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The first years of this century have been heady ones for global health. International donors – whether national governments, such as the United States, through its PEPFAR program, or new international funding initiatives, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and Gavi, the Vaccine Alliance – have invested billions of dollars in national disease-control programs and health systems, saving millions of lives.But now some of the countries that have benefited from these programs face a new challenge: sustaining the gains they have made once external support is withdrawn. Founded in 2000 by a partnership of major donors, international agencies and vaccine industry leaders, Gavi's goal is to help the world's poorest countries introduce new lifesaving vaccines and strengthen their immunization programs.Support is phased out over a period of several years.Will countries be able to continue purchasing and delivering the vaccines that were introduced with Gavi support?Or will fiscal pressures lead, in some countries, to vaccine shortages, to declines in immunization coverage or even, in the worst case, to vaccines being dropped altogether from national programs, reversing the hard-won gains of recent years?
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