Protecting progress: Vaccines are a down payment on a more prosperous future

Immunization systems are among global health’s most remarkable engines of innovation and impact. Over the years, they have ushered in a series of successes once thought impossible: bringing polio to the brink of eradication; introducing the first-ever vaccines against the ancient scourge of malaria; and preventing cervical cancer.

However, as donor countries announce reductions in foreign assistance funding, some of this progress for women and children is at risk. According to a recent survey of World Health Organization country offices, the resulting disruption to critical health services is at a level the world hasn’t seen since the COVID-19 pandemic.

This is the second article in our series looking at what funding gaps could mean for women and children around the world. With both disease prevention through immunization and the ability to detect outbreaks under threat, deadly childhood diseases are poised to surge unless a new set of donors and governments work together quickly to fill the gap left behind.

The stakes are high, but so is the opportunity for new stakeholders to make an immense impact. The health and economic return on investment for immunization is profound, and it is shared: just as a vaccine protects an individual and a community, so, too, do immunization systems benefit a nation within and beyond its borders.

Continuing our deep dive on financing data from the Institute for Health Metrics and Evaluation (IHME), we conducted a preliminary analysis of foreign assistance provided by global donors for immunization. We found that three-quarters of the world’s vaccine funding flows through Gavi, the Vaccine Alliance; UNICEF; and the Gates Foundation. Gavi alone is the channel for almost half of all global development assistance funding for immunization, leveraging that support to help provide vaccines to nearly half of the world’s children.

Gavi is the first line of defense against disease threats, protecting everyone from outbreaks of diseases that know no borders. Supported by a broad donor base of more than 40 sovereign and philanthropic donors, Gavi has vaccinated more than 1 billion of the world’s children since its inception. In 2022 alone, Gavi vaccinated 68 million children.

The UK is the biggest government donor to Gavi, followed by the United States and Germany. Over the 2021-2025 investment period, these three donors provided nearly $3 billion in funding to Gavi’s important programming.

The funding from these three donors could result in an approximate $160 billion return on investment, based on the methodology developed by the Decade of Vaccine Economics study—which estimates that every $1 spent on immunization in Gavi-eligible countries over the next decade would save $54 in future health care costs, lost wages, and the added value of long and healthy lives lived.

As major donors reassess their foreign assistance spending, the future impact of Gavi on healthy families and economies is in flux unless other parties step in to continue its legacy.

Established in 2000, Gavi is as much a triumph of innovation as the vaccines it delivers. It tackles a major conundrum of global health: on one hand, countries that struggle with the highest disease burden are least able to afford vaccines. On the other hand, vaccine manufacturers need a market that justifies their production expenses. Gavi funding bridges that gap, providing a steady, guaranteed market for manufacturers to supply vaccines to the world’s poorest while their scale allows them to deliver shots at a lower cost per dose.

Gavi works on a lean model. With 97 cents of every dollar raised going toward immunization programming, any funding disruptions directly impact programs. According to a Kaiser Family Foundation (KFF) analysis, 61 percent of Gavi funding goes directly to vaccine support, with another 18 percent going to foundational health systems strengthening and immunization campaign support to ensure the vaccines purchased reach the children who need them.

A smart buy for investors, sustainability is built into Gavi’s model because the cost is shared between donors and recipient countries on a sliding scale. As a country’s economy improves and its capacity to pay for vaccines increases, the proportion of Gavi funding decreases. After a certain threshold, countries “graduate” from Gavi’s subsidized funding, fully financing their national immunization systems. As of 2022, 19 countries have graduated from Gavi support.

Regardless of a country’s economic classification, immunization remains a best buy. The simplest way to quantify return on investment is the number of lives saved due to vaccination: an estimated 154 million lives over the past 50 years. This astronomical number nonetheless falls short of capturing the full value of vaccination.

Consider the example of the rotavirus vaccine, which saved more than 140,000 lives from 2006–2019 by protecting against the most lethal form of childhood diarrhea. In countries where the vaccine has been introduced, diarrhea-related hospitalizations have decreased, easing the burden on health systems and preventing families from slipping into poverty. A hospital visit—and the resulting loss of income-earning activities—can mean the difference between making ends meet from one day to the next.

Domestic financing for immunization is an important investment in healthy families and productive citizens. National immunization financing champions understand that forgoing immunization investments is more costly in the long run. Countries like Malawi are demonstrating what is possible in resource-constrained settings, such as tapping into the private sector and proposing various tax and fee structures. Other countries are exploring solutions that increase the impact of current funds, such as in Kenya, where primary health care improvements include better use of data to target areas of low immunization coverage. As an external funding gap emerges, now is an opportune moment to test creative strategies.

Immunization is often called the backbone of primary health care because it is an investment in health delivery infrastructure. Immunization systems are critical scaffolding—from basic tools to human resources—onto which other health interventions can be delivered. Fully resourced immunization systems can deliver routine immunizations and swiftly react to emergencies.

Conflict, extreme weather, and rising antibiotic resistance are markers of the “polycrisis” era in which global health programs now operate. Funders should take comfort that, despite so many unpredictable variables, vaccination remains one of our strongest tools to halt the dire downstream consequences of these phenomena, preventing deadly, disruptive, and expensive infectious disease outbreaks before they start. For this reason, Gavi maintains global stockpiles of vaccines against Ebola, cholera, meningitis, and yellow fever.

At this critical juncture, we cannot afford to short-change vaccination and the funding mechanisms we have built over a quarter of a century. The human and economic impacts of diminished investment in immunization would be far-reaching, and families in the poorest communities would pay the highest price. On the flip side, we also know that immunization is still among the most powerful tools for creating healthy outcomes for the greatest number of people—we just need to come together to put forward the down payment.