Sustainable domestic financing – a critical ingredient to driving immunisation progress

Big results, require big ambitions and there are few bigger for primary healthcare than universal immunization coverage. Governments have committed to this through the Global Vaccine Action Plan (GVAP) and the Addis Declaration on Immunisation (ADI). And while there has been good progress over the last decade – 86% of children globally now receive basic vaccinations – far too many children are still missing out. One in seven children under the age of one is still excluded from basic immunisation.

We believe that increased domestic financing is one of the critical ingredients to going further to deliver more equitable and sustainable immunisation coverage and to ensure GVAP goals are met. The Strategic Advisory Group of Experts on Immunization (SAGE) also highlight this in their recent mid-term review of the GVAP. Improved financing is needed to strengthen health systems that can deliver routine immunisation and other primary health services in reach of all children, as part of building Universal Health Coverage (UHC). In the SDG period, it is clear that domestic investment will be what makes the difference in achieving universal services that leave no one behind.
 
Sustainable financing is particularly important as countries make the transition away from development aid – e.g. from Gavi, the Vaccine Alliance and the Global Polio Eradication Initiative. We must ensure that immunisation programmes and other health priorities are not negatively impacted as a result of this and that GVAP progress continues.
 
Through our partnership, GSK and Save the Children are committed to supporting progress on the GVAP. We recognise that progress against these goals and the SDGs themselves will only be realised through a multi-sectoral approach – with action and accountability from all stakeholders involved to tackle challenges and drive change.
 
While improved financing is critical, countries also need access to affordable vaccines. To that end, commitments from Biological E, GSK, Janssen, Panacea Biotech, Pfizer, Sanofi Pasteur, and Serum Institute of India were made in 2015 towards helping reach Gavi’s goal of immunising 300 million children in the world’s poorest countries between 2016 and 2020.
 
Working with Save the Children and others, GSK has also made a commitment to support vaccine access for humanitarian organisations providing immunisation for refugees and displaced populations. Subsequently, Pfizer followed by making a similar commitment to broaden vaccine access in humanitarian emergencies. However, we recognise that vaccine affordability continues to be a challenge for many countries in sustaining and growing their immunisation programmes.
 
Immunisation and domestic financing – high priority at the World Health Assembly
Immunisation had a high profile at this year’s World Health Assembly (WHA) and the need for sustainable financing was front and centre in a lot of the discussions. The official GVAP session (agenda 14.1) saw the endorsement of a new resolution to strengthen immunisation to achieve the GVAP goals. The resolution – adopted by all Member States – includes a call for countries to mobilise domestic financing to achieve GVAP goals. This was supported by strong statements from over 50 Member States and non-state actors, with many speaking out on the importance of domestic financing. For example, the UK government spoke about the importance of national ownership and financing of immunisation programmes to ensure sustainability and the role of Gavi Alliance partners in providing technical support and advocacy to help improve domestic financing. The need for affordable vaccines also emerged through Member State interventions and in the final text of the resolution.
 
During the immunisation technical briefing delegates and partners discussed ways to accelerate progress towards global immunisation goals. The Minister of Health from Angola talked of their increasing investment of domestic financial resources for immunisation and health, but also highlighted key challenges they face in light of dwindling support from Gavi and polio eradication resources and the potential implications on routine immunisation and other primary health care interventions.
 
Save the Children spoke on the need for increased domestic investment in immunisation and health systems to ensure the progress and sustainability and to deliver services in reach of every last child, as part of UHC. We also highlighted the role of donors in supporting countries with this. During closing remarks, WHO’s Dr Flavia Bustreo emphasised that “when a country invests significantly in immunisation programs, other health services also benefit.”
 
Action needed to make progress
The message is clear – improved financing is needed to drive progress on the GVAP and wider SDG goals. But concerted action is needed to turn this message into reality.
 
The Roadmap to implement the ADI was launched at the 1^st WHO Africa Health Forum in Kigali, on 27 June 2017. The Roadmap outlines strategies for countries to accelerate progress against the ADI commitments, bringing particular attention to the need for political commitment to increase and sustain domestic investments and funding allocations for immunisation.
 
Many countries are making good progress and a lot can be learned from this. However, strong political commitment and leadership is critical to driving further progress. Countries must allocate additional resources to immunisation, as part of a growing health budget – the global health community calls for countries to allocate a minimum of 5% of GDP in public funding to health. 
 
Donor countries and development partners must also play their part – as a catalyst for domestically-driven change – supporting countries to strengthen national systems and increase domestic fiscal space for health and immunisation.
 
The GSK and Save the Children Partnership is using its joint voice to call for improved and more equitable vaccination coverage and combining the resources and expertise of both organisations around technical provision of immunisation services, training health workers and reaching marginalised populations to help improve access to routine immunisation services for the hardest-to-reach children.