As Gavi plans next five-year strategy, it must do more to get vaccines to people excluded from vaccination

With routine vaccination efforts failing to reach people in fragile and emergency settings, MSF is seeing low vaccination coverage and more outbreaks of vaccine-preventable diseases, like diphtheria and measles.

Geneva, 15 April 2024 – Ahead of Gavi, the Vaccine Alliance’s Board Retreat on April 17-18, where the Board will shape Gavi’s strategic framework for the next five years, Doctors Without Borders/Médecins Sans Frontières (MSF) stressed that Gavi and its Board need to do more to get Gavi-supplied vaccines to people in humanitarian settings, including by incorporating MSF’s lessons learned from decades of vaccinating people in hard-to-reach places.

“Between October and December 2023, admissions of people with measles to MSF facilities in Maiduguri, Northeast Nigeria reached record numbers, with 3,965 patients treated – almost three times more than for the same period in 2022,” said Abdulwahab Mohamed, MSF medical coordinator. “The alarming rise in the number of cases is partly due to the challenges of running vaccination campaigns in the rural communities surrounding Maiduguri, which include building community trust and oftentimes simply being unable to access some areas due to insecurity in the region. One reason why Gavi should adapt their policies and practices, is so that the vaccine providers who are better able to access hard-to-reach places can more readily protect people, and especially children, from vaccine preventable diseases.”

To reach people outside of government vaccination activities, or who have little or no convenient access to vaccination, Gavi should incorporate the following recommendations into its upcoming five-year strategy:

• Make vaccine support for children up to age five a permanent Gavi policy for all relevant vaccines, so that children up to age five who missed out on their routine vaccines due to immunisation disruptions are eligible to receive their “catch-up” vaccinations and be fully protected from vaccine preventable diseases.
• Develop framework agreements with governments to guarantee that non-governmental organisations (NGOs) can quickly and efficiently engage in vaccination activities in hard-to-reach areas. Currently, access to fragile or emergency areas is negotiated on a case-by-case basis, making the rollout of vaccination activities slow and cumbersome.
• Enable the creation of in-country stocks of vaccine doses to which, as part of framework agreements with governments, NGOs have swift and unhindered access when undertaking vaccination activities, including for reactive outbreak campaigns, and for people in hard-to-reach areas. Gavi should also ensure direct and rapid access to vaccine doses from Gavi/UNICEF to NGOs when necessary.
• Provide direct funding for staffing to support vaccination activities by NGOs and local civil society organisations (CSOs), so that independence from governments is ensured and safety and success in insecure regions prioritised. Gavi should also fast-track the disbursement of in-country funds to support the implementation of reactive outbreak campaigns, including those in fragile and humanitarian settings.

“We’re seeing people in humanitarian settings falling through the cracks because government-run immunisation activities are sometimes unable to reach certain areas, even in cases where nationwide vaccination campaigns are underway,” said Alain Alsalhani, Head of MSF’s Vaccination Working Group. “Gavi must ensure agreements are in place with Ministries of Health so that NGOs can maintain the operational freedom to vaccinate children in hard-to-reach places and can have systematic and independent access to Gavi-funded vaccine doses instead of relying on the current ad hoc approaches for accessing vaccines – an approach structured in this way will allow for more children in fragile and humanitarian settings to be protected from killer diseases in a more timely manner."