75th World Health Assembly High Level Messages

Over the past two years, a range of profound societal, geopolitical, economic and technological shifts have occurred, many of them as a direct or indirect result of the COVID-19 pandemic. The pandemic has exacerbated existing inequities in access to health and immunisation between and within countries well beyond the inequity seen in the distribution of COVID-19 vaccines. The ongoing measles outbreaks and growing cases of vaccine-derived poliovirus in several countries are grim reminders that equity gaps might be widening as a result of pandemic-related disruptions, reversing hard-won immunisation gains and creating conditions for disease outbreaks, household medical impoverishment and social disruption. Going forward, a renewed collaborative effort will be needed to make health systems and routine immunisation more equitable and resilient as a pathway to achieve Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs), and to foster trust and social cohesion for building peaceful and inclusive societies.

The pandemic has seen unprecedented investment, political attention and engagement for new health interventions such as COVID-19 vaccines, which were developed and scaled up in record time. COVAX has so far delivered nearly 1.5 billion doses of COVID-19 vaccines to 145 countries and territories, with more than 1.3 billion having been shipped to 87 lower-income economies. However, nearly 2.7 billion people are still unvaccinated and in some of the most resource-poor and difficult to reach places in the world, including in humanitarian settings. With vaccine supply finally exceeding demand, the focus is now on providing low-income and low-coverage countries with the support they need to scale up their delivery systems and increase their absorptive capacity and demand, with a particular focus on high-risk groups. 

To ensure future pandemic preparedness, it is essential we build on two decades of Gavi and recent COVAX best practice and lessons learnt with a consideration for what must be sustained in the interval between pandemics to make sure we are better prepared for the next one. It is also essential that the new emerging global health architecture is fit for purpose, able to move quickly, take on risk and coordinate effectively in the high uncertainty of early stages of future pandemics.  

As Member States and stakeholders are coming together for the 75th World Health Assembly, Gavi calls upon Member States to:

• Adopt a global pandemic preparedness approach that supports a truly global response. Infectious diseases need to be simultaneously controlled all across the world, or they will continue to spread, increasing the risk of emergence of new and potentially more dangerous variants.
• Ensure rapid and agile contingency financing that can be deployed at-risk to support surge capacity and enable a network of global health agencies to orchestrate a rapid and robust global response during crisis, guided by principles of equity, global cooperation and solidarity.
• Maintain the key and rapidly scalable innovations driven by COVAX, such as:
  • Deployment of an end-to-end approach leveraging core strengths of each partner, with clear hand-offs between steps in the value chain.
  • Hand-off from R&D and manufacturing ‘push’ funding to procurement ‘pull’ funding.
  • Model indemnification & liability (I&L) language and no-fault compensation (NFC) schemes as an interim solution for carrying risk for manufacturers in roll-out of vaccines under emergency authorisation.
  • Development of an allocation framework – published online to promote transparency – that laid out allocation principles on how to fairly distribute vaccine doses.
  • Fast-tracking of normative processes to allow for expedited Emergency Use Listing (EUL) and policy development.
  • Leveraging the International Finance Facility for Immunisation (IFFIm) to allow surge financing for vaccines.
  • Establishment of several new front-loading and guarantee facilities including the contingent capability of IFFIm, which will soon allow donors to make pledges to IFFIm ‘on standby’ until pre-defined trigger events occur.
  • Establishment of cost-sharing that has allowed lower-income countries to access multilateral development bank (MDB) resources for additional vaccine procurement.
  • The new Pandemic Vaccine Pool to enable early at-risk investment in rapid and equitable access.  
• Strengthen long-term investment in routine immunisation and Primary health care (PHC), with a focus on health system access by the most marginalised communities who are most at risk from outbreaks due to gender-related, geographic and socioeconomic barriers.
• Diversify and expand manufacturing in emerging economies to increase global vaccine supply security, including pandemic vaccines when the need arises, while managing its impact on routine immunisation.
• Intensify efforts to develop comprehensive, contextually appropriate integrated service delivery strategies of essential immunisation and PHC, including vaccine-preventable disease surveillance, community engagement and outbreak response measures that strengthen components of routine immunisation systems and enhance our ability to respond rapidly in an emergency.

Furthermore, here are some Gavi recommendations towards ongoing Member State discussions on strengthening global architecture for Health Emergency, Preparedness, Response and Resilience (HEPR):

• Recognise agility and the ability to take on risk as key principles in the HEPR architecture, the value of a network approach of global health agencies that pulls together relative strengths, expertise and existing partnerships across the current global health architecture, leveraging the capacity established by decades of regular investment in global health in the intra-pandemic period for an agile and cost-effective pandemic response.
• Recognise the crucial role of innovative finance in providing rapid access to liquidity in any new coordination platforms for financing, such as the Pandemic Vaccine Pool, that can be funded by both cash and contingent pledges, backed by mechanisms like the International Finance Facility for Immunisation (IFFIm) or cost-sharing.
• Ensure the governance of a Financial Intermediary Fund results in rapid decision-making based on best available science to support at-risk investments in rapid and equitable access.
• Promote inclusivity in any heads of state/heads of government level Council for health emergencies, engaging both health and finance sectors, and integrating health financing institutions such as Gavi that are at the front lines of outbreak and pandemic response.
• Strengthen sustainability and diversity in the global health emergency workforce, ensuring that the experience gained from outbreak and pandemic response continues to feed back into routine programmes and vice versa.

Immunization Agenda 2030

• Maintain, restore and strengthen routine immunisation in the context of pandemic response and recovery, to reach nearly 14 million children in Gavi supported low- and middle-income countries and 17 million globally who in 2020 did not receive a single dose of the most basic vaccines – known as zero-dose children. These children account for nearly 50% of vaccine-preventable deaths¹ and are markers of communities facing multiple deprivations and severe inequities. Reaching these children with a first vaccine increases the likelihood of them receiving several vaccines – a phenomenon dubbed ‘the immunisation cascade’, as well as other PHC interventions. 
• Leverage, maintain and integrate best practices, innovations and investments made for the COVID-19 response, such as strengthening of real-time data surveillance, to strengthen routine immunisation services. In particular, leverage the wide reach of COVID-19 vaccinations to reach missed communities in which zero-dose children live and establish new contact points with health systems and services, including routine immunisation. 
• Prioritise differentiated and targeted sub-national strategies that identify and sustainably address the social determinants influencing inequity in immunisation to reach the Immunization Agenda 2030 target of reducing the number of zero-dose children by 50% by 2030.
• Prioritise health system strengthening as the pathway to COVID-19 vaccine roll-out, simultaneously reinforcing and extending existing routine immunisation services while ensuring political commitments to COVID-19 vaccination translate into sustained investments in immunisation and PHC services that reach every person in every community.
• Prioritise strengthening of health information and disease surveillance systems to map populations, access real-time data, identify and reach zero-dose children and missed communities with targeted vaccinations as a way to strengthen early warning and outbreak response measures at national and sub-national levels.

Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem

• Rebuild momentum and recommit to accelerate HPV vaccination coverage and ensure equitable provision and access to cervical cancer prevention interventions. This should consist of HPV vaccination, screening and treatment, with interventions prioritising girls and young women, including the most vulnerable and in-need populations, in high-burden, lower-income countries. HPV vaccines are safe and effective and can prevent up to 90% of all cervical cancer cases. However, cervical cancer remains a leading cause of cancer-related death among women in Gavi-supported countries. About 90% of the new cases and deaths worldwide in 2020 occurred in low- and middle-income countries, where women often lack access to cervical cancer screening, treatment and other essential health services.
• Prioritise sustainable disease control through significant investments and a holistic health system approach that is responsive to all life stages, including the needs of adolescents. Shifting from control to elimination will require increased investments and sustained domestic funding, including for promotion of disease prevention and integration of vaccine programmes into national health systems. 

Poliomyelitis

• Fully implement and finance the GPEI Polio Eradication Strategy 2022–2026, including ensuring an integrated approach to reach zero-dose children and communities with other vaccines and PHC interventions. This is all the more important given the negative impacts of COVID-19 on routine vaccination coverage and the need to optimise each and every contact with communities.
• Accelerate transition of essential polio and broader immunisation functions by integrating polio-funded assets into existing national health systems. This will help ensure their experience and expertise are leveraged to strengthen routine immunisation coverage and the delivery of polio and other life-saving vaccines, while creating an opportunity for alignment on increasing coverage to zero-dose and missed communities, and synergy of assistance and resources to countries.

1. Prevent, Protect, Prosper - Gavi Alliance 2021-25 Investment Opportunity