Effect of the Global Alliance for Vaccines and Immunisation on diphtheria- tetanus- and pertussis vaccine coverage: an independent assessment.

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 chil