GENEVA (Reuters Health) Jan 14 – In the first independent assessment of the Global Alliance for Vaccines and Immunisations (GAVI), Save the Children, UK, takes the program to task for less than optimal results.

Set up in 1999, GAVI is one of the first joint public-private partnerships to address the issue of global immunization. Targeting 74 of the world's poorest countries, it aims to reverse falling immunization levels by providing vaccines. The assessment study focused on four of those countries: Mozambique, Ghana, Tanzania and Lesotho.

Carried out in collaboration with the London School of Hygiene and Tropical Medicine, the evaluation is critical of three main areas. The first is the haste with which the program was set up, haste that often forced participating countries to make major decisions with no time to weigh the options or assess the long-term consequences.

In comments to Reuters Health, Regina Keith, Save the Children's UK's senior health advisor for children, cited Ghana as an example. Once approved for participation, the country was given 10 days to choose what vaccines to request from GAVI.

The second area of criticism is sustainability. The funding, while quite adequate, is provided for only 5 years. After that, it is up to the local government to assume the cost of continuing the program, something that is far from guaranteed in most of the targeted countries.

The third area is governance. Here the study cites the problems of both marginal representation of developing countries on the program's executive board and possible conflicts of interest. An example of the latter, Keith continued, is Aventis Pasteur, which is represented on the board and also furnishes the program with a vaccine. Furthermore, only 2 of 15 board seats are allotted to developing countries.

Lisa Jacobs, GAVI's communications secretary, acknowledged the governance problem and said it is one of many points to be explored by an independent consultant. The board could be expanded to include more developing countries, she told Reuters Health, adding that there was even the possibility that some existing seats might be reassigned to developing countries, depending upon what the consultant concluded.

Overall, Jacobs was quite positive about the report. "It confirms some of our early impressions and feedback we received," she told Reuters Health. "It is a solid report, reflective, analytical and objective, and it points the way forward for this initiative as well as for others such as the Global Fund."

Keith, however, was more cautious. She pointed out that the refusal of the program to allow any money to be spent on recurrent costs, such as the upkeep and development of infrastructure, means that parts of the basic framework needed to vaccinate properly (refrigerators, for example), continue to be missing. This condemns the effort to highly variable results.

Another shortcoming, Keith told Reuters Health, was the gauge used to measure success, a simple tabulation of how many vaccinations are given. In Mozambique, it has been reported that 375% of the children were vaccinated for measles. That alone, she said, should put everybody on guard against accepting the figures gathered by local clinics. "It's clear," she added, "that a much more reliable system must be devised."