III 118th CONGRESS 2d Session S. RES. 684 IN THE SENATE OF THE UNITED STATES May 14, 2024 Mr. Wicker (for himself and Mr. Cardin ) submitted the following resolution; which was referred to the Committee on Foreign Relations RESOLUTION Supporting the role of the United States in helping save the lives of children and protecting the health of people in low-income countries with vaccines and immunization through Gavi, the Vaccine Alliance ( Gavi ).

Whereas, prior to 2000, the distribution of and the resources for vaccines for children in the developing world were declining, immunization rates were stagnant or decreasing, and nearly 10,000,000 children died each year before reaching their 5th birthday; Whereas, prior to 2000, it was common for new lifesaving vaccines to take up to 15 years to be introduced in the world’s most impoverished countries; Whereas access to routine immunization and vaccines protects children from deadly but preventable diseases and contributes to national economic growth and poverty reduction by ensuring people live longer, healthier, and more productive lives; Whereas, in 2000, the United States, the United Nations Children’s Fund (UNICEF), the World Health Organization (WHO), the World Bank, government donors, lower-income country governments, foundations (including the Bill & Melinda Gates Foundation), the private sector (including the vaccine industry), faith-based organizations, civil society, and other partners joined forces to create a public-private partnership now known as Gavi, the Vaccine Alliance, in order to expand access to new and underused vaccines and support the introduction and scaleup of these vaccines into routine immunization systems in the world’s most impoverished countries; Whereas, from 2000 through 2022, with support from the United States, and other donors and partners, Gavi has supported country-led vaccine initiatives in 78 countries to support the immunization of more than 1,000,000,000 additional children and averted an estimated 17,300,000 deaths in the world’s most impoverished countries; Whereas Gavi has been a major contributor in reducing the number of childhood deaths in lower-income countries due to vaccine-preventable disease by 70 percent since 2000; Whereas country ownership and sustainability are at the core of the Gavi model, which requires Gavi-eligible countries to contribute to a portion of vaccine costs and directly invest in immunizing children, and Gavi-supported countries contributed more than $1,500,000,000 to immunization campaigns between 2008 and 2022; Whereas 78 low-income countries currently provide co-financing for new and underused vaccines supported by Gavi, more than 19 countries have transitioned from Gavi support by the end of 2022, and an additional 10 countries may transition by 2040, moving toward fully funding their immunization programs; Whereas Gavi has transformed the market for vaccines by matching pooled demand from low-income countries with secure, predictable financing to make vaccines more affordable and supply more reliable, reducing the price of the most common vaccines by 24 percent from 2015 to 2020 and increasing the number of global vaccine manufacturers selling pre-qualified Gavi-supported vaccines to the world’s most impoverished countries from 5 in 2001 to 18 in 2018; Whereas Gavi estimates that its market shaping efforts will result in savings of over $900,000,000 from 2021 to 2025 and may encourage research and development of new vaccines; Whereas Gavi is poised to provide the most comprehensive package of support in the 2021 to 2025 period by financing and delivering 18 vaccines to the world’s most impoverished countries; Whereas Gavi, the African Union, and the Africa Centers for Disease Control (Africa CDC) have jointly established the African Vaccine Manufacturing Accelerator (AVMA) to provide innovative financing to expand sustainably vaccine manufacturing capacity in Africa and improve the region’s resilience in the face of pandemics, outbreaks, and other health emergencies, while preserving the health of vaccine markets globally; Whereas Gavi is collaborating with the Global Polio Eradication Initiative on the final push to end polio, and expanding the integration of the inactivated polio vaccine into routine immunization programs; Whereas Gavi has made significant progress in supporting the development and stockpiling of effective vaccines to combat cholera, measles, meningococcal, yellow fever, and Ebola, which could also protect Americans in the event of an outbreak on United States soil; Whereas malaria is one of most long-standing and deadliest diseases in Africa, and in 2022, malaria killed an estimated 580,000 children in Africa, 78 percent of whom were children under five; Whereas Gavi has begun deliveries of new malaria vaccines and will expand the program to dozens of countries as vaccine supply becomes available; Whereas Gavi recently allocated 18,000,000 doses of the malaria vaccine RTS,S in 2023 and 2024, the World Health Organization estimates that at least 40,000,000 to 60,000,000 doses will be needed annually by 2026 and 80,000,000 to 100,000,000 doses will be needed by 2030; Whereas Gavi is supporting expanded procurement, access, and implementation of new malaria vaccine programs to help meet rising demand; Whereas data from malaria vaccine trials indicate that these vaccines can save one life for every 200 children vaccinated, with the potential for significantly impacting public health and saving tens of thousands of lives annually; Whereas Gavi supports the strengthening of health systems to ensure effective immunization and health services, including through the provision of cold chain equipment that can also be effectively repurposed for emergency response, as was demonstrated during the COVID–19 pandemic; Whereas, through COVAX, Gavi and global partners delivered nearly 2,000,000,000 doses of COVID–19 vaccines to 146 economies, and averted an estimated 2,700,000 deaths in Advance Market Commitment lower-income participating economies; Whereas Gavi is providing additional vaccine support to address health service interruptions that occurred during the COVID–19 pandemic and contributed to the largest backslide in routine childhood immunization in 30 years, and is also focusing on the 14,000,000 zero-dose children in Gavi-supported countries who had not received a single vaccine; Whereas vaccines programs are widely regarded as high-impact, evidence-based interventions and are among the most efficient, cost-effective, and successful health initiatives in history, returning over $50 in health and economic savings for every $1 invested in Gavi-supported countries; Whereas the prevention of infectious disease through immunization in Gavi-eligible countries provides protection and health security in the United States by reducing the prevalence of infectious diseases and stemming outbreaks at their source; Whereas United States investment in Gavi complements and enhances the effectiveness of other United States investments in global health, particularly in maternal and child health and nutrition; Whereas Gavi is committed to working with partners, including United States bilateral programs administrated by the United States Agency for International Development (USAID) and the Centers for Disease Control and Prevention (CDC), to ensure children in developing nations have access to lifesaving vaccines and immunizations; Whereas Gavi’s next strategic cycle will cover the strategic period of 2026 to 2030, which will include the expansion of Gavi’s malaria program; Whereas the launches of the Gavi’s Investment Opportunity for 2026 through 2030 and AVMA will be held in June 2024 and co-hosted by the Government of France, African Union, and Africa CDC to obtain funding commitments; Whereas the United States has consistently supported the goal of saving lives by contributing annually to Gavi to meet its projected replenishment and program goals; Whereas with this support and support from other donors, Gavi will have contributed $220,500,000,000 in economic benefits in Gavi countries as of 2022, with each $1 invested yielding $54 return on investment; and Whereas an increased commitment from the United States remains necessary to ensure predictability and stability to the vaccine market, to enable strong global health security efforts, spur confidence in Gavi-eligible countries, and encourage continued innovative vaccine-related approaches: Now, therefore, be it

That the Senate— (1) affirms the continued support of the United States Government for the purchase of vaccines for low-income countries through Gavi as a cost-effective, efficient means to reduce mortality and as a critical component of meeting the United States goal to end preventable child and maternal deaths; (2) supports the principles and goals of Gavi to— (A) introduce and scale up new and routine immunizations in low-income countries; (B) improve sustainability of immunization programs; (C) ensure healthy markets for vaccines and related products; and (D) strengthen health systems to increase equity in immunization; (3) recognizes that United States Government support for Gavi is a critical component to ensuring health security in the United States; (4) encourages the continued use of USAID maternal and child health and CDC global immunization resources to strengthen local public health capacity to introduce and sustain new and underutilized vaccines supported by Gavi through routine immunization systems; (5) recognizes the need for multiyear pledges from the United States to allow Gavi to maximize its impact to provide lifesaving vaccines and to leverage contributions from other countries and donors; and (6) encourages continued increased commitment and investment by the United States Government to Gavi in the 2026 to 2030 strategic period in order to ensure that lives are protected and saved through access to vaccines and immunizations.