Fiona Fleck, Geneva
BMJ 2002;324:129 ( 19 January )
A global initiative that seeks to save millions of children's lives by immunisation is in danger of saddling the world's poorest countries with expensive vaccine regimes they cannot afford and perhaps do not need, a new study has found.
The study, conducted by the UK charity Save the Children and the London School of Hygiene and Tropical Medicine, criticised the Global Alliance for Vaccines and Immunisations (GAVI) for including managers from pharmaceutical companies on its governing board, saying that this created a potential conflict of interest.
"GAVI needs to ensure that it can focus on the most appropriate assistance to an immunisation system without the risk of commercial, product-oriented pressure," the UK charity said in a statement.
The alliance, based on partnership between the public and private sectors, was launched in 1999 to combat falling immunisation levels by providing vaccines to 74 of the world's poorest countries. Dubbed the "billion dollar fund" after a contribution of $750m (£517m; 839m) from Microsoft's founder and chief executive, Bill Gates, it seeks to achieve this by incorporating new vaccines into national health systems while promoting existing immunisation programmes.
The study, reported on Tuesday in Geneva, was based on research conducted in Mozambique, Ghana, Lesotho, and Tanzania. It concluded that although the initiative had succeeded in raising the profile of immunisation programmes in developing countries, it had failed to ensure that additional resources were provided to countries with weak health systems before they take on expensive new vaccines.
It warned that raising poor countries' awareness of immunisation programmes without detailed advice and financial support in implementing such schemes could end up creating markets for costly new vaccines while doing little to tackle the biggest killer diseases.
The report said, for example, that refrigerators for storing vaccines were poorly maintained and often broke down. It also said that Ghana was given only 10 days to decide whether to accept a new high tech vaccine for hepatitis B without any evidence that this was actually neededa decision that more than doubled the cost of the country's immunisation programme.
It concluded that although the funding gap would initially be covered by the alliance, the long term sustainability of the programme was in question.
"Due to lack of funding and the added burden of the HIV crisis, many countries' health systems are on the verge of complete and utter collapse," said Regina Keith, a senior health adviser at Save the Children in the United Kingdom.
"Money must be spent on the upkeep of equipment, as well as on training and paying
the salaries of health workers. If the billion dollar fund goes bust,
developing countries will be left footing the bill for costly new vaccines that
are of no use to the children whose lives they are meant to save," she