In an interview with the Guardian, Bill Gates make the case for where and how Gavi funds are spent
Microsoft founder and philanthropist Bill Gates dismissed suggestions that money pledged to the Global Alliance for Vaccines and Immunisation (Gavi) should be directed to middle-income countries, saying funds would continue to go to the world's poorest, wherever they lived.
Research published last year found that around three-quarters of the world's poor now live in middle-income countries, and so do the majority of the world's unvaccinated children.
In an interview with the Guardian on Monday, Gates said: "Most poor people live in the poorest countries. Gavi is very careful. We cover the places where people are in need of vaccines."
He added that if a country was perceived not to have the money to pay for vaccines, "we need to go into the country to get them to prioritise that spending. We need to do that".
He added: "Our goal is very simple, if any child doesn't get the rotavirus or pneumoccocal vaccines [for diarrhoea and pneumonia respectively], we have not done our job."
Gates, whose foundation, the Bill & Melinda Gates Foundation, is a founding partner of Gavi, addressed criticism that the cost of vaccinations continued to be too high and was dominated by large pharmaceutical companies, such as GlaxoSmithKline. Last week, the GSK, along with Merck, Crucell and Sanofi-Aventis, announced they were reducing the cost of their vaccines.
Gates said: "I'm very business-minded about these things and have development experts to understand the true marginal costs of producing vaccines. So what GSK did... was get to the marginal cost to make those vaccines."
He defended the inclusion of GSK on the Gavi board, saying the company didn't vote on issues to do with vaccine prices.
"We just gave $1bn [to Gavi] and not a cent of that we would give unless it was helping the world's poorest children. And if people think they understand vaccine plants and costs better than we do, I would like to meet the people who think that. This is our life's work and we are hiring the best people to make sure this gets done."
At present around 80% of Gavi money goes directly to pay for vaccines, the remainder is used to support country health systems, and delivery and overheads.
Vaccine delivery and health worker shortages are major obstacles for some developing countries, although Gates said he didn't believe more money should be diverted from the cost of vaccines to meet costs for infrastructure. He acknowledged that sometimes delivery "was tricky" but immunisation, he said, "doesn't require a doctor", so the costs are relatively low.
However, Dr Sophie Harman, senior lecturer in International Politics specialising in Global Health at City University London, said donors need to be mindful that investment in vaccines "is not the magic answer to global health issues such as pneumonia and diarrhoea".
"Without proper funding commitments to health infrastructure – ie: building health centres, training and keeping medical practitioners in developing countries – any advancement in vaccine research will be redundant.
"Should Cameron and Gates ignore the important issue of infrastructure, lots of expensive vaccines paid for by the UK taxpayer will just sit in medical store departments in developing countries, with no means of getting them to those most in need. Better health for all can only be achieved by a combination of investment in vaccine research and the development of systems to get the outcome of such research to the poor."
The Gates foundation announced it was giving $1bn to Gavi at the alliance's pledging conference, hosted by prime minister David Cameron in London on Monday. The amount is part of the $10bn the foundation previously pledged to give over the next decade.
The conference aimed to raise $3.7bn (£2.3bn) to meet a funding shortfall at Gavi over the next five years, which it estimates will save 4 million children's lives. However, pledging exceeded this amount, hitting $4.3bn. The UK pledged £814m of new funding up to 2015, while the US is believed to have pledged $450m. Brazil and Japan pledged money for the first time, and Australia increased its commitment tenfold.
