Web Appendix: The Impact of Gavi on Vaccination Rates: Regression Discontinuity Evidence

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1 Web Appendix: The Impact of Gavi on Vaccination Rates: Regression Discontinuity Evidence Sarah Dykstra, Amanda Glassman, Charles Kenny, & Justin Sandefur This version: February 9, 2015 A Appendix This appendix presents further details on our data set to (a) allow interested readers to inspect individual observations near the Gavi eligibility threshold which may have inordinate influence on our treatment effect estimates, and (b) enable other researchers to more easily replicate what we have done. A.1 Data construction Our dataset is a cross-national time-series dataset covering the period We compile data from five sources: the WHO, UNICEF, World Bank, Gavi and IHME. With the exception of mortality rates, all data are available on an annual basis. We restrict our sample to countries with gross national income per capita figures within two log points of Gavi s threshold, as defined by the World Bank in the first year of each phase. This mirrors the way in which eligibility is structured for all phases, whereby countries are designated as eligible or not at the beginning of the phase based on the most recent year of GNI data. All authors are affiliated with the Center for Global Development (CGD) in Washington, D.C. We are grateful for helpful comments from Elisabetta De Cao, Victoria Fan, Willa Friedman, Owen Ozier, Heather Schofield, and numerous seminar participants. We appreciate comments and clarification offered by individuals from Gavi, the Vaccine Alliance, and the Gates Foundation. CGD does not take institutional positions, and the views expressed here do not necessarily reflect those of CGD s board or its funders. The most recent version of the paper can be downloaded at 1

2 Table 1: Data sources Income eligibility Treatment Immunization coverage Created using gross national income per capita, Atlas method (current US$) data drawn from original PDFs of the World Banks World Development Indicator (WDI) publications, when available. Data from the 2013 WDI report was not available in PDF format and was downloaded from the World Bank s DataBank using Stata. For several countries, these reports provide only an income category due to a lack of data. When an estimate for GNI is not available for low-income countries, we impute the mean GNI for LICs in that year. See Section A.7 for more information. Created from Gavi disbursement data , reported by program year, the year in which vaccines/programs are implemented. Percent of children who have completed a series of the following vaccines by age 1: diphtheria, pertussis and tetanus (DPT), hepatitis B (HepB), Haemophilus influenzae type B (Hib), measles and rotavirus (rota). For rota, coverage rates were imputed as 0 before the year the vaccine was introduced in a country. We use the WHO/UNICEF official coverage estimate (WUENIC) for years Source World Bank ( ) Gavi WHO Income classification Historical World Bank income group classifications World Bank Population Gavi-purchased doses We use population estimates for the population under age 1, 5 and total population. This estimate is based on the de facto definition of population, which counts all residents regardless of legal status or citizenship except for refugees not permanently settled in the country of asylum. Our estimate of the number of doses purchased by Gavi is constructed using Gavi s data on disbursements and UNICEF data on total doses purchased and total spending by vaccine worldwide. Estimates account for buffer stocks and country-reported (when unavailable, mean) wastage rates. We use disbursements from the previous year to estimate doses, as vaccination rates are calculated as children who have been vaccinated by age 1 and children vaccinated as a result of these doses will not be measured until the following year. World Bank UNICEF Gavi 2

3 Table 1: Data sources (continued) Source Vaccine wastage Countries report vaccine-specific wastage rates in the Joint Report- WHO ing Form. When an estimate is unavailable, we impute the mean wastage rate for that vaccine and year. Mortality rate Probability of a child dying between birth and age 1 (infant mor- WHO tality) or age 5 (under-5 mortality), expressed as a rate per 1,000 live births. Data is available in 5-year increments. Disease-specific mortal- Probability of a child under age 5 dying due to diseases preventable IHME ity rates by 6 vaccines, expressed as a rate per 100,000 population. Data is reported by cause (e.g. diphtheria) and aggregated by vaccine. GBD does not report deaths due to all diseases preventable by the 6 vaccines. For example, the pneumococcal and Hib vaccines prevent both meningitis and pneumonia caused by those types of bacteria, but GBD does not provide data on deaths due to pneumococcal or H influenzae type B pneumonia.riley, et al. (1986) estimate that the pneumococcal vaccine prevented 50% of deaths due to lower respiratory infections (LRIs) in Papua New Guinea. 1 We use this estimate to attribute 50% of LRIs to pneumococcal disease. Data is available for 1990, 2005 and 2010 (2008 for deaths due to rotavirus). Health system financing Non-income eligibility Vaccine financing data is drawn from the JRF, which began recording financing figures in 2006, and Gavi disbursement data. Government spending is drawn from the JRF and includes all funds allocated through the national government budget. Total spending on vaccines, as reported in the JRF, reports financing from all sources, including government, donors, out-of-pocket and informal private payments. Spending is expressed as a per infant rate using World Bank population figures. Data is available until Created using country official vaccination coverage rates, which Gavi used to determine eligibility for ISS and NVS funding during phases 1 and 2. WHO World Bank Gavi WHO 1 Riley, I. D., et al. (1986). Pneumococcal vaccine prevents death from acute lower-respiratory-tract infections in Papua New Guinean children. The Lancet 328, no. 8512:

4 A.2 Changes in eligibility We re particularly interested in countries whose eligibility status changed over time, and whether Gavi s actual disbursement followed suit. As described in the main text, for the period covered by our sample income eligibility was evaluated at four points in time, using GNI data from 1998, 2003, 2009, 2010 and Twenty-one countries experienced a change in eligibility, either because their income changed or the eligibility line changed around them. These twenty-one countries are listed in Table 2. Of these twenty-one countries, seventeen initially qualified and then subsequently became ineligible. 2 In fourteen of these seventeen cases, Gavi continued to disburse aid in subsequent periods exceptions being 2 Other cases are more complex. Bolivia entered eligibility partway through phase 1 and subsequently exited eligibility, but received Gavi aid in all periods. Equatorial Guinea became eligible in phase 2, but has never received Gavi aid. Kiribati is the sole case of a country that fell into eligibility and began receiving Gavi assistance for the first time after phase 1. Table 2: Countries experiencing a change in Gavi eligibility over time Eligible? Received GAVI aid? GAVI Phase: Albania Yes No No No Yes Yes Yes Yes Angola Yes Yes No No Yes Yes Yes Yes Armenia Yes Yes No No Yes Yes Yes Yes Azerbaijan Yes Yes No No Yes Yes Yes Yes Bhutan Yes Yes No No Yes Yes Yes Yes Bolivia No Yes No No Yes Yes Yes Yes Bosnia and Herzegovina Yes No No No Yes Yes Yes No China Yes No No No Yes Yes No No Congo, Rep. Yes Yes No No Yes Yes Yes Yes Equatorial Guinea No Yes No No No No No No Georgia Yes Yes No No Yes Yes Yes Yes Guyana Yes Yes No No Yes Yes Yes Yes Honduras Yes Yes No No Yes Yes Yes Yes Indonesia Yes Yes No No Yes Yes Yes Yes Kiribati No Yes No No No Yes Yes Yes Moldova Yes Yes No No Yes Yes Yes Yes Mongolia Yes Yes No No Yes Yes Yes Yes Sri Lanka Yes Yes No No Yes Yes Yes Yes Timor-Leste NA Yes No No No No No Yes Turkmenistan Yes No No No Yes Yes No No Ukraine Yes Yes No No Yes Yes No No The table lists the 21 countries whose eligibility status changed between Gavi phases. The last four columns report whether Gavi disbursed any aid to the country during the phase. Where eligibility is listed as NA, no GNI data is available. 4

5 Equatorial Guinea, China and Ukraine. 3 Gavi s graduation policy allows countries which become ineligible to continue to receive funding support approved earlier for an agreed period of time, typically 5 years. This policy explains a number of the cases in which Gavi disbursed funding to ineligible countries. 4 The bottom line here is that Gavi disbursement appears to be determined primarily by income eligibility in phase 1. In most but not all cases, subsequent changes to eligibility did not lead to the appearance or disappearance of a Gavi country program. 3 Azerbaijan and Indonesia also experienced interruptions in disbursement after exiting eligibility, but both appeared to have active Gavi programs at the end of the study period. 4 As a robustness check, we estimated the impact of Gavi aid using 1998 income levels and the original eligibility threshold for all phases and our estimates did not change substantively. This policy of providing funding to countries based on eligibility in earlier phases, if they had applied before becoming ineligible, is similar to our robustness check and we do not anticipate that it affects our estimates. 5

6 A.3 Non-income eligibility Table 3: Testing enforcement of Gavi s non-income eligibility rules Immunization Services Support New and Underused Vaccines Support (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) E 0.725*** 0.228*** * ** *** 3.006* (0.272) (0.0442) (0.223) (0.552) (0.924) (1.982) (0.105) (1.693) (2.056) (2.354) DP T ** 15.99** 38.15** (1.391) (9.018) (26.17) (6.949) (15.21) (37.27) DP T ** 65.74** (33.72) (221.1) (30.17) (208.4) DP T ** (576.8) (320.6) E DP T ** *** (1.405) (9.020) (26.17) (7.140) (17.46) (39.91) E DP T ** *** (33.76) (221.1) (33.59) (236.2) E DP T ** (576.8) (320.4) Constant *** 0.397* 0.981* 2.216** 0.547*** 3.851*** 5.106*** 5.299** (0.0287) (0.219) (0.549) (0.922) (0.103) (1.455) (1.808) (2.080) Optimal b.w Observations R-squared Note: Each column presents a separate OLS regression, the dependent variable is the Gavi treatment dummy. Standard errors are clustered at the country level. 6

7 A.4 Alternative counterfactuals Table 4: Testing alternative counterfactuals Older Vaccines Newer Vaccines Placebo (1) (2) (3) (4) (5) (6) Hep B DPT Hib Rota Pneumo Measles Bandwidth = 2 Linear -55.7*** -10.3* (11.0) (6.1) (11.8) (10.1) (8.0) (5.9) Quadratic -50.1*** (17.1) (8.7) (19.4) (9.0) (7.2) (8.4) Obs No. of countries Bandwidth = 1 Linear -42.8*** (15.0) (7.8) (16.4) (9.3) (7.2) (7.7) Quadratic -60.6* (34.5) (13.9) (38.9) (32.9) (110.7) (12.0) Obs No. of countries Bandwidth = 0.5 Linear -55.7** (26.7) (10.9) (28.4) (13.7) (0.08) (9.6) Quadratic ** (26.2) (8.4) (52.3) (32.5) (0.3) (8.0) Obs No. of countries Note: This table tests the null hypothesis that vaccination rates in Gavi-eligible countries would have remained at baseline levels without Gavi support. Coefficients less than zero imply Gavi s official impact claims are biased upward by an incorrectly low counterfactual. Each coefficient in the table (i.e., each row and each column) represents the treatment on the treated effect from a separate regression. Each column uses a different dependent variable, listed in the column heading. Each row uses a different set of controls (i.e., polynomials of GNI and interactions with the Gavi treatment dummy). Standard errors are clustered at the country level. 7

8 A.5 Causes of under-5 mortality In order to estimate the potential for subsidized vaccines disbursed by Gavi to impact child mortality, it is necessary to know who many people were dying of the relevant diseases in countries near Gavi s income threshold before Gavi began providing funding. Table 5 describes the diseases each vaccine protects against and the amount Gavi has spent on those vaccines between 2000 and In Figure 1, we estimate the disease-specific mortality rate at various points in time using estimates from the Global Burden of Disease (GBD) project. For each disease or group of diseases, we fit a local polynomial regression of death rates on baseline GNI for countries below the Gavi threshold of $1,000 in For all diseases, mortality rates are unsurprisingly declining over time and with per capita income. Overall, mortality rates before the widespread roll-out of Gavi aid were highest for measles, pneumococcal disease and rotavirus, though measles mortality had been dramatically reduced prior to Gavi s launch and the pneumococcal vaccine was not. The main conclusion we take from Figure 1 is that there was limited scope for further mortality reduction through Gavi-funded vaccines by the 2000s in countries near the eligibility threshold. 8

9 Table 5: Gavi vaccines, prices and purchases 9 Disease(s) Description Presentations Vaccine price Gavi purchases 5 Diphtheria, Pertussis, Tetanus (DPT) Diphtheria is a potentially acute disease affecting respiratory tract, caused by a bacterial toxin, affecting mainly children. Pertussis is a potentially acute, highly contagious disease of the respiratory DPT, DTaP or pentavalent (TetraDTP-HepB- Hib) Haemophilus influenza type b (Hib) Hepatitis B (Hep B) Rotavirus Pneumococcal disease tract, caused by a bacteria, frequently complicates into pneumonia among children. Tetanus is an infectious bacterial disease causing muscular stiffness and spasms, primarily birth associated. Hib causes bacterial meningitis and an important cause of severe pneumonia in children <5 yrs old Hepatitis B is a viral infection that attacks the liver and causes both acute and chronic disease. Most mortality occurs many years after the infection, therefore mainly in adulthood. Rotavirus causes severe, dehydrating diarrhea. Many strains of rotavirus exist. S. pneumonia has >90 serotypes, and related infections cause meningitis, bacteraemia and pneumonia, and more common illnesses such as sinusitis and otitis media. More severe disease is called invasive pneumococcal disease (IPD). Monovalent Hib, DPT-Hib, pentavalent vaccine (see DTP) Monovalent hepatitis B vaccine, pentavalent (see DTP) RV1, RV5 (vaccines cover the referenced number of rotavirus strains) PCV-7, PCV-10, PCV-13 (vaccines cover the referenced number of serotypes) $ per dose for DPT presentation $ per dose for pentavalent $ per dose for DPT- Hib presentation $ per dose for monovalent presentation $ for DPT-HepB $ per dose $ per dose DPT: N/A Incentivized through ISS support. Pentavalent: $2.35 billion DPT-Hib: $11.2 million Pentavalent: $2.35 billion DPT-HepB: $158.6 million Pentavalent: $2.35 billion $187.6 million $1.4 billion 5 Cost per dose approximations are drawn from UNICEF awarded prices per dose, Gavi purchase totals are from

10 Figure 1: Death rates by disease for Gavi-eligible countries: 1990, 2005, 2010 (a) Hepatitis B (b) DPT $125 $250 $500 $1k Baseline GNI $125 $250 $500 $1k Baseline GNI (c) Hib (d) Rotavirus $125 $250 $500 $1k Baseline GNI $125 $250 $500 $1k Baseline GNI (e) Pneumococcal (f) Measles (MCV) $125 $250 $500 $1k Baseline GNI $125 $250 $500 $1k Baseline GNI Data are based on modeled estimates from the Global Burden of Disease database. Each graph presents a local polynomial regression of estimated death rates (age-standardized rates per 100,000 children) at up to three points in time for children under five years old on countries 1998 log per capita GNI. 10

11 A.6 Sample countries by Gavi phase The rest of this appendix provides a partial list of the data used in the regressions, with a separate table for each of the five Gavi phases, as we define them (phase 1 from 2001 to 2005, phase 2 from 2006 to 2010, phase 3 in 2011, phase 4 in 2012 and phase 5 in 2013). We arrange each table in order by the GNI used to determine eligibility, i.e., the forcing variable in the regression discontinuity design. The logic of producing separate tables by phase is that eligibility was re-evaluated at the outset of each phase. As a consequence, our sample and the running variable, GNI, are updated in each phase. Our sample includes countries within a bandwidth of 2 log points of the eligibility cut-off at the time eligibility was evaluated. The tables also present the lower and upper bound for the other bandwidths used in our analyses. For phase 1, the full sample of countries reporting data for 1998 GNI and at least one outcome variable is listed in Table 7. Eligibility for phase 1 was determined on the basis of 1998 GNI, as recorded in the 2000 World Development Indicators and reported in the second column of the table. The third column shows the average amount of aid received from Gavi per annum during phase 1, in millions of U.S. dollars. The rest of the table reports data for five outcome indicators: under-five mortality, DPT, hepatitis B and Hib vaccination coverage, and the intermediate outcome, national spending on immunization in millions of U.S. dollars. For each outcome, the table lists the level recorded at the end of the period (2005 in the case of phase 1) and the annualized change from beginning to end (2000 to 2005). As seen, data for mortality rates and national spending are particularly incomplete. The end-line national spending data is from 2006 rather than No spending data is available prior to 2006, and thus no changes over time are available for phase 1. The same information is presented for Gavi phases 2, 3, 4 and 5 in Tables 8, 9, 10 and 11 respectively. Data coverage improves over time. Note, however, that under-five mortality data is not available for 2011 and 2013, and expenditure data is not available for 2013, creating missing columns in tables 9, 10 and

12 Table 6: Gavi Phase I Sample 1998 Gavi aid U5 mortality DPT Hep B Hib Expenditure Country GNI ($ millions) Sierra Leone Burundi Guinea-Bissau Niger Eritrea Mozambique Nepal Malawi Tanzania Rwanda Chad Burkina Faso Mali Madagascar Cambodia Sao Tome Yemen, Rep Sudan CAR Nigeria Uganda Lao PDR Togo Zambia Gambia, The Bangladesh Kenya Vietnam Bandwidth 1 lower bound Tajikistan Nicaragua Comoros Afghanistan* Myanmar* Bosnia and Herzegovina* Turkmenistan* Somalia* Liberia* Korea, Dem. Rep.* Angola Mongolia Moldova Kyrgyz Rep Benin Ghana Haiti Mauritania India Armenia Pakistan Bhutan Azerbaijan Senegal Guinea Lesotho Bandwidth.5 lower bound Cameroon Zimbabwe Indonesia Congo, Rep Cote d Ivoire Honduras China Solomon Islands Guyana

13 Table 6: Gavi Phase I Sample (continued) 1998 Gavi aid U5 mortality DPT Hep B Hib Expenditure Country GNI ($ millions) Albania Sri Lanka PNG Uzbekistan Georgia Ukraine Eligibility threshold Bolivia Syria Philippines Samoa Eq. Guinea Maldives Jordan Kiribati Cabo Verde Bulgaria Morocco Vanuatu Egypt, Arab Rep Macedonia Kazakhstan Romania Swaziland Ecuador Algeria Guatemala Bandwidth.5 upper bound Iran Suriname Jamaica Tonga Paraguay Dominican Rep Micronesia, Fed. Sts El Salvador Namibia Tunisia Thailand Belarus Fiji Russia Latvia Peru Colombia Lithuania St. Vincent Belize Bandwidth 1 upper bound Costa Rica Panama Botswana Dominica Turkey Grenada South Africa Estonia Venezuela, RB Lebanon St. Lucia Malaysia Slovak Republic Mauritius Mexico Poland

14 Table 6: Gavi Phase I Sample (continued) 1998 Gavi aid U5 mortality DPT Hep B Hib Expenditure Country GNI ($ millions) Gabon Hungary Trinidad and Tobago Croatia Brazil Chile Czech Republic Uruguay St. Kitts and Nevis Seychelles Saudi Arabia GNI was imputed as the mean GNI for LICs in Table 7: Gavi Phase II Sample 2003 Gavi aid U5 mortality DPT Hep B Hib Expenditure Country GNI ($ millions) Guinea-Bissau Sierra Leone Malawi Eritrea Niger Tajikistan Mozambique Rwanda Chad Nepal Uganda CAR Gambia, The Mali Madagascar Tanzania Burkina Faso Sao Tome Cambodia Togo Ghana Kyrgyz Rep Lao PDR Nigeria Bandwidth 1 lower bound Myanmar* Afghanistan* Somalia* Zimbabwe* Korea, Dem. Rep.* Zambia Haiti Kenya Bangladesh Mauritania Uzbekistan Guinea Benin Comoros Sudan Timor-Leste Mongolia Vietnam PNG Yemen, Rep Pakistan

15 Table 7: Gavi Phase II Sample (continued) 2003 Gavi aid U5 mortality DPT Hep B Hib Expenditure Country GNI ($ millions) India Senegal Solomon Islands Moldova Bandwidth.5 lower bound Lesotho Cameroon Bhutan Congo, Rep Cote d Ivoire Eq. Guinea Angola Nicaragua Georgia Indonesia Azerbaijan Kiribati Bolivia Guyana Djibouti Sri Lanka Armenia Honduras Ukraine Eligibility threshold Philippines China Paraguay Turkmenistan Syria Vanuatu Morocco Swaziland Egypt, Arab Rep Samoa Cabo Verde Tonga Bosnia and Herzegovina Belarus Bandwidth.5 upper bound Albania Kazakhstan Colombia Ecuador Jordan Guatemala Algeria Namibia Macedonia Iran Micronesia, Fed. Sts Bulgaria Dominican Rep Peru Thailand Tunisia Fiji Romania Suriname El Salvador Maldives Russia Marshall Islands Bandwidth 1 upper bound Brazil

16 Table 7: Gavi Phase II Sample (continued) 2003 Gavi aid U5 mortality DPT Hep B Hib Expenditure Country GNI ($ millions) South Africa Turkey Jamaica St. Vincent Dominica Gabon Belize Venezuela, RB Botswana Grenada Argentina Uruguay Malaysia Lebanon St. Lucia Panama Mauritius Costa Rica Chile Latvia Lithuania Slovak Republic Poland Croatia Estonia Mexico Hungary Palau St. Kitts and Nevis Czech Republic GNI was imputed as the mean GNI for LICs in Table 8: Gavi Phase III Sample 2009 Gavi aid U5 mortality DPT Hep B Hib Expenditure Country GNI ($ millions) Malawi Afghanistan Eritrea Ethiopia Niger Sierra Leone Zimbabwe Guinea Madagascar Nepal Mozambique Togo Gambia, The CAR Uganda Rwanda Tanzania Guinea-Bissau Burkina Faso Haiti* Korea, Dem. Rep.* Myanmar* Somalia* Bandwidth 1 lower bound Bangladesh Chad Cambodia

17 Table 8: Gavi Phase III Sample (continued) 2009 Gavi aid U5 mortality DPT Hep B Hib Expenditure Country GNI ($ millions) Mali Tajikistan Benin Kenya Comoros Kyrgyz Rep Lao PDR Bandwidth.5 lower bound Solomon Islands Zambia Lesotho Mauritania Pakistan Nicaragua Vietnam Senegal Yemen, Rep Cote d Ivoire Uzbekistan Sao Tome PNG Nigeria Ghana Cameroon India Sudan Djibouti Eligibility threshold Moldova Bolivia Mongolia Philippines Honduras Kiribati Sri Lanka Bhutan Indonesia Egypt, Arab Rep Congo, Rep Iraq Paraguay Syria Timor-Leste Swaziland Bandwidth.5 upper bound Micronesia, Fed. Sts Georgia Vanuatu Guatemala Guyana Morocco Ukraine Samoa Cabo Verde Marshall Islands Armenia Tonga El Salvador Turkmenistan China Tunisia Belize Angola Thailand Fiji

18 Table 8: Gavi Phase III Sample (continued) 2009 Gavi aid U5 mortality DPT Hep B Hib Expenditure Country GNI ($ millions) Maldives Ecuador Jordan Albania Bandwidth 1 upper bound Peru Namibia Macedonia Algeria Iran Dominican Rep Jamaica Bosnia and Herzegovina Suriname Azerbaijan Dominica Colombia St. Vincent St. Lucia Cuba Belarus Grenada South Africa Serbia Bulgaria Palau Botswana Costa Rica Panama Montenegro Kazakhstan Mauritius Malaysia Gabon Argentina Lebanon Brazil Romania Seychelles Turkey Mexico Uruguay Russia Chile Venezuela, RB St. Kitts and Nevis GNI was imputed as the mean GNI for LICs in Table 9: Gavi Phase IV Sample 2010 Gavi aid U5 mortality DPT Hep B Hib Expenditure Country GNI ($ millions) Malawi Eritrea Sierra Leone Niger Ethiopia Guinea Afghanistan Madagascar Mozambique Gambia, The Zimbabwe

19 Table 9: Gavi Phase IV Sample (continued) 2010 Gavi aid U5 mortality DPT Hep B Hib Expenditure Country GNI ($ millions) CAR Nepal Togo Uganda Somalia* Korea, Dem. Rep.* Myanmar* Rwanda Tanzania Burkina Faso Bandwidth 1 lower bound Guinea-Bissau Mali Chad Haiti Bangladesh Cambodia Comoros Benin Kenya Tajikistan Kyrgyz Rep Bandwidth.5 lower bound Mauritania Solomon Islands Lesotho Lao PDR Pakistan Zambia Senegal Nicaragua Cote d Ivoire Vietnam Yemen, Rep Cameroon Nigeria Sao Tome Ghana India Sudan Djibouti Uzbekistan PNG Eligibility threshold Bolivia Moldova Mongolia Bhutan Honduras Kiribati Philippines Congo, Rep Timor-Leste Sri Lanka Iraq Egypt, Arab Rep Indonesia Bandwidth.5 upper bound Vanuatu Georgia Paraguay Micronesia, Fed. Sts Guatemala Syria Morocco

20 Table 9: Gavi Phase IV Sample (continued) 2010 Gavi aid U5 mortality DPT Hep B Hib Expenditure Country GNI ($ millions) Guyana Swaziland Samoa Ukraine Armenia Cabo Verde Tonga El Salvador Fiji Marshall Islands Turkmenistan Belize Ecuador Angola Albania Bandwidth 1 upper bound Thailand Tunisia China Jordan Algeria Namibia Iran Macedonia Peru Tuvalu Bosnia and Herzegovina Jamaica Dominican Rep Azerbaijan Colombia Cuba Serbia Maldives Suriname Belarus South Africa Bulgaria St. Vincent St. Lucia Palau Dominica Montenegro Botswana Costa Rica Grenada Panama Kazakhstan Gabon Mauritius Malaysia Romania Argentina Lebanon Mexico Brazil Seychelles Turkey Russia Chile Uruguay GNI was imputed as the mean GNI for LICs in

21 Table 10: Gavi Phase V Sample 2011 Gavi aid U5 mortality DPT Hep B Hib Expenditure Country GNI ($ millions) Burundi Liberia Congo, Dem. Rep Malawi Niger Ethiopia Eritrea Guinea Madagascar Mozambique Uganda Togo CAR Sierra Leone Gambia, The Tanzania Rwanda Afghanistan Guinea-Bissau Bandwidth 1 lower bound Somalia* Myanmar* Korea, Dem. Rep.* Nepal Burkina Faso Mali Haiti Benin Zimbabwe Bangladesh Tajikistan Cambodia Kenya Comoros Kyrgyz Rep Chad Bandwidth.5 lower bound Mauritania Senegal Yemen, Rep Lao PDR Pakistan Cote d Ivoire Cameroon Solomon Islands Zambia Lesotho Sao Tome Sudan South Sudan Vietnam Ghana India PNG Uzbekistan Eligibility threshold Nicaragua Nigeria Bolivia Moldova Honduras Kiribati Congo, Rep Bhutan Mongolia

22 Table 10: Gavi Phase V Sample (continued) 2011 Gavi aid U5 mortality DPT Hep B Hib Expenditure Country GNI ($ millions) Bandwidth.5 upper bound Sri Lanka Philippines Egypt, Arab Rep Georgia Vanuatu Swaziland Guatemala Indonesia Morocco Samoa Guyana Micronesia, Fed. Sts Paraguay Ukraine El Salvador Armenia Cabo Verde Tonga Fiji Marshall Islands Tunisia Angola Timor-Leste Bandwidth 1 upper bound Jordan Algeria Belize Albania Thailand Turkmenistan Bosnia and Herzegovina Macedonia Ecuador Jamaica China Iraq Namibia Peru Tuvalu Dominican Rep Serbia Azerbaijan Maldives Cuba St. Vincent Colombia Belarus Bulgaria Dominica South Africa Botswana St. Lucia Grenada Montenegro Costa Rica Mauritius Panama Kazakhstan Suriname Romania Malaysia Gabon Mexico Lebanon

23 Table 10: Gavi Phase V Sample (continued) 2011 Gavi aid U5 mortality DPT Hep B Hib Expenditure Country GNI ($ millions) Palau Turkey Brazil Russia Seychelles GNI was imputed as the mean GNI for LICs in