Africa: Gavi Funding Cuts Could Be Africa’s Moment of Reckoning for Vaccine Financing

Gavi, the Vaccine Alliance has played a pivotal role in ensuring access to vaccines across low-income countries, especially in 40 African countries since 2000. This sustained contribution is one that not only deserves to be commended but also offers an example for other organisations to emulate, given the results it has yielded in over three decades.

At the heart of Gavi ‘s success is its unique public-private partnership model designed to expand access to vaccines in developing countries. Since its inception, it has worked with at least 40 countries on the African continent, fighting 18 infectious diseases, including malaria, Ebola, and COVID-19.

The organisation’s life-saving investment co-financed with African governments has enabled the immunisation of approximately 438 million children across the continent. Gavi-supported countries in Africa have also disbursed US$11.9 billion, accounting for 58% of its total disbursements. According to the Vaccine Impact Modelling Consortium (VIMC), these investments have averted and estimated 11.1 million deaths.

According to a document submitted to the US Congress in March 2025, the United States’ has proposed defunding Gavi as part of the broader push to scale back foreign assistance. Given that the U.S contributes about a quarter of Gavi’s funding, there are concerns that this would affect the future of the 25-year effort that has saved at least 18 million lives in 19 countries.

Unlike many other global health institutions, Gavi retained surplus funds from the COVID-19 response. The funds exceed the World Health Organization’s (WHO) annual budget, and are nearly three times the size of the World Bank’s Pandemic Fund. However, in view of the shifting geopolitics and the United States’ proposed withdrawal of support, continued donor funding can no longer be guaranteed as reliable or sustainable.

The threat of Gavi’s defunding is not just a US policy issue, it serves as a stark warning to African leaders. Now is the time to take and urgent bold steps toward self-reliance in vaccine financing and to strengthen systems that are sustainably funded and led from within the continent.

Africa’s dependency

Donor funds have been instrumental in expanding immunisation coverage across Africa. However, it has also created a cycle of dependency that leaves countries shifting geopolitics. When donor countries such as the U.S which currently contributes to about 13% of Gavi’s budget change course, driven by a political shifts the consequences can be far reaching. For many African countries, like Nigeria, that rely heavily on Gavi support, the withdrawal of funding compromises vaccine coverage and health of children jeopardising hard-won gains.

This fragility undermines national health goals and weakens long-term resilience. Moreover, the unpredictability of donor funding often makes it difficult for countries to plan and implement sustainable, long-term health strategies. Health ministries are currently left juggling budget shortfalls and urgent needs, with little room for innovation or long-term planning.

Nigeria’s case is especially instructive. In a recent move, Gavi approved a US$191 million Health Systems Strengthening (HSS-3) grant to Nigeria, covering the period from 2025 to 2028. This investment while significant is aimed at addressing persistent challenges, including the country’s high burden of zero-dose children. The country accounts for the second-highest number of zero-dose children globally, estimated at 2.2 million, according to UNICEF and WHO’s 2023 global immunisation coverage report. The HSS-3 grant specifically targets underserved populations and aims to expand immunisation coverage, particularly at the sub-national level.

Importantly, this investment also coincides with Nigeria’s expected transition out of Gavi support by 2028, adding pressure to reach the national target of 84% immunisation coverage within the same timeline. However, while the funding is welcome and needed, it does not negate the underlying vulnerabilities. Nigeria’s high fertility rate of 5.3 births per woman means demand for vaccinations will continue to grow. Without robust, domestically funded systems, gains will remain fragile. Health systems strengthening has historically been neglected by donors focused on vertical programmes. This grant signals a positive shift, but sustaining progress will require more than temporary injections of external funding.

Time to take the lead

In the evolving global health landscape, African countries are reimagining healthcare financing and rethinking how the continent can sustainably fund life-saving interventions like vaccines.

As countries like Kenya near the end of Gavi’s support for routine immunisation, their readiness or lack of readiness raises important questions. The transition was intended to mark a new chapter of self-sufficiency.

Instead, it has exposed systemic weaknesses, especially in financing. Kenya’s journey highlights significant gaps in financial preparedness. The government’s failure to meet its co-financing obligation to Gavi could leave up to six million children without routine vaccines. An unpaid bill of $12.4 million for the 2024/2025 fiscal year has set off alarm bells.

Unless the funds are urgently disbursed, vaccine stockouts are imminent. This is not an isolated issue; Kenya was supposed to gradually transition away from Gavi support, but repeated delays and budget shortfalls have exposed a fragile system. Its counties also still struggle to buy basic immunisation supplies like syringes, even while Gavi continues to provide vaccines. Health officials have raised concerns about logistical delays, cold chain weaknesses, and a lack of transparency around vaccine costs.

In many countries, budgeting is impossible because the actual price of vaccines and procurement processes remain unclear. Nigeria offers another cautionary tale. Initially scheduled to transition from Gavi support in 2018, Nigeria has repeatedly postponed its transition due to its inability to meet co-financing requirements. Despite its middle-income status, the country remains reliant on donor aid for routine vaccines. This dependency highlights a wider problem: external funding, while helpful, is not a permanent solution.

These challenges underscore a clear message — African countries must take ownership of their immunisation programmes. Vaccine procurement should be treated as a core public health responsibility, not an optional line item dependent on donor goodwill. Now more than ever, Africa’s immunisation systems must be built on solid domestic foundations immune to external donor shifts.

From dependency to ownership

The shift from donor reliance to vaccine ownership in Africa demands more than new funding streams. It demands a re-evaluation of health as a national investment. Innovative financing mechanisms offer sustainable options, such as taxes on sugar-sweetened beverages or tobacco.

African governments must start taking full ownership of vaccine procurement to ensure sustainability. This means integrating immunisation costs into national and local budgets, improving transparency in vaccine pricing, and strengthening logistics systems. The solution lies not just in more money, but in better planning, better data, and stronger political will.

Governments must also explore regional procurement collaborations to leverage better pricing and reliable supply chains. Public-private partnerships can help ease financial pressure and increase innovation. In the end, Africa’s immunisation future must be led by Africa. The path ahead will not be easy, but the cost of inaction is far greater.

The recent HSS-3 grant to Nigeria is a timely and vital intervention, however it must be seen as a bridge. Without deeper structural reform and domestic ownership, the progress it enables may prove short-lived. Eswatini and South Africa demonstrate that ownership is achievable This must be the moment to move from dependence to self-reliance, where African countries take their vaccine future into their hands.

By Nigeria Health Watch.