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US Funding Withdrawal from Gavi
The Potential Impact of Proposed Gavi Funding Cuts on Global Health Security
Context: The U.S. had pledged $2.6 billion to Gavi for 2026–2030—around 13% of the alliance’s total budget for that period. However, ongoing cuts to U.S. foreign aid, including the near-total dismantling of USAID contracts, suggest the country may renege on this commitment.
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- If confirmed, this could result in over one million additional child deaths in the next five years, especially in countries where out-of-pocket medical expenses are prohibitive.
- Gavi has played a central role in global immunisation, preventing 154 million deaths since 1974.
- The US contributed $4 billion for Covid-19 vaccine procurement via COVAX in 2021.
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Gavi’s Co-Financing Model
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Gavi’s Role in Global Health
- Founded in 2000, Gavi supports vaccine access in low- and middle-income countries (LMICs) through a public-private partnership with WHO, UNICEF, the World Bank, and the Gates Foundation.
- The alliance also helps reduce the number of “zero-dose” children—those with no access to routine immunisation—and supports global initiatives like the Immunisation Agenda 2030 and SDG3 GAP.
- Gavi’s goals:
- Support vaccine equity
- Promote national ownership through co-financing
- Gavi has vaccinated over 1 billion children and funded $23 billion in immunisation efforts.
- It provides vaccines against 20 diseases, including measles, Ebola, cholera, HPV, and malaria.
- For every $1 invested in Gavi, there’s an estimated $54 return in economic benefit.
Potential Impact of U.S. Disengagement
- Disrupt immunisation campaigns, leading to resurgences of Measles, whooping cough, rotavirus, Diphtheria, cholera, and polio.
- Vaccine hesitancy in HICs + funding shortfalls in LMICs = global herd immunity erosion
- Reduce vaccine stockpiles, affecting emergency responses to outbreaks, such as the April 2025 meningitis outbreak in Nigeria. Rabies elimination (‘Zero by 30’) and cholera control efforts may stall.
- Undermine malaria control, delaying the rollout of the R21/Matrix-M and RTS,S vaccines in Africa, where 94% of global malaria deaths occur.
- Jeopardise Africa’s vaccine autonomy, including Gavi’s $1 billion African Vaccine Manufacturing Accelerator (AVMA) initiative. The initiative requires $1 billion, now under threat due to US cuts.
- Gavi is also a key player in the global rabies elimination strategy and was pivotal in responding to cholera and mpox (formerly known as monkey pox) outbreaks.
India’s Strategic Position
- Vaccine Supply Hub: India supplies 60% of Gavi’s vaccines. Received $1.7 billion in Gavi support, became a donor in 2014, and fully self-financing in 2022.
- Pandemic Leadership: Developed eVIN (vaccine supply tracking). Serum Institute of India (SII) partnered with Gavi and Gates Foundation to manufacture COVISHIELD under COVAX.
- Current Vulnerabilities: Ongoing Gavi agreements (e.g., 10 million annual doses of PCV by SII) may be disrupted. Immunisation strengthening and HPV and typhoid vaccine rollout depend on Gavi ties.
Geopolitical Implications
- U.S. withdrawal from Gavi opens the door for China to expand its influence. With over $1 billion already invested in health aid across Belt and Road Initiative (BRI) countries, China is poised to become a dominant player in global immunisation efforts.
- Meanwhile, India can leverage its biotechnology strength and partnerships through BRICS, Quad, and Indo-Pacific Health Security networks to assert its role as a health security provider.
Reimagining Global Health Partnerships
- The Gavi model remains a successful proof-of-concept for PPPs in global health. However, concerns around accountability, transparency, and donor conditionalities must be addressed.
- Insights from COVAX—including its ability to deliver 2 billion COVID-19 doses to 146 countries—can inform future strategies.
- Yet, challenges like vaccine nationalism, donor biases, and health infrastructure gaps underscore the need for resilient and equitable systems.
The Road Ahead
- Gavi needs $9 billion for its 2026–2030 cycle.
- EU and Gates Foundation are co-hosting the next pledging summit.
- Need for transparent, monitored partnerships and leveraging India’s biotech ecosystem through policies like Bio-E3 and Bio-RIDE.
Regional partnerships, alternative PPP models, and localised capacity-building are essential.
