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Gavi got the money it wanted to vaccinate kids. Now what?

The recent replenishment conference for Gavi, the Vaccine Alliance in Berlin was a big success. In the wake of persistent campaigning by global citizens over the past 12 months, governments and private donors dug deep and enabled Gavi to achieve its funding target of US$7.5 billion. The UK's contribution was crucial - up to £1 billion. This money will sustain Gavi’s vaccine programs over the 2016-20 period, and will save 5-6 million lives worldwide. I’m not prone to overstatement, but I consider this to be one of the greatest achievements in the world during my lifetime. Excellent!
But now that the $7.5 billion has been pledged, the real work starts. Gavi’s questions will shift from “how much funding will we have to work with?” to “how do we deliver maximum impact with this amount of funding?” If anything, that’s an even trickier question than the first one.

Because Gavi is jointly funded by various governments and private foundations, and works in partnership with other governments and NGOs, there are naturally plenty of different opinions flying around as to how to achieve maximum impact over the next five years. But even taking a further step back, what even is “maximum impact”? Is it vaccinating as many kids as possible with the money, and that’s all? Or is it also allocating resources to strengthen health systems in hard-to-reach areas, so that there are indirect, ongoing benefits from Gavi’s work in these areas? Is it introducing new, extra vaccines, or giving more kids the basics instead?
Jasmine Whitbread, the International CEO of Save The Children, thinks that figuring this out is “not going to be a walk in the park”, and she has a point. Her further opinion is that “Gavi can only be successful if it prioritises equity of coverage before the introduction of new vaccines”, though I don’t think I’d have to spend a lot of time on Google to find a quote from someone emphasising the urgency of introducing an Ebola vaccine. It’s going to be Gavi’s job to find a way to balance all of these opinions, and get results.
The next five years is also going to involve capitalising on technological innovations. Vaccines need to be kept cold in order to be effective, so how do we get 500 doses of a vaccine up a mountain with no roads, to a village with no reliable electricity… and have the doses still cold when they arrive three days later? How do we use mobile phones to improve record-keeping and planning? Important questions.

Then there’s the matter of health system strengthening. Numerous Gavi donors and NGOs believe that an important part of Gavi’s impact should be an improved health system that delivers ongoing services and benefits to communities. An example of this has been seen in West Africa recently, where polio vaccination efforts in Nigeria had a legacy of better trained doctors, a better planning system, and faster response times to other disease outbreaks. When Ebola appeared in Nigeria in 2014, it was quickly contained, with few deaths. Over in Sierra Leone, the weaker health system wasn’t able to respond in the same way, and the virus killed thousands. 
This health system strengthening is increasingly becoming a priority around the world, and we’re pushing the UK Government to bring it right to the forefront of its aid and development strategy after the General Election in May.
So as you can see, the $7.5 billion of funding is a fantastic outcome, and an exciting opportunity to improve the health and prospects of people living in extreme poverty. Though it also brings with it the need to make some important decisions on how to get the greatest “bang for the buck”. But hey… these are pretty good problems to have!
Michael Wilson