title: Effect of the Global Alliance for Vaccines and Immunisation on diphtheria, tetanus, and pertussis vaccine coverage: an independent assessment.
abstract: BACKGROUND
  The Global Alliance for Vaccines and Immunisation (GAVI) was created in 1999 to enable even the poorest countries to provide vaccines to all children. We aimed to assess the effect of GAVI on combined diphtheria, tetanus, and pertussis vaccine (DTP3) coverage.
  
  
  METHODS
  We examined the relation between DTP3 coverage for GAVI recipient countries from 1995 to 2004 and immunisation services support (ISS) and non-ISS expenditure per surviving child, controlling for income per head and local political governance variables. We analysed DTP3 coverage reported by governments and estimated by WHO/UNICEF. We also investigated the effect of GAVI on country reporting behaviour.
  
  
  RESULTS
  In countries with DTP3 coverage of 65% or less at baseline, ISS spending per surviving child had a significant positive effect on DTP3 coverage (p=0.0005). This effect was not present in countries with DTP3 coverage of 65-80% or 80% or more at baseline. If ISS expenditure only is assessed, the estimated cost per additional child immunised in countries with baseline coverage of 65% or less is US$14 and if ISS and non-ISS expenditures are included the cost per child is almost $20.
  
  
  CONCLUSIONS
  The success of ISS funding in countries with baseline DTP3 coverage of 65% or less provides evidence that a public-private partnership can work to reverse a negative trend in global health and that performance-related disbursement can work in some settings. Because ISS funding seems to have no effect in countries with baseline coverage greater than 65%, GAVI should consider redistributing its resources to countries with the lowest coverage.
authors.affiliation: Harvard Initiative for Global Health, 104 Mount Auburn St, Cambridge, MA 02138, USA.
authors.forename: Chunling
authors.initials: C
authors.lastname: Lu
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Michaud
authors.forename: Emmanuela
authors.initials: E
authors.lastname: Gakidou
authors.forename: Kashif
authors.initials: K
authors.lastname: Khan
authors.forename: Christopher J L
authors.initials: CJ
authors.lastname: Murray
mesh_terms: D002662:Child Health Services / Q000191:economics / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003906:Developing Countries; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000008:administration & dosage / Q000191:economics; D006801:Humans; D017589:Immunization Programs / Q000191:economics / Q000706:statistics & numerical data*; D007223:Infant; D012044:Regression Analysis
chemical_list: D015721:Diphtheria-Tetanus-Pertussis Vaccine