GAVI Alliance - 2009 review

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GiveWell aims to find the best giving opportunities we can and recommend them to donors. We tend to put a lot of investigation into the organizations we find most promising, and de-prioritize others based on limited information. When we decide not to prioritize an organization, we try to create a brief writeup of our thoughts on that charity because we want to be as transparent as possible about our reasoning.

The following write-up should be viewed in this context: it explains why we determined that we wouldn't be prioritizing the organization in question as a potential top charity. This write-up should not be taken as a "negative rating" of the charity. Rather, it is our attempt to be as clear as possible about the process by which we came to our top recommendations.

What do they do?

GAVI provides funds to developing world governments aiming to increase immunization coverage.1 However, based on reviewing available financial reports for GAVI, it appears that GAVI also offers significant funding outside of these channels, by funding "Investment Cases." For example, in 2007, GAVI provided $428.5 million to "Investment Cases." These appear to be direct grants to the Global Polio Eradication Initiative, Measles Initiative, Maternal and Neonatal Tetanus Initiative, and the Yellow Fever Initiative.2

According to GAVI's 2007 Progress Report, cumulative disbursements from 2000-2007 through "normal" channels totaled $1.41 billion.3 Thus, GAVI's "investment case" grants for 2007 alone were almost 25% of their cumulative allocations for 2000-2007.

Given this information, we are unsure of how GAVI allocates its funds and how additional donations would likely be used. (We wonder whether the significant allocation to "Investment Cases" indicates that GAVI has more money that it can reasonably spend through "normal" channels.)

Does it work?

Expanding immunization coverage is a proven, cost-effective means of saving lives and improving health in the developing world. (For more information, see our full report on expanding immunization coverage.) However, because of our questions about how GAVI allocates its funds (see above), we are not confident that GAVI increases immunization coverage.

What do you get for your dollar?

Immunization is a proven, highly cost-effective method of improving health in the developing world.

For a traditional immunization program (DTP, measles, polio, and BCG) implemented in sub-Saharan Africa, the Disease Control Priorities report estimates approximately $14.21 per fully immunized child, $205 per child's death averted, and $7 per disability-adjusted life-year (DALY) averted.4 (More on DALYs in our overview of the DALY metric.)

Some of the vaccines that GAVI provides (such as those for yellow fever, Hib, and Hepatitis B)5 could increase the cost significantly (for example, nearly doubling the cost per immunized child in Sub-Saharan Africa), depending on the delivery strategy used and the specific vaccines administered.6 For more information, see the cost-effectiveness section of our full report on expanded immunization coverage.

Room for more funds?

We have not seen any expansion plan, "funding gap" analysis, or list of strong but underfunded proposals from GAVI. In addition, the fact that it makes large grants to other (similar but not identical initiatives) - as noted above - implies that it may have more funding available than it can productively use on core activities.

Update: In 2011, GAVI raised more than enough funds to cover its projected needs through 2015 (full discussion on our blog).

Unanswered questions

  • What are GAVI's expenses by program? GAVI has several programs that fund a variety of approaches to expanding immunization coverage. In order to evaluate their impact, we would like to know how large each area is as a portion of GAVI's total expenses. Is this information available?
  • Can GAVI productively use additional funds? In 2007, GAVI provided a significant amount of funding to other immunization-related initiatives such as the Measles Initiative and the Polio Eradication Initiative. Does GAVI's funding these other programs indicate that they no longer can productively use funds for core activities? Does GAVI have an expansion plan, "funding gap" analysis, or examples of underfunded proposals available?
  • Does GAVI have procedures for ensuring the appropriate delivery and use of vaccines?
  • How does GAVI hold grantees accountable in the area of general "health system strengthening?"
  • How frequently does GAVI stop funding poorly performing grants?

Sources

  • 1

    GAVI provides different types of funding:

    • Funds to directly increase immunization coverage. Funds (a) to puchase new vaccines and associated technology (GAVI, "New and Underused Vaccines Support (NVS).") and (b) to purchase equipment to increase vaccine safety (GAVI, "Injection Safety Support (INS).")
    • Health systems support. Funds to support non-vaccine-specific health services, necessary to ultimately increase immunization coverage. GAVI, "Health System Strengthening (HSS)."
    • Funds as an incentive to increase immunization coverage. GAVI provides funds to countries "per additional child immunized," intended as an incentive for countries to increase vaccination rates. GAVI, "Immunisation Services Support (ISS)."
    • Civil society organization support. "In many countries CSOs deliver 10-60% of immunisation services. GAVI's new funding aims to strengthen CSOs and to encourage the public sector and civil society to work together to plan and deliver sustainable health care." GAVI, "Civil Society Organisation Support."

  • 2

    GAVI, "Progress Report 2007," Pg 77.

  • 3

    GAVI, "Progress Report 2007," Pgs 78-79.

  • 4

    Jamison et al. 2006, Pg 401, Table 20.5.

  • 5

    GAVI, "New and Underused Vaccines."

  • 6

    "The discounted incremental cost [of additional vaccines] per person ranges from less than US$1 to US$16.23, depending on the unit price of vaccine, the type ofvaccine, the delivery strategy, and the coverage levels." Jamison et al. 2006, Pgs 403-404.