SEATTLE — This year, five countries are fully transitioned away from Gavi support to domestic funding for vaccine programs, and by 2020, 19 more countries will have done the same. Numerous self-financing problems, though, have led various groups to look into how they can help this process.
Gavi improves access to new and underused vaccines for children living in the world’s poorest countries. Its programs provide vaccines and injection supplies, direct financial support and indirect technical assistance through its partners.
In order to deliver to the countries that need this aid the most, Gavi has a cutoff for aid. Only countries with an average Gross National Income of less than or equal to $1,580 over the past three years are eligible. If they rise above the cutoff, countries transition away from Gavi support to domestic financing.
These countries have risen from lower-income to lower-middle income country (LMIC) status but often still face serious challenges to successfully financing themselves after a complete transition away from Gavi.
When the program was originally designed in 2012, Gavi’s first step was to collect data on transitioning countries. Key country documents were reviewed and countries were visited in order to work with the governments and partner with staff members to collect additional data.
Potential issues were then identified and financial projections and analyses of potential transition countries were prepared. Finally a transition plan was created for monitoring and following up with the countries.
In 2013 the transition process was tweaked to alleviate the challenges transition countries faced. They now have a grace year in which they can continue to buy new and underused vaccines at the low Gavi cost. They can also access time-limited investments to support their transition plans.
Despite these efforts, major challenges still persist for countries that must transition away from Gavi support. Members of Results for Development (R4D), a nonprofit that focuses on solving development issues, coauthored an article with Gavi that highlighted the challenges countries face during the transition to domestic financing. Most of the problems were financial or capacity based.
The most common issues were the financial burden, weak vaccine regulatory capacities to ensure the monitoring of vaccine quality and follow-up after immunization, inefficient procurement policies and mechanisms, problems with coverage and equity and the lack of an institutional, independent body to provide objective, expert advice.
To see how Gavi can combat these issues, R4D obtained a grant from the Bill and Melinda Gates Foundation to look into the necessity of laying a groundwork for a learning network for transitioning countries.
Such a learning network would provide countries with the opportunity to work together to solve the problems that arise as they transition. They could come together during workshops, virtual dialogues and country-to-country knowledge sharing activities in order to discuss their practical problems and receive advice.
The Center for Strategic and International Studies (CSIS), a bipartisan policy research organization, also looked into ways to help countries as they transition away from Gavi support, specifically how the U.S. can help it’s neighbors in Central America. Honduras has now fully transitioned, and Nicaragua is currently transitioning.
CSIS’s research showed that both countries had successfully introduced new and underused vaccines with Gavi support and maintained generally high immunization coverage rates. However they also face political and technical challenges to sustainable domestic financing.
In both countries, the political impact of health sector reform is still unclear, and numerous technical problems exist. Neither has the capacity to maintain cold chain equipment (used for storing vaccines) or to collect, manage or evaluate information about immunization coverage and program impact. It is also difficult to retain qualified health workers thanks to low pay and dangerous environments that don’t encourage people to say, such as the violence in Honduras.
CSIS suggests three possible approaches for U.S. aid:
- On a global level, it recommends that the U.S. use its position on the Gavi board to advocate for further refinements to the transition process, such as extended access to the low Gavi prices and an extended transition period.
- On the regional level, CSIS says the U.S. should continue to regional mechanisms that facilitate the procurement of vaccines at a low cost and to respond to requests for technical assistance with immunization program design and disease detection programs.
- Nationally, it suggests that the U.S. reverse its current trend of withdrawing bilateral health assistance in Honduras and Nicaragua, noting that while the U.S. has contributed more money to ensuring food security and democracy in these countries, poor health is also “both a driver of and a consequence of inequality and insecurity.”
– Anastazia Vanisko