by Ollie Sayeed, Ph.D.
The historic malaria vaccine roll-out that began in earnest earlier this year is directed by Gavi, the global health partnership that buys vaccines from manufacturers and allocates them to African countries at a discount. Gavi’s role is crucial: without international financing, low-income countries like South Sudan and the Central African Republic would find it difficult to afford enough doses for their populations. However, 1Day Africa’s work with health professionals across Africa has found that the timetable of Gavi’s operations creates significant delays in distributing malaria vaccines, potentially costing thousands of lives.
Currently, Gavi has three deadlines a year for vaccine funding applications: the most recent deadlines have fallen in January, April, and September 2024, with the next one in four months’ time on 22nd January 2025. Each application only starts being processed after the close of the window in which it’s submitted. This means countries that submit early on in a submission window face a long wait to even start the application process: an application submitted at the very end of September, for example, will sit unread for four months.
On top of the delay caused by Gavi’s fixed deadlines, there have already been significant delays in processing times even for countries that have submitted their applications precisely on the deadline. Burkina Faso, for example, submitted an application for Gavi co-financing on 18th April 2024 but had to wait for two months after submission before a committee sat to consider its application. For countries yet to submit, the combination of waiting for the next available deadline and a further two-month wait after that deadline could mean a total delay of six months or more.
The scale of the ongoing malaria crisis means even a delay of a few months has enormous costs. Tanzania, which is currently preparing its application to Gavi, suffers from around 11,500 deaths from malaria per year among children under five, or 1,000 every month. The death tolls for countries that have already been through the slow submission process are even higher, with nearly 3,000 deaths per month in Uganda, 4,000 in the DRC, and over 10,000 in Nigeria. Whatever the arguments for the delays in the current system for reviewing funding applications, we have to reckon with the consequence of thousands of deaths.
Instead of imposing artificial deadlines with a spacing of several months and adding further delays after those deadlines, Gavi should start allowing rolling submissions for funding applications. This would mean reviewing each new application from now on as soon as it’s submitted rather than waiting until January 2025. A fix like this could speed up the application process and help to more quickly get vaccines to those who urgently need them.