Welcome to Gavi’s 2022 Annual Report, the second of Gavi’s 2021-2025 strategic period. Even in the midst of the COVID-19 pandemic in 2022, this report demonstrates that vaccination coverage in low-income countries supported by the Alliance is recovering. Indeed, coverage for the third dose of the diphtheria, pertussis and tetanus (DTP3) vaccine increased by 3 percentage points during this year.
According to WHO and UNICEF estimates for national immunization coverage in 2022, almost half of low-income countries have returned to or even exceeded their pre-pandemic DTP3 coverage level. Gavi-supported countries have managed to reach similar numbers of children compared to the pre-pandemic period, although coverage has not yet fully returned to 2019 levels, partly due to population growth in Africa. However, some countries have made slower progress. The number of unvaccinated children increased from 12.4 to 10.2 million, which represents considerable progress. However, this figure remains higher than the estimate of 9 million in 2019, and a further reduction of 34% is needed to meet our 2025 target. As we reflect on the important progress and ongoing challenges, the Vaccine Alliance recognizes the considerable efforts made by countries to restore routine vaccination.
The year 2022 has indeed been complex and difficult for global health. More people have been infected with COVID-19 than in 2020 and 2021 combined; and until the end of August, more than a million deaths linked to COVID-19 had been recorded in 2022 alone.
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The negative impact of the pandemic on routine vaccination, causing the largest decline in childhood vaccinations in three decades, continues to present challenges. In some countries, cases of polio and diphtheria have been detected for the first time in decades. Uganda has had to deal with an outbreak of ebolavirus in Sudan, against which authorized vaccines do not provide protection. Additionally, mpox (formerly known as monkeypox) has been declared a public health emergency of international concern (PHEIC).
This is precisely why the Vaccine Alliance has designated 2023 as the Year of Renewal. In December 2022, the Gavi Board approved Gavi 5.1, an evolution of the current five-year strategy to renew the focus on essential vaccinations and the fight against COVID-19, reach unvaccinated children, introduce new vaccines such as those against HPV and malaria, and to strengthen the role of our Alliance in pandemic prevention, preparedness and response (PPRP).
Alongside the growing threat of measles outbreaks, we have seen a continued risk of polio outbreaks, both wild poliovirus 1 (WPV1) and vaccine-derived poliovirus type 2 (VDPV2). This highlights the urgency of increasing routine immunization coverage, reaching unvaccinated children and ensuring they receive the full package of vaccines.
Additionally, expanding girls’ access to the human papillomavirus (HPV) vaccine, one of the most impactful Gavi-supported vaccines, remains a central priority. To compensate for losses suffered during the pandemic, the Gavi Board approved in December 2022 an investment of more than $600 million to protect 86 million girls by 2025. Reaching 10% in 2022, HPV vaccination coverage continued to exceed pre-pandemic levels (7%), and thanks to efforts to strengthen program implementation and facilitate new introductions, as well as increased vaccine production and a new recommendation for a single dose, we expect further increase in coverage over the next few years.
Our fight against the COVID-19 pandemic continued with the same determination as at the start of 2020. By the end of 2022, COVAX had shipped more than 1.88 billion doses of COVID-19 vaccine to 146 countries and territories. Coverage of the full primary series in the 92 low-income countries supported by Gavi’s COVAX AMC was 53%, up from 31% in January. Across the 69 AMC countries reporting, 82% of healthcare workers were vaccinated. While COVAX continued to plan for worst-case scenarios, the Board agreed, in principle, to explore the integration of future COVID-19 vaccinations into Gavi’s core activities.
Faced with the increased risk of infectious disease outbreaks due to climate change, deforestation and migration, the number of cholera cases and cholera-related deaths increased significantly worldwide in 2022. This sad reality follows years of decline. As the risk of a new pandemic with the same impact as COVID-19 increases by around 2% each year, we are reminded of the importance of Gavi’s commitment to vaccine equity in planning. of the PPRP, alongside the negotiations of the Pandemic Agreement. Here, Gavi is working with partners to apply lessons learned from the COVID-19 response, COVAX and Ebola response to the PPRP, as well as how we respond to new outbreaks. Between 2016 and 2022, we have invested more than $4.5 billion in PPRP-related activities, with an addition of more than $2 billion during the first half of 2022. In addition, we have allocated 12, An additional $5 billion to Gavi’s COVAX AMC to finance vaccines, their distribution and systems to combat COVID-19.
As we learned the hard way during the COVID-19 pandemic, one of the biggest obstacles to vaccine equity is the lack of vaccine production in some regions, particularly Africa. In 2022, less than 0.1% of the global vaccine supply was produced in Africa. As the world’s largest vaccine purchaser and the main source of supply for African nations, Gavi plays a critical role in strengthening vaccine markets in Africa. We will work closely with African countries and the African Union to support the vision of sustainably expanding vaccine manufacturing capacity in Africa by 2040.
Recognizing the unique strengths of the Alliance, our Operational Excellence program launched in 2023 aims to improve the way we work to ensure we are as efficient and effective as possible in achieving our mission. It will transform the way Gavi supports countries and collaborates with partners by creating a Gavi Secretariat that is more responsive to country needs, with a particular focus on the health of the Alliance and its ways of working. Ensuring ethical behavior, robust risk management and compliance with laws and regulations remains essential to our operation, sustainable funding and innovation. In 2023, we created a dedicated Ethics, Risks and Compliance Office, led by a new Ethics, Risks and Compliance Officer.
Our six core values guide our work at Gavi: teamwork, respect, openness, accountability, innovation and country focus, meaning we put the countries supported by Gavi at the heart of everything we do. None of the Vaccine Alliance’s achievements in 2022 would have been possible without the collective effort of our partners in civil society, government and the private sector, who work in support of the healthcare workers who actually administer vaccinations . We are sincerely grateful and proud to work alongside them to ensure that no one is left behind when it comes to vaccination.