On Thursday, 30th November 2017, the Gavi Board approved a $85 million funding window for 2019-2020 to support the introduction of Typhoid Conjugate Vaccine (TVC) in developing countries. This means that millions of children in the poorest countries could soon be protected against typhoid fever.

“Typhoid fever imposes a dramatic burden on children in the poorest nations affecting countries, communities and families. This disease has long been eliminated from most industrialised nations, but it is still a serious threat in developing countries where the vast majority of deaths occur. I lost my cousin and nearly lost my son because of typhoid. This vaccine will be a lifesaver for millions of children, especially those living without access to clean water or sanitation,” said Dr Ngozi Okonjo-Iweala, Gavi Board Chair.

Typhoid fever is a serious enteric fever caused by ingesting contaminated food or water. According to the latest estimates, typhoid fever killed more than 128,000 people in 2016 and affected nearly 12 million. Improved living conditions and the use of appropriate antibiotics have resulted in the virtual elimination of the disease in industrialized nations and this has led to a dramatic global reduction in the proportion of deaths.

However, this progress is now in danger of being undermined because of the growing problem of antimicrobial resistance (AMR). Drug-resistant typhoid is spreading across Asia and Africa, posing a serious threat to public health.

“This vaccine is safe, effective and can provide lasting protection. The growing spread of drug resistant strains of typhoid is a major threat, not just to individuals but also to our efforts to control the disease, and requires us to prioritise prevention strategies. Strong coverage through routine immunisation together with efforts to improve access to clean water and hygiene will play a key role in dramatically reducing the disease,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance.

A new typhoid conjugate vaccine manufactured by Bharat Biotech International Limited and first licensed in India in 2013, is currently under review for prequalification by the World Health Organization (WHO). This follows the recent recommendation by the WHO Strategic Advisory Group of Experts on Immunization (SAGE) that typhoid conjugate vaccines should be introduced in endemic countries to all children over six months of age. Vaccines from five additional manufacturers are also under development and are expected to be available between 2018 and 2022.

Gavi expects the first countries to apply in 2018 with introductions forecasted to begin the year after. The Gavi Board also noted that the use of this new vaccine would enable further studies on the impact of the disease, challenges with diagnosis and appropriate immunisation strategies.

The Gavi Board in the 2008 Vaccine Investment Strategy (VIS) first saw typhoid conjugate vaccines as a priority although no financial commitment was made at that time in the absence of a suitable vaccine.

The Vaccine Investment Strategy is Gavi’s evidence-based process for assessing the suitability of new vaccines to further support countries. Developed every five years, the next VIS will be completed at the end of 2018. Today, the Gavi Board approved the evaluation criteria that will be used for assessing potential new investments in vaccines and other immunization products for endemic disease prevention.

Engagement with transitioning countries and post-transition

Between 2016 and 2020, at least 20 Gavi-supported countries are expected to transition out of Gavi’s financial support. Most of these countries are on track to fully finance their immunisation programmes and sustain the progress they have made since 2000 when Gavi was created. However, the Gavi Board recognised that a small number of countries are facing more significant challenges.

“Sustainability is at the heart of the Gavi model. Our transition approach is an unprecedented attempt to systematically support countries with growing economies to take full ownership of their immunisation programmes. The Alliance will work closely with governments to ensure that they remain on track so that children are not left unprotected against deadly diseases,” said Dr Berkley

The Gavi Board agreed to allow countries to apply for new vaccine support at any point during their transition. It decided that the Alliance should continue to engage with countries after they transition to track progress and continue to advocate for immunisation. The Board also made available US$30 million through 2020 for the Alliance to provide targeted technical support to address specific challenges in countries after transition.

“I want to strongly commend the spirit of this Board meeting, All partners have come together to take this important step towards Gavi’s vision and support countries to develop sustainable health systems and economies, thanks to immunization,” said Dr Ngozi Okonjo-Iweala.

The Gavi Board also approved a tailored transition plan for Papua New-Guinea, which is due to transition in 2021, and approved a set of principles to guide the Alliance in developing a tailored transition plan for Nigeria. At the Board’s request, Gavi will also assess whether tailored post-transition support is needed in Angola, the Congo Republic, and Timor-Leste. The Board emphasised that governments will need to demonstrate clear commitment to ensure the sustainability and full domestic financing of immunisation programmes.

Finally, as part of Gavi’s flexible approach with countries facing fragility or emergencies, the Gavi Board decided that South Sudan will continue to receive Gavi support despite not fulfilling its co-financing obligations in 2016.

What you need to know about Gavi, the Vaccine Alliance

  • Gavi, the Vaccine Alliance is a public-private partnership committed to saving children’s lives and protecting people’s health by increasing equitable use of vaccines in lower-income countries.
  • The Vaccine Alliance brings together developing countries and donor governments, the World Health Organization, UNICEF, the World Bank, the vaccine industry, technical agencies, civil society, the Bill & Melinda Gates Foundation and other private sector partners.
  • Gavi uses innovative finance mechanisms, including co-financing by recipient countries, to secure sustainable funding and adequate supply of quality vaccines.
  • Since 2000, Gavi has contributed to the immunisation of nearly 640 million children and the prevention of more than 9 million future deaths. Learn more at www.gavi.org and connect with us on Facebook and Twitter.
  • Gavi, the Vaccine Alliance is supported by donor governments (Australia, Brazil, Canada, Denmark, France, Germany, India, Ireland, Italy, Japan, the Kingdom of Saudi Arabia, Luxembourg, the Netherlands, Norway, the People’s Republic of China, Republic of Korea, Russia, South Africa, Spain, the State of Qatar, the Sultanate of Oman, Sweden, United Kingdom, and United States), the European Commission, Alwaleed Philanthropies, the OPEC Fund for International Development (OFID), the Bill & Melinda Gates Foundation, and His Highness Sheikh Mohamed bin Zayed Al Nahyan, as well as private and corporate partners (Absolute Return for Kids, Anglo American plc., The Children’s Investment Fund Foundation, China Merchants Group, Comic Relief, Deutsche Post DHL, the ELMA Vaccines and Immunization Foundation, Girl Effect, The International Federation of Pharmaceutical Wholesalers (IFPW), the Gulf Youth Alliance, JP Morgan, “la Caixa” Foundation, LDS Charities, Lions Clubs International Foundation, Majid Al Futtaim, Philips, Unilever, UPS and Vodafone).

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