It’s easy to take for granted just how amazing vaccines are, particularly where killer diseases have become all but a distant memory.

We have seen smallpox eradicated and endemic wild poliovirus wiped out in all but three countries; between 2002 and 2013, coverage of routine immunization, such as diphtheria, tetanus and pertussis (DTP) vaccines, has increased from 73 per cent to 84 per cent. More than 200 years after Edward Jenner’s first pioneering work, vaccines continue to be one of the most efficient, innovative and cost-effective ways of saving children’s lives.

But while every child has the right to access these innovations, nearly 20 per cent of children under the age of one still do not complete the basic course of vaccination, and less than 5 per cent are fully vaccinated with the 11 antigens recommended for children by the World Health Organization (WHO). In 2008 alone, 1.5 million children died from vaccine-preventable diseases. There is so much more we can do.

While scientists working to develop and improve vaccines are constantly innovating, we must continue to innovate beyond the laboratory to get these vaccines to all the children who need them. We must find new ways to finance global health to supplement not only traditional development aid – which must become more efficient and effective – but also already stretched government budgets. Furthermore, reaching the nearly 22 million children who are not fully vaccinated will require creative approaches to vaccine delivery that take advantage of new technologies, better data, and the improvement and optimization of supply chains.

A child is vaccinated in the Democratic People's Republic of Korea.
A child is vaccinated in the Democratic People’s Republic of Korea. | PHOTO COURTESY OF GAVI

Compared to their older counterparts, modern vaccines tend to be technologically advanced, and use innovative and complex processes that make them more effective. Often, they combine multiple antigens to protect against more than one disease, such as five-in-one pentavalent vaccines, which, in turn, combine DTP vaccines with hepatitis B and Haemophilus influenzae type B (HiB). Meanwhile, others contain multiple serotypes, such as pneumococcal vaccines that can target as many as 13 of the most common forms of the bacteria responsible for 70 per cent of the cases of childhood pneumococcal disease in Africa.

In addition to the use of adjuvants – some of which have been added to vaccines for decades, with others more recently developed to help stimulate an immune response – a number of vaccines now use a sophisticated process called conjugation to boost the immune response to inactivated or non-live vaccines. This process involves binding one or more antigens to a protein, which helps to trigger a broader and more powerful immunological response. Conjugation is particularly useful for infants, whose immature immune systems are normally less responsive to these sorts of vaccines.

Such advances in vaccine technology can come at a cost. Historically, these new vaccines are expensive, and it could take a decade or even longer for prices to come down to levels affordable for poor countries, which is typically where the vaccines are most needed.

A vaccinator with a family in Pakistan.
Polio remains endemic in Afghanistan, Nigeria and Pakistan. | PHOTO COURTESY OF GAVI

Gavi has used a public-private business model to work with partners, such as UNICEF’s Supply Division, to help increase the supply of new vaccines while simultaneously bringing down their prices. Such efforts have helped to lower the total price of vaccinating a child with pentavalent, pneumococcal and rotavirus vaccines – to prevent diphtheria, tetanus, pertussis, hepatitis B, HiB; pneumonia; and diarrhoea – from US$35 in 2010 to US$22 today – and this is a combination that costs hundreds of dollars in the industrialized world. To make this possible and subsidize the purchase of vaccines for the poorest countries, we currently operate three innovative finance vehicles:

The International Finance Facility for Immunisation (IFFIm) uses long-term pledges from nine governments as assets that underlie the issuance of vaccine bonds to investors. The money raised provides readily available funds for Gavi, with investors repaid over time from the pledges. This moves money through time, providing Gavi with financial flexibility and predictability, so resources can be applied to have the greatest public health impact.

Vaccine bonds have proved popular with institutional and individual investors who are able to generate a market-based return while making a socially responsible investment. The most recent vaccine bond raised US$700 million. IFFIm, with the World Bank as its treasury manager, has transformed Gavi, helping nearly double its financial support to countries.

The Advance Market Commitment funds and makes available effective and affordable vaccines to prevent pneumococcal disease, the leading cause of pneumonia, which is the leading killer of children under age 5. The vaccine was so expensive that poor countries were not able to purchase it.

But there is no reason that new, effective vaccines should not be introduced simultaneously in developed and developing countries. In the case of the pneumococcal vaccine, the solution has been the Advance Market Commitment, which uses US$1.5 billion in donor commitments to incentivize manufacturers by guaranteeing large purchases in exchange for a low price. Gavi and its country partners have paid no more than US$3.50 per dose, and in 2013, they secured a new lowest price for pneumococcal conjugate vaccine of US$3.30 per dose from 2014 onwards. Thanks to the Advance Market Commitment, 42 developing countries have introduced the pneumococcal vaccine as of September 2014, and 15 more have been approved.

Gavi has also managed to reduce the price of rotavirus vaccine. This vaccine provides protection against diarrhoea, which rivals pneumonia in its lethalness for young children. In 2012, we began buying rotavirus vaccines at US$2.50 a dose, a two-third reduction compared to Gavi’s previous lowest price. Our purchase of this vaccine and more than a half dozen others is supported by IFFIm as well as the Gavi Matching Fund.

Under the Gavi Matching Fund, the Government of the United Kingdom and the Bill & Melinda Gates Foundation have pledged about US$130 million combined as a challenge grant to the private sector, matching contributions from corporations, foundations, their customers, employees and business partners. This mechanism is used to bring critically needed private sector expertise to the Alliance’s efforts, and as of September 2014, Gavi has raised more than US$222 million from 12 private-sector partners through the Gavi Matching Fund.

Gavi is not alone in using innovative finance. For example, UNITAID receives funding from a levy assessed by nine governments on airline tickets. The Global Fund to Fight AIDS, Tuberculosis and Malaria is supported by (RED), under which companies contribute a share of profits from the sale of (RED)-branded products. (RED) – created by Bono and Bobby Shriver – works with popular brands and organizations to develop (RED)-branded products and services whose purchase triggers corporate giving to the Global Fund.

Looking ahead, we are also exploring how we can innovate the way vaccines are delivered to improve and extend supply chains that help us bring vaccines to those children who are the hardest to reach. This includes the use of powerful computer simulations to improve and optimize the design of supply chains. And with our partner Vodafone, we are looking at ways to use cellphones to help improve outreach and data collection. Allowing real-time data of stock levels in remote facilities to filter back up the chain can help prevent unnecessary stock-outs and ensure that vaccines are available when infants and children are brought in to be immunized. Meanwhile, the technology will also enable health-care workers in the field to access health records and schedule appointments using their phones. They can even issue automated text reminders to parents about when to bring their children in for vaccination.

Innovation has already played a major role in Gavi’s work and we hope that it will help us to ensure a healthy future for an entire generation of children living in low-income countries.