![全球发展中心-超越“符合全球疫苗免疫接种条件”:全球疫苗免疫在不符合条件的中等收入国家提高疫苗获取和吸收的高杠杆机会(英)_第1页](http://file4.renrendoc.com/view14/M02/14/21/wKhkGWYdM-mAEFLQAAGgjL40s-A804.jpg)
![全球发展中心-超越“符合全球疫苗免疫接种条件”:全球疫苗免疫在不符合条件的中等收入国家提高疫苗获取和吸收的高杠杆机会(英)_第2页](http://file4.renrendoc.com/view14/M02/14/21/wKhkGWYdM-mAEFLQAAGgjL40s-A8042.jpg)
![全球发展中心-超越“符合全球疫苗免疫接种条件”:全球疫苗免疫在不符合条件的中等收入国家提高疫苗获取和吸收的高杠杆机会(英)_第3页](http://file4.renrendoc.com/view14/M02/14/21/wKhkGWYdM-mAEFLQAAGgjL40s-A8043.jpg)
![全球发展中心-超越“符合全球疫苗免疫接种条件”:全球疫苗免疫在不符合条件的中等收入国家提高疫苗获取和吸收的高杠杆机会(英)_第4页](http://file4.renrendoc.com/view14/M02/14/21/wKhkGWYdM-mAEFLQAAGgjL40s-A8044.jpg)
![全球发展中心-超越“符合全球疫苗免疫接种条件”:全球疫苗免疫在不符合条件的中等收入国家提高疫苗获取和吸收的高杠杆机会(英)_第5页](http://file4.renrendoc.com/view14/M02/14/21/wKhkGWYdM-mAEFLQAAGgjL40s-A8045.jpg)
版权说明:本文档由用户提供并上传,收益归属内容提供方,若内容存在侵权,请进行举报或认领
文档简介
Beyondthe“Gavi-Eligible”
High-LeverageOpportunitiesforGavitoEnhanceVaccine
AccessandUptakeinIneligibleMiddle-IncomeCountries
RACHELSILVERMANBONNIFIELD·MORGANPINCOMBE·JANEENMADANKELLER
Abstract
Thegloballocusofundervaccinationisincreasinglyshiftingfromthepoorestcountriesintheworld—whichareeligibleforsupportfromGavi,theVaccineAlliance(Gavi)—to
middle-incomecountries(MICs)thatdonotqualifyfortraditionalGavisupport.Given
thesegrowingchallenges,GavimustrethinkitsengagementwiththoseMICsthatare
ineligiblefortraditionalsupport.Althoughthisengagementisintendedtobe“catalytic”andhasbeenintentionallytargetedtocountryneeds,italsohasbeenrelativelysmall-
scaleandadhoc.Gavi’snextfive-yearstrategicperiodfrom2026to2030,knownas
“Gavi6.0,”offersawindowofopportunityforitsboardandleadershiptoconsidernew
anddifferentwaysforGavitoengagewithMICstoadvanceglobalvaccineaccessand
improvevaccinationoutcomes.Tohavethegreatestimpactinthiscontext,Gavimust
leanintoitscomparativeadvantageinmarketshapinganddemandconsolidation
todriveitscontributionstoglobalvaccinationeffortswithfiniteresources.Weoffer
recommendationsforGavitooperationalizebroaderengagementwithMICs,specifically
byenablinganexpandedcohortofMICstoaccessmoreaffordablepricesforbothnewer,costliervaccinesandfuturevaccinesviaopt-inframeworkagreementsandbysupportingaglobalcoordinatinghubtoshapeaforward-lookingimmunizationinnovationagenda.
POLICYPAPER326•APRIL2024
Beyondthe“Gavi-Eligible”:High-LeverageOpportunitiesforGavitoEnhanceVaccineAccessandUptakeinIneligibleMiddle-IncomeCountries
RachelSilvermanBonnifield,MorganPincombe,andJaneenMadanKeller
CenterforGlobalDevelopment
TheauthorswouldliketothankNimaAbbaszadeh,KellyCarr,KalipsoChalkidou,JavierGuzman,andGavi
colleaguesfortheirfeedbackandinputonearlierdraftsofthispaper.TheCenterforGlobalDevelopmentis
gratefulforcontributionsfromtheBill&MelindaGatesFoundationinsupportofthiswork.
RachelSilvermanBonnifield,MorganPincombe,andJaneenMadanKeller.2024.“Beyondthe“Gavi-Eligible”:
High-LeverageOpportunitiesforGavitoEnhanceVaccineAccessandUptakeinIneligibleMiddle-Income
Countries.”CGDPolicyPaper326.Washington,DC:CenterforGlobalDevelopment.
/
publication/beyond-gavi-eligible-high-leverage-opportunities-gavi-enhance-vaccine-access-and-uptake
.
CENTERFORGLOBALDEVELOPMENT
TheCenterforGlobalDevelopmentworkstoreduceglobal
2055LStreet,NWFifthFloor
povertyandimprovelivesthroughinnovativeeconomic
Washington,DC20036
researchthatdrivesbetterpolicyandpracticebytheworld’s
topdecisionmakers.UseanddisseminationofthisPolicyPaper
1AbbeyGardens
isencouraged;however,reproducedcopiesmaynotbeused
GreatCollegeStreet
forcommercialpurposes.Furtherusageispermittedunderthe
London
termsoftheCreativeCommonsAttribution-NonCommercial4.0
SW1P3SE
InternationalLicense.
TheviewsexpressedinCGDPolicyPapersarethoseofthe
authorsandshouldnotbeattributedtotheboardofdirectors,
CenterforGlobalDevelopment.2024.
fundersoftheCenterforGlobalDevelopment,ortheauthors’respectiveorganizations.
Contents
Introduction 1
Section1:Whyineligiblemiddle-incomecountriesarebecoming
“groundzero”forglobalunder-immunization 3
KeyPoint1:Non-GaviMICsnowaccountforalarge—and
increasing—shareoftheworld’sundervaccinatedpopulation,
withagrowingconcentrationofzero-dosechildren 3
KeyPoint2:ManyMICsaregettinglessformorewith
theirimmunizationexpenditures 5
KeyPoint3:MICsarestillrecoveringfromCOVID-inducedhealth
andeconomicshocksandfacingaperiodoffiscaltightening 9
Section2:Gavi’sexistingapproachtosupportingmiddle-income
countries 11
OverviewofGavisupportavailabletodifferentcategoriesofMICs 12
ChallengesandgapswithGavi’scurrentapproach 15
Section3:PolicyrecommendationsforrethinkingGavi’sengagement
withmiddle-incomecountries 17
Recommendation1:Fornewerandcostliervaccines,facilitate
opt-inframeworkagreementswithcentrallynegotiatedtiered
pricingforanexpandedcohortofMICs 19
Recommendation2:Forfuturevaccines,facilitateopt-inmarket
entryframeworkagreementswithcentrallynegotiatedtieredpricing
foranexpandedcohortofMICs 21
Recommendation3:Supportaglobalcoordinatinghubforthe
ImmunizationInnovationAgenda(CHIIA) 23
Conclusion 24
AppendixA 25
Figures
1.Introductionsofneworunderutilizedvaccinesbycountryincomegroup
andGavieligibilitystatus........................................................................................................................6
2.Numberofzero-dosechildrenbycountryincomegroupandGavieligibility,
2019–2021......................................................................................................................................................10
Tables
1.Summarybreakdownof108MICs(classificationsforFY2024),data
formostrecentyear 4
2.Pricecomparisonsfromvaccinepurchasesin2020–2022acrosscountrygroups
andbyprocurementmechanism 8
A1.Breakdownof108MICs(classificationsforFY2024),dataformostrecentyear 25
Introduction
Althoughvaccinesaretypicallyadministeredinaprivateinteractionbetweenahealthworkerandapatient,“vaccination”writlargeisaglobalissue.Allcountries,atallincomelevels,haveaninterestinensuringthatexistingvaccinesareaccessibletotheirpopulations,includingvialocallyaffordablepricingandsupplysecurity;promotingvaccineuptakeamongeligiblepopulationstomaximizebothindividualprotectionandpopulation-levelprotectionvia“herdimmunity”;and,tosomeextent,
developingsafeandeffectivenewvaccinestoaddressexistingandpotentialhealththreats.1
Gavi,theVaccineAlliance(Gavi),isamajorglobalinitiativethatseekstopromoteglobalvaccinationandservethisglobalpublicgood.Gaviwasfoundedin2001withthemission“tosavelivesandprotectpeople’shealthbyincreasingequitableandsustainableuseofvaccines.”2Inthenearly25yearssinceitsfounding,Gavihastargeteditssupporttothepoorestcountries,withgrossnationalincome(GNI)percapitaunderapresetthreshold;thisGNIthresholdhasrangedfrom$1,000in2001to$1,810
asof2024.
InGavi’searlyyears,thisfocuswasclearlylogical;the77eligiblecountriesthatmetGavi’s
eligibilitythresholdwerepreviously“groundzero”forglobalundervaccination.Asof2005,forexample,84percentoftheworld’szero-dosechildren—thosewhohavenotreceivedanyroutinevaccination—livedinGavi-eligiblecountries.3However,thesituationischangingatarapidpace.
Increasingly,thegloballocusofundervaccinationismovingfromGavi-eligiblecountries—the
poorestintheworld—tosomewhatwealthiermiddle-incomecountries(MICs)thatnolongerqualifyfortraditionalGavisupport.
Thereareseveraltrendsunderlyingthisbroadphenomenon,whichwillbediscussedand
substantiatedatgreaterlengthinSection1.First,sinceitsfoundingin2001,Gavihasseen
substantialsuccessinsupportingpartnercountriestoraisevaccinationrates.VaccinationcoveragegapsbetweenthepoorestcountriesandwealthierMICshavenarrowedand,insomecases,even
closed.Second,manylargeMICshavealreadytransitionedfromGavisupport,orareexpectedtodosoby2030,becausetheirGNIspercapitacurrentlyorwillsoonexceedtheGavieligibilitythreshold.BecauseGavi’seligibilitymodelisbasedonincomeandnotonprogrammaticreadinessorcoveragerates,countriesmaytransitionwithouthavingfirstachievedhighcoverageratesforcertain
vaccines.Third,MICsthathaveneverbeeneligibleforGavisupportsometimesfacehighervaccinepricesthanthosethataremadeavailabletoGavi-eligiblepeers,especiallyfornewervaccinesand
whenself-procuring.ThesecountrieshaveseenslowintroductionofnewWorldHealthOrganization(WHO)-recommendvaccines,inlargepartowingtoaffordabilityandcost-effectivenesschallenges.
1Manylow-andmiddle-incomecountrieswouldstronglyprioritizeaffordableandreliableaccesstoexistingvaccinesoverdevelopmentofnewvaccines;however,thesesamecountriesmightnonethelessbenefitfromdevelopmentofnewvaccinesifandwhentheycometomarketandareofferedatlocallyaffordableprices.
2“AboutOurAlliance,”Gavi,theVaccineAlliance,lastaccessedMarch22,2024,
/our-alliance/about
.
3“GAVIAllianceProgressReport2005,”Gavi,TheVaccineAlliance,2005,
/sites/default/files/
publications/progress-reports/Gavi-Progress-Report-2005.pdf
.
BEYONDTHE“GAVI-ELIGIBLE”:HIGH-LEVERAGEOPPORTUNITIESFORGAVITO1
ENHANCEVACCINEACCESSANDUPTAKEININELIGIBLEMIDDLE-INCOMECOUNTRIES
(Thereare57countriesclassifiedasMICsthathaveneverbeeneligibleforGavisupport,
including13lower-middle-incomecountriesand44upper-middle-incomecountries.)4
Gavi-ineligibleMICsnowaccountforalargeandgrowingshareoftheglobalundervaccination
challenges.YetallMICs—boththosethathavetransitionedfromGavisupportandthosethatwere
neverGavi-eligible—arefacingthischallengewithoutcoordinated,comprehensivesupportfromtheinternationalcommunity.Despitethetremendousinternationalimportanceofvaccination,nosingleinternationalorganizationhastheglobalmandate,broadlyspeaking,tosupportcountriestoprocure
vaccines,ensurehighcoverage,andreachglobalvaccinationgoals.Thereare,ofcourse,several
organizationswithpartialmandatesaroundvaccinedevelopment,access,affordability,quality,coverage,andinnovation,includingtheWHO,theCoalitionforEpidemicPreparednessInnovations(CEPI),the
UnitedNationsChildren’sFund(UNICEF),regionalprocurementplatformsandtechnicalblocs(e.g.,thePanAmericanHealthOrganization[PAHO]),philanthropies,andevenGaviitself.Theseorganizations
engagewithsomenoneligibleMICsthroughnarrowlytargetedformsofsupport(seeSection2).However,formostcountries,theoverallsupportprovidedbythesemechanismsisfragmented,inconsistent,andincomplete.MostMICsreceivelimitedsupportorservicesinaddressingkeyvaccinationobstacles.
IfGaviwishestoremainthepremierorganizationsupportingglobalvaccineaccess,itmustexpanditsbusinessmodelbeyondthegroupofcountrieseligiblefortraditionalsupport,towardfacilitatingandsupportingbettervaccinationoutcomesinMICs.YetGaviisaninitiativewithlimitedfinancialandtechnicalresources,atleastrelativetothescaleofthechallengesconfrontingtheentirecohortofMICs.MICs,asacollective,havelargerpopulations,higherhealthspending,andgreateroverall
resourcescomparedtothecohortoflower-incomecountriesthatareeligiblefortraditionalforms
ofGavisupport.Tohavethegreatestimpactinthiscontext,Gavimustleanintoitscomparative
advantageandbestrategicaboutwhereitcanuseitsfiniteresourcestomakethelargestpossible
contributionstoglobalimmunizationgoals.Gavi’snextfive-yearstrategicperiodfrom2026to2030,knownas“Gavi6.0,”offersawindowofopportunityforitsboardandleadershiptoconsidernewanddifferentwaysforGavitoengagewithMICs,aswellashelpGaviprepareforfurtherevolutioninthepost–SustainableDevelopmentGoalsera.
ThispaperwillfirstdemonstratewhyMICsarenowcentraltoglobalchallengesofundervaccination.ItwilldescribethespecificchallengesMICsfacewithvaccinationandconsiderhowthesechallengesdifferacrosssubcategoriesofMICs—forinstance,formerlyeligibleGavicountriescomparedwith
neverGavi-eligiblecountries.Second,itwillreviewGavi’sexistingeffortsandmodesofsupportinMICs,highlightwhatweknowabouthowtheseeffortshaveworkedtodate,andassesswheretheycontinuetofallshort.Finally,itwillofferthreeideasforhowGavicanexpanditsengagementwithMICs,buildingonitscomparativeadvantageinmarketshaping,formaximumglobalbenefits.
4Authors’calculationsbasedonfiscalyear(FY)2024WorldBankincomegroupsand2024Gavieligibility:“WorldBankCountryandLendingGroups,”WorldBank,lastaccessedMarch22,2024,
/
knowledgebase/articles/906519-world-bank-country-and-lending-groups
;“Eligibility,”Gavi,theVaccineAlliance,lastaccessedMarch22,2024,
/types-support/sustainability/eligibility
.
BEYONDTHE“GAVI-ELIGIBLE”:HIGH-LEVERAGEOPPORTUNITIESFORGAVITO2
ENHANCEVACCINEACCESSANDUPTAKEININELIGIBLEMIDDLE-INCOMECOUNTRIES
Section1:Whyineligiblemiddle-incomecountriesare
becoming“groundzero”forglobalunder-immunization
KeyPoint1:Non-GaviMICsnowaccountforalarge—and
increasing—shareoftheworld’sundervaccinatedpopulation,withagrowingconcentrationofzero-dosechildren
AtGavi’sfounding,thepoorestcountriesintheworld—thosethatwereeligibleforGavisupport—
hadverylowuptakeofbasicchildhoodvaccinations.In2000,Gavi-eligiblecountrieshadabout
65percentcoverageofthethirddoseofthecombineddiphtheria,tetanus,andpertussiscontainingvaccine(DTP3);around20percentcoverageoftheHepatitisBvaccine;and0percentcoverage
oftheHaemophilusinfluenzaetypeb(Hib)vaccine.5Sincethen,Gavi’sinvestmentshavehelped
eligiblegovernmentsachieveremarkablegainsinvaccinecoverage.Asof2022,countriesthat
remainedGavi-eligiblehadpentavalentcoverageof81percent(includingDTP3,HepatitisB,andHibprotection)—justslightlylowerthanglobalcoveragerates(84percent).6Perhapsmostremarkably,Gavireportedin2022thatthe“breadthofprotection”acrossallvaccinetypeswasnowhigherin
Gavi-eligiblecountriesthanintherestoftheworld.7
Yettheglobalpictureisnotquitesorosy.Astaggeringlyhighnumberofchildrenaroundtheworldcontinuetomissoutentirelyorpartiallyonroutinevaccination,leavingthemunprotectedagainstpreventableillnesses.Inpart,butnotentirely,duetoGavi’sownsuccessinraisingcoveragerateswithineligiblecountries,agrowingproportionofthesechildrennowlivewithinthecohortofnon-GaviMICs—includingbothformerlyeligiblecountriesandnever-eligiblecountries(seeTableA1inAppendixA).Countryexperiencesvaryamongthediversecohortofnon-GaviMICs,butthereareseveralalarmingdatapoints.8
First,severallargerMICsthathavetransitionedfromGavistillcontainsignificantpocketsof
underimmunizedgroups,oftenconcentratedinspecificgeographicregionsorsocioeconomic
subgroups(seesummarybreakdowninTable1).IntheexamplesofAngolaandBolivia—both
lower-middle-incomecountriesthattransitionedfromGavisupportin2017—DTP3coverageis
42percentand69percent,respectively,andcoverageoftheseconddoseofthemeaslescontainingvaccine(MCV2)is25percentand49percent,respectively,asof2022(seeTableA1inAppendixA
5GAVIAllianceProgressReport2008,Gavi,TheVaccineAlliance,2008,
/sites/default/files/
publications/progress-reports/Gavi-Progress-Report-2008.pdf
.
6“ImmunizationCoverage,”WorldHealthOrganization(WHO),lastaccessedMarch22,2024,
/
news-room/fact-sheets/detail/immunization-coverage
.
7BreadthofprotectionisdefinedastheaveragevaccinationcoverageacrosskeyGavi-supportedvaccines.See:“EightThingsYouNeedtoKnowabouttheStateofGlobalImmunization,”Gavi,theVaccineAlliance,July18,2023,
https://www.gavi.
org/vaccineswork/eight-things-you-need-know-about-state-global-immunisation
;AnnualProgressReport2022,Gavi,theVaccineAlliance,lastupdatedJanuary2024,
/progress-report
.
8RobertJohnKolesar,RokSpruk,andTshetenTsheten,“EvaluatingCountryPerformanceAfterTransitioning
FromGaviAssistance:AnAppliedSyntheticControlAnalysis,”GlobalHealth:ScienceandPractice11,no.4(2023),
/10.9745/GHSP-D-22-00536
.
BEYONDTHE“GAVI-ELIGIBLE”:HIGH-LEVERAGEOPPORTUNITIESFORGAVITO3
ENHANCEVACCINEACCESSANDUPTAKEININELIGIBLEMIDDLE-INCOMECOUNTRIES
forbreakdownbycountry).Othercountries,likeHondurasandBolivia,haveseencoverageratesofcertainvaccinesdropofffollowingtransitionfromGavisupport.9
TABLE1.Summarybreakdownof108MICs(classificationsforFY2024),adataformostrecentyear
StatusofGavi
GDPPer
Average
CurrentHealth
DTP3
MCV2
TotalBirths
Share
Eligibility
Capita
GDP
Expenditure
Coverage
Coverage
(Thousands)c
ofTotal
(USD)b
Growth
OverPast
5years(%)a
(USDMillions)b
(%)b
(%)b
MICBirth
Cohort
(%)c
Transitioningby2030
2,454
3.25
3,959
79
58
14,718
15
Nottransitioningby2030
1,543
2.75
1,632
80
67
15,236
16
FormerGavi
5,159
2.46
50,800
87
82
20,907
22
(noIndia)
Indiad
2,411
4.16
104,211
93
90
23,114
24
NeverGavi
7,423
1.33
14,063
86
78
23,563
24
Notes:(a)SeeTableA1inAppendixAforbreakdownbycountry.Numberandshareofzero-dosechildrenareexcludedfromthissummarytable
becausethedataincludeimpreciseestimatesforsomecountries.(b)Figuresreflectaveragesacrossthegroup.(c)Figuresreflectthesumofvaluesforthegroup.(d)Indiaisseparatedouttoavoidskewingsummarystatistics,givenIndia’slargeeconomyandbirthcohort.GDP=grossdomestic
product;USD=U.S.dollars.
Sources:SeeTableA1inAppendixAforallsources.
Second,coverageforroutinevaccinesalsoremainslowinsomeneverGavi-eligibleMICs,includingthePhilippines(DTP3=72percent;MCV2=64percent)andEquatorialGuinea(DTP3=53percentandMCV2=13percent).10Inaddition,immunizationcoverageremainshighlyinequitableinsomenon-
GaviMICs,mostnotablythosewithlargebirthcohorts.Forexample,coverageofage-appropriate
vaccinationsamongchildrenaged12to23monthsinthePhilippinesvariesacrossregionsfrom
15percentto82percent.11(ThePhilippineshasneverbeeneligiblefortraditionalGavisupportbutis
currentlyeligibleforlimitedsupportundertheMICsApproach,discussedatgreaterlengthinSection2.)
Third,anincreasingconcentrationofzero-dosechildren(thosewhohavenotreceivedtheirfirst
doseoftheDTPvaccine)liveinnon-GaviMICs(seeTableA1inAppendixAforadditionaldata).12
Nearlyaquarterofzero-dosechildrenliveinjustfiveMICsthatareineligiblebasedon
9BrianWebster,LydiaRegan,andVictoriaFan,“AfterGraduation,HowDoGavi-EligibleCountriesFare?,”Centerfor
GlobalDevelopment(blog),March20,2024,
/blog/after-graduation-how-do-gavi-eligible
-
countries-fare
.
10“InputtotheWHO/UNICEFEstimatesofNationalImmunizationCoverage(WEUNIC),”WHO,July17,2023,
https://
/publications/m/item/wuenic_input
.
11SeeMap10.1inPhilippinesDHS,2022—FinalReport,DHSProgram,June2023,
/publications/
publication-FR381-DHS-Final-Reports.cfm
.
12“Zero-Dose:TheChildrenMissingOutonLife-SavingVaccines,”UNICEF,April2023,
/resources/
zero-dose-the-children-missing-out-on-life-saving-vaccines/
.
BEYONDTHE“GAVI-ELIGIBLE”:HIGH-LEVERAGEOPPORTUNITIESFORGAVITO4
ENHANCEVACCINEACCESSANDUPTAKEININELIGIBLEMIDDLE-INCOMECOUNTRIES
Gavi’sstandardeligibilitycriteria:India(7.92percentofglobalzero-dosechildren),Angola
(4.32percent),Indonesia(4.02percent),thePhilippines(4.48percent),andBrazil(3.03percent).13
Thisgeneraltrend—anincreasingconcentrationofundervaccinationinGavi-ineligibleMICs—islikelytoaccelerateinthecomingyearsasadditionalcountriestransitionfromGavisupport.
Mostnotably,NigeriaiscurrentlyprojectedtotransitionfromGavisupportin2028,eventhoughitsDTP3coverageratesaveragejust62percentnationwideand51percentinthe20least-vaccinated
districts.14And,asof2022,Nigeriaishometo2.2millionzerodosechildren,nearly16percentoftheworld’sunvaccinatedpopulation(seeTableA1inAppendixA).Atthenationallevel,thismeansthat
NigeriaislikelytotransitionfromGavisupportlongbeforereachingherdimmunity,evenforroutinevaccines.Cambodia,Comoros,theKyrgyzRepublic,Nepal,Senegal,andTajikistancouldalsocross
Gavi’seligibilitythresholdby2040,losingaccesstofullsupportfromGavi.15
KeyPoint2:ManyMICsaregettinglessformorewiththeir
immunizationexpenditures
Althoughtheunderlyingfactorsdrivingdifferencesmayvary,non-GaviMICgovernments
have,onaverage,significantlyhigherexpendituresonroutineimmunization.Forexample,in2022,theaverageGavi-ineligibleMICspent$170.13onroutineimmunizationpersurvivinginfant—aboutsixtimesasmuchasGavi-eligibleMICs($26.93)andlow-incomecountries
(LICs)($29.04).16Moreover,despitesignificantlyhigherimmunizationexpendituresby
MICgovernments,childreninGavi-ineligibleMICsreceivefewervaccinesonaveragethandotheirpeersinGavi-eligiblecountries.ManyMICshavenotyetintroducednewerWHO-recommended
vaccines,suchasthepneumococcalconjugatevaccine(PCV),thehumanpapillomavirus(HPV)
13Shareofzero-dosechildrenfrom“WUENICAnalytics,”UNICEF,lastaccessedMarch22,2024,
https://unicef-dapm.
shinyapps.io/wuenic-analytics-2023/
.IndiatransitionedfromGavisupportin2021andnowhasaspecialpartnershipwithGaviuntil2026witha$250millionenvelopeandparticularfocusonreachingzero-dosechildren.See“GaviandGovernmentofIndiaEstablishNewPartnershiptoProtectMillionsofChildrenby2026,”Gavi,theVaccineAlliance,
February3,2023,
https://ww/news/media-room/gavi-and-government-india-establish-new-partnership
-
protect-millions-children-2026
.Angola,thePhilippines,andIndonesiaareeligibleundertheMICsApproach,but
thisisforsmall-scaleandone-offtargetedformsofsupport(seeSection2).Seealso:“ListofCountriesandEconomiesEligibleforSupportundertheMICsApproachasof1July2023,”Gavi,theVaccineAlliance,lastaccessedMarch22,
2024,
https://ww/sites/default/files/programmes-impact/support/Countries-and-economies-eligible-for
-
support-under-Gavi-MICs-Approach.pdf
.
14“Nigeria,”Gavi,theVaccineAlliance,lastaccessedMarch22,2024,
https://ww/programmes-impact/
country-hub/africa/nigeria
.
15MorganPincombeetal.,“ProjectionsofEligibilityandTransitionTrajectoriesupto2040:ImplicationsforGavi’sNextStrategicPeriodandBeyond,”CenterforGlobalDevelopment,December14,2023,
https://ww/publication/
projections-eligibility-and-transition-trajectories-2040-implications-gavis-next
.
16Authors’calculationsbasedontotalexpenditureofvaccinesfrom2022andnumberofbirthssurvivingtoage1from
2021.See:“FinancingforImmunizationCountryDashboard,”WHO,lastaccessedMarch22,2024,
https://ww/
teams/immunization-vaccines-and-biologicals/vaccine-access/planning-and-financing/immunization-financing
-
indicators
;“WorldPopulationProspects2022,”UnitedNationsDepartmentofEconomicandSocialAffairs,PopulationDivision,2022,
/wpp/Download/Standard/MostUsed/
.
BEYONDTHE“GAVI-ELIGIBLE”:HIGH-LEVERAGEOPPORTUNITIESFORGAVITO5
ENHANCEVACCINEACCESSANDUPTAKEININELIGIBLEMIDDLE-INCOMECOUNTRIES
vaccine,andtherotavirusvaccine(RV).17Gavi-eligiblecountrieshaveaccesstosupportfornew
vaccineintroductions,butoncetheytransitiontofullyself-financing,thissupportissignificantlydownsizedandmoretime-limited(seeSection2).
TheslowintroductionofnewervaccinesisespeciallyapparentinMICsthathaverecently
transitionedfromGavisupport,aswellasinneverGavi-eligiblecountriesthatarejustabove
Gavi’seligibilitythreshold(seeFigure1).Forexample,93percent(26/28total)ofGavi-eligible
MICshaveintroducedPCV,butonly78percent(18/23total)offormer-GaviMICsand74percent
(42/57total)ofneverGavi-eligibleMICshaveincorporatedPCVintonationalimmunization
programs.18Importantly,vaccineadoptiondecisionsrequiredelicatetrade-offsbetweencostandhealthbenefit,andcountriesmayberationallyhealth-maximizingiftheopportunitycostofanewvaccineinvestmentoutweighsitsexpectedhealthimpact.Nevertheless,limiteduptakeoflife-
savingvaccinesbythesecountries—howeverrational—isamissedopportunityfornewvaccine
technologiestotranslateintopublichealthimpact.19
FIGURE1.IntroductionsofneworunderutilizedvaccinesbycountryincomegroupandGavieligibilitystatus
100%90%80%70%60%50%40%30%20%10%0%
93%
81%
79%
77%
78%
74%
70%
54%
52%
52%
54%
42%
PCVIntroductionsHPVVaccineIntroductionsRVIntroductions
Lowincome(n=26)Gavi-eligibleMIC(n=28)Former-GaviMIC(n=23)Never-GaviMIC(n=57)
Note:DatareflectintroductionsintonationalimmunizationprogramsasofFebruary20,2024,usingFY2024WorldBankincomegroupsand2024Gavieligibility.
Sources:InternationalVaccineAccessCenter,“VIEW-hub,”JohnsHopkinsBloombergSchoolofPublicHealth,last
accessedFebruary20,2024,
/
;“WorldBankCountryandLendingGroups,”WorldBank,lastaccessedMarch22,2024,
/knowledgebase/articles/906519-world-bank-country-and-lending
-
groups
;“Eligibility,”Gavi,theVaccineAlliance,lastaccessedMarch22,2024,
/types-support/
sustainability/eligibility
.
17ThispatternisparticularlyvisiblewithPCVandRVintroductions.However,ahighershareofGavi-ineligiblecountrieshasintroducedtheHPVvaccinecomparedtoGavi-eligiblecountries,asshowninFigure1.
18InternationalVaccineAccessCenter,“VIEW-hub,”JohnsHopkinsBloombergSchoolofPublicHealth,lastaccessedFebruary20,2024,
/
.
19JasonZhuetal.,“OpportunitiestoAccelerateImmunizationProgressinMiddle-IncomeCountries,”Vaccine(2023),
/10.1016/j.vaccine.2023.06.079
.
BEYONDTHE“GAVI-ELIGIBLE”:HIGH-LEVERAGEOPPORTUNITIESFORGAVITO6
ENHANCEVACCINEACCESSANDUPTAKEININELIGIBLEMID
温馨提示
- 1. 本站所有资源如无特殊说明,都需要本地电脑安装OFFICE2007和PDF阅读器。图纸软件为CAD,CAXA,PROE,UG,SolidWorks等.压缩文件请下载最新的WinRAR软件解压。
- 2. 本站的文档不包含任何第三方提供的附件图纸等,如果需要附件,请联系上传者。文件的所有权益归上传用户所有。
- 3. 本站RAR压缩包中若带图纸,网页内容里面会有图纸预览,若没有图纸预览就没有图纸。
- 4. 未经权益所有人同意不得将文件中的内容挪作商业或盈利用途。
- 5. 人人文库网仅提供信息存储空间,仅对用户上传内容的表现方式做保护处理,对用户上传分享的文档内容本身不做任何修改或编辑,并不能对任何下载内容负责。
- 6. 下载文件中如有侵权或不适当内容,请与我们联系,我们立即纠正。
- 7. 本站不保证下载资源的准确性、安全性和完整性, 同时也不承担用户因使用这些下载资源对自己和他人造成任何形式的伤害或损失。
最新文档
- 2024年燃油箱项目合作计划书
- 部编版语文四年级上册第七单元习作:写信(说课稿)
- 2024年旋挖钻机合作协议书
- 2024年耗尽关机传感器项目建议书
- 2024年自营批发服务合作协议书
- 2024年风机、风扇及类似设备合作协议书
- 《金孔雀轻轻跳》-教案
- 2024年润滑油加氢异构脱蜡催化剂合作协议书
- 2024家政保洁服务合同协议书
- 专利产业化在生物医药领域的应用
- 奥数知识点-简单数阵图(精品)
- 通用简约房屋租赁合同word模板
- 工程验收会议主持词开场白.doc
- 病案及时归档量化考核制度
- 马鞍山三基轻合金成型科技有限公司年产30000吨轻量化高性能铝合金零部件项目
- 2021年万科集团企业内部控制分析报告
- 711便利店供应链管理
- 2021年部编人教版四年级语文下册期末全册分类复习全面
- 加油站突发环境事件预防与预警机制
- 装饰装修工程施工单位自检表格(检验批)汇编
- PLC控制柜出厂检测报告[共2页]
评论
0/150
提交评论