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

InnovationHealth systemstrengtheningUS$ 92 millionGAVI country-specificprogrammes*US$ 210 millionYellow FeverUS$ 38 millionMaternal andneonatal tetanusUS$ 49 millionPolioUS$ 191 millionPentavalentUS$ 181 millionMeaslesUS$ 139 millionSource: The GAVI Fund, Washington DC, United States, 2007* including vaccines and safety equipmentFigure 1: Expected IFFIm disbursements, 2006–2007Ethiopia will receive a total of US$ 76.5 million for healthsystem strengthening for 2007–2009, with the majority –US$ 56 million – arriving in 2007.The predictability of this funding is an essential part of itsvalue. Fragile economies cannot give firm assurances ofconsistent financial support to long-term plans. But plansinvolving human resources training have to be sustained.Breakthrough funding like this from IFFIm makes all thedifference: it assures the whole period.Equally essential in this mix is a solid national plan that canbear the strain of such dramatic acceleration. And the endresult has to bring the widest possible range of benefits.Tedros Ghebreyesus, Ethiopian Minister of Health and GAVIAlliance board member, described the critical significance ofthe new programme to improving his country’s healthservices. He said, “Our vehicle has not been strong enoughto carry all the programmes we have loaded on it. Now weare working to strengthen the vehicle so that it can carry allour programmes, the vaccines and the other health careinterventions, to every corner of this vast country.”The benefits of this type of funding go beyond providingstability to developing country plans. It also has marketshapingpotential – a vital component in the endeavour toincrease access to new and better vaccines through usingmarket forces and economies of scale to stimulate demandand reduce product prices.By signaling financial stability and long-term committedfinancing, it is also possible to spur larger markets, acceleratevaccine development, and promote increased production,availability and lower prices.For example, IFFIm funds are being used to stimulateincreased demand for combination vaccines not currentlyproduced in sufficient quantities. US$ 181 million of IFFImfunding has allowed the GAVI Alliance to make a bindingcommitment to purchase “5-in-1” pentavalent vaccine at areduced price by making a longer-term commitment. Thisproduct provides, in a single shot, protection against fivediseases: diphtheria, tetanus, pertussis, hepatitis B and Hib.The availability of IFFIm funds over the next decade supportssecurity of supply: it also provides an incentive to newmanufacturers to enter the market, a dynamic which canfurther reduce vaccine price.This dynamic – the “pull factor” of having long-term,substantial funding ready – has already worked very well insupport of the global polio eradication campaign. In a WHOledinitiative, a stockpile of completely new monovalentvaccines to secure the post-eradication phase is beinggenerated. The IFFIm funding was essential to spurmanufacturers rapidly to manufacture and evaluate the newvaccines that are critical to this process. Demonstrating theasset of flexibility, when the eradication campaign alerted theBoards of the GAVI Alliance to a critically damaging fundinggap, reprogramming of IFFIm funds allowed (exceptionally)this crisis to be averted and the campaign to continueunimpeded.Through the GAVI Alliance, the catalytic funding IFFImoffers is quickly channelled to where it will have most impact.In line with the concept that early intervention withvaccination incrementally saves lives in infectious diseaseepidemics, an early investment was in a stockpile of yellowfever vaccine, working through the Yellow Fever Initiative.This was rapidly useful when, three months after IFFImwas launched, Togo reported an outbreak of this highlyinfectious and lethal viral disease. In the first two weeks ofFebruary 2007, a broad range of partners, led by the Ministryof Health in close collaboration with WHO, worked together tobring yellow fever vaccine to 1.33 million Togolese in 11districts of the Savanes and Kara regions.In a further benefit, the risk assessment activitiesundertaken as part of the Initiative in 12 countries in Africa,Global Forum Update on Research for Health Volume 4 ✜ 097