Gavi spoke to HealthNews.NG on its new plan for Nigeria as 2021 transition date nears
The Vaccine Alliance Gavi, has told HealthNews.NG that it is working on a special plan with other stakeholders for Nigeria. This plan will ensure that Gavi continues to support immunisation in Nigeria beyond 2021 when it was initially expected that the country would have undergone full transition and would not be dependent on Gavi for immunization support.
Gavi told HealthNews.NG that Nigeria entered into the accelerated transition phase in January 2017 and should fully transition in 2021. However, it is working on an exceptional plan for Nigeria in the light of the fact that the country currently has the highest number of under-immunised children in the world and still has low immunisation coverage.
“Due to these challenges, at the latest Board meeting in November 2017 the Gavi Board decided to allow, on an exceptional basis, discussion of a tailored plan for transition in Nigeria. This tailored plan will be discussed amongst all partners, including the Government of Nigeria. Gavi, its partners and the Government of Nigeria have been working in full partnership and collaboration for years and will continue to do so in order to increase vaccination coverage in country,” Gavi told HealthNews.NG.
GAVI has supported immunisation in Nigeria for years, but Nigeria was close to losing support for immunisation after a rebasing of its economy pulled the country out of the league of low-income countries.
Past history of distrust
While Gavi did not comment on HealthNews.NG‘s inquiry on its position regarding financial appropriation and corruption in management of donor funds in Nigeria, the CEO of Gavi, Dr Seth Berkley, in 2016 expressed disappointment with how the federal government officials utilised donor funds for health care in the past.
He said Gavi and the Global Fund were disappointed when forensic audit revealed systemic weaknesses and corruption in the utilisation of funds given to Nigeria in the past.
In his response, President Muhammadu Buhari said Nigeria is making genuine efforts to correct the lapses.
“We are very serious about people behaving themselves, and being accountable,” Buhari told Gavi leadership.
“We thank you for deciding to re-engage with us, despite our inefficiencies. You decided to be here, not minding our shortcomings. There are other countries that would bring less problems. We appreciate your commitment, and we will do our best to put ourselves in the best shape to help us.”
Nigeria is key to Gavi’s mission
One of the reasons why Gavi continues to engage with – and is deciding to further improve its level of engagement in Nigeria is due to crucial nature of the country to the actualisation of Gavi’s major goal which is to create equal access to new and underused vaccines for children living in the world’s poorest countries.
In his December 2017 letter, Berkely noted that a lot still needs to be done to improve immunisation indices in Nigeria.
“In Nigeria, one of the three countries that are still polio endemic, national coverage is less than 50%. In the other two, Pakistan and Afghanistan, there are still pockets where coverage is below 50%. To change this, and to protect against potential outbreaks, we will need to concentrate efforts to boost routine immunisation,” he said.
Between 2001 and 2017, Gavi has disbursed over US$732 million out of over US$1 billion it has committed to support various efforts to improve immunisation in Nigeria.
Sigh of relief
This latest announcement, several Nigerian public health experts told HealthNews.NG, is a huge sigh of relief has they would not be worried that the achievements recorded by Gavi and partners would be in ruins if they withdraw in 2021 and Nigerian government is unable to take over.
Earlier this year and throughout 2017, several media reports called attention to the potential fate of immunization in Nigeria if Gavi goes ahead and effect the transition phase of its support for Nigeria by 2021.
To ensure Nigeria’s preparedness, the federal parliament promised to commit adequate budgetary allocations to pay for vaccines and effective immunization.
Muhammad Usman, deputy chair of the House of Representatives committee on health, said both the House and the Senate are concluding effective legislations to guarantee adequate funds for vaccine procurement, immunisation services and PHC in general, beginning from 2018 financial year.
Since 2001, Gavi, the Bill and Melinda Gates Foundation and other donors have been providing funding support towards vaccines procurement and strengthening of Nigeria’s health systems for effective delivery of immunization services.
The Gavi funding is for countries whose Gross National Income per capita is below the eligibility benchmark of $1580; with the rebasing of its economy in 2014, Nigeria has exceeded this benchmark and therefore ineligible for the support. Consequently, Nigeria began a five-year accelerated exit transition phase of Gavi funding beginning from 2017.
According to the National Immunization Comprehensive Multi-Year Plan (cMYP 2016-2020), Gavi funding shall witness annual progressive decrease from $199 million in 2017 to $74 million in 2021 while funding from the Federal Government is expected to rise annually and progressively from $123 million in 2017 to $279 million in 2021.
Explaining the Nigerian situation, Dr. Chiyoba Wonodi, Nigeria Country Director of Johns Hopkins University International Vaccine Access Centre (JHU-IVAC) and Convener of the Women Advocates for Vaccine Access (WAVA), noted that while the rapid ramp down of Gavi funding begins this year, the rollover of excess vaccine stock and existing loans will cushion the impact of the transition on the 2017 budget, as only 21% of need was budgeted for.
She said: “In 2018, the situation will be very different. Without additional loans or carry over vaccines, Nigeria must come up with $141 million (N43 billion) to meet its co-financing obligations. Given the prevalent tight fiscal space and uninspiring macroeconomic indices, the feasibility of raising a single budget line item by four and half times (from $25M to $I41M) is still an open question.”
The National Primary Health Care Development Agency (NPHCDA), which oversees primary health care across the country, rallied lawmakers to reach common alignment and understanding between Nigerian government, its partners, donors and development partners on the transition out of GAVI funding.
Gavi’s past support
Gavi told HealthNews.NG it has worked with the government of Nigeria since 2001. To date, the organisation’s support of new vaccines includes the introduction of Pentavalent vaccine – a vaccine that protects against five major infections: diphtheria, tetanus, pertussis (whooping cough), hepatitis B and Haemophilus influenzae type b (Hib) – the pneumococcal vaccine (PCV), and the inactivated Polio Vaccine (IPV) in 2013, 2014-2015 and 2015-2016 respectively. Other Gavi vaccine support is related to vaccination campaigns for yellow fever, measles and meningitis A.
Gavi also invests in Health Systems Strengthening (HSS), such as supporting procurement of logistical equipment like fridges and medical material.
Recently, the Government of Nigeria, with the support of Gavi and its partners (WHO, Unicef, and NGOs), launched its biggest ever yellow fever campaign. The campaign aimed to vaccinate more than 25 million people against the disease. In Kwara state which was one of the states where the exercise was held, it was able to achieve 90% coverage.
Previous Gavi intervention in Nigeria also included the September 2017 cholera outbreak in Borno state, with more than 40 deaths. Gavi and its partners supported a mass vaccination effort, targeting over 915,000 people, to contain the cholera outbreak.