Gavi, the Vaccine Alliance is a global health group that thinks in the billions.
Since its founding in 2000 the organization says it has played a role in vaccinating 1.1 billion children against a raft of potentially devastating diseases from polio to malaria to mpox.
When kids in lower-resource countries get their vaccines, Gavi is a critical part of the chain. With its massive budget — donated by both countries and philanthropies — the alliance contributes cash to countries to help them buy vaccines from manufacturers and also is a supporter of programs that take the vaccines from their arrival in-country to the many places where they're administered.
Gavi also wants to encourage countries to take responsibility for their own vaccine programs. When a country's economy improves, they're asked to pay a larger share of the vaccine costs. And some countries graduate. Indonesia, for example, once a beneficiary, is now a Gavi donor.
The United States has provided 13% of Gavi's funding since its inception — and had pledged under the Biden Administration a grant of $2.53 billion starting in September 2022 through the year 2030. Of that amount $880 million has so far been dispersed.
On the list of canceled programs
But this week, according to a 281-page document detailing foreign aid cuts and compiled by the United States State Department, that billion-dollar grant was canceled. It was one of thousands of contracts totaling billions of dollars in allocations eliminated as part of a review to eliminate expenditures "that did not serve, (and in some cases even harmed), the core national interests of the United States" according to a statement posted on X by Secretary of State Marco Rubio.
The U.S. is the third biggest donor among countries and philanthropic groups that support the organization, behind the United Kingdom and the Gates Foundation.
This cut won't put Gavi out of business. But the news comes as Gavi has already been facing a tough road in fund-raising to meet its goals — there's more competition in the global arena from a variety of groups and continuing [demands including humanitarian, health care and defense from Ukraine and the Middle East, among other issues.
So the loss of the U.S. funds is a blow.
"A cut in Gavi's funding from the U.S. would have a disastrous impact on global health security, potentially resulting in the deaths of over a million children over five years and endangering lives everywhere from dangerous disease outbreaks," Sania Nishtar, CEO of Gavi, told NPR.
Nishtar holds out hope that, as with some other USAID cuts there could be a change of heart. "We have not received a termination notice from the U.S. government and are engaging with the White House and Congress with a view to securing the $300 million approved by Congress for our 2025 activities and longer-term funding for Gavi," she said.
The potential impact
If the funding cuts stand, "we don't know the timeline for the ramifications," says Dr. William Moss, who leads the International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health. But he has no doubt there will be an impact: "What is almost certain is that we will see more frequent and larger measles outbreaks globally but also a resurgence of many other vaccine-preventable diseases, such as whooping cough and rotavirus diarrhea — both of which can be fatal. We would also see delays or disruptions to the introduction of new, life-saving vaccines in the communities most in need." That would include new, promising malaria vaccines just being introduced.
And outbreaks of infectious disease in other countries can travel to the U.S.
"Some of the infectious diseases that Gavi combats includes those that have implications for U.S. health security such as mpox and measles," says Dr. Amesh Adalja, a senior scholar at Center for Health Security at Johns Hopkins. "With measles, for example, as U.S. vaccine hesitancy increases, the chance of outbreaks linked to international travel increases and will increase more if areas in which Gavi operates in have a higher measles burden due to lower vaccination rates."
Thomas Bollyky, director of the global health program at the Council on Foreign Relations, a nonpartisan think tank in Washington, D.C., tells NPR that it will be difficult, if not impossible, to make up the shortfall that Gavi would face from a cut in U.S. funding — as well as funds lost from other donors. The United Kingdom, the largest donor to Gavi, which pledged the equivalent of 1.9 billion dollars for GAVI's 2021 to 2025 funding cycle, has announced a decision to slash development assistance from 0.5% of GDP to 0.3% by 2027 — a move aimed at increasing defense spending in response to the wavering U.S. commitment to Ukraine, says Bollyky.
The Gates Foundation, which had pledged $1.8 billion from 2021 to 2025, would likely seek to make up some of the gap, "but that will be difficult to sustain on its own, indefinitely," says Bollyky.
In a statement released this week, Mark Suzman, CEO of the Gates Foundation (which is a funder of NPR and this blog) said: "We are going to do everything possible to convince the Administration and the Congress to reverse these actions if true."
Bollyky says that what worries him most is that when Gavi was created in 2000, there were 43 countries, including most of sub-Saharan Africa, where at least 1 out of 10 children died before age 5 from infectious diseases. Today there are only five such countries — Chad, Niger, Nigeria, Sierra Leone and Somalia "[and] GAVI is a big part of the reason why."
Asked to comment on the Gavi funding termination and concerns about the impact on infectious disease outbreaks, a State Department spokesperson confirmed that the termination of the grant is "accurate" and reiterated the reasoning behind all the 5,300-plus cancellations — they were "inconsistent with the national interest or Agency policy priorities."
The State Department response stressed that "critical USAID program awards remain active," noting: "USAID continues to support the U.S. coordinated, interagency response to the Ebola outbreak in Uganda; to provide lifesaving HIV care and treatment services; to provide emergency assistance in conflict zones; and to support key American strategic partners."
Fran Kritz is a health policy reporter based in Washington, D.C., and a regular contributor to NPR. She also reports for the Washington Post and Verywell Health.
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