GAVIs Contribution to Vaccination in Developing Countries

GAVIs 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
nations 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.

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

Immunization (GAVI)

GAVIs Contribution to Vaccination in Developing Countries

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 worlds 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 worlds poorest children, who needed them

GAVIs Contribution to Vaccination in Developing Countries

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 timeconsuming 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 healthcare 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

GAVIs Contribution to Vaccination in Developing Countries

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 20112015 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: Its all about finding the sweet spot. Theres an
optimal gap between what you know and what youre 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 GAVIs 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.

It is noteworthy that Coyles 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.

GAVIs Contribution to Vaccination in Developing Countries

Chapter one of Coyles 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 ones failures into skills (Coyle D. , 2009). But, can deep practice alone help in building
expertise? I agree with Robert Bjorks 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-WeDo/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)/

GAVIs Contribution to Vaccination in Developing Countries

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.13652214.2009.01003.x