In December 2023 Gavi announced that it was expanding its portfolio to include more vaccines to support countries who are eligible. These countries can now apply to introduce diphtheria, tetanus, a pertussis (DTP)-containing vaccine boosters and to switch to a hexavalent vaccine. The six-in-one vaccine combines the pentavalent vaccine with inactivated polio vaccine (IPV). These programmes are part of Gavi’s “commitment to leave no child behind with immunisation”.
What is available?
Countries who are eligible may apply for the DTP-containing boosters and a switch to the hexavalent vaccine: this combines diphtheria, tetanus, whole-cell pertussis (DTwP), hepatitis B, and Haemophilus influenzae type b with inactivated polio vaccine. The Gavi Board approved this hexavalent vaccine in June 2023, and it is expected to support countries in efforts to protect against all six diseases more efficiently, reducing programmatic challenges associated with multiple vaccines and injections.
Furthermore, in support of polio eradication, the addition of IPV increases opportunities for under-immunised children to receive the appropriate IPV doses. Providing it as part of a combination vaccine “ensures streamlined integration into national immunisation programmes”.
Leave no child behind
Gavi states that these new programmes are part of its commitment to leave no child behind. They will “enable countries to protect more children” against these 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).”
These boosters will be “vital” for children who are “under-immunised” or have been missed by immunisation programmes.
“Low immunisation coverage makes vulnerable communities susceptible to recurrent vaccine-preventable disease outbreaks, worsening health and development outcomes.”
Thus, Gavi is reinforcing the “life-course approach to vaccination” and hopes to strengthen vaccination contacts during the second year of life and in school health programmes. Thabani Maphosa, Managing Director of Country Programmes Delivery at Gavi, commented that “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.”
MSF demands catch up
This announcement from Gavi came shortly after a public call from MSF that the organisation should “make catch-up vaccination a priority” by allocating the remaining COVAX funds appropriately. MSF suggested that, in advance of the Gavi board meeting in December, the team should “consider going beyond” the currently supported vaccines to include other “critical vaccines” such as rotavirus and pneumococcal conjugate vaccine (PCV).
“Ensuring sufficient funds are available to close these gaps will be crucial.”
Dr Louis Massing is MSF Medical Intersectional Coordinator, Democratic Republic of Congo, and expressed concern that “in some of the countries where we work” many children have been missed by routine vaccinations and are “now too old” to be eligible in their country.
“To reach every child, there simply needs to be more financial support for countries.”
Recognising “several factors that limit catching up children on their vaccines”, Dr Massing recommended that Gavi could “temporarily” waive co-financing for “all catch-up vaccines”. Victorine de Milliano, Vaccines Policy Advisor, MSF Access Campaign, believes that “with nearly $2 billion leftover from COVAX”, Gavi “certainly has the means” to make significant catch-up progress.
“If the Gavi board wants to truly reach its ambition…they should vote to fully fund all catch-up vaccine doses requested by countries for children up to 5 years of age.”
de Milliano states that there is “really no excuse” for the board to not show “willingness” to support countries in “catch-up ambitions”.
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