca, Pfizer-BioNTech, Janssen and GSK-Sanofi vaccines. Our goal is to deliver 2 billion doses in 2021, and we continue to negotiate with other manufacturers and hope to announce further agreements shortly.
What kind of influence has GAVI demonstrated with governments and intergovernmental agencies in ensuring equitable distribution of the COVID vaccines?
COVAX is the biggest collaborative global health effort the world has ever seen – involving 190 economies, covering most of the world’s population. It brings countries of all income levels together behind a common goal of ensuring fair, equitable and rapid access. Gavi has also set up the COVAX Advance Market Commitment (COVAX AMC) covering 92 lower income countries including India. COVAX AMC would ensure that countries which might not have the fiscal space to buy Covid-19 vaccines are not disadvantaged.
Donor countries and private foundations have already provided over US$ 6 billion in funding pledges to help COVAX reserve and accelerate supply of at least 1.3 billion doses for these 92 AMC countries in the immediate-term plus additional support in readiness and delivery. This demonstrates the depth of commitment in the international community for multilateral cooperation, as well as effectiveness of public-private partnership in achieving goals that no government or international agency could achieve working on its own.
What has been Gavi’s role in strengthening immunization and in engaging with countries like India that are not its typical beneficiaries?
Gavi was set up at the turn of the millennium to expand access to life saving immunisation in 73 lower-income countries. Starting with 6 vaccines, our portfolio has expanded to 17 vaccines. India is among countries that has benefited from Gavi support. Our partnership with India has focused on introducing essential vaccines to bring down morbidity and child deaths. These include pentavalent, rota, pneumococcal, and rubella vaccines. As a result of Gavi-India strategic partnership, children in India now have access to free vaccines through the publicly funded Universal Immunisation Programme which offers protection against deadly diseases such as pneumonia and diarrhea.
Our support to India has also encouraged several innovations to strengthen immunisation delivery. For example, Gavi funded eVIN, an innovative digital system to monitor availability and quality of vaccines. eVIN has now been upgraded, with Gavi support, as Co-Win, a mammoth digital platform to roll out and monitor Covid-19 vaccines. India would receive upwards of 200 million doses through COVAX AMC worth about Rs 7000 crore plus over 200 crore as delivery support for cold chain, logistics and technical assistance.
While immunisation is an essential health service in every country, the formidable scale of Covid-19 vaccination involves unprecedented effort and preparedness. Gavi is therefore providing funding to WHO, UNICEF, and other partners to support the 92 AMC countries in the planning and preparation for rolling out COVID-19 vaccines as well as support for augmentation of cold chain equipment, critical to keeping vaccines refrigerated at the required temperatures. Our aim is to support countries in exploiting synergies between delivery of routine immunisation and Covid vaccines, with high capacity to identify and reach vulnerable populations.
How do you see other private players like Bill & Melinda Gates Foundation influencing the COVID vaccine agenda especially with GAVI?
While the majority of the funding for both COVAX and for Gavi’s routine vaccination programmes comes from donor governments around the world and from international organisations like the European Commission, a sizeable portion comes from private foundations, companies and individual donors. In addition to the funding itself, private donors such as the Bill & Melinda Gates Foundation are also a valuable source of advocacy, innovation, expertise and skills, and we work closely with them to leverage their comparative advantage to ensure that this historic rollout can be a success for all the countries we serve.
How do you think India should deal with vaccine hesitancy and any lessons from GAVI’s experience with other similar vaccines?
We must not take demand for vaccines for granted. Covid-19 vaccines have been developed in record time and it is essential that we keep on reminding people that the same exacting standards of safety and efficacy are being applied to Covid-19 candidates as they would to any other vaccine candidate. Indeed, trials have been halted on a number of occasions already while researchers investigate potential adverse effects – so the process has been shown to work.
The best response to vaccine hesitancy is ready access to high quality information. But this alone will not solve this challenge. We know that the anti-vax community is well-organised and able to use sophisticated tactics on social media to spread disinformation and play on hesitancy towards COVID-19 vaccines to grow opposition to these inoculations in particular and ultimately vaccination in general. This will disproportionately affect poorer households where access to information and media literacy is lower than in other parts of the population.
During polio campaigns, highly effective strategies were deployed in India to combat rumours and misinformation. Religious leaders, celebrities, high profile influencers, community mobilisers played a big role as did frontline health workers and health providers. Equipping them with right information and tools so they can effectively respond to questions and doubts and dispel myths will be vital. Media, both print and electronic, must continue to be relentless in bringing the truth to people. In addition, social media networks need to ensure they are doing their part. Some recent actions have been encouraging, but more needs to be done.
Views expressed above are the author’s own.
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