I enjoy a lot of government services (my library, my bus, the mail) but if I had to pick one thing I love about the US government, it would be “fund gavi”.
the cow An international organization, funded by wealthy governments and philanthropists, that bankrolls and mobilizes life-saving vaccines in the Global South. The country becomes eligible if their Gross national income per capita is below $1,810. It’s less than you think – many countries that we think of as quite poor, like Bangladesh or Kenya very rich To qualify for Gavi support. Those who receive aid are the poorest of the poor: Haiti, Liberia, Democratic Republic of Congo, etc.
You may have heard of Gavi when it was co-leading Covax, the less than entirely successful international effort to ensure poor countries had access to Covid-19 vaccines. But its bread and butter is routine vaccine-type financing given to children in rich countries Of course, like the polio vaccine or the measles and rubella vaccine. Its work has saved millions of lives.
Gavi, like many international organizations, is funded in “replenishment cycles”, where every few years the group asks rich countries to pledge funding for a fixed period (usually around three to five years). It is currently seeking $9 billion from rich country donors to cover its budget from 2026 to 2030. A large part of it, Over $1.1 billionFunds are earmarked to purchase newly approved vaccines against malaria, a disease that Kills more than a thousand children a day, most of whom are in the world’s poorest countries. Such vaccines have only become available in the last few years, and their existence has made the case for Gavi’s generous funding even stronger.
At the same time, raising $9 billion is never easy, and experts say Gavi is unlucky to be seeking funding at this time. “Replenishment Pileup.” A large number of international humanitarian groups — the World Bank; World Health Organization; Global Fund to Fight AIDS, Tuberculosis and Malaria; The Pandemic Fund; depending on the climate Loss and damage fund — Everyone is asking for donor funds at about the same time This has fueled fears that donor fatigue and tight budgets will mean some, many or all of these groups will fall short of their targets.
Fortunately, Gavi seems to have avoided that fate. The United States has already The pledge is $1.58 billion The group requested $9 billion. And there’s bipartisan support in Congress — yes, the same Congress that can’t agree on anything — to go even further.
Case for cow
We know that vaccines in general are an incredibly effective way to save millions of lives, but Gavi in particular seems to be an effective way to buy and distribute them. For one thing, because it is Buy lots of vaccinesThis could lower prices, enabling more people to be vaccinated at lower cost.
It has played an unusual role in the development of new vaccines. When the alliance began in 2000, the only available pneumococcal vaccines (preventing pneumonia, meningitis and other diseases caused by the pneumococcus bacteria) targeted forms of the bacterium prevalent in the rich world, not in poor countries, where the disease is endemic. More common and more serious. What is called a set up Advance market commitment A promise to mass buy a vaccine proven effective in poor countries, Gavi Three have spurred the development of effective new vaccines.
A recent paper A study of Gavi’s initial rollout since 2016 estimated it saved about 9 million lives, at a cost of $118 each. Another paper The cost per life saved using a different empirical strategy is higher (between $4,265 and $17,059) but still very low in the scheme of things. Expanding Medicaid in the United States, for example, Saves a life for about $5.4 millionor at least 300 times higher than when vaccinating cows.
Delivering vaccines in a cost-effective manner is not always straightforward. A study by a team at the Center for Global Development found that Gavi funds for countries such as Ukraine or the Philippines that were close to closing their income often paid for vaccines that the country would have paid for itself – but the authors are clear to emphasize that Gavi can have a significant impact on vaccine coverage Very poor countries are nowhere near the cut-off and this, even for less poor countries, can help them adopt newer, more sophisticated vaccines and free up public funds for other worthwhile social services.
That track record has resulted in a “long history of bipartisan support in Congress for Gavi,” according to Adam Wexler, director of the Global Health Budget Project at the research group KFF. Over the Obama and Trump years, Congress has consistently either met or exceeded the president’s pledged support for the group. In 2011, the The United States pledged $450 million Funded through 2015; Actually Congress $733 million has been allocated. In 2020, the Trump administration The commitment is $1.16 billion For four years, which is Congress matched.
which continues to this day. Bipartisan resolution introduced home And The Senate Support high funding levels for cows this spring, as have bipartisanship “Dear Colleague” letters Annual funding for the group is being called for at $340 million. That means $1.7 billion in funding over five years, or significantly more than the $1.58 billion promised by the Biden administration. when Declaration of commitmentThe administration was careful to call for “at least $1.58 billion,” leaving the door open for Congress to exceed that amount.
Recently, the House Appropriation Committee said Pass a funding bill on a Party line voting With some severe cuts, such as zeroing out support for the World Health Organization altogether. But even the Republican-backed package included $300 million for Gavi — not the full $340 million advocates wanted, but consistent with Biden’s pledge. Colin Pujo Smith, global policy director for the pro-aid advocacy group Results, told me the $1.58 billion would be distributed as $300 million in the first year and $320 million over the next four, meaning the House bill keeps things on track.
Funding has not yet been finalized, and House and Senate approvers will likely clash with other elements of the package. But for now, at least $300 million in Gavi funding by 2025 seems a sure thing.
Funding for new malaria vaccines
I’m fed up enough with American politics that whenever I see that either side wants to commit serious funding to a good program, it’s enough to get me excited. But there is a real fact that favoritism should aim much higher.
Note that there are not one, but two new vaccines available for malaria. RTS,S, which has been in development for decades, is expensive to produce, but R21, the second approved vaccine, is not. RTS,S currently costs About $10 per dose, while R21 costs $3.90 per dose. Once production ramps up, GlaxoSmithKline, which makes RTS,S, estimates it could make 15 million doses a year; The Serum Institute, which manufactures R21, estimates that it can currently make it As many as 100 million doses a year Both because it costs less than half and because it can be produced in much larger quantities, here’s the R21 vaccine to look out for.
A full course of any one vaccine requires four doses, meaning we could theoretically produce enough to vaccinate about 29 million children a year. It’s not enough to cover every child at risk of the disease, but it’s a huge number. And right now, the Gavi budget is not enough to reach that goal. It projects to vaccinate 50 million children from 2026 to 2030, or 10 million a year. This is less than half the number that could theoretically be vaccinated if the total production capacity of serum and GSK were reached.
In the near term, the situation is worse. Advocacy group 1DaySooner has been pushing a goal Immunizing 50 million children This year and next (2024 and 2025). It takes 200 million doses, which the serum claims it can produce. But Gavi only projects a total of 2 million vaccinated children between 2021 and 2025, or theoretically 25 times fewer children could be vaccinated with more funding.
The rollout of R21 is encountered resistance From some quarters in public health I find it frankly surprising. It is not clear to eradicate malaria, the way the smallpox vaccine eventually wiped out that disease. The largest study I’ve seen suggests that this is the case 68-75 percent effective In the first year, which is very good but not as high as some vaccines, for which measles. It’s best to think of it as one tool among several, and a tool that can be replaced if we ever develop a more effective malaria vaccine, as I think we will. (If you live near Baltimore, you can help and Attend a candidate trial right now!)
The R21 vaccine is still an incredibly cost-effective way to prevent malaria infection and death. one Recent analysis found that distributing R21 saves a year of a child’s life by about $39. Anti-malaria bednets save a year of life for about $38. Bednets are one of the most cost-effective public health interventions known to mankind, so being roughly as cost-effective as they are is hitting a very, very high bar. If Gavi is able to buy it in bulk and negotiate the price down, it will be more affordable than bednet, and more of a no-brainer.
So while bipartisan support for Gavi is a great thing, I think there’s a strong case that donors like the US should commit significantly more to ensure that every single dose of RTS,S and R21 can be purchased and used to prevent . Malaria is Funding for standard vaccines is excellent. But every 100,000 children vaccinated with R21 629 fewer children died from malaria. The gap of 48 million children between 1DaySooner’s vaccination target and Gavi’s plan for this year and next represents about 300,000 additional child deaths. These are lives we can save with adequate investment.
As Jacob Trefethen, a funder of global health research at Open Philanthropy, Recently asked“Will we, as a country, as a world, allow money to get in the way of children getting the malaria vaccine?”
