Gavi expands portfolio, introduces new vaccine programmes to save more lives and support child health
Countries eligible for Gavi support can now apply to introduce diphtheria, tetanus and pertussis (DTP)-containing vaccine boosters (DTP boosters) – as well as to switch to hexavalent vaccine – a six-in-one vaccine that combines the pentavalent vaccine (diphtheria, tetanus, whole-cell pertussis [DTwP], hepatitis B and Haemophilus influenzae type b) with inactivated polio vaccine (IPV).
A hexavalent vaccine that includes whole-cell pertussis and IPV would be preferable to giving pentavalent and IPV separately because it would require fewer vaccination sessions, meaning more children are likely to receive all the recommended doses for protection against these diseases. It would also reduce the risk of countries prematurely discontinuing the use of IPV if victory over polio is declared. Reducing the number of vaccinations could also make vaccinating against these diseases cheaper, by cutting the number of syringes and safety boxes needed, and reducing transportation, cold-chain and labor costs.
These new programmes, part of Gavi’s commitment to leave no child behind with immunization, will enable countries to protect more children against common childhood illnesses, use public health resources more efficiently and strengthen the reach of health systems. Combined, the three pathogens, DTP, are estimated to kill about 110,000 people annually, with the greatest burden in Asia and sub-Saharan Africa (mainly children aged one to four years). The DTP boosters will be vital in protecting children who have not received any routine vaccines, are under-immunised or come from missed communities. Low immunisation coverage makes vulnerable communities susceptible to recurrent vaccine-preventable disease outbreaks, worsening health and development outcomes. Providing these boosters also reinforces a life-course approach to vaccination and can strengthen vaccination contacts during the second year of life and in school health programmes.
Starting from 6 weeks of age (minimum), the World Health Organization (WHO) recommends that the hexavalent vaccine is expected to be given as three doses at six, ten, and 14 weeks — with a booster dose given between the child’s first and second birthday, which should be at least 6 months after the third dose.
The fourth dose of hexavalent, when given at 12-23 months of age, adds to strengthening the second year of life (2YL) contact alongside other vaccines delivered at this time (e.g. second dose of measles-containing vaccine, malaria vaccine).
Although recommended by WHO, many countries are not yet providing DTP-containing vaccine boosters. To support a life-course approach to vaccination, Gavi has opened a funding window for introducing DTP-containing vaccine boosters. The hexavalent booster aligns with and can serve as the first dose in the recommended DTP-containing vaccine booster series (2YL, 4–7 years and 9–15 years).
The Gavi Board approved the whole-cell pertussis hexavalent vaccine in June 2023. This combination vaccine is expected to help countries deliver protection against all six diseases more efficiently and reduce programmatic challenges due to multiple vaccines and injections – which would reduce the burden on children, caregivers and healthcare workers and make it easier to reach un- and under-immunised children. In support of polio eradication, combining IPV with pentavalent increases opportunities for under-immunised children to receive sufficient IPV doses, and providing IPV as part of a combination vaccine with other core antigens ensures streamlined integration into national immunisation programmes, as we look toward a post-polio world.
The Hexavalent vaccine contains IPV but not bivalent Oral Polio Vaccine (bOPV), and both are needed. So Countries will need to continue using bivalent oral polio vaccine (bOPV) in their routine immunisation programmes until global cessation.
Thabani Maphosa, Managing Director of Country Programmes Delivery, Gavi, said: “Immunisation reaches more communities than any other routine health intervention; however, there are still too many un- and under-immunised children in the world, and this situation has been made worse by the COVID-19 pandemic. By continually expanding our vaccine portfolio, and targeting the children and communities most frequently left behind, we can save more lives, support child and adolescent health through vaccinations beyond infancy, and make way to provide other important services.”
Every five years, Gavi develops a Vaccine Investment Strategy, with a rigorous process to identify new vaccines or vaccine candidates that would have the most impact in lower-income countries. DTP boosters, the hepatitis B birth dose, rabies vaccine, multivalent meningococcal conjugate vaccine (MMCV) and respiratory syncytial virus (RSV) vaccines were all part of Gavi’s 2018 Vaccine Investment Strategy. However, the introduction of these products was delayed due to the COVID-19 pandemic and countries’ limited bandwidth to establish new programmes or, in the case of RSV vaccine and MMCV, lack of WHO-approved vaccines. Gavi and Alliance partners are preparing to open the funding windows for the remaining vaccines in 2024. The process of developing Gavi’s 2024 Vaccine Investment Strategy is underway, with a shortlist of candidates to be discussed at the Gavi Board meeting this week in Accra, Ghana.
Currently Gavi, the Vaccine Alliance is providing support to the Federal Ministry of Health through the National Primary Health Care Development Agency together with United Nations Children’s Fund (UNICEF), World Health Organization (WHO) and other partners to provide free Human Papilloma Virus (HPV) Vaccines to protect the girl child against the risk of cervical cancer.
The HPV vaccination is scheduled to kick off as a five-day mass vaccination campaign in schools and communities will be carried out during the inaugural roll-out in 16 states and the Federal Capital Territory of Nigeria. The vaccine will then be incorporated into routine immunisation schedules within health facilities. The second phase of the vaccination introduction is set to start in May 2024 in 21 states.
In the same vein, Gavi, in conjunction with the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA), has supported the Government of Togo in introducing the human papillomavirus (HPV) vaccine its into routine immunisation system to prevent cervical cancer on Monday, 4 December 2023. Several other local partners, such as the Togolese Red Cross, Civil Society (Platform of Civil Society Organizations for Immunization and Vaccination in Togo – POSCVI) and the private health sector, are supporting this high-impact immunisation milestone.
Before the introduction, a catch-up campaign was planned for girls aged 9 to 14. The campaign, scheduled to run from 27 November to 1 December 2023, is expected to reach approximately 656,240 girls within that age group.
Global supply shortages have slowed Gavi-supported vaccine introductions. These supply issues are now easing thanks to years of market-shaping efforts to develop a more robust HPV vaccine market and the single dose recommendation. Recognising this critical opportunity to reach more girls with higher levels of global HPV vaccine supply and renewed momentum towards accelerating efforts to prevent cervical cancer, the Gavi board approved the revitalisation of its HPV vaccine programme with an investment of more than US$ 600 million by the end of 2025. With the additional funding, Gavi and its partners have set an ambitious goal to reach more than 86 million girls by 2025, aiming to avert more than 1.4 million future deaths from cervical cancer.
Currently, 27 out of 47 countries in Africa have introduced the human papillomavirus vaccine. In West Africa, 10 out of 17 countries have already introduced it, including Senegal, Burkina Faso, Côte d’Ivoire, Liberia, Sierra Leone, Cape Verde, Nigeria, Mauritania and Gambia
Gavi, the Vaccine Alliance is a public-private partnership that helps vaccinate more than half the world’s children against some of the world’s deadliest diseases. 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.
Since its inception in 2000, Gavi has helped to immunise a whole generation – over 1 billion children – and prevented more than 17.3 million future deaths, helping to halve child mortality in 78 lower-income countries. Gavi also plays a key role in improving global health security by supporting health systems and outbreak response as well as funding global stockpiles for Ebola, cholera, meningococcal and yellow fever vaccines. After two decades of progress, Gavi is now focused on protecting the next generation, above all the zero-dose children who have not received even a single vaccine shot. The Vaccine Alliance employs innovative finance and the latest technology – from drones to biometrics – to save lives, prevent outbreaks before they can spread and help countries on the road to self-sufficiency.
(Source: Gavi.org)
