Peer-reviewed article
Has Gavi lived up to its promise? Quasi-experimental evidence on country immunisation rates and child mortality
Pascal Jaupart, Lizzie Dipple, Stefan Dercon ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study evaluates whether Gavi, the Vaccine Alliance, has successfully improved immunisation coverage and reduced child mortality in 51 low-income countries since 2000. Using data from 1995 to 2016, researchers compared countries eligible for Gavi funding with similar countries that were not eligible. The analysis found that Gavi funding significantly increased vaccination rates for DPT and measles, and reduced both infant and under-five mortality rates. The findings suggest that providing focused international health funding through a specialised global fund can have substantial positive effects on child survival in poorer countries.
Key points
- DPT immunisation coverage increased by an average of 12.02 percentage points in Gavi-eligible countries
- Measles immunisation coverage increased by 8.81 percentage points on average
- Gavi support was associated with 6.22 fewer infant deaths per 1000 live births
- Under-five mortality was reduced by 12.23 deaths per 1000 live births
- The analysis covered 51 recipient countries over a 21-year period using WHO/UNICEF data
Limitations
The study uses observational data and a quasi-experimental design with matching, which cannot fully control for all unmeasured confounding factors that might differ between eligible and ineligible countries. The analysis cannot determine which specific Gavi programmes or strategies were most effective, or explain the mechanisms through which funding improved outcomes.
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.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Gavi funding and support programmes for vaccine procurement and immunisation services
- Population
- 51 low-income countries eligible for Gavi support, children aged 12-23 months
Key finding
DPT immunisation coverage increased 12.02 percentage points (95% CI 6.56-17.49) in Gavi-eligible countries