Gavi, the Vaccine Alliance, has been a cornerstone in improving health outcomes in low-income countries, particularly across Africa. Since its inception in 2000, Gavi has facilitated the delivery of vaccines to more than 700 million children, saving millions of lives. However, with Gavi’s funding facing reductions, the continent is at a critical juncture that could reshape its approach to vaccine financing and health security.
Historically, Gavi has been instrumental in increasing immunisation coverage across Africa, helping governments provide essential vaccines at reduced prices. This partnership has been vital in combatting diseases such as malaria, polio, pneumonia, and rotavirus, which have long plagued the continent. In countries where healthcare systems have struggled to reach the most remote populations, Gavi’s initiatives have brought life-saving vaccines to millions who would otherwise have been left behind.
However, the alliance’s future funding has come under strain, particularly as major donors, including the United States and the United Kingdom, reduce their contributions. These cuts are due to several factors, including global economic uncertainty, shifting political priorities, and the ongoing effects of the COVID-19 pandemic, which has put significant pressure on national budgets worldwide. This financial downturn has led to concerns about Gavi’s ability to continue its work at the same scale in Africa, where vaccination rates still lag behind global averages.
The implications for African nations are significant. Many African countries rely heavily on external funding to secure vaccines. In places like Nigeria, the Democratic Republic of Congo, and Kenya, Gavi’s support has been essential in filling the gap left by insufficient domestic funding for health programmes. Without continued financial assistance, these countries risk seeing setbacks in immunisation progress, leading to a potential resurgence of preventable diseases that could overwhelm already fragile healthcare systems.
In response to the potential shortfall, African governments are under increasing pressure to find alternative sources of funding for vaccination programmes. Some experts suggest that African nations may need to bolster their own domestic health financing efforts, increasing public investment in immunisation and health infrastructure. However, the ability of many African nations to self-finance these initiatives is limited by economic challenges, including low GDP per capita, high levels of debt, and ongoing socio-political instability.
Several African countries have begun exploring innovative financing mechanisms to address these gaps. The African Union’s African Vaccine Acquisition Trust , for instance, was launched to secure vaccines through collective purchasing. While this initiative has shown promise, it has been hampered by funding shortages and logistical challenges in distributing vaccines across the continent. Furthermore, AVAT’s long-term sustainability is uncertain, given that many African nations are still grappling with the economic fallout from the pandemic.
Another avenue being explored is the expansion of public-private partnerships. Global pharmaceutical companies and philanthropic organisations such as the Gates Foundation have stepped in to fill some of the funding gaps. These partnerships could provide critical resources, but they also bring about concerns related to equity and access. There is the risk that vaccine procurement becomes increasingly driven by market dynamics rather than public health needs, potentially putting vulnerable populations at a disadvantage.
The cuts to Gavi’s funding come at a time when Africa faces a heightened need for vaccines, especially in the context of emerging health threats. Malaria remains a top priority, with the World Health Organisation identifying Africa as the epicentre of the disease. In 2021, 95% of global malaria cases occurred on the continent, highlighting the ongoing vulnerability of African populations. As the continent continues to battle malaria, new vaccine candidates, such as the RTS,S/AS01 malaria vaccine, are showing promise, but only if they can be scaled up quickly and effectively.
Similarly, there is growing concern over the threat of a new wave of vaccine-preventable diseases. Routine vaccination programmes, such as those for measles, diphtheria, and polio, have seen significant disruptions due to the COVID-19 pandemic. These disruptions have led to a decline in vaccination coverage across Africa, with the WHO warning that the world is facing a “backslide” in immunisation rates. The disruption of essential services has left millions of children unprotected, and without Gavi’s continued support, many African countries may struggle to recover ground.
Gavi’s role as a leader in global vaccine financing is now under intense scrutiny. Its funding model, which has been reliant on donations from high-income countries, is increasingly seen as unsustainable in the face of shrinking budgets and the changing priorities of international donors. For Africa, this is a moment of reckoning, where the continent must decide whether to continue depending on external aid or take control of its own vaccine financing future.
As the global health landscape evolves, there is a growing call for greater investment in Africa’s health systems, with a focus on building domestic capacity for vaccine production, distribution, and financing. Local vaccine production has the potential to reduce reliance on external donors and ensure that African countries are better equipped to respond to future health crises. Several countries, including South Africa and Rwanda, are already taking steps to boost vaccine manufacturing capacity, with the hope of creating a more self-sufficient health system.