The World Health Organization (WHO) credits vaccinations as one of the greatest medical innovations of our time, preventing up to 5 million deaths annually and saving at least 154 million lives through the last 50 years. However, 67 million children have missed out on one or more vaccines in recent years, heightening the risk of new infectious outbreaks fueled by climate change, population growth, and escalating conflict. The question is not if another health emergency will strike, but when. 

That’s where Gavi, the Vaccine Alliance, comes in. They have set out an ambitious five-year agenda that aims to vaccinate 500 million children, save 8 million lives, and generate over $100 billion in economic benefits.

To do this, they need to raise at least $9 billion through its next replenishment campaign. This may sound like a steep bill — but vaccinations are among the most cost-effective, potent tools policymakers have at their disposal to improve billions of lives and create a safer, fairer world.

Here’s everything to know about Gavi’s and their next replenishment campaign — and why it’s one of the best bets to make in global health. 

What is Gavi?

Gavi was set up in 2000 as a public-private partnership between governments, United Nations agencies, and private philanthropies. Its core mission is to deliver to the world’s poorest countries the same life-saving vaccines such as polio or rubella that are readily available to infants born in wealthier nations.

Currently, Gavi helps countries fight against 20 of the world’s most infectious diseases. Countries qualify for Gavi funding if their gross national income (GNI) per capita is under $1,810, which means that only the most vulnerable places, such as Haiti, Syria, and the Democratic Republic of the Congo, are eligible. 

How Does It Work?

Gavi uses a unique partnership model, collaborating with countries to buy vaccines in bulk to reduce costs and allow manufacturers to access new markets across the Global South that might otherwise be considered too risky. The Alliance has a lean operating budget, ensuring that 97 cents out of every dollar invested into Gavi goes directly to its vaccine programs. 

Countries receiving Gavi funding are expected to co-finance their immunization programs, and gradually increase their contributions over time until they can cover all costs independently. Gavi currently supports 54 countries, but 19 have graduated from its assistance since it first launched, demonstrating its role as a short-term boost for countries rather than a long-term crutch. 

What Has Gavi Accomplished So Far?

In a little more than two decades, Gavi’s made some historic strides. While we already know vaccines are incredibly effective at saving lives, Gavi’s model amplifies their impact — so far, it’s helped immunize over1 billion children. That’s about one-eighth of humanity. 

To date, Gavi-funded vaccines have saved over17 million lives. In 2000, only 47% of the world’s children in lower-income countries had received their basic vaccines. By 2019, Gavi helped bump this figure to 82%. 

These accomplishments become even more impressive when you consider that vaccinations are one of the smartest investments in economic development — every dollar spent on immunization returns $54 in broader economic benefits, allowing people to thrive and boosting communities. 

What Challenges Does Gavi Face?

Despite tremendous progress, universal access to vaccines remains far from reach. In 2022, there were 14.5 million estimated ‘zero dose children’, or kids who have never been vaccinated at all. These children make up nearly half of all child deaths from vaccine-preventable illnesses. 

The COVID-19 pandemic also disrupted immunization progress, causing vaccine coverage to decline for the first time in decades — and rates still remain below 2019 pre-pandemic levels. What’s more, climate change and antimicrobial resistance disproportionately impact low-income countries where Gavi works, furthering the risk of diseases. Just this year, multiple African nations faced a virulent new cholera outbreak as a direct result of climate change.

And vaccine inequity persists. Mpox was recently declared an international public health emergency last month after spreading across African countries with extremely limited vaccine supplies. Now more than ever, it’s crucial for the international community to come together to address these global challenges by supporting Gavi.

Wait — What Exactly Is a ‘Replenishment Campaign’?

Like many other international organizations, Gavi raises funding during “replenishment campaigns” where it seeks financing from wealthy countries and organizations through multi-year pledges. This year, Gavi is requesting an additional $9 billion to help cover its $11.9 billion 2026-2030 budget ($2.9 billion has already been secured through pre-existing funds and pledges). 

What Does Gavi Plan to Do With $11.9 Billion?

Gavi’s next plan is its most ambitious yet. If fully funded, it could deliver 4 new vaccines to vulnerable countries around the world, making this generation potentially the most protected in history.

Specifically, Gavi will:

Scale-Up Immunization Efforts

• Turbocharge its vaccination rate, immunizing 1 billion children in just ten years (500 million in the next five). This could save 8 million lives
• Spend $5 billion on the immunization infrastructure, supply chains, data management, and healthcare tools to make this goal possible
• Provide $250 million in emergency funds to middle-income countries for the first time to maintain their current vaccination rates

Introduce New Vaccines

• Expand its vaccine portfolio from 20 to 24 diseases, including new vaccines against tuberculosis (TB), shigella, dengue, and hepatitis-E 
• Use $1.1 billion to distribute two newly approved malaria vaccines to immunize 50 million people against a disease that currently kills over a thousand children a day

Increase Equity and Strengthen Health Systems

• Invest in new initiatives like the “Big Catch-Up” to provide vaccinations missed during the pandemic and the Day-Zero Financing Facility to offer $2.5 billion to low-income countries during public health emergencies 
• Facilitate over 1.4 billion meetings between families and healthcare providers, offering ideal chances to combine routine vaccinations with other essential services like nutritional support and clean water. 

Invest in Local Vaccine Manufacturing

• Build up local vaccine manufacturing infrastructure through the African Vaccine Manufacturing Accelerator (AVMA) along with regional partners, including the African Union. Currently, 99% of vaccines administered in Africa are produced elsewhere, with the continent accounting for less than 0.1% of global vaccine production. This shortfall means Africans are victim to wealthier nations hoarding vaccines, logistical holdups, and ultimately, higher death rates that could have been prevented. 
• Subsidize vaccine manufacturing start-up costs with the AVMA, leading to at least 800 million African-made doses by 2035.  

Gavi’s next five years will be pivotal. The last two decades have demonstrated the strength and viability of Gavi’s model — now its continued success depends on the political will of its donors. The U.S. has already announced it will step up to Gavi’s call by giving $1.58 billion this year, setting a strong example for other countries to follow. 

Investing in vaccines is not only fundamental to good health policy, but also as a catalyst to lift people out of poverty. The COVID-19 pandemic underscored that diseases don’t pay heed to borders. To prevent the next public health crisis, supporting Gavi’s replenishment campaign might just be the best way to keep us all healthy and safe.