In two decades, Gavi has immunised more than 981 million children, and child mortality has been reduced by half. Nowhere has this work had a more profound impact than in Africa, where Gavi has invested 65% of its disbursements to reach 364 million children and averted more than 8.9 million future deaths on the continent.

Sub-Saharan Africa’s population is projected to double between 2022 and 2050, and demand for stronger health systems and access to vaccines are growing, too. IFFIm financing for Gavi programmes, from vaccine introductions to health system strengthening, will make a difference in vaccines delivered and lives saved.

IFFIm provides funding for 15% of Gavi’s immunisation programmes across Africa

IFFIm’s strong commitment to health across Africa has been crucial to Gavi’s work, providing more than US$ 1 billion* from IFFIm’s inception to 2021. Between 2010 and 2021, about 40% of IFFIm’s total disbursements to Gavi was spent on immunisation programmes in Africa.

IFFIm supports multiple initiatives in Africa, and major support for three Gavi programmes in particular has helped shape health outcomes. Gavi’s introduction of the pentavalent vaccine, which at US$ 1.4 billion is IFFIm’s largest-ever single programme disbursement, has protected millions of children. More than 25 million children received the third dose of pentavalent vaccine in Africa in 2020. In 2007, IFFIm support accelerated Gavi’s pentavalent programme by financing more than 90% of Gavi's promised payment to UNICEF to secure initial doses of pentavalent, a single shot which immunises against five infectious diseases: diphtheria, tetanus, pertussis, haemophilus influenzae type B (Hib) and hepatitis B. IFFIm’s upfront US$ 191 million investment in pentavalent encouraged manufacturers to increase production and decrease the price. In 2020, Gavi was able to procure pentavalent vaccines for US$ 0.86 per dose compared to US$ 2.98 in 2010.

IFFIm’s global support for the pneumococcal vaccine (US$ 600 million) and HSS (US$ 421.9 million), its second and third highest Gavi disbursements respectively, have also contributed to health and broader benefits across Africa. For example, health system strengthening facilitates the introduction of modern cold chain equipment to make sure that vaccines can safely reach everyone who needs them. This is critical in Africa where remote communities lack electricity and other means of safely storing vaccines.

Gavi focuses on zero-dose children

With IFFIm support, Gavi is currently focused on the future with priorities that include reaching the unimmunised, pandemic preparedness and response and building capacity and infrastructure across the globe.

Reaching children who have yet to receive any vaccine is a priority. Gavi estimates there were still more than 7 million “zero-dose” children living in Africa as of 2020. To reach these children, Gavi’s current five-year strategy (2021 to 2025) is focused on reaching the most marginalised by strengthening health systems, building and sustaining community demand, addressing gender-related barriers and bringing innovative approaches to the table.

African countries, which are disproportionately affected by deaths due to infectious or parasitic diseases, also will be partners in Gavi’s efforts to prepare for emergencies and outbreaks, known as pandemic preparedness and response (PPR). IFFIm has proven its capability as a source of surge funding that can be called upon when needed. For example, in 2014, IFFIm provided standby funding to help Gavi mobilise resources to respond to a deadly outbreak of Ebola in the Democratic Republic of the Congo. More recently, IFFIm provided nearly US$ 1 billion to the COVAX AMC. So far, COVAX has distributed 1.84 billion COVID-19 vaccines worldwide. As a trusted, tested financing tool, IFFIm also has the potential to support Africa’s pandemic preparedness through contingent financing, a tool currently in development to help donors make advance pledges that would only be called upon in an emergency.

Despite progress, challenges remain

African countries still face formidable threats and funding gaps on multiple fronts, said Hassatou N’Sele, an IFFIm board member who is the Vice-President for Finance & Chief Financial Officer of the African Development Bank Group (AfDB). Progress in health across Africa has been hampered by the COVID-19 pandemic, and other longstanding challenges continue to delay further gains in some regions of the continent, she said.

“Climate change continues to lead to drought, extreme flooding, the displacement of people, and food and water insecurity.  We have a huge infrastructure gap as well. There is no access to electricity for half of the population, which is affecting livelihoods and economic growth.  Health is threatened, also.”

Vaccine inequity is exacerbated, as well, by a lack of vaccine manufacturing in Africa which only produces about 0.1% of the global supply of vaccines. Gavi is among the global health leaders advocating for increased production in Africa. More than 30 vaccine manufacturing initiatives are currently underway, and the African Union aims to produce and supply more than 60% of the doses required across Africa by 2040.

Getting routine immunisation back on track

Gavi and its country partners are prioritising increases in routine immunisation, which lagged during the pandemic, to prevent outbreaks of diseases like yellow fever, polio and measles.  Countries demonstrating recent progress against these challenges, including Chad, Kenya and Ethiopia, have been able to engage their populations through networks of trusted health workers. They are key to building relationships with communities to ensure parents bring their children to be vaccinated.

“We have no reason not to bring our children for immunisation,” said Chinenye Adoke, a mother in Ebonyi State which ranks first in routine immunisation in Nigeria, Africa’s most populous country.  “And, even when we don’t come, the vaccinators will come to the communities to vaccinate the children.”

_{*Figures are current as of 30 June 2022 unless otherwise noted.}