Combining health and social protection measures to reach the ultra ...

Innovation
Health system
strengthening
US$ 92 million
GAVI country-specific
programmes*
US$ 210 million
Yellow Fever
US$ 38 million
Maternal and
neonatal tetanus
US$ 49 million
Polio
US$ 191 million
Pentavalent
US$ 181 million
Measles
US$ 139 million
Source: The GAVI Fund, Washington DC, United States, 2007
* including vaccines and safety equipment
Figure 1: Expected IFFIm disbursements, 2006–2007
Ethiopia will receive a total of US$ 76.5 million for health
system strengthening for 2007–2009, with the majority –
US$ 56 million – arriving in 2007.
The predictability of this funding is an essential part of its
value. Fragile economies cannot give firm assurances of
consistent financial support to long-term plans. But plans
involving human resources training have to be sustained.
Breakthrough funding like this from IFFIm makes all the
difference: it assures the whole period.
Equally essential in this mix is a solid national plan that can
bear the strain of such dramatic acceleration. And the end
result has to bring the widest possible range of benefits.
Tedros Ghebreyesus, Ethiopian Minister of Health and GAVI
Alliance board member, described the critical significance of
the new programme to improving his country’s health
services. He said, “Our vehicle has not been strong enough
to carry all the programmes we have loaded on it. Now we
are working to strengthen the vehicle so that it can carry all
our programmes, the vaccines and the other health care
interventions, to every corner of this vast country.”
The benefits of this type of funding go beyond providing
stability to developing country plans. It also has marketshaping
potential – a vital component in the endeavour to
increase access to new and better vaccines through using
market forces and economies of scale to stimulate demand
and reduce product prices.
By signaling financial stability and long-term committed
financing, it is also possible to spur larger markets, accelerate
vaccine development, and promote increased production,
availability and lower prices.
For example, IFFIm funds are being used to stimulate
increased demand for combination vaccines not currently
produced in sufficient quantities. US$ 181 million of IFFIm
funding has allowed the GAVI Alliance to make a binding
commitment to purchase “5-in-1” pentavalent vaccine at a
reduced price by making a longer-term commitment. This
product provides, in a single shot, protection against five
diseases: diphtheria, tetanus, pertussis, hepatitis B and Hib.
The availability of IFFIm funds over the next decade supports
security of supply: it also provides an incentive to new
manufacturers to enter the market, a dynamic which can
further reduce vaccine price.
This dynamic – the “pull factor” of having long-term,
substantial funding ready – has already worked very well in
support of the global polio eradication campaign. In a WHOled
initiative, a stockpile of completely new monovalent
vaccines to secure the post-eradication phase is being
generated. The IFFIm funding was essential to spur
manufacturers rapidly to manufacture and evaluate the new
vaccines that are critical to this process. Demonstrating the
asset of flexibility, when the eradication campaign alerted the
Boards of the GAVI Alliance to a critically damaging funding
gap, reprogramming of IFFIm funds allowed (exceptionally)
this crisis to be averted and the campaign to continue
unimpeded.
Through the GAVI Alliance, the catalytic funding IFFIm
offers is quickly channelled to where it will have most impact.
In line with the concept that early intervention with
vaccination incrementally saves lives in infectious disease
epidemics, an early investment was in a stockpile of yellow
fever vaccine, working through the Yellow Fever Initiative.
This was rapidly useful when, three months after IFFIm
was launched, Togo reported an outbreak of this highly
infectious and lethal viral disease. In the first two weeks of
February 2007, a broad range of partners, led by the Ministry
of Health in close collaboration with WHO, worked together to
bring yellow fever vaccine to 1.33 million Togolese in 11
districts of the Savanes and Kara regions.
In a further benefit, the risk assessment activities
undertaken as part of the Initiative in 12 countries in Africa,
Global Forum Update on Research for Health Volume 4 ✜ 097