Gavi must reach the 10 million children missing vaccines worldwide

The Vaccine Alliance’s meeting this week to approve its five-year strategy must include an approach to reach children in fragile and humanitarian settings who are still missing out on routine immunizations.

Child getting a measles vaccination in Timbuktu

An MSF health worker vaccinates a child against measles in Tassakane, in northern Mali’s Timbuktu region. | Mali 2020 © Mohamed Dayfour/MSF

The Board of Gavi, the Vaccine Alliance, is meeting in Geneva this week to approve and endorse the one-page framework for Gavi 6.0, which outlines its five-year strategy for 2026-2030.

Gavi, which is funded by public and private donors, was set up nearly 25 years ago to help the 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

Half of “zero-dose” children live in fragile settings

About 10 million—49 percent—of the world’s children who are under-vaccinated or “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 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 by reaching zero-dose children with immunizaton. 

Specifically, the Gavi Board must ensure that Gavi 6.0 offers a concrete, effective approach for how to immunize 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.

Why we’re concerned about vaccine access

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 organizations 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-vaccination of people in hard-to-reach places.

What Gavi must do now

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 organizations already involved in these activities at the center of their design.

To do this, 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.

Gavi must do more to get vaccines to people excluded from vaccination

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