GAVI was created in 2000 as a successor to the
Children's Vaccine Initiative, which was launched in 1990. In August 2014, Gavi changed its name from "GAVI Alliance" and rebranded itself with a new logo deliberately reminiscent of UN organization logos, but using green as a mark of difference. Gavi has been particularly successful at promoting the uptake of newer vaccines. Gavi's main objective is vaccination programs. Gavi has been the main funder of vaccination in low and middle income countries. MSF criticized the Global Vaccine Action Plan (GVAP), a WHO global collaboration of which Gavi is listed as a leader, as flawed for failing to help those 20%, which is some 19 million infants.
Pneumococcal vaccine In 2010, as part of a 10-year
pneumococcal vaccine Advance Market Commitment, the companies
GlaxoSmithKline (GSK) and
Pfizer were both allocated $225 million in AMC subsidies to provide 30 million doses annually at a maximum tail price of $3.50 per dose ($10.50 per child for three doses). In 2011,
Médecins Sans Frontières (MSF) recommended that Gavi change the ways in which it procures vaccines. MSF argued that the Advance Market Commitment had transferred more money to GSK and Pfizer than the Gavi grants had transferred to low-cost suppliers for technology transfer and product development. MSF said that large pharmaceutical multinationals had been found to put very high
markups on prices, and internationally certified vaccine could be made for about 40% less cost by smaller companies in India and China, despite patent-related obstacles. In January 2015, MSF also called upon GSK and Pfizer to cut the price of the pneumococcal vaccine to US$5 per child in developing countries, a price they estimated as competitive. They said that, as Pfizer had made $16 billion in revenue on pneumococcal vaccine in the last four years, a larger price cut would be affordable. In early 2016, they ran the "A fair shot" campaign to pressure GSK and Pfizer to drop prices. Pfizer said that they were already selling the vaccine at "far below" cost, while GSK said that the price enabled them to "just about" cover their costs, and "To discount it further would threaten our ability to supply it to these countries in the long-term".
Bill Gates said that criticizing pharmaceutical company pricing deterred them from investing in medicines for the developing world, and said that instead, pharmaceutical companies should be praised for
price discrimination which reduces the price in poor countries. He also advocated improving low-temperature supply chains (a.k.a.
cold chains) in developing countries. In August 2019, MSF asked Gavi to stop giving Advance Market Commitment subsidies to GSK and Pfizer, whom they called a
duopoly, and instead buy vaccine from a new third manufacturer, the
Serum Institute of India, which offered the vaccine at 2/3 of the price then offered by the two. As the pneumococcal vaccine made up 40% of Gavi's vaccine purchasing costs, a 33% price drop would save Gavi billions (13% of its total vaccine purchasing costs). Pneumonia kills more than a quarter of children dying before the age of five, almost a million children each year. MSF said that GSK and Pfizer's pricing was exploitative and had left millions of children who could have been protected vulnerable. Gavi responded that low prices required large, stable, high-volume deals, and "careful consideration and the support of key constituencies". In June 2020, under Gavi's Advance Market Commitment, UNICEF and the Serum Institute of India entered an agreement which reduced the price of
pneumococcal conjugate vaccines to $2 per dose.
Health systems strengthening debate supplied by Gavi at
Mecha health centre, in northern
Ethiopia , speaking at the UK-hosted Gavi pledging event in June 2011 In the 20-naughts, Gavi had intense internal debate about its role in vaccinations and in
health systems strengthening (HSS). This was part of a broader discussion in healthcare about "vertical" approaches (often targeting specific diseases or behaviours) and "horizontal" ones, targeting broad programs such as
primary care. At Gavi, some argued that vaccination could not be effectively carried out and sustained without strengthening healthcare, citing experiences in Gavi's vaccination programmes, where availability of staff, training, transport, and funds had hindered vaccination and reporting of vaccination coverage and stocks. There were also worries that Gavi was undermining and paralyzing health care systems. Others argued that HSS was a distraction from Gavi's single-minded focus on vaccines, and HSS was a nebulous concept that could not be defined and quantified. in practice it has been around 10%. After 2010, this funding went through a joint-venture Health Systems Funding Platform. Gavi's funding for this platform was conditional on the platform meeting vaccine coverage goals. Julian Lob-Levitt, who was Gavi's CEO between 2004 and 2010, was rumoured to have left over conflicts around his support for health system strengthening. It has been argued that Gavi's HSS spending in the early 2010s went to selective, disease-specific interventions repackaged as HSS.
Market shaping In 2011 Gavi added "shape the market for vaccines and other immunisation supplies" to its strategic goals. File:Prequalified pentavalent and years of sales to UNICEF. Figure 5.jpg|The number of manufacturers making certified pentavalent vaccine increased, making the market more competitive. Graph by Gavi; manufacturers are not named. File:Pentavalent per-dose price ranges, to UNICEF, 2005–2019. Figure 7.jpg|All pentavalent vaccine prices fell and
price discrimination almost vanished. Graph by Gavi; non-UNICEF prices not shown
COVID-19 pandemic In April 2020, Gavi's CEO
Seth Berkley commented that the
COVID-19 pandemic needed a global response whereby the best global facilities for separate parts of the processes should then be integrated into a global process. He said he hoped that the
G20 countries should work together with a budget of tens of billions of dollars, and that individual countries should be prepared for finished
vaccines to be allocated according to greatest need. In September 2020, Gavi was announced as one of the organisations leading the
COVAX vaccine allocation plan, created to ensure that any new
COVID-19 vaccine would be shared equally between the world's richest and poorest countries. The following month, Gavi announced the approval of up to $150 million to help 92 low- and middle-income countries prepare for the delivery of future COVID-19 vaccines, including technical assistance and
cold chain equipment. In January 2021, Seth Berkley announced that Gavi hoped to deliver 145 to 150 million doses of COVID-19 vaccines in the first quarter of 2021 and 500 million doses in the second quarter, and then 1.5 billion in the second half of the year. In January 2022,
The Washington Post reported that following 309 million coronavirus vaccine doses being delivered in December 2021, COVAX had delivered over 1 billion for the pandemic. ==Awards==