Boosting vaccines

Prevention is better than cure, so the UK should be congratulated for its funding and leadership in winning fresh support for the Global Alliance for Vaccines and Immunisation (GAVI). Now it must ensure the money is well spent.

GAVI has already bought $2bn in vaccines for the poor that were previously available only to the rich, saving an estimated 5m lives. With $7.6bn now secured till 2015, it can spread these products more widely and add new ones to tackle diseases such as diarrhoea and pneumonia.

All the donors involved should be praised, as well as the pharmaceutical manufacturers that have developed vaccines and cut prices, while cautioning over the need to ensure quality and cover costs.

But GAVI and its partners must make the money go further. They should not be intoxicated by this week’s strong international support, which generated $600m beyond the $3.7bn target the agency had sought.

First, developing countries themselves need to do more, both through greater “co-funding” of GAVI vaccines for their own citizens’ benefit, and by ensuring that these programmes work better in future. There are concerns about corruption; and wastage caused by inadequate storage, distribution and community education. Better monitoring of results is needed.

Second, GAVI’s own governance needs to be reviewed to address concerns over potential conflicts of interest of the organisations, including pharmaceutical companies sitting on its board; and to ensure it redoubles efforts to reduce vaccine prices to the lowest sustainable levels.

Finally, there should be no vaccine euphoria. Not every jab is equally cost efficient, and there are trade-offs with other valuable health and development activities. While the case for GAVI’s existing products seems good, there is justifiable debate about which future products to purchase.

The billions of dollars being spent on polio eradication (not currently funded by GAVI) might have been more productively invested in deworming of school children, for instance. More lives may yet be saved through wider provision of mosquito nets, drugs and diagnostic kits than a partially effective malaria vaccine (which GAVI is considering purchasing).

Donors, recipients and GAVI alike should take seriously next year’s “accountability conference” to assess progress, drawn on independent expertise, and think wisely about how best to spend the money now pledged to save lives.

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