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Co-financing key to vaccine access

Published Updated

Access to vaccines without donor support in the developing world can best be secured through cost sharing by governments, known as co-financing. This is one of the main findings from a new report by the Norwegian Institute of Public Health commissioned by Gavi, the Vaccine Alliance.

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Gavi is a vaccine financing alliance which has supported the purchase of over 1 billion doses of vital vaccines in 73 developing countries, including vaccines against yellow fever, pneumococcal disease and rotavirus. In 2007 Gavi implemented a co-financing policy, with the objective of preparing countries for phasing out of Gavi support and sustainably finance new vaccines on their own.

In the aftermath of revising its co-financing policy in 2012, Gavi requested the Norwegian Institute of Public Health (NIPH) to conduct an independent evaluation. This evaluation was conducted by a team of researchers at the Department of International Public Health under the scientific supervision of Dr. John-Arne Røttingen. The report, issued in 2014 and entitled “Evaluation of the GAVI Alliance co-financing policy”, presents results, lessons learnt and recommendations from this work.


Key findings from the report

  • Co-financing requirements have been affordable for most partner countries. An increasing number of countries are co-financing more than what is required due to political prioritizations and increasing health and immunization budgets.  Countries also take great pride in complying with their co-financing commitments. A total of 68 countries have co-financed Gavi-supported vaccines from 2008 to 2013, with a combined total of US$ 254.7 million for the six-year period.
  • Administrative challenges in governments, lack of clear prioritization of vaccines and growing co-financed vaccine portfolios in some countries may be causing budgetary stress. This has led to an increase in the number of countries delaying co-payments in recent years. However, a mechanism of penalties and incentives is in place that encourages countries to respect their commitments, while reasonable flexibilities are being applied in cases of extreme economic or political constraints.
  • Key drivers for sustaining country ownership of vaccine financing include:capacity-building in financial planning and national procurement services for purchasing vaccines; greater efforts by countries to make informed decisions about which vaccines to introduce in their routine immunization programmes based on public health needs; and strengthening linkages between relevant ministries for policy implementation.
  • Key drivers for incentivizing sustainable financing of vaccines by countries with own resources include: reliable domestic funding to support co-financing; prioritization and greater willingness-to-pay for vaccines by central governments; and continued access to low vaccine prices after Gavi support phases out entirely.
  • Key barriers to continuing co-financing policy success in the future include: too frequent changes to co-financing requirements and exemptions of Gavi-supported vaccines from co-financing requirements by Gavi; unaffordable vaccine prices and stagnant health and immunization budgets in countries.

Three key recommendations

The report was well received by Gavi, and is an important contribution to the future use of the co-financing policy.  

“The authors have used an appropriate and broad set of data sources which they have triangulated, to give us what I would describe as the best understanding of what is really occurring. This should be a very useful input in to the redesign of the co-financing policy”, says the Evaluation Advisory Committee of Gavi, which assessed the quality and usefulness of the NIPH’s report.

The report recommends a number of measures, the most important of which are:

1) Broader country government participation in policy revisions and greater alignment with other Gavi policies would be beneficial in the future; and greater policy alignment should be pursued with fiscal and immunization planning cycles of partner countries. Nonetheless, co-financing is considered an innovative policy in the field of global health that has been based on extensive analytic groundwork and consultations to inform policy design and revision processes to-date.

2) More realistic timeframe scenarios would facilitate smoother transitions to vaccine financing with own resources by countries in the process of phasing out of Gavi support, including measures for continued access to Gavi prices and technical assistance for efficient procurement services for vaccines.

3) Closer monitoring and technical assistance to countries facing low immunization budgets, poor intra-ministry coordination and conflict would reduce the number of countries delaying their co-financing obligations. This includes special attention to economically fragile countries and countries with rapidly growing co-financed vaccine portfolios.

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Please contact Dimitrios Gouglas at Dimitrios.gouglas@fhi.no for a copy of the full report in French.