Global vaccine initiative creates inequity

[Guest guest]

Global vaccine initiative creates inequity,analysis concludes

Gavin Yamey BMJ BMJ 2001;322:754 ( 31 March )

An analysis of the operation of the Global Alliance for Vaccines and

Immunization (GAVI), the private-public venture launched last year

with a $750m (?500m) donation from the Bill and Melinda Gates

Foundation, has concluded that it overemphasises high tech vaccines,

lacks sustainability and transparency, and relies too heavily on

private sector funding.

The alliance, whose founding partners include the World Health

Organization, Unicef, the World Bank, and some national

governments, aims " to fulfil the right of every child to be protected

against vaccine-preventable diseases of public health concern "

(www.vaccinealliance.org).

The analysis, by Dr Anita Hardon, head of the medical anthropology

unit at the University of Amsterdam, examined how the funds

were being distributed to 13 developing countries in the first round

of disbursement. Only 10% of these funds, said the author,

were being used to strengthen essential immunisation services, whereas

90% were going towards introducing high tech vaccines,

mainly against hepatitis B.

By spending so heavily on new vaccines, she said, the alliance " runs

the risk of compounding health inequities in the poorest

countries. " These new vaccines are being sent to countries which

already have some vaccine coverage, whereas the poorest

countries are still not receiving even basic immunisations, such as

those against diphtheria, tetanus, and polio.

With the donation from the Gates Foundation set to be spent within

five years, the analysis questioned how the vaccine initiative

would be sustained. Dr Hardon told the BMJ: " Donations are, in my

view, not a sustainable solution to the problem of vaccinating

children in developing countries. "

The inclusion of the pharmaceutical industry in the alliance, she

believes, creates a possible conflict of interest, as the industry's

interest in marketing new products could be at odds with the overall

aims of the alliance. The alliance's structure, she said, also

" includes no clear mechanisms for accountability, nor is there

transparency in its decision-making. "

Responding to these concerns, Dr Tore Godal, executive secretary of

the alliance, said: " The goal is that by 2005, 80% of districts

in 80% of countries will have full vaccination coverage. This

addresses the question of equity. " The alliance, he said, will be

changing its policies to increase allocation of funds to basic

immunisation services.

Even though the alliance involves industry, conflicts of interest are

avoided, he believes, because Unicef is responsible for

procuring vaccines via a " competitive, open process of bidding. " The

alliance, he explained, is accountable to the boards of the UN

agencies and to the World Health Assembly, and it has an independent

technical review committee made up largely of public

health experts in the developing world.

He agreed that long term sustainability of the initiative will be " a

challenge, " but said that other funding options are being

considered, such as loans from the World Bank.