Gavi’s next strategy must make sure to reach the 10 million children in fragile and humanitarian settings who are missing vaccines

This week, on 6-7 June 2024, the Board of Gavi, the Vaccine Alliance, is meeting in Geneva to approve and endorse the one-page framework for Gavi 6.0, which outlines its strategy for the five-year period from 2026-2030. Gavi, which is funded by public and private donors, was set up nearly 25 years ago to help governments of the world’s poorest countries vaccinate children against some of the world’s deadliest diseases. While Gavi has been pivotal in improving access to vaccines for millions of children, protecting over 1 billion children against vaccine-preventable diseases since 2000, far too many children in fragile and humanitarian settings are still missing out on their routine vaccinations, creating, a situation of inequity among Gavi end-beneficiaries.

Approximately 10 million (49%) of the world’s children who are ‘zero-dose’ (defined as children who haven’t received a single dose of diphtheria, tetanus and pertussis-containing vaccine) or under-vaccinated live in fragile or humanitarian settings, including in countries impacted by conflict. With nearly half (46%) of Gavi-supported countries currently classified as fragile or conflict-affected – a proportion that is set to increase as other countries transition away from Gavi support – Gavi needs to do much more if it wants to achieve its goal of leaving no one behind with immunisation by reaching zero-dose children. Specifically, the Gavi Board must ensure that Gavi 6.0 offers a concrete, effective approach for how to immunise children in fragile or humanitarian settings, especially if they are in areas that are excluded from government vaccination efforts. In addition, the Gavi Board must make sure that vaccine support for children up to age five becomes a permanent policy for all relevant vaccines, in order to catch up older children who have missed out on their vaccines.

For over five decades, Doctors Without Borders/Médecins Sans Frontières (MSF) has been vaccinating children through routine and preventive vaccination campaigns, and in response to disease outbreaks in some of the world’s most challenging humanitarian contexts. Often, MSF and other organisations are the sole providers of vaccination for people who are not reached by government-led vaccination activities for various reasons, including security constraints and geographic challenges.

Lately, we have witnessed the reemergence of preventable and previously controlled diseases like diphtheria and measles – outbreaks which are often the result of chronic under-immunisation of people who are in hard-to-reach places.

MSF is calling on Gavi and its Board to use the opportunity of Gavi 6.0 to adapt its current operating model to include alternative approaches to reach people outside of government vaccination activities, or who have little or no convenient access to vaccination, and to put organisations already involved in these activities at the centre of their design.

To show that Gavi will meaningfully engage in an approach to reach people outside of government vaccination activities, or who have little or no convenient access to vaccination, the Gavi Board should ensure that Gavi 6.0 contains a dedicated funding stream for this work, includes MSF’s recommendations gathered from decades of vaccinating people in hard-to-reach places, and makes vaccine support for children up to age five a permanent Gavi policy for all relevant vaccines, so that zero-dose and under-vaccinated children can be fully protected from vaccine-preventable diseases.