New Delhi: In a move that could potentially undermine India’s immunization programme, the Global Alliance for Vaccines and Immunisation (GAVI) plans to withdraw funding to the country.

“India is now getting close to the threshold level, at which point we stop providing support. So, once a country crosses that level, they have five years time for GAVI support," said Seth Berkley, chief executive of the GAVI Alliance.

GAVI is now in talks with the government to decide the course of action for the next five years, he said.

GAVI’s withdrawal of implementation and technical support means the central and state governments’ contribution to public health will have to make up for the shortfall.

GAVI’s approved budget for India from 2000-2015 was $278.70 million.

This would be the second roll-back of external funding of critical health programmes; the Global Fund to Fight AIDS, Tuberculosis and Malaria has stopped funding for India. The country was the second largest recipient of grant assistance from the fund, with a three-year allocation of $850 million.

At present, India’s public expenditure on health averages 1% of gross domestic product (GDP), while the global norm ranges around 4-5%.

In 2011, GAVI established a country-eligibility threshold of US$1,500 gross national income (GNI) per capita, with annual adjustments to ensure consistency in real terms. Every year, the most recent World Bank GNI per capita estimates are used to determine the countries eligible for its support.

According to the World Health Organization (WHO), India’s immunization coverage still remains at less than 80%. In March, the government launched the ambitious nationwide immunization drive called Mission Indradhanush. The government has committed to immunizing 90% of India’s infants by 2020.

Experts and officials say GAVI’s withdrawal of funding is unlikely to pose a serious setback to India’s critical health programmes. “GAVI’s support to India was catalytic in nature," said Pradeep Haldar, deputy commissioner, immunization, Public Health Foundation of India. Most of the spending on immunization is borne by the Indian government, he added.

According to Evidence-based National Vaccine Policy, a 2010 policy document, the government of India spends around 200 crore annually on the procurement of the six universal immunization programme (UIP) vaccines alone. The vaccines are administered for Diphtheria, Tuberculosis, Tetanus, Meningitis, Pertussis, Measles, Hepatitis B and polio.

This excludes the spending on the pulse polio immunization programme. Under the UIP, the inclusion of DPT-Hep-BHib pentavalent vaccine was estimated to cost 1,200 crore, of which 400 crore came from the Indian government and 800 crore from GAVI.

The cost of procuring vaccines is a small fraction of the total cost of increasing vaccination coverage, which includes logistics and manpower. Some of these costs may be shared; even so, there will be an inevitable inflation in the overall costs of immunization and, if funding along with the benefit of subsidized vaccines is removed, the country’s vaccination programmes face a threat.

“The money for immunization comes out of the National health Mission’s Flexipool," said Jagdish Prasad, director general of health services.

“We do not have a earmarked budget separately for immunization, but we have enough money to fund and ensure our programmes do not get affected. GAVI’s exit should not set back our progress towards universal immunization."

The country’s 1.25 billion population and geographical size have hindered vaccination coverage.

(This story has been since updated to reflect a corrected date.)

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