Inside Public Citizen’s Work to Advance Vaccine Equity Worldwide
Public Citizen News / September-October 2024
By Liza Barrie
This article appeared in the Sept/Oct 2024 edition of Public Citizen News. Download the full edition here.
Vaccination is one of the most effective public health strategies, critical to saving lives and stopping viral threats before they can spread around the world. Civil society organizations are crucial in advancing this vital strategy by ensuring that vaccines are available, affordable, and accessible to everyone—especially the most vulnerable populations.
As Vice Chair of the Civil Society Steering Committee for the international vaccine alliance known as Gavi, Public Citizen has a singular opportunity to influence global vaccine access. In this elected role, the group is promoting policies to tackle unfair vaccine pricing, supporting local vaccine production, and working to ensure that civil society plays a full role in national immunization programs. Public Citizen’s leadership is helping drive policies that address systemic health disparities and enhance the effectiveness of vaccination efforts worldwide.
Established in 2000, Gavi’s mission is to ensure equitable access to new and underused vaccines for children in the world’s poorest countries. The vaccine alliance brings together governments from developing and industrialized countries, UNICEF, WHO, the World Bank, the pharmaceutical industry, the Bill & Melinda Gates Foundation, and civil society to boost vaccine coverage in 54 low- and middle-income countries. Gavi has helped immunize nearly 1 billion children over the last two decades, resulting in a significant reduction in preventable deaths.
Despite these achievements, global childhood vaccination rates have stalled. New data from WHO and UNICEF reveals an alarming increase in unvaccinated children, exacerbated by the COVID-19 pandemic when child immunization rates plunged. The rise in ”zero-dose” children has led to more frequent outbreaks of vaccine-preventable diseases such as diphtheria and measles, particularly in conflict and fragile settings.
“Gavi must act swiftly to restore and expand vaccination coverage to avert further public health crises,” said Peter Maybarduk, director of Public Citizen’s Access to Medicines Group.
In this critical context, Public Citizen is working to build stronger coordination and collaboration among the thousands of civil society organizations that Gavi relies on to support vaccine delivery, generate vaccine demand, and advocate for and mobilize financial support. These groups include the formidable Doctors Without Borders, which provides essential medical aid in 70 countries; grassroots women’s groups raising community awareness about the importance of vaccination; and religious leaders who can significantly increase vaccine acceptance and uptake. Another influential partner working with Public Citizen is RESULTS, the D.C.-based advocacy organization that helped build a bipartisan coalition in Congress that led to the Biden administration’s recent pledge of $1.58 billion over five years to Gavi—the largest U.S. pledge since its inception.
Effective collaboration among civil society organizations in global immunization efforts can greatly enhance their impact. Collaborative networks can resolve common challenges more effectively by fostering the exchange of knowledge, best practices, and resources. When groups present a unified front, their influence is markedly stronger, particularly in negotiations with major stakeholders like Gavi and its partners. Strong collaboration helps prevent duplicate efforts, streamlines activities, and harnesses each organization’s strengths. Together, civil society organizations can address barriers to vaccination coverage and access.
The Civil Society Steering Committee operates independently from Gavi but receives funding support from Gavi for coordination, advocacy, communications, and participation in global meetings and events. Civil society needs to be actively involved in discussions where key vaccine-related policy decisions are made. The Steering Committee regularly brings together civil society organizations to share updates on disease outbreaks (such as the recent global mpox emergency declared by the WHO) and to discuss new vaccine rollouts. For instance, a recent call that Public Citizen led focused on the introduction of two new malaria vaccines in 15 African countries. These rollouts of the new vaccines are finally taking place after significant delays since the first malaria vaccine received major regulatory approval in 2015. With demand for these vaccines expected to far outstrip supply for several years, the active involvement of civic organizations is crucial to ensuring an effective and equitable rollout.
Since 2000, Gavi has spent around $23 billion in immunization efforts across poorer countries and over $12 billion to buy vaccines for COVAX, the initiative aimed at ensuring equitable access to COVID-19 vaccines. As the largest purchaser of vaccines for poorer countries, primarily funded by public money, Gavi wields significant bargaining power in negotiations with pharmaceutical companies. This position allows Gavi to purchase vaccines through pooled procurement, long-term agreements, and market shaping to encourage competition. The prices of the vaccines that Gavi buys vary considerably. For example, in 2023, Gavi secured measles vaccines at just $0.23 to $0.52 per dose. However, newer vaccines such as HPV and malaria are much more costly. The price for HPV vaccines last year ranged from $2.90 to $26.75 per dose. Public Citizen believes Gavi can reduce the cost of HPV and other vaccines, as was accomplished with measles.
In line with Public Citizen’s commitment to advancing vaccine equity, the organization is mobilizing allies to strategically pressure Gavi to negotiate the best possible prices from pharmaceutical companies. In response to the growing mpox crisis and related challenges, Public Citizen led a civil society letter to Gavi’s CEO Sania Nishtar, urging her and the Gavi board to leverage their influence to secure fair pricing for millions of doses of Jynneos, Bavarian Nordic’s mpox vaccine, for which the Danish pharma company is charging the exorbitant price of $50-75 per dose. This high cost risks depleting Gavi’s resources and limiting funds for future outbreaks. Our letter sparked major media coverage, forced a response from Bavarian Nordic’s CEO, and is being used by health agencies including the Africa Centers for Disease Control to secure a more affordable price.
“Price matters for access, and Bavarian Nordic’s price for mpox vaccines is far, far too high,” said Maybarduk “The world cannot afford for Gavi to sit on the sidelines of pricing and must use its power to negotiate affordable cost-plus pricing and ensure that public funds are spent responsibly.”