Countries facing fragility, emergencies or hosting refugees make up a significant number of Gavi-supported countries. Many face complex, sometimes hidden challenges – political, economic, environmental and security – which can severely limit their governments’ ability to reach children with vaccines.
“Growing fragility is one of several shifts in the global landscape, which have exacerbated the challenges facing Gavi in this period. Since the start of 2016, more than 100 conflicts have seen 25.4 million refugees flee their countries. Climate change and natural disasters are also combining to displace communities and disrupt systems.”
Mid-Term Review report, page 3
In fragile settings, a variety of crises can compromise governments’ capacity to effectively leverage Gavi support. They include displacement due to conflict, political extremism, food crises or natural disasters. Any one of these factors can disrupt or degrade national infrastructures, such as transport, electricity and water networks, as well as essential services like food distribution, sanitation and healthcare services. In combination or isolation, they significantly complicate the delivery of life-saving vaccines to children.
Today, 17 Gavi-supported countries are classified as fragile. During the past two and a half years, the Alliance has invested over US$ 165 million in strengthen the health systems of these countries to improve the effectiveness of their routine immunisation services. Gavi is also increasingly tailoring its approach to meet the unique needs of fragile countries.
Since 2017, the revised policy on fragility, emergencies and refugees has allowed the Alliance to respond more flexibly to specific immunisation challenges in fragile settings, while working in close collaboration with partners and other development organisations. The policy also details flexibilities that can be extended in humanitarian emergencies, as well as to Gavi-supported countries hosting refugees.
 States of Fragility Report 2018. OCED. http://www.oecd.org/dac/conflict-fragility-resilience/listofstateoffragilityreports.htm