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Has Gavi lived up to its promise? Quasi-experimental evidence on country immunisation rates and child mortality
  1. Pascal Jaupart1,2,
  2. Lizzie Dipple1,3,
  3. Stefan Dercon1,2,3
  1. 1Centre for the Study of African Economies, University of Oxford, Oxford, UK
  2. 2Blavatnik School of Government, University of Oxford, Oxford, UK
  3. 3Department of Economics, University of Oxford, Oxford, UK
  1. Correspondence to Dr Pascal Jaupart; jaupart.p{at}gmail.com

Abstract

Introduction Gavi, the Vaccine Alliance, was set up in 2000 to improve access to vaccines for children living in the poorest countries. Funding has increased significantly over time, with Gavi disbursements reaching US $1.58 billion in 2015. We assess whether Gavi’s funding programmes have indeed increased immunisation coverage in 51 recipient countries for two key vaccines for 12–23 month olds: combined diphtheria, pertussis and tetanus (DPT) and measles. Additionally, we look at effects on infant and child mortality.

Methods Taking a difference-in-differences quasi-experimental approach to observational data, we estimate the impact of Gavi eligibility on immunisation coverage and mortality rates over time, using WHO/UNICEF figures covering 1995–2016. We control for economy size and population of each country as well as running a suite of robustness checks and sensitivity tests.

Results We find large and significant positive effects from Gavi’s funding programmes: on average a 12.02 percentage point increase in DPT immunisation coverage (95% CI 6.56 to 17.49) and an 8.81 percentage point increase in measles immunisation coverage (95% CI 3.58 to 14.04) over the period to 2016. Our estimates show Gavi support also induced 6.22 fewer infant deaths (95% CI −10.47 to −1.97) and 12.23 fewer under-five deaths (95% CI −19.66 to −4.79) per 1000 live births.

Conclusion Our findings provide evidence that Gavi has had a substantial impact on the fight against communicable diseases for improved population and child health in lower-income countries. In this case, the health policy to verticalise aid—specifically development assistance for health—via a specialised global fund has had positive outcomes.

  • vaccines
  • immunisation
  • child health
  • other study design
  • health policy

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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Footnotes

  • Handling editor Sanni Yaya

  • Contributors PJ did the analysis with input from LD. LD wrote the first draft with input from PJ, which was reviewed by SD, who is the overall PI of the Bill & Melinda Gates Foundation-funded research.

  • Funding The research in this report was supported by funding from the Bill & Melinda Gates Foundation.

  • Disclaimer The content of this report is solely the responsibility of the authors and does not represent the official views of the Bill & Melinda Gates Foundation.

  • Competing interests SD reports grants from the Bill & Melinda Gates Foundation, during the conduct of the study.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available from public, open access repositories.

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