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The United Nations, which delivers life-saving vaccines to poorer countries, has the widest range of vaccines ever but is battling financial constraints on donations from wealthy nations, its chief executive warned.
Sania Nishtar said financial demands on Gavi’s main donors, from rebuilding struggling economies to conflict and climate change, were leading them to explore greater use of “vaccine bonds”, which spread payments over multiple years.
Nishtar’s comments highlight a broader global public health dilemma ahead of next week’s UN General Assembly talks, where funding pressures could choke off vital supplies to countries most in need. Gavi’s work ranges from vaccinating against common diseases to responding to emergencies such as the measles outbreak centered in the Democratic Republic of Congo.
“We currently have the broadest portfolio of vaccines,” Nishtar said in an interview, “and ironically, this is also a time when donors are financially constrained and have many other competing priorities.”
Nishtar, who took up her post earlier this year, said Gavi has raised about $2.4 billion of the minimum $9 billion it is seeking from donors for the next five-year funding cycle starting in 2026. Nishtar is “cautiously optimistic” about reaching the target but is aware of the “challenging financial environment”, which is why Gavi is encouraging countries to make greater use of existing alternative funding mechanisms.
Gavi is proposing that potential Western and Gulf donors provide up to two-thirds of their funding in some cases through vaccine bonds backed by legally binding sovereign commitments, which would allow Gavi to raise capital in international markets to fund routine immunization programs or rapidly respond to crises such as the COVID-19 pandemic.
“This is a long-standing and proven model and we are looking to increase that proportion in refills,” said Nishtar, a Pakistani cardiologist and public health expert who has served as a senator and government minister.
GAVI chief executive Sania Nishtar: “We now have the broadest portfolio of vaccines. Ironically, this is a time when donors are financially constrained and there are many other competing priorities.” © Noam Galai/Getty ImagesMpox vaccines arrive at N’djili airport in the Democratic Republic of Congo © Justin Makangara/Reuters
Reports of financial pressure echo comments from some of the world’s leading public health figures who point to spending pledges such as to help Ukraine counter a Russian all-out invasion. Microsoft founder and philanthropist Bill Gates has warned that a reluctance from wealthy countries to donate threatens progress on children’s health.
Since its launch in 2000, GAVI has supported countries with routine immunization of over one billion children, as well as coordinating vaccines for other campaigns and crises such as COVID-19. The vaccines target a range of threats, including measles, meningitis A and the human papillomavirus that causes cervical cancer.
Nishtar said GAVI has sought to avoid a “paternalistic relationship with countries in the South.” GAVI’s co-funding policy means countries pay part of the cost of vaccine procurement, and 19 countries, including Angola, India and Moldova, have already moved to fully fund their immunization programs. Donors like the model, feeling it provides value for money as well as improved public health, Nishtar said.
“This delivers results from a human perspective and is cost-effective from an economic perspective.”
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Gavi established its Emergency Response Fund for Health Emergencies after the COVID-19 pandemic exposed the toll of inequities in vaccine supply, and this week used it to secure 500,000 doses of the MPOX vaccine for distribution this year.
GAVI also created a $1.2 billion financing vehicle to boost vaccine manufacturing in Africa with incentive payments to offset high upfront production costs. Nishtar said the group is also promoting greater use of mobile payments by health workers and artificial intelligence-based analysis to identify “challenge pockets” across countries where children are not being vaccinated.
“The big change is to focus on disadvantaged communities, but to use all modern tools to achieve that,” she said.
