“For some of these countries, especially those that have adopted many new vaccines, obtaining adequate and sustainable financing is one of the most daunting challenges posed by the transition”

countries be able to continue purchasing and delivering the vaccines that were introduced with Gavi support?

Equally important, will that commitment hold up over time? If government budgets are cut, will immunisation be protected, along with other essential health services? Will countries be able to introduce new lifesaving vaccines as they become available? Will they sustain and strengthen disease surveillance, so that outbreaks are detected and addressed quickly?

Or will fiscal pressures lead, in some countries, to vaccine shortages, to declines in immunisation coverage, or even, in the worst case, to vaccines being dropped altogether from national programs, reversing the hard-won gains of recent years?

The answers to these questions are important not only for the countries themselves, but also for their neighbors, which could be put at risk by backsliding on immunisation. After all, infectious diseases do not respect national boundaries. The recent yellow fever epidemic in Angola, for example, spread to its much poorer neighbor, the Democratic Republic of