The potential to markedly reduce childhood mortality from vaccine preventable causes is perhaps higher today than it has been for decades. Progress has been made to scale up existing vaccines in developing countries, thanks in part to GAVI and its partners, but waiting in the wings are a series of new vaccines that target some of the most important causes of childhood death: the pneumococcal and rotavirus vaccines against pneumonia and diarrhea respectively. These should be exciting times for the immunization world, however, not everyone is optimistic about its future.

Despite having shown progress, and despite the potential of the powerful new vaccines, donors have not jumped onto the immunization bandwagon in the way in which they have for other global health priorities. The troubled financial future of GAVI was recently highlighted in a story in the Lancet. GAVI has enjoyed long term financial commitments from the Gates Foundation and a number of bilateral donors, including the US, Norway (by far the largest bilateral donor on a per capita basis for child health and immunization), the Netherlands, my home country Canada, the UK, Sweden and Denmark. But at a time where GAVI actually needs to be scaling up resources, its core donors actually appear poised to scale back funding.

Last week, the conservative government of Canada announced sweeping cost-cutting measures to contain the mounting federal deficit. They explicitly have targeted parts of the budget that will be least felt by Canadians – foreign assistance and military spending. Sweden has also announced cut backs, including cut backs to its commitments to GAVI.

Advocates for universal treatment for HIV have been tremendously vocal against the threat of cutbacks in aid to their cause and so far have been successful at securing commitments to protect these funding flows. This highlights one of the numerous limitations in relying on international donors to provide sustainable financing flows for global health programs – the winners are going to be those with the most vocal and outspoken advocacy groups – not those issues that might most benefit from increased attention.

I am happy to see calls for more attention to these issues from people like Bill Frist and others, but this is an important issue that will need more advocates. Count me among them.

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