It is estimated that each year 1.7 million children die from diseases that could be prevented through immunization. Campaigns to vaccinate all of the world’s children against fatal childhood diseases have been an ongoing initiative of the Rockefeller Foundation (RF) since 1985. Although much work remains, the combined efforts of the RF and other major international organizations have had a profound impact on the health of children world-wide.
RF’s global efforts to provide childhood vaccines began in 1984, following an international meeting at the RF conference center in Bellagio, Italy, on the protection of the world’s children. International delegates from the fields of medicine, government and philanthropy met to discuss the concept of a global immunization program for children as one means of providing primary health care and reducing mortality among children in the developing world. The World Health Organization (WHO) had already initiated the Expanded Program on Immunization (EPI) in 1980; however, in later years, the program had suffered from financial constraints. The Bellagio meeting resulted in hundreds of millions of dollars in funding allocated to the EPI. As a result immunization rates rose to 80% in some places, saving millions of lives. However, by 1990 donor fatigue had set in, and the spectacular success of the mid-1980s could not be repeated. The problem of childhood immunization required new ideas.
The Children’s Vaccine Initiative (CVI), begun in 1990, represented one such idea. The CVI was a collaborative effort between the United Nations Development Programme (UNDP), the United Nations Children’s Fund (UNICEF), the WHO, the World Bank, and the RF, working with private and public partners that included government agencies, scientists and vaccine manufacturers. CVI served as an early model of a private-public partnership.
The ultimate goal of CVI was the creation of a one-dose oral vaccine that could be made easily available to children in the developing world. The ideal vaccine would protect against major childhood diseases and be easily administered to infants. Vaccines to be deployed in the developing world also had to be easily transportable and be able to maintain effectiveness without the benefit of refrigeration.
The CVI adopted a gradual strategy to develop this one-dose vaccine, with each goal resting on the one before it. These intermediate goals included:
- Improving existing vaccines
- Developing new vaccines
- Combining vaccines
- Enhancing vaccine production and quality control, and ensuring vaccine availability world-wide
As a major sponsor of the CVI, the RF made a significant financial contribution toward its goal. In 1994 and in 1995, the RF allocated $1.3 million and $1.2 million, respectively, in order “[t]o support vaccine research programs and other activities related to the development and distribution of developing country children’s vaccines.” Yet, in spite of such contributions, CVI still confronted financial shortages.
A New Player
The Bill and Melinda Gates Foundation was formed in 1994, and one of its earliest goals centered on global immunization efforts. Publicity surrounding the new foundation and its funding agenda renewed attention on the issue and brought new funding opportunities. A World Bank Summit held at Bellagio in 1999 included senior staff of the RF, the Gates Foundation, WHO, World Bank and UNICEF. Participants concluded that a new organization, more closely linked to its funders, needed to replace the CVI. From this idea emerged the Global Alliance for Vaccines and Immunization (GAVI) in 2000.
GAVI defined its mission “to save children’s lives and protect people’s health by increasing access to immunization in the world’s poorest countries.” To accomplish these goals GAVI created a four-part strategy that includes:
- Accelerating the use of underused and new vaccines
- Strengthening health systems that deliver vaccines
- Increasing funding for vaccination and making such programs sustainable
- Shaping vaccine markets, so that vaccines remain affordable and appropriate for the world’s neediest
Following an RF model begun early in the 20th century with the hookworm campaigns, GAVI requires the full cooperation of governments that choose to participate in the program. Commitment includes creating committees that can coordinate the work of NGOs as well as government and United Nations agencies and local vaccine manufacturers. This level of participation ensures long-term commitment and creates a vested interest by nations included in the program. The involvement of local agencies and manufacturers also avoids the appearance of paternalistic relationships between international donors and local organizations. Sustainability is the primary goal of this model, which is intended to create permanent health agencies rather than build a reliance on external donors. Furthermore, GAVI aims to be country-specific in approach, dealing with challenges particular to each nation, whether the challenges are institutional or relating to a disease specific to an area.
The RF remains a committed sponsor of GAVI. As part of RF’s ongoing Health Equity Initiative, the organization has appropriated grants for new vaccine research, the study of vaccine delivery and stabilization methods, and the promotion of collaboration through meetings, consultations and public/private partnerships.
 Children’s Vaccine Initiative, Rockefeller Archive Center (RAC), Unprocessed Material, Box R2999, File H9232.
 Children’s Vaccine Initiative.
 Gustav J.V. Nossal, “The Global Alliance for Vaccines and Immunization – A Millennial Challenge,” Nature: Immunology 1 (2000).