gavi's contribution to vaccination in developing countries - a brief case study

GAVI’s Contribution to Vaccination in Developing Countries 1

GAVI’s Contribution to Vaccination in Developing Countries: A Case Study –

Arzi Adbi

Bill & Melinda Gates Foundation states, “Vaccines are among the most cost-effective

investments in global health, saving about 2.5 million lives each year. But every 20 seconds, a

child dies from a vaccine-preventable condition such as diarrhoea or pneumonia” (Gates

Foundation). Vaccines undoubtedly play a vital role in improving public health and in relieving a

nation’s disease burden. It should not be too hard for policy makers in developing countries to

realize that vaccines are one of the cheapest and most effective solutions to prevent morbidity

and mortality due to vaccine-preventable diseases. But, why then the vaccination coverage in

developing countries, like India, remains low despite the awareness in policy makers? What

factors differentiate developing country from a developed country, when it comes to

vaccination? And, how is it that a multi-lateral organization like GAVI1, and not a domestic

organization, is able to develop the right expertise in improving vaccine delivery and deployment

in developing countries?

Francis (2010) in his article states that if left to market forces alone, the people of less

developed countries will suffer and die of easily preventable diseases (Francis, 2010). In the

same article, Francis shows a figure, appended below, to highlight the differences between

industrialized countries and developing countries in the global vaccine market.

1 See http://www.gavialliance.org/about/mission/what/ for details on Global Alliance for Vaccines and

Immunization (GAVI)

http://www.gavialliance.org/about/mission/what/


Source: Francis, D. P. (2010). Successes and failures: Worldwide vaccine development

and application. Biologicals. doi:10.1016/j.biologicals.2010.06.003

Ironically, developing countries with 85% of world’s population and 93% of disease

burden account for only 18% of total vaccine market. It is even more disconcerting that

developing countries account for only 10% of vaccine R&D. There is enormous inequity

between developing and developed countries in the area of vaccination and this issue deserves

top attention.

GAVI was formed as a result of one such attempt to address the inequity in vaccination.

It was formally launched in January, 2000 at the World Economic Forum in Davos, Switzerland

with a mission to deliver vaccines to millions of the world’s poorest children, who needed them


most (GAVI). So, how did GAVI succeed in building an expertise in vaccine delivery in

developing countries?

First, let us admit that developing countries are different from developed countries from

demand-side as well as supply-side perspectives. Vaccine development is a costly and time-

consuming process. If the vaccine makers do not get reasonable return on their investments, then

they do not have an economic incentive in investing in vaccine R&D. In addition to lack of

adequate financial resources, developing countries also distinguish themselves from developed

countries as significant chunks of population lack awareness of vaccines. Thus, despite massive

population, the demand for vaccines in developing countries is low. Therefore, the market size is

not attractive enough for vaccine makers to develop and supply vaccines in developing countries.

Second, we need to understand that developing countries generally lack robust health-

care infrastructure. Scholars have documented that availability of health facility and information,

education and communication activities plays a significant role in determining the level of

immunization coverage among children (Sahu, Pradhan, Jayachandran, & Khan, 2010). Thus,

even when the vaccines are available in developing countries, there is no certainty that it would

reach the needy at an appropriate time and be administered correctly.

So, what did GAVI do to overcome these challenges? GAVI alliance, in phase I during

its first five years from 2000 to 2006, focussed on overcoming the lack of financial resources by

getting funds to developing countries quickly to extend the reach and quality of immunization

programmes in these countries (GAVI). It focussed on strengthening vaccine delivery systems in

these focal countries. In phase II from 2007 to 2010, GAVI alliance aimed to increase the

predictability and sustainability of long-term financing for national-level immunisation


programmes and accelerated the uptake and use of underused and new vaccines and improved

vaccine supply security. In phase III from 2011 onwards, GAVI has scaled up communications

and advocacy efforts that are critical for engaging stakeholders. With defined targets and

measurable performance indicators, GAVI is able to monitor and track its progress for the 2011-

2015 strategy. Monitoring progress helps in early identification of challenging issues and

provides them adequate time to seek sustainable solutions to address those issues. Lob-Levyt

(2011) states in a review paper, “By the end of 2010, according to WHO data, GAVI support had

resulted in 288 million children being immunized and 5.4 million deaths prevented” (Lob-Levyt,

2011). As of mid-2010, GAVI had committed USD 5.6 billion to support the vaccination

programmes of the poorest countries in the world (Lob-Levyt, 2011).

Was it possible for a domestic organization in a developing country to achieve what

GAVI did in 10 years from 2000 to 2010? Coyle (2009), in his book2 ‘The Talent Code’ quotes

Robert Bjork, the chair of Psychology at UCLA: “It’s all about finding the sweet spot. There’s an

optimal gap between what you know and what you’re trying to do. When you find that sweet

spot, learning takes off” (Coyle D. , 2009). In my opinion, GAVI was able to find that sweet spot

amidst challenges, but it could have been unlikely for a domestic organization in a developing

country to be able to find that sweet spot. At the core of GAVI’s success, lies its access to

credible donors worldwide. Such access to diverse sources of funds and willing donors was

unlikely for a domestic organization in a developing country.

2 It is noteworthy that Coyle’s book is about how an individual can build expertise through deep practice and not

about an organization; however, an organization is a collection of individuals along-with its systems and processes. So, an organization can also make use of the learning tools that an individual can to build expertise in a field. Of course, the settings would be different for an organization. Heterogeneity in these settings can make it more complex for an organization to develop expertise as compared to an individual.


Chapter one of Coyle’s book signifies the integrated sequence of events: trying,

struggling, failing, analysing, learning, tinkering, correcting, and experiencing as deep practice

and posits that by practicing deeper, one can position oneself well in leveraging the learnings

from one’s failures into skills (Coyle D. , 2009). But, can deep practice alone help in building

expertise? I agree with Robert Bjork’s statement that it is all about finding the sweet spot. But,

who can find that sweet spot and how, is an important question to address! Uniquely inherent

advantages of GAVI manifest in the form of its reliable access to willing donors worldwide and

placed it in a favourable position. GAVI was able to find the sweet spot. Finding the sweet spot

may not have been possible for a domestic organization in a developing country, given the lack

of financial resources and the lack of access to willing donors to overcome the challenges posed

by the lack of financial resources.

Works Cited Coyle, D. (2009). The Sweet Spot. In D. Coyle, The Talent Code: Greatness Isn't Born. It's

Grown. Here's How. (pp. 11-29). New York: Bantam Dell.

Coyle, D. (2009). The Talent Code: Greatness Isn't Born. It's Grown. Here's How. New York:

Bantam Dell.

Francis, D. P. (2010). Successes and failures: Worldwide vaccine development and application.

Biologicals. doi:10.1016/j.biologicals.2010.06.003

Gates Foundation. (n.d.). What We Do/Global Development/Vaccine-Delivery. Retrieved June

16, 2014, from Gates Foundation Web site: http://www.gatesfoundation.org/What-We-

Do/Global-Development/Vaccine-Delivery

GAVI. (n.d.). About the Alliance : What we do : Mission. Retrieved May 21, 2014, from GAVI

Alliance Web site: http://www.gavialliance.org/about/mission/what/

GAVI. (n.d.). about/mission/history. Retrieved June 16, 2014, from GAVI alliance Web site:

http://www.gavialliance.org/about/mission/history/

GAVI. (n.d.). about/strategy/phase-i-(2000-06)/. Retrieved June 16, 2014, from GAVI Alliance

Web site: http://www.gavialliance.org/about/strategy/phase-i-(2000-06)/


Lob-Levyt, J. (2011, September 5). Contribution of the GAVI Alliance to improving health and

reducing poverty. Philiosophical Transactions of The Royal Society Biological Sciences.

doi:10.1098/rstb.2011.0040

Sahu, D., Pradhan, J., Jayachandran, V., & Khan, N. (2010). Why immunization coverage fails to

catch up in India? A community-based analysis. PubMed. doi:10.1111/j.1365-

2214.2009.01003.x

gavi's contribution to vaccination in developing countries - a brief case study

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