Gavi, the Vaccine Alliance, has played a pivotal role in ensuring vaccine access, especially in 40 African countries since 2000.
At the heart of Gavi’s success is a unique public-private partnership model designed to expand access to vaccines in developing countries. Since its inception, it has been working with at least 40 countries on the African continent to combat 18 infectious diseases, including malaria, Ebola and Covid-19.
The organisation’s life-saving investments in partnership with the African government have enabled the vaccination of approximately 438 million children across the continent. Africa’s Gavi-Supported countries also paid US$11.9 billion, accounting for 58% of total payments. According to the Vaccine Impact Modeling Consortium (VIMC), these investments have been avoided, with an estimated 11.1 million deaths.
According to documents filed with the US Congress in March 2025, the US is proposing Gavi refunds as part of a broader push to reduce foreign aid. Given that the US contributes about a quarter of Gavi’s funding, there are concerns that this will affect the future of the 25-year effort that saved at least 18 million lives in 19 countries.
Unlike many other global health institutions, Gavi retained surplus funds from its Covid-19 response. The funds exceed the World Health Organization’s annual budget and are almost triple the size of the World Bank’s Pandemic Fund. However, in light of shifting geopolitics and withdrawal of proposed US support, continued donor funding cannot be guaranteed as reliable or sustainable.
The threat of Gavi’s refunds serves as a harsh warning to African leaders rather than just a US policy issue. It’s time to take bold steps towards independence in vaccine funding and strengthen a sustained, funded and led system from within the continent.
Africa’s dependence
Donor funds have helped to expand vaccination coverage across Africa. But it also created a cycle of dependency that would change geopolitics. If donor countries like the United States, which currently contribute roughly 13% of Gavi’s budget change courses, are driven by political change, the results could be broadly reached. For many African countries like Nigeria, relying heavily on Gavi’s support, withdrawal of funding puts vaccine coverage and children’s health at risk.
This vulnerability undermines the health goals of the nation and undermines long-term resilience. Furthermore, the unpredictability of donor funding often makes it difficult for countries to plan and implement sustainable long-term health strategies. The Ministry of Health is currently juggling budget shortages and urgent needs, with little room for innovation or long-term planning.
The Nigerian case is particularly beneficial. In a recent move, Gavi has approved a US$191 million Health System Enhancement (HSS-3) grant to Nigeria covering the period from 2025 to 2028. According to UNICEF and the 2023 global vaccination compensation report, the country accounts for the world’s second-highest zero-dose child, estimated at 2.2 million. The HSS-3 Grant aims to expand vaccinations, particularly at the sub-national level.
Importantly, this investment coincides with the expected transition from GAVI support in Nigeria by 2028, exerting pressure to reach a national target of 84% vaccination coverage within the same timeline. However, funding is welcome and necessary, but does not deny underlying vulnerabilities. A high pregnancy rate of 5.3 births per Nigerian woman means that demand for vaccinations continues to increase. Without a robust, domestically funded system, profits remain vulnerable. The strengthening of the healthcare system has historically been ignored by donors focusing on vertical programs. The grant shows positive change, but it requires more than a temporary injection of external funds to keep things moving forward.
Time to lead
In an evolving global health situation, African countries are rethinking health funding and rethinking how the continent can fund life-saving interventions like vaccines.
As countries like Kenya are near the end of Gavi’s support for routine immunization, their lack of preparation and preparation raises important issues. The transition was intended to mark a new chapter of self-sufficiency.
Instead, it highlights systematic weaknesses, particularly in fundraising. The Kenya journey highlights important gaps in financial preparation. The government has not fulfilled its jointly qualifying obligation to Gavi, leaving up to six million children without a routine vaccine. An outstanding invoice of $12.4 million for fiscal year 2024/2025 caused an alarm bell.
Vaccine stocks are imminent unless funds are paid urgently. This is not an isolated issue. Kenya was to gradually move from Gavi support, but repeated delays and budget shortages exposed the vulnerable system. And while the county is struggling to buy basic vaccination supplies like syringes, Gabi continues to provide the vaccine. Health officials have expressed concerns about delayed logistics, the shortcomings of cold and lack of transparency regarding vaccine costs.
Budgeting is not possible in many countries as the actual prices of vaccines and procurement processes remain unknown. Nigeria offers another warning story. Nigeria, which was originally scheduled to move from GAVI support in 2018, has repeatedly postponed the transition as it is unable to meet the requirements for joint assets. Despite its middle-income status, the country relies on daily vaccine donor assistance. This dependency highlights a broader problem. External funding is helpful, but not a permanent solution.
These challenges underline a clear message – African countries must acquire ownership of vaccination programs. Vaccine procurement should be treated as a core public health responsibility, not an optional line item that relies on donor friendly. Now, more than ever, Africa’s vaccination systems must be built on a solid domestic foundation that is immunized to the shift of external donors.
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From dependency to ownership
The transition from trust in donors to ownership of vaccines in Africa requires more than a new source of funding. It calls for a reassessment of health as a national investment. An innovative fundraising mechanism offers sustainable options such as taxes on sugary drinks and tobacco.
The African government must begin to acquire full ownership of vaccine procurement to ensure sustainability. This means consolidating vaccination costs into domestic and local budgets, improving transparency in vaccine pricing and strengthening logistics systems. The solution lies not only in more money, but in better planning, better data, stronger political will.
Governments should also explore collaboration in regional sourcing to leverage better pricing and reliable supply chains. Public-private partnerships help ease financial pressures and increase innovation. Ultimately, the future of vaccination in Africa must be led by Africa. The future path will not be easy, but the cost of omission will be much higher.
Recent HSS-3 grants to Nigeria are timely and important interventions, but must be considered a bridge. Without deeper structural reforms and domestic ownership, the progress it allows may prove to be short-lived. Eswatini and South Africa show that ownership is achievable. This must be the moment when African countries move from dependence to independence, giving the future of vaccines to hand.
