Global health agencies and vaccine-preventable deaths

Vaccines and immunisation

Vaccines are widely acknowledged as one of the most important advances in global health, allowing people to live longer and healthier lives. There are now vaccines to prevent more than 20 life-threatening diseases, including diphtheria, polio, and measles. The World Health Organization (WHO) describes immunisation as “the foundation of the primary health care system and an indisputable human right.”

More general information about vaccine preventable diseases and immunisation is provided in the following sources:

• WHO, Vaccines and immunization and Vaccine-Preventable Diseases (including pipeline vaccines)
• United Nations International Children’s Emergency Fund (UNICEF), Immunization

Vaccine coverage

In April, the WHO reported that global immunisation efforts had saved “an estimated 154 million lives – or the equivalent of 6 lives every minute of every year” in the last 50 years. The WHO referred to a study , published in the Lancet in May 2024, which assessed the impact of the Expanded Programme on Immunization (EPI) which, since 1974, has immunised children against diseases such as diphtheria, measles, polio and tuberculosis worldwide:

Founded in 1974 by the World Health Assembly, EPI’s original goal was to vaccinate all children against diphtheria, measles, pertussis, polio, tetanus, tuberculosis, as well as smallpox, the only human disease ever eradicated. Today, the programme, now referred to as the Essential Programme on Immunization, includes universal recommendations to vaccinate against 13 diseases, and context-specific recommendations for another 17 diseases, extending the reach of immunization beyond children, to adolescent and adults.

The EPI seeks to ensure vaccine availability to all infants globally, and the WHO reported that “today, 84% of infants are protected with 3 doses of the vaccine against diphtheria, tetanus and pertussis (whooping cough) (DTP) – the global marker for immunization coverage.”  However, it highlighted that there are still children across the world who are not vaccinated, and more work in this area is required.

Whilst global vaccination coverage has increased, in recent years, the Covid-19 pandemic has negatively impacted on this through disruptions to immunisation programmes, with numbers only starting to recover. In July 2022, the WHO and UNICEF reported that official data had shown the “largest sustained decline in childhood vaccinations in approximately 30 years” with 25 million children missing one or more doses of DTP (the vaccine against diphtheria, tetanus and pertussis) through routine immunisation services in 2021 alone.

UNICEF’s 2023 State of the World’s Children report called for urgent action to increase vaccination rates amongst children:

The world is facing a red alert for children’s health: Vaccination coverage dropped sharply during the COVID-19 pandemic, leaving millions more children unprotected against some of childhood’s most serious diseases. Catch-up and recovery are urgently needed to vaccinate the children missed and to avoid further backsliding.

Gavi, the Vaccine Alliance, is an organisation which works with the public and private sector to secure access to critical vaccines in low-income countries. It noted, in its 2022 progress report, that while there had been a rebound in some vaccination figures in lower income countries since the pandemic, there were still challenges.

It acknowledged a fall in the number of zero-dose children (those who have not received a single vaccine dose), from 12.4 million in 2021, to 10.2 million in 2022. However, this is still higher than the estimated 9 million zero-dose children in 2019.

The then CEO of Gavi, David Marlow also warned of challenges ahead including deteriorating economic conditions and the impacts of climate change:

“The data reported in this year’s Annual Progress Report shows that immunisation really is a global success story in terms of the unprecedented levels of collaboration we are seeing to expand vaccinations, drive equity and build a long-term pathway towards sustainability,” said David Marlow, CEO of Gavi, the Vaccine Alliance. “At the same time, we must not lose sight of the challenges ahead, as countries face a very uncertain future as a result of deteriorating economic conditions, an uncertain geopolitical outlook and the impact of climate change among other factors. The need for continued collaboration and innovation, today, is greater than ever.”

Another threat to immunisation coverage is vaccine hesitancy, which in 2019 the WHO described as one of its ten threats to global health. It raised concerns that this may reverse the progress made in tackling vaccine preventable diseases.  The 2023 UNICEF report notes research from the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine that shows that “in all but 3 of 55 countries for which data are available, confidence in the importance of vaccines for children has declined.”

More information on current immunisation coverage is provided in the WHO factsheet, Immunization coverage (July 2023).

Global immunisation strategies and campaigns

Launched in 2021, the WHO Immunization Agenda 2030 is a global health plan focused on improving access to vaccines for all.  The WHO estimates that if it is fully implemented, it will “save 50 million lives over the next decade.” The agenda includes the following targets:

• Achieving 90% coverage for essential vaccines given in childhood and adolescence
• Halving the number of children completely missing out on vaccines
• Completing 500 national or subnational introductions of new or under-utilized vaccines–such as those for COVID-19, rotavirus, or human papillomavirus (HPV)

Aligned to the Immunization Agenda, Gavi’s 5.0 strategy includes a vision of leaving no one behind with immunisation by 2030.  It has a “core focus on reaching “zero-dose” children [those who have received no routine vaccinations] and missed communities, with equity as the organising principle.”

UNICEF’s Immunization Roadmap To 2030 sets out the organisation’s approach to addressing the setbacks in childhood immunisation programmes due to the Covid-19 pandemic and to “accelerate progress towards the achievement of global immunization goals by 2030.”  Priorities include “catching up on children missing vaccination, restoring disrupted immunization services and strengthening systems to reach zero-dose children sustainably.”

During World Immunisation week 2024, held in April 2024, a group of health organisations including Gavi, the Bill and Melinda Gates Foundation, UNICEF and the WHO launched a campaign called Humanly Possible.  This calls on governments around the world to invest in immunisation through investing in Gavi and similar programmes, and strengthening immunisation programmes.

UK Government support for global health and immunisation programmes

In May 2022, the Foreign, Commonwealth and Development Office (FCDO) published a ten-year strategy for international development. This set out four priorities for UK aid, one of which is global health. Under this priority, UK aid will help:

• Invest in vaccines, therapeutics and diagnostics to reduce the impact of disease
• Build stronger health systems
• Make investments in organisations such as Gavi, the vaccine alliance, and the Global Fund.
• Help end the preventable deaths of mothers, babies, and children.

In May 2023, the Government published its Global Health Framework: working together towards a healthier world.  This sets out the “ambition to play a leading role in improving health globally and in building resilience to future threats.”  It includes 4 strategic objectives:

• strengthen global health security through improved preparedness and response to future epidemics, pandemics, drug-resistant infections, and climate change
• reform global health architecture including through a strengthened World Health Organization, driving more coherent governance and collaboration across the international system (including the global health initiatives, financing institutions and the Quadripartite Collaboration for One Health)
• strengthen country health systems and address key risk factors for ill health, working towards ending preventable deaths of mothers, babies and children in the world’s poorest countries and enabling women and girls to exercise their rights
• advance UK leadership in science and technology, strengthening the global health research base of UK and partner countries, while supporting trade and investment.

A large proportion of UK Government contributions are provided through global health initiatives such as the Global Fund, GAVI the Vaccine Alliance, and the WHO. In November 2022, the Government announced it would pledge £1 billion to the seventh replenishment of the Global Fund (running from 2024 to 2026). Some NGOs, such as STOPAIDS, expressed concerns that the pledge represented a cut from previous pledges. More information on the Global Fund, and the UK pledge at the Seventh replenishment is provided in a Library briefing, UK aid and the Global Fund to fight HIV, Tuberculosis and Malaria. 

In its November 2023 White paper, International development in a contested world: ending extreme poverty and tackling climate change, the Government said it would work with partners to:

drive reform across the global health architecture through the next Global Health Initiatives (GHI) replenishments […] to ensure effective and co-ordinated GHIs, and a stronger WHO able to respond in health crises and deliver on health services and well-being.

There have been concerns raised about the level of aid funding on infectious diseases following the Government’s decision to spend 0.5% of gross national income (GNI) (rather than the previous 0.7%) on overseas aid from 2021 as a “temporary measure”.  A Lords Library briefing provides further information on potential impacts of aid cuts on funding for control of malaria and other conditions, How have cuts to overseas aid affected the control of malaria and other diseases?, July 2022. More information on the 0.7% target and the reduction in UK aid spending is provided in a Library briefing, The 0.7% aid target.

In September 2023, at the UN General Assembly, International Development Minister Andrew Mitchell and Health Minister Will Quince announced investment for research and development on global health issues.  This included “up to £103.5 million for developing affordable new vaccines through the UK Vaccine Network funding.”

UK aid spent on vaccination

The UK reports its aid spending using rules set by the Organisation for Economic Co-operation and Development (OECD). This allows aid spending to be broken up into “sectors”, which describe the “specific area of the recipient’s economic or social structure” that the aid is intended to help.

Between 2009 and 2022, around £2.6 billion of UK aid has been spent on sectors that are related to vaccinations. This breaks down as shown in the chart below.

Source: FCDO, Statistics on International Development, multiple years

Between 2014 and 2020, the UK provided between £100 million and £200 million per year for infectious disease control in general and for tuberculosis control. These amounts decreased in 2021 and 2022 (as did UK aid spending in general), although spending on Covid-19 control meant that total vaccination-related aid spending remained relatively high.

Most of this aid went to programmes that were not directly connected with any particular country or region (and some may have been spent within the UK itself, for example on research). Out of the remaining aid, more went to Africa than to any other region, as shown in the chart below (which excludes aid spending on Covid-19 control).

Source: FCDO, Statistics on International Development, multiple years

Much of the aid shown in the charts above is bilateral aid – that is, aid given for a specific programme or purpose. The UK also provides aid in the form of contributions to the core budgets of multilateral organisations (such as UN agencies). By looking at the way in which these organisations choose to spend their funding, the Foreign, Commonwealth and Development Office (FCDO) produces imputed figures estimating the amount of UK aid that was spent on specific sectors.

The chart below shows the total amounts of UK aid impute to have been spent on vaccination-related sectors between 2017 and 2021.

Source: FCDO, Statistics on International Development: final UK aid spend 2022, 14 September 2023, table A9

This shows that UK multilateral aid spending to vaccination-related sectors has increased in recent years. In 2021, the most recent year for which we have data, total UK multilateral aid spent on these sectors was estimated at around £351 million.

The UK also supports several specific multilateral organisations which focus on health in general or vaccination specifically. Some of the most recent UK allocations to these organisations are shown in the table below.

Source: FCDO, Statistics on International Development: final UK aid spend 2022, 14 September 2023, table A8

This shows that of these organisations, the UK has given the most funding to the Global Fund, with a total of £814 million over 2021 and 2022.