Board -2022-Mtg -02-Doc 00 a




G avi Alliance Board Meeting
22 -23 June 202 2
Global Hea lth Campus, Geneva , Switzerland

Monday 20 and Tuesday 21 June : Pre -Board meetings
Wednesday 22 June : 09 .00-17.30 (Board meeting Day One)
Thursday 23 June : 09 .00-17.15 (Board meeting Day Two)
Quo rum: 14

Document list

No. Docu me nt
00a Document list
00b Agenda
01a Declarations of interest
01b Minutes from 30 Novemb er ? 2 December 2021
01c Minutes from 6 April 2022
01 d No Objection Consent Decisions
01 e Consent Agenda
01f Workplan
02 CEO?s Report ? To follow
03 Strategy , Programmes a nd Partnerships : Pr ogress, Risks and Challenges
04 Financial Update, including forecast
05 COVAX: K ey Strategic Issues
06 Gav i?s potential role in pandemic preparedness response
07 Review of Fragility, Emergencies, Refugees Policy
08 Update on Malaria Vac cine Programme
09 Gavi ?s Approach to Engagement with Former and Never -Eligible Middle -Income
Countries (MICs) ? To follow
10 Committee Chair and IFF Im Board reports ? To follow
11 Review of decisions ? No paper
12 Closing remarks and review of Boa rd workplan ? No paper
No. Ad ditional Doc uments f or Informa tion (on Boa rdEffect )
A Board and Committee minutes (For i nformation only)
B CEPI 202 1 Annual Progress Report

Boa rd-2022 -Mtg -02-Doc 0 0b





G avi Alliance Board Meeting
22 -23 June 2022
Global Health Campus, Geneva, Switzerland


Monday 20 and Tuesday 21 June : Pre -Board meetings
Wednesday 22 June : 09.00 -17.30 (Board meeting Day One)
Thursday 23 June : 09.00 -17.15 (Board mee ting Day Two)
Quo rum: 14


Agenda























Nex t Board Me eting : 7-8 December 2022
29 -30 March 2023 (Board Retreat )
28 -29 June 2023
6-7 December 2023

---
Brenda Killen , Director, Governance and Secretary t o the Board, +41 22 9 09 6680 , bkillen @gavi.o rg
Joanne Goetz , Head, Governa nce, + 41 22 9 09 6 544, jgoetz@gavi.org
Please note that the Board mee ting will be recorded. This recording will be used as an aid to minute t he meeting .
A transcr iptio n of the full proceed ings will not normally be made . Shou ld a tr ansc riptio n be mad e it wil l be used
only as an aid to minute the meeting .
 

Bo ard-2022-Mt g-02-Doc 0 1a




Gavi Alliance Board Meeting
22 -23 June 202 2
Global Health Campus, Geneva, Switzerland
Quorum: 1 4
Declarations of Interest

Declarations
Section 5.5 of the Conflicts of Interest Policy for Governance Bodies states ?Members
involved in decisio n-makin g proce sses on b eha lf of Gavi must take appropriate action to
ensure disclosure of Interests and Conflicts of Inter est, and take the necessary action in
respect thereof.?
Section 6.2 of the Conflicts of Interest Policy for Governance Bodies further states , ?T he duty
to d isc lose [in 6.1 above] is a continuing obligation. This means that Members are obliged to
disclose any Interests and/or Conflict of Interest, whenever the Member comes to know the
relevant matter.?
The following declarations were made b y me mbe rs of the Bo ard on their most recent annual
statements .
Board members:
Member Org anisational Interest s

Financial/Personal/Advisor Int /
Others














Jos? Manuel Barroso , Chair




























Non e














Goldman Sachs International
(Chairman and Non -Executive
Director -Advisor); Princeton
University - Princeton School of
Public Policy, LISD, (Non
Resident Fellow); Catholic
Unive rsity of Portugal (Visiting
Professor); Centre for European
Studies (Director); Graduate
Institute of International and
Development Studies -Geneva,
(Visiting Professor); The
EUROPEAUM (Board Member);
WPL -Women Political Leaders
(Advisory Board Member); Jea n
Monnet Foundation for Europe
(Honorar y Committee Member);
European Centre for Culture,
(Honorary Co -President);
Portuguese Diaspora Council
(Chairman General Assembly);
Bilderberg Meetings (Steering
Committee Member); Concordia
(Leadership Member Counci l);
World Leadership Alliance ? Club
de Madrid (Member); Teatro Real
Madrid (International Council
member); Royal Institute of
International Affairs (Chattam

Board -202 1-Mtg -04 1
Minutes


Gavi Alliance Board Meeting
30 November 2021 ? 2 December 2021
Virtual meeting


1. Chair?s Report

1.1 Noting that the meeting had been duly convened and f inding a quorum of members
present, the meeting commenced at 15.15 Geneva time on 30 November 2021.
Prof Jos? Manuel Barroso, Board Chair, chaired the meeting.

1.2 The Chair welcomed Kenneth Lay, Chair of the International Finance Facility for
Immunisation (IFFIm) Board and other directors of the IFFIm Board ; as well as
James Hargreaves, Chair of the Evaluation Advisory Committee .

1.3 Prof Barroso provided a summary of the Board and Board Committee ?s activity
since the last Board meeting in September 2021 , which ha d included 16 formal
meetings of Gavi Board Committees and other related bodies . He noted that this
high level of engagement meant that the decisions before the Board ha d been well
prepared a nd should not require further detailed discussion .

1.4 The Chair presented a short summary of the All Chairs Group (ACG) meeting on
30 November 2021 , during which the Group had discussed the Board agenda and
recent discussions of the agenda items in the Gavi Board Committees . The ACG
also emphasised the importance of good governance practices, especially
throughout this period of uncertainty and heavy Board workload.

1.5 He reflected on the progress that ha s been seen on both Gavi core business and
COVAX. He noted that d espite pandemic -related disruptions to immunisations
services, the Alliance had achieved or exceeded all of its Gavi 4.0 mission targets.

1.6 The Chair also noted that the ambitious targets set for COVAX for 2021 ha d not
all been reached. This reflects a whole range of issues ? from export restrictions
to stockpiling to production shortfalls ? most of which were outside Gavi?s control.
But it do es not reflect any lack of commitment by those working on COVAX, who
have gone beyond expectations to find ways to bring vaccines to the developing
world. The latest figures show the impact of the ?year -end sprint? that has resulted
in 555 million doses ha ving been shipped and 1.4 billion doses having been
allocated.

1.7 He also remarked that the current period has brought new challenges, including a
recent surge in cases , the emergence of new variants , along with a clamour for
boosters and continued vaccine hesitancy , demonstrat ing that the pandemic has
not reached its end.

1.8 Prof Barroso reported that he ha d participated in several high -level engagements
recently where global leaders ha d expressed their conviction about the importance
of the work of COVAX. He also informed the Board of the honour that the

Board -202 2-Mtg -01 1

Minutes



Gavi Alliance Board Meeting
6 April 2022
Hotel Ermitage, Evian -les -Bains, France


1. Opening Remarks

1.1 Noting that the meeting had been duly convened and finding a quorum of members
present, the meeting commen ced at 16.45 Evian time on 6 April 2022. Prof Jos ?
Manuel Barroso, Board Chair, chaired the meeting which was held in closes
session.

1.2 The Chair welcomed participants to the first formal Board meeting of 2022 , noting
that this was also the first in-person Board meeting since December 2019. He
informed the Board that two members - Faisal Sultan and Yibing Wu - had joined
the meeting by phone .

1. 3 The Board Chair briefly introduced the agenda, and explained that he would ask
Seth Berkley, CEO , and Anuradha Gupta, DCEO , to leave the meeting room for
the third item on the agenda (Annual CEO Performance Review) given the
confide ntial nature of this item.

------

2. Consent Agenda

2.1 Professor Barroso informed the Board that there were two decisions on the
consent agenda:
? The appointment of Lucy Elliot as Managing Director, Audit and Investigations;
and
? Amendments to the Market -Sensitive Decisions Committee Charter.

2.2 He explained that both items had been discussed in committees and that relevant
documentation had been shared with the Board ahead of the meeting. As there
had been no requests to place any of these items on the main agenda, he
confirmed that these decisions would be covered in the review of decisions at the
end of the Board meeting.

2.3 Closing this agenda item, Professor Barroso informed the Board that they would
have the opportunity to meet the incoming Managing Director for Audit and
Investigations at the drinks reception for the Board retreat later in the day. He then
asked Seth and Anuradha to leave the meeting before the discussion of Item 3.



 

1



Board -2022 -Mtg -02-Doc 01d



Since the Nov ember/December 2021 Board meeting, six decisions have b een
circulated to the Board electronically for approval by no -objection consent in line
with Section 11 of the Board and Board Committee Operating Procedures .

1) On 1 0 January 2022 , Board members were invited to consider approval of the
appointment of CEO Se arch Committee Members .

No objections were received prior to the end of 2 0 January 2022 and the
following decision was therefore entered into the record:

In accordance with Decision 1 of the Gavi Board at its meeting on 30 November
2021, and with Section 11.3 of the Board and Board Committee Operating
Procedures, on a no -objection basis, the Gavi Alliance Board:

Confirmed that the composition of the CEO Recruitment Search C ommittee
be constituted as follows:

Jose Manuel Barroso, Board Chair and S earch Committee Chair
Sarah Goulding (Governance Committee Chair ? ex officio)
Beth Arthy
Zsuzsanna Jakab
Violaine Mitchell
David Sidwell
Faisal Sultan

2) On 27 January 2022 , Board members were invited to consider approval of the
appointment of an Alternate Board Member.

No objections were received prior to the end of 8 February 2022 and the
following decision was therefore entered into the record:

In accordance with Section 11.3 of the Board and Board Committee Operating
Procedures, on a no -objection basis, the Gavi Alliance Board:

Appointed Takeshi Akahori as Alternate Board Member to Sarah Goulding
representing Japan, effective immediately and until 31 December 2023.


SUBJECT : NO -OBJECTION CONSENT DECISIONS
Agenda item: 01 d
Category: For Decision
Report to the Board
22 -23 June 2022

1



Board -2022 -Mtg -02-Doc 01e


Section A: Introduction
Nine recommendations are being presented to the Board under the Consent
Agenda for consideration. Detailed information on the items can be found in the
relevant Committee paper s in a dedicated folder on BoardEffect at:
https://gavi.boardeffect.co.uk/workrooms/6459/resources/190583
Section B: Actions requested of the Board
The Gavi Alliance Board is requested to consider the following recommendat ion s
from the Gavi Alliance Governance Committee , Audit and Finance Committee and
Programme and Policy Committee.
Decision One ? Board Committee Chair Appointments

The Gavi Alliance Governance Committee recommend s to the Gavi Alliance
Board that it:

Appo int Anne Schuchat as Chair of the Programme and Policy Committee
effective 1 July 2022 and until 31 December 2023.
Decision Two ? Board and Committee Member Appointments

The Gavi Alliance Governance Committee recommend s to the Gavi Alliance
Board that it:

a) Appoint Deena Schiff as an Unaffiliated Board Member in the seat currently
held by Helen Rees effective 1 July 2022 and until 30 June 2025 ;

b) Appoint Aamer Ikram of Pakistan as Board Member representing the
implementing country constituency in the seat currently held by Faisal Sultan
of Pakistan, effective immediately and until 31 December 2023 ;

c) Appoint Won Do -yeon as Alternate Board Member representing the Republic
of Korea on the donor constituency anchored by the United States in the seat
currently held by Takeshi Akahori of Japan, effective immediately and until 31
December 2023 ;

SUBJECT : CONSENT AGENDA ? UPDATED AS AT 20 JUNE 2022
Agenda item: 01 e
Category: For Decision
Report to the Board
22 -23 June 2022

June 202 2
INVESTMENT COMMITTEE CHARTER
1. P U RP O S E
The Investment Committee (?Committee? or ? the I C?) is established by the Board
(?Board?) of the Gavi Alliance (?Gavi?) to support the Board in fulfilling its oversight
responsibilities in a timely manner in respect of the management of Gavi?s investments .
This is done in a manner consistent with Gavi?s operating needs and overall programme
goals, asset preservation and growth within Gavi?s investment portfolio, and p rude nt
maximis ation of risk - adjusted returns on investment consistent with objectives stated in
the Investment Policy.
The Committee is to provide assurance to the Board on the effectiveness of
Gavi?s investment portfolio.
The Committee will review, monitor and make recommendations to the Board on the
areas within its scope of responsibilities and on any other matters which the Board may
request.
Words and expressions used in this Charter shall, unless the context requires otherwise,
have the meaning attributed to them in the Gavi Board and Board Committee Operating
Procedures (?Operating Procedures?) .
2. M E M B E RS H I P
The membership , resources, responsibilities and authorities of the Committee to perform
its role effectively are stipulated in this Charter, which may be amended by the Board as
and when required or deemed necessary and are specifically governed by Article 18 of
the S tatutes and Section 18 of the Operating Procedures.
A. Composition and size
The composition of the I C shall allow it to function efficiently and effectively in fulfilling
its functions and responsibilities . The composition of the IC is intended to comprise
individuals suitably competent in the affairs and issues falling within the Charter so as to
be able to provide the Board and the Secretariat with sound advice on matters set out in
this Charter.
Doc 01e - Annex A

Report to the Board


1
Board -2022 -Mtg -02-Doc 01 e-Annex B
Annex B: Decision language for co -financing flexibilities approved by the Board in
December 2019
In December 2019, the Board approved an approach to apply co -financing flexibilities for
countries facing severe fiscal distress and/or a humanitarian crisis. The paragraphs below
describe the approach that was submitted to the PPC and Board and approved.
Paragraphs 2.8 to 2.10 of Doc 04 to the PPC in October 2019

2.8 Definition: The proposed approach is summarised in Figure 4 . Given the
unpredictable nature of such events, it would not be possible to define a priori
indicators and thresholds that would be universally valid to identify countries which
might need co -financing flexibilities. However, it would be governed by clear
principles. At its core are the underlying principles that Co -financing Policy
flexibilities should only be envisaged in very rare, exceptional circumstances,
created by severe economic and fiscal distress (significantly beyond the usual
fluctuations of economic cycl es, e.g. , annual GNI drop of 30%) or humanitarian
crises (i.e. widespread, large -scale conflict or disasters of such magnitude that
profoundly hamper the delivery of health services ). In the case of humanitarian
crises, a country would only be considered f or co -financing flexibilities if it were
also contemplated under Gavi?s Fragility, Emergencies and Refugee (FER) Policy 1
to align with a broader set of flexibilities they might access. To complement these
principles, operational guidelines would be develop ed to promote process
consistency. Detailed background analyses are summarised in Appendix 4 of
Doc 04 to the PPC in October 2019 and provide examples of indicators that could
be leveraged at the operationalisation process to inform the identification of
possible cases.
2.9 Support: Proposed flexibilities include:
a) Countries facing severe fiscal distress : in these situations, co -financing
obligations could be adjusted as per the rules prevailing in the country?s
previous phase. To illustrate this using current co -financing rules, this means
that co -financing obligations for countries in preparatory transition phase would
not increase (as for countries in initial self -financing), and countries in
accelerated transition phase would see their year -on -year c o-financing
obligations increase by 15% (as for countries in the preparatory transition
phase). Specific ramp -up rates will be reviewed as part of Phase II of the policy
review.
b) In countries facing humanitarian crises : as a reflection of the severity of the
disruption in government functioning inflicted by a large humanitarian crisis, co -
financing obligations would be temporarily waived on an annual basis.
2.10 Governance : It is envisaged that the decision -making process for the application
of fle xibilities would rely on a similar process as the one described for the mitigation
of risk of unsuccessful transition ( Figure 3 ). Although humanitarian crises or
severe fiscal distress episodes are inherently difficult to predict, the PPC and the

1
Report to the Board
Board -2022 -Mtg -02 -Doc 01e -Annex C
Annex C: Proposed innovation approach for Gavi 5.0
This annex is a n extract of Section 2 of the May 2022 PPC paper
2.1 Innovation in Gavi 5.0 will be defined as new products, practices and
services that unlock more efficient and effective ways to accelerate
countries? immunisation objectives in line with Gavi?s mission. Rather
than a radical shift, the approach is an evolution of Gavi?s existing innovation
model a nd is intended to help accelerate progress towards reaching its
ambitious strategic goals for Gavi 5.0 and beyond 1.
2.2 A Theory of Change describes how the innovation approach will
contribute to Gavi ?s four strategic goals including access to COVID -19
vacci nes 2 (see Figure 1). The key expected outcomes of the innovation
approach are to accelerate the restoration of routine immunisation, reach more
zero -dose children, and help scale -up COVID -19 vaccination in an integrated
way. This will be achieved using new products, practices, and services across
priority programmatic areas at the country level. Gavi also expects innovations
to increase the effectivenes s, efficiency, and sustainability of immunisation
programmes. An example of an innovation that helped improve programmes?
effectiveness and efficiency is the eVIN 3 platform in India. eVIN was designed
to record supply chain transactions and collect data o n vaccine stock and
storage temperatures up to last -mile health facilities and led to significant
savings in vaccine utilisation (30%) and reduced stock -outs (by 40%) 4. Building
on eVIN and with Gavi support, the Government of India built a new tool, call ed
CoWIN integrating the tracking of COVID -19 vaccine beneficiaries. Applied to
routine immunisation, CoWIN could have a tremendous impact in reducing the
number of zero -dose and under -immunised children.

1 Innovations linked to Gavi?s operating model, policies, and processes are not part of this approach 2 At its December 2021 meeting the Board reconfirmed that ensuring access to COVID -19 vaccines are part of the recalibrated Gavi 5.0 priorities 3 Electroni c Vaccine Intelligence Network 4 eVIN 2018 Assessment report

1



Board -2022 -Mtg -02-Doc 02 _FR

R ap port pour le Conseil
d?administration
22-23 juin 202 2


Le 15 juin 202 2

Chers membr es du Conseil d?administration ,
Au moment de r?diger ce rapport et de pr?parer les importantes discussions et
d?cisions qui nous attendent lors de not re prochaine r?union, je ne peux
m?emp?cher de penser au plaisir que j?ai eu ? vous voir tous ? ?vian . Je r?alise
l'importance , pour les membres du Conseil d?administration , de se r?unir en
personne . La retraite d??vian ?tait notre premi?re r?union depuis plus de deux ans
- la premi?re avec la participation de Jos? Manuel, Pr?sident de notre Conseil
d'administration, et de plusieurs autres nouveaux membres du Conseil . Elle a
permis un dialogue ouvert et constructif sur l'?volution de la situation et sur le r?le
et l'ambition de Gavi. ? la fin du mois dernier, nous avons ?galement tenu notre
premi?re r?union en pr?sentiel du Comit? des programmes et des politiques
(Programme and Policy Committee - PPC ) depuis le d?but de la pand?mie ,
r?union au cours de laquelle nous avons pu nous appuyer sur les nombreuses
discussions tenues lors de la retraite , sachant qu?elles sous -tendent les points ?
l?ordre du jour du prochain Conseil d?administration. Les discussions qui ont eu lieu
lors de notre retraite, ainsi que celles que nous avons tenues de fa?on r?currente
dans le cadre du Comit? des programmes et des politiques et du Comit? d'audit et
des finances (Audit and Finance Committee - AFC ), nous ont permis de mettre en
?vidence quelques fils conducteurs : l'?quit? comme principe f?d?rateur ; la
planification en ces temps d'incertitude, ? l?aide des enseignements de la COVID -
19 et de COVAX ; l?implication de Gavi dans la pr?paration et la riposte aux
pand?mie s (Pandemic Preparedness and Response - PPR ) ; et la sant? de
l'Alliance et de son personnel. Je me r?jouis de vous rencontrer ? la fin du mois
pour aborder ces th?mes sur la base du r?sultat de no tre r?flexion au cours de la
retraite et des discussions des diff?rents Comit?s .
L'?quit? comme principe f?d?rateur
Il faudra encore un certain temps avant de pouvoir quantifier pleinement l'impact
de la pand?mie de COVID -19. D?apr?s les estimations de l'OMS publi?es le 5 mai
2022 ? le nombre total de d?c?s associ?s directement ou indirectement ? la
pand?mie de COVID -19 (la ?surmortalit? ?) entre le 1er janvier 2020 et le
Rapport du Directeur ex?cutif

1



Board -2022 -Mtg -02-Doc 02

Report to the Board
22-23 June 202 2


15 June 202 2

Dear Board members,
In drafting this Report and anticipating the important discussions and decisions
ahead , I was reflecting on how good it was to see you all in Evian and how vital it
is that we have these moments to come together in person as a Board. The Retreat
was our first in-person meeting in over two years ? the first with our Board Chair,
Jos ? Manuel, and several other newer Board Members ? and proved an important
moment for open and constructive dialogue on the shifting landscape and Gavi?s
role and ambition. Late last month, we also had our first in-person Programme and
Policy Committee (PPC ) meeting since the start of the pandemic , where we built
upon many of the discussions from the Retreat as they underpin the agenda items
coming before us at the Board. There were a few key thr eads that came through
in both the Retreat and recurrent PPC and Audit and Finance Committee (AFC )
discussions : equity as our unifying principle; planning in times of uncertainty,
including embracing the learnings from COVID -19 and COVAX, and Gavi?s
engage ment in pandemic preparedness and response (PPR ); and the health of the
Alliance and our staff. Building on these themes and the strong foundation of our
Retreat and Committee discussions, I am looking forward to our upcoming meeting
and seeing you in person later this month.
Equity as our unifying motivation
It will still be some time before we are able to fully quantify the impact of the COVID -
19 pandemic. WHO estimates released on 5 May 2022 suggest that a ?staggering
14.9 million excess deaths were directly or indirectly attributable to COVID -19
between 1 January 2020 and 31 December 2021?. The global reported number of
COVID -19 cases and deaths in Gavi eligible -countries is much lower , but testing
has always been limited and recently plummeted, whi ch also puts at risk
identification of new variants. Fortunately, South Africa is continuing to test and
sequence ; however, unfortunately the country is seeing a new outbreak of BA.4
and BA.5 Omicron variants ? while the USA is seeing BA.2.12.1 spreading and
now BA.4 and BA.5 as well. We may be done with the virus, but it is not done with
us.
Report of the Chief Executive Officer

1



Board -2022 -Mtg -02-Doc 03


Section A: Executive Summary
This is the second report to the Board on progress in implementing Gavi?s
2021 -2025 strategy and associated risks 1, and the first update reporting
against the new Gavi 5.0 measurement framework. This report provides
quantitative updates on a limited numbe r of strategy indicators for which new data
is available 2 as well as a more qualitative perspective of progress across the four
Strategic Goals.
2021 was the first year of the new Gavi 5.0 strategic period and focused on
preventing backsliding of routine immunisation in light of the COVID -19
pandemic, as well as establishing strategic and operational alignment
towards achieving Gavi 5.0 goals 3. As discussed by the Board at its retreat in
April 2022, the pandemic has placed an incredible strain on immunisa tion
programmes, contributing to a 2.7 million 4 increase in the number of zero -dose
children across Gavi -57 eligible countries in 2020 . Routine immunisation has
continued to show some level of disruption in 2021 as countries have tried to ramp
up COVID -19 vaccinations, particularly in the second half of the year. Equity gaps
are widening, reversing the pre -pandemic hard won gains. As a result, Gavi?s
mission i s both more important and more challenging than ever.
As the Alliance enters the second year of Gavi 5.0, focus is shifting to
?executing for impact? against the backdrop of continued COVID -19 related
disruptions. In 2022 the focus is on supporting in -coun try programming to both
sustain coverage and stretch to reach zero -dose children. For example, India and
Pakistan are going through their Full Portfolio Planning (FPP) process, putting
unprecedented efforts on identifying zero -dose children and missed comm unities
and developing targeted strategies to reach them. In addition, up to 40 countries
are expected to apply for the Equity Accelerator Funding (EAF) to help reach zero -

1 Associated risks refer to the top risks described in the 2021 Risk & Assurance Report . The AFC
update on risk management provides a more detailed update on majo r changes in Gavi?s risk profile
since the Risk & Assurance Report was discussed in December. 2 Noting that the WUENIC coverage data for 2021 will not be released until July 2022, and therefore
a more comprehensive update on Strategic Goals 1 and 2 will be provided at the next Board
meeting 3 For example, through the development of new guidelines and application materials to help
strengthen country programming, the realignment of existing funding streams, and the creation of
a new dedicated funding stream targeting zero -dose children and missed communities (the Equity
Accelerator Fund (EAF)) 4 Coverage across Gavi -57 eligible countries, WUENIC, July 2021
SUBJECT : STRATEGY, PROGRAMMES AND PARTNERSHIPS:
PROGRESS , RISKS AND CHALLENGES
Agenda item: 03
Category: For Guidance
Report to the Board
22 -23 June 2022

Report to the Board

Board -2022 -Mtg -02-Doc 03 -Annex A

Annex A : Gavi 5.0 dashboard and update on key metrics
This is a technical report providing definition s of and progress against Mission and
Strategy Goal indicators in the new Gavi 5.0 measurement framework. The technical
report is populated based on available data and updated bi -annually. The available data
for 2021 included in this report relate s to Strategi c Goal (SG) 1.4, 3.1, 4.1, 4.2 & 4.3. The
remaining indicat ors will be updated in September .

Gavi 5.0 Mission Indicators
M.1: Under -five mortality rate

By increasing access to immunisation and
enabling equal access to new and underused
vaccines, Gavi support is contributing to the
reduction in under -five deaths from vaccine -
preventable diseases.

Indicator will be updated for 2021 in April 2023.
M.2: Number of future deaths averted with Gavi support

This indicator estimates the impact of Gavi -
supported vaccinations in terms of averting
futur e deaths from vaccine -preventable
diseases.

Indicator will be updated for 2021 in September
2022.

M.3: Number of future disability -adjusted life years (DALYs) averted

Reduction in overall disease burden from
vaccine -preventable diseases is one of the
ultimate impact measures of Gavi support.

Indicator will be updated for 2021 in September
2022.
M.4: Reduction in the number of zero -dose children

The indicator serves as an equity measure,
giving an indication of the reach of routine
immunisation services to missed communities,
with an emphasis on regularly reaching children
who are being missed by routine immunisation.

Indicator will be updated for 2021 in September
2022.

58 56
Target: decrease by 10%
0
20
40
2019(Baseline) 2020 2021 2022 2023 2024 2025
Target: 7 -8M
0M
2M
4M
6M
8M
10M
2021 2022 2023 2024 2025
Target: 320 - 380M
0M
100M
200M
300M
400M
2021 2022 2023 2024 2025
9.7M 12.4M
Target: decrease by 25%
0.M
5.M
10.M
15.M
2019(Baseline) 2020 2021 2022 2023 2024 2025

1



Board -2022 -Mtg -02-Doc 04


Section A: Executive Summary
At its December 2021 meeting, the Gavi Alliance Board reviewed and approved
the Financial Forecasts for (i) Gavi (excluding COVAX) for the Strategic Period
2021 -2025 ( Gavi 5.0 ) and (ii) COVAX Advance Market Commitment ( COVAX
AMC ).
This paper presents the updated Financial Forecasts for Gavi 5.0 and COVAX
AMC (2020 -2023) including the impact of the additional Gavi 5.0 investment priorit y
presented for decision at this Board meeting and the outcome of the April 2022
Break COVID Now Summit . Further, solely for compl iance with the Programme
Funding Policy and to enable the Secretariat to allot funding , an initial financial
forecast for the 2026 -2030 Strategic Period (Gavi 6.0) is presented for the first time
based on existing programmes .
While many risks remain elevated and this uncertain environment continues to
require close monitoring of assumptions and frequent updates to the forecast as
risks may evolve and materiali se, at this point there are no material changes to
the approved expenditure s in the Gavi 5.0 financial forecast although certain
activities have been rephased to reflect 2021 performance . The consequences of
implementing key strategic initiatives during a global pandemic may continue to
impact 2022 disbursement levels and the pha sing of this financial forecast, which
the Secretariat considers ambitious but achievable, has been carefully considered
as part of the reforecast. The key assumptions underpinning the financial forecast
reflect the Secretariat?s continued assessment that while routine immunisation
programmes are at risk of disruption from the pandemic and implementation of
COVID -19 immunisation programmes, implementing countries continue to
demonstrate resilience and strong commitment to these programmes .
The future direct ion of the C OVID -19 pandemic is uncertain. While COVAX? s
challenge is to ensure it is ready should any of the WHO pandemic scenarios come
to pass, we are at a new juncture in that vaccine supply is readily available. COVAX
is adapting and providing differentiated support in line with the national plans,
priorities and coverage targets of each AMC country. The COVAX AMC forecast
has been updated to reflect the new commitments made at the April 2022 Break
COVID Now Summi t that will enable COVAX to provide urgent delivery support for
lower -income countries , ensure dose donations can be shipped and administered ,
and enable Gavi to launch the Pandemic Vaccine Pool. COVAX is currently
?resizing and rephasing? its portfolio to meet the latest demand context from
countries (working closely with the Market -Sensitive Decision s Committee (MSDC)
SUBJECT : FINANCIAL UPDATE, INCLUDING FORECAST
Agenda item: 04
Category: For Decision
Report to the Board
22 -23 June 2022

Report to the Board
Board -2022 -Mtg -02-Doc 04 -Annex A

Annex A: Implications/Anticipated Impact
General Overview: Forecast Process and Governance including anticipated
impact

Impact on countries
Approval of the Financial Forecast enables funding to be allotted to programmes in
accordance with the Programme Funding Policy.

Risk implication and mitigation, including information on the risks of inaction
Determination of Gavi?s financial capacity to approve the recommended decisions
relies on the Financial Forecast.
Risks that may impact the reliability of the financial forecast are described below, as
well as the mitigation strategies in place to address these risks.
One of those risks arises from exposure to foreign currency exchange rate
fluctuations. In the forecast, non -USD pledges are valued at their USD equivalents
using the Bloomberg spot exchange rates when compiling the forecast (consistent with
the approach agreed with donors) or, where hedged, at the hedge rate. Pledges are
hedged progressively.
Gavi?s Cash and Investments Reserve provides a cushion for adverse fluctuations in
resources and expenditures. Gavi can also decline or defer funding re quests based
on resource availability.
Risks associated with the financial forecast and mitigation
Factors that may impact the expenditure forecast include:
Demand volumes can vary significantly based on small changes in country
introduction assumptions . While the introduction assumptions made in the current
forecasts leverage the information readily available, there remains an inherent high
degree of uncertainty on these assumptions. In addition, the assumptions on
introduction timing are often dependen t on projections of when a country will no longer
be eligible for new Gavi support. This forecast represents the application of the current
Board approved Eligibility and Transition Policy. Changes or exceptions to this policy
could vary demand significant ly.
Price forecasts reflect expected market dynamics specific to each vaccine. The point
forecast represents a moderate most likely scenario estimate among a range of
possible estimates and reflects information available at the time of preparation.
The forecast includes assumptions for supply availability as currently anticipated and
assumes no widespread or macro impact to supplier capacity or pricing, based on the
outcome of recent tenders and no indications to date of any widespread disruption to
suppliers which could impact Gavi?s core vaccine programmes . The impact of long
term disruption to supply or input prices from the Ukraine/Russia?s conflict is currently
assessed as low and the Secretariat is actively working with partners to mitigate risk

Report to the Board
Board -2022 -Mtg -02-Doc 04 -Annex B

Annex B: Financial Forecast Detail Gavi 5.0
1. Expenditure to meet country demand
1.1 The expenditure estimates in this June 2022 (v19.1) forecast are based on the
latest vaccine cost forecast (version 19.0), issued in August 2021, adjusted as
of March 2022. The forecast reflects all previous funding decisions of the Board.
It incorporates updated implementation assumptions bas ed on latest
information regarding country readiness and vaccine supply availability.
1.2 The overview of projected expenditures (below) illustrates the scale -up of
country demand, with Gavi -funded expenditure having reached an average
level of US$ 1.9 billion per year in 2016 -2020. Based on the current vaccine
investment strategy and approved Gavi 5.0 expenditure forecast, this will
increase to US$ 2.1 billion per year in the 2021 -2025 period.
Figure 1: Evolution of expenditure

The increase of expenditures from the last strategic period (2016 -2020) to the
current (2021 -2025) results primarily from expanded programmatic support 1,
partially offset by the impact of countries that will transition out of Gavi support.
1.3 Country co -fina nced & self -financed amounts are shown at the top of each bar.
Total co -financed and self -financed amounts for 2016 -2020 amounted to
US$ 0.7 billion and US$ 0.9 billion, respectively (with a yearly average of
US$ 0.3 billion, per year, including both amounts). These amounts are
estimated to increase to approximately US$ 1.1 billion, US$ 2.3 billion and
1 YF EYE strategy, extension of IPV support across Gavi 5.0 (including rollout of IPV 2 nd dose),
expansion of HPV program and increase in cash -based support ( including Equity Accelerator Funding ,
increases in PEF -related expenditure and institutionali sing post -transition support & exploring MICs )
-
200
400
600
800
1,000
1,200
1,400
1,600
1,800
2,000
2,200
2,400
2,600
2,800
3,000
3,200
3,400
3,600
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
Expenditure Estimates 2016 - 2025 (US$ millions)
Secretariat Partners Cash Based Programmes
Vaccine Programmes Other Programmatic New Investments (for decision)
Country co-financing Transitioned country Total GAVI funded
2021 -25 average per year
$2.1 bn Gavi
Country (co -financed + self -financed) $0.7bn
Gavi funding
Co -financing
2016 -20 average per year
Gavi $1.9 bn
Country (co -financed + self -financed) $0.3 bn
Countries s elf -financing*
*Country self -financing includes India

Report to the Board
Board -2022 -Mtg -02-Doc 04 -Annex C

Annex C: Financial Forecast Detail Gavi 6.0
The Gavi Programme Funding Policy requires that :
a) As a prerequisite to the approval or endorsement of any new programme, an
amount of Qualifying Resources shall be set aside to fully cover all commitments
arising in the period from the start of the then current year through the next two
calendar years (th e Defined Period): 2022 -2024;
b) The Secretariat shall also provide the Board with a projection of commitments
arising and Qualifying Resources in the three years subsequent to the Defined
Period, so that the Board can take into account the longer -term implications when
considering the funding of new programmes: 2025 -2027
c) The Board or EC may from time -to -time approve a financial forecast for a period of
between five and ten year s within the limits of which the Secretariat is authorised
to allot funding to programmes for up to a 5-year period at the time of allotment or
other period as the Board or EC may specify for the continuation and adjustment
of funding for existing programm es and for new programmes
1. To ensure compliance with the requirements of the Programme Funding Policy
and enable the Secretariat to allot funding in accordance with the Multi -Year
Approvals for up to a 5 year period the table below provides a year -by -year view
of the cash outflows to meet the needs of existing and future programmes, and
the resource inflows t o meet those needs, highlighting the two 3 -year periods
relevant to the Funding Policy: 2022 -2024 and 2025 -2027.
Figure 1: Projected Expenditure (2022 -2027)

2. The outer years of the rolling six -year period includes the first two years of the
next strategic period. Therefore, the Secretariat has prepared a draft high -level
estimate of the next strategic period forecast expenditure incorporating the
continuation of existing programmes only to enable the Secretariat to provide
Multi -Year Approvals to existing programmes and not prejudge future Board
considerations of Gavi 6.0 strategic investments.
Cash flow basis, US$ millions 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030
Total Expenditure to meet demand* 1,892 1,915 2,155 2,143 2,329 1,759 1,662 1,484 1,416 1,489
Qualifying Resources available 1,622 2,108 2,170 1,984 2,437 1,727 1,802 1,723 1,615 1,690
Additional available / (required) - for year (270) 193 15 (159) 108 (32) 141 239 200 201
Additional available / (required) - cumulative 90 284 298 139 247 215 356 594 794 995
2024 2027
Six-year period
* Expendi ture from 2026 onwa rds i s ba s ed on conti nua ti on of exi s ti ng progra mmes onl y

Report to the Board
Board -2022 -Mtg -02-Doc 04 -Annex D

Annex D: Financial Forecast Detail COVAX AMC
Figure 1: COVAX AMC Resources

Qualifying Resources Overall cash Qualifying Resources are US$ 12.3 billion . This
reflects the new US$ 1.7 billion pledges from the April 2022 Break C OVID Now
Summit . There was a US$ 253 million decrease to the past resources primarily due to
IFFIm?s Gearing Ratio drawdown l imit and adverse foreign exchange impact . Of the
US$ 12.3 billion pledged, US$ 10.2 billion has been received, US$ 9.4 billion relating
to vaccine procurement and ancillary costs and US $0. 8 billion relating to delivery
support.
IFFIm Proceed s have come down by US$ 69 million to reflect the COVAX portion of
the gearing ratio drawdown li mit (currently 73%) across both Gavi 5.0 and COVAX
resources (US$ 144 million) despite a US$ 75 million increase from two direct pledges
that were converted to IFFIm pledges after December 2021.
The European Investment Bank ( EIB ) Loan has been hedged and will be swapped
on a quarterly basis . The proceeds and repayment now reflect the hedged rate, which
results in a US$ 40 million lower value than the rate used in the previous forecast. This
is a frontloading capacity consideration only, and does not impac t total Qualifying
Resources. The COVAX AMC Financial Forecast only considers the EUR 440 million
AMC portion of the loan, as the balance relates to SFPs.
Dose -sharing and cost -sharing initiatives are key factors in COVAX achieving
vaccine coverage targets . While both initiatives are excluded from the Gavi financial US$ million, cash-flow basis 2020-2023
Prior
Forecast
Dec 2021 Board
Change
upon updating
estimates
Phase III
Investments
New
Forecast
June 2022 Board
Resources Available
New contributions - Phase III - - 1,690 1,690
Direct contributions - Vaccines 8,875 (216) - 8,659
IFFIm Proceeds (projected) 1,153 (69) - 1,084
Subtotal Vaccines (projected) 10,028 (285) - 9,743
Direct contributions - Delivery 799 32 - 831
Subtotal Delivery (projected) 799 32 - 831
EIB Loan Proceeds 537 (40) - 497
BMGF Loan Proceeds 300 - - 300
Investment Income, etc. 1 - - 1
Total Inflows 11,665 (293) 1,690 13,062
EIB Loan Repayment (537) 40 - (497)
BMGF Loan Repayment (300) - - (300)
Qualifying Resources (US$) 10,828 (253) 1,690 12,265
$10.8 bn ($0.3 bn) $1.7 bn $12.3 bn

1

Board -2022 -Mtg -02-Doc 05


Section A: Executive Summary
Context
In less than two years since the creation of COVAX and the Access to COVID -19
Tools Accelerator, COVAX has now delivered over 1.5 billion COVID -19 vaccine
doses to 145 economies, including over 1. 3 billion doses to Advance Market
Commitment (AMC) economies, contributing significantly to coverage rates
achieved in AMC countr ies: 54 % with at least one dose and 46 % fully vaccinated
as of 24 May 2022, though overall coverage between, and within, countries
remains uneven as does coverage of high risk populations. Despite a challenging
supply situation in 2021, successful fundrais ing to the COVAX AMC, advance
purchase agreements (APAs) with multiple manufacturers, and generous dose
donations have ensured that COVAX has adequate supply to meet participants?
vaccine demand going forward. As we look to the future, Gavi will begin plan ning
for integration of COVAX , both operationally into the Gavi Secretariat and
programmatically as part of the Gavi 5.1 strategy (see Doc 03 ). We will need to
ensure adequate capacity as well as talent to ensure we can continue delivery on
the ne w integrated mission of Gavi 5.0 and COVAX as we continue to monitor and
adapt to an evolving environment.
This paper comprises three sections: 1) the current status of COVAX Facility
operations; 2) COVAX Facility role and ambition in vaccine procurement a nd
delivery in 2023, including integration of COVAX Facility operations and activities
into core Gavi Secretariat and programming as part of Gavi 5.1; and 3) COVAX
Facility vaccine policies. This paper builds on previous Board and Committee
discussions and presents decisions for the Board to approve of Gavi?s continued
administration of the COVAX Facility, flexibility to develop new or revised Gavi
COVAX AMC positions aligned with SAGE (Strategic Advisory Group of Experts
on Immunization) guidance, such as on paediatrics and boosters, and support for
the continued limited provision of paediatric doses.
Questions this paper addresses
Part I: Current Status of Operations
? What progress has Gavi made supporting AMC participants achieve their
COVID -19 vaccination goals?
SUBJECT : COVAX: KEY STRATEGIC ISSUES
Agenda item: 05
Category: For Decision
Report to the Board
22 -23 June 2022

Report to the Board
Board -2022 -Mtg -02-Doc 05 -Annex A

Annex A: Interim Approach to Paediatric Support

This section provides an update on the interim, time -bound, policy approach on
paediatric vaccination support for children aged 5 -11 valid until June 2022.

The Office of the COVAX Facility, in close consultation with other COVAX partners,
established an interim, time -bound, approach to allocate paediatric vaccines for
children aged 5 -11 fro m April to June 2022 in response to several time -sensitive
demand and supply considerations. Several AMC participants that had achieved high
coverage or demonstrated high absorptive capacity requested paediatric doses from
COVAX and signaled that if COVAX was not able to meet this demand they would
consider buying paediatric doses through bilateral deals at their own expense
(potentially incurring health expenditures in the order of ~US$ 1-1.5 billion 1). In
aggregate, the initial expressed demand was equiv alent to approximately 150 million
doses. In view of the potential availability of Pfizer donated doses that may otherwise
have gone to waste, a decision was taken for COVAX to facilitate access of paediatric
doses for the sub -set of AMC participants expre ssing demand by requesting donors
convert commitments for adult doses to paediatric formulation to meet this demand on
a short -term basis, pending formal governance review and approval of a longer -term
approach. Given the urgent need to respond to particip ants? requests, this approach
was discussed and endorsed by the Chairs of the PPC, Board, and AFC as well as
the Vice Chair of the Board in late March 2022. Separate from this interim approach,
if there is demand from SFPs for paediatric doses and supply f rom donations that are
eligible to go to SFPs, COVAX intends to serve as a channel to allocate these
donations.

Based on feedback from the Chairs and partner consultations, the interim approach
included defined guardrails in terms of timing (until Jun e 2022), supply (meeting
whatever demand there was through donated Pfizer doses ? the only vaccine currently
with EUL and a SAGE recommendation for this age group), and demand, namely
1) Pfizer -eligible participants with >40% primary series coverage; 2) pa rticipants
proactively expressing demand; 3) participants making progress towards vaccinating
(with primary series and boosters) higher priority groups in the WHO prioritisation
roadmap; and 4) participants with demonstrated capacity to continue delivering EPI
vaccines through routine immunisation. It was also agreed that participants would not
be able to use COVID delivery support (CDS) funding to support the administration of
these paediatric doses. Syringes suitable for the paediatric formulation would b e
substituted for the adult formulation syringes that would otherwise have been
purchased for this volume of doses, and in principle, donors would cover the syringe
and other ancillary costs.??

To formali se demand requests for the interim approach, Expression of Interest forms
were sent to 26 participants in early April 2022 , all of whom had previously proactively
requested paediatric doses from COVAX and had already achieved or were expected
to achieve greater than 40% primary series cover age of their total population by
mid - May 2022 . Of those, 23 responded and 18 requested approximately 120 million
doses to be delivered between May and December 2022, although it should be noted
that demand is skewed heavily toward a few participants. Base d on a review of the
demand in the context of implementation feasibility as well as status of higher priority

Report to the Board
Board -2022 -Mtg -02-Doc 05 -Annex B

Annex B: Supporting Considerations for a Future COVAX -Supported Paediatrics
Program me and Risks and Trade -offs

Supporting considerations related to Option 2 ?

Paediatric vaccine supply : At present, there is one vaccine product (Pfizer) which has
received WHO EUL and SAGE recommendation for administration to children aged 5 -
?11 and which could be readily available through COVAX; currently there are no
vaccines with WHO EUL or SAGE recomm endation for administration in children
under 5. In addition, although the Moderna vaccine has not yet received EUL or SAGE
recommendation for use in under 12s, the EMA has approved a 6 -11 year paediatric
indication that is the same formulation as the boos ter already available through the
COVAX Facility. Subject to national policy, it is possible that countries could decide to
use Moderna booster doses they have received through COVAX for a paediatric
vaccination program me. The products available and expect ed over the next months
come with program matic challenges including UCC requirements (Pfizer), the
management of paediatric vs. adult formulations, and the availability of syringes.
Regarding devices, Pfizer requires a 0.2ml and Moderna a 0.25ml dose ? vol umes
without readily available supply of AD devices - and will require COVAX to provide 1ml
RUPs as an alternative (in line with WHO guidance). Several other products across
different platforms (mRNA, inactivated, ad -based, protein subunit) are undergoing
regulatory review and awaiting SRA, WHO EUL or SAGE recommendation in the short
and medium term (i.e. mid 2022 and 2023), broadening the supply options to meet
existing and future demand.

Paediatric vaccine demand from COVAX AMC participants: The AMC pa rticipants that
sought COVAX support for paediatric vaccination in the first few months of 2022 would
be covered by the interim policy approach. While there are no specific estimates,
additional demand from COVAX participants is expected to materialise in the coming
months as participants follow the policies and practices of high -income -countries
(HICs), countries in their respective region, and highly absorptive countries, to direct
resources to vaccinate children in parallel with their continued efforts t o reach their
higher priority populations. This trend will accelerate as additional vaccines for 5 -11
and as vaccines for younger age groups (under 5 -year -olds) receive WHO EUL and
are recommended by SAGE. Option 2 would seek to meet demand whilst also put ting
in place limited guardrails to ensure focus on higher priority population groups is
reinforced and avoid displacing routine immunisation .

Public health impact of paediatric vaccination: The WHO SAGE roadmap for
prioritising use of COVID -19 vaccines advises the administration of primary series and
boosters to higher priority groups, such as older adults, immunocompromised persons
or health care workers, before reaching medium and lower pr iority groups, such as
children and adolescents. The rationale for this is that globally, there are fewer
symptomatic infections and cases of severe disease and death in children than in older
adult age groups; the burden of long COVID also appears lower a mong children
compared to adults. However, benefits of vaccinating children go beyond direct health
benefits, such as positive psychosocial benefits and minimising school disruptions and
consequently disruptions to parents and society at large. 22 Paediatri c vaccine
effectiveness data in the context of Omicron indicates that immunity against infection
wanes rapidly but, as for adults, protection against severe disease is

Report to the Board

Board -2022 -Mtg -02-Doc 05 -Annex C

Annex C : COVAX Reporting Framework
Section A: Update on Gavi?s COVAX Facility and COVAX AMC Monitoring,
Evaluation and Learning (MEL) strategy

The table below provides some of the key highlights and updates on progress against
the core elements of Gavi?s COVAX Facility and COVAX AMC MEL Strategy since the
December 2021 Gavi Board.

MEL
strategy
component
Key activity Highlights / update ( June 2022)
Cross -
cutting
COVAX Theory of
Change
Refined and updated core theory of
change reflecting 2022 strategy developed.
Nested theories of change will also be
utilized by the independent evaluators as
part of their theory -based evaluation.
Monitoring COVAX Reporting
Framework
Reporting against COVAX Reporting
Framework made available for PPC and
Board.
Refined COVAX Reporting Framework to
reflect strategic shifts for 2022. The
framework may be further refined over the
course of 2022 to reflect further evolutions
in programming / strategy.
Complementary
monitoring to
COVAX Reporting
Framework
COVAX Facility, Gavi Secretariat teams
and core COVAX partners continue to
monitor aspects of the Facility and AMC to
a much greater extent beyond the metrics
currently captured in the topline Reporting
Framework. E xamples include:
? Vaccine Delivery Partnership outputs
focusing on absorption rates and other key
delivery metrics;
? Monitoring of operational progress
across subgrants funded through COVID19
Delivery Support;
? Other operational metrics and
analyses across supply, allocation,
deliveries and in -country implementation
gathered internally.
Core country
monitoring and
re porting on
COVID -19 /
COVAX
COVAX continues to utilise the WHO -
UNICEF electronic Joint Reporting Form
COVID -19 module (monthly reporting)
launched in March 2021 to gather core
reporting from COVAX participants.
Despite improvements over time, reporting
completeness continues to be an issue.

1



Board -2022 -Mtg -02-Doc 06


Section A: Executive Summary
This paper sets out a proposition for Gavi?s strategic engagement in the
pandemic preparedness and response ( PPR ) agenda , build ing on the
significant capacity Gavi has developed over more than twenty years of experience
in routine immunisation (RI) , and lessons learned from COVID -19 and COVAX .
Firstly , Gavi has a vital role to play in PPR as a vaccine alliance which builds
countries? capacity to respond in emergencies by strengthening RI programmes,
increasing efficiency , focusing o n equity and reaching missed communities. In
addition, the Alliance, together with CEPI (Coalition for Epidemic Preparedness
Innovations) , provides a unique, networked end -to -end view , from ?lab to jab ?,
across an extensive portfolio of diseases and vaccines. Going forward, t he Alliance
can use this strategic position, aided by learning from COVID -19 , to better define ,
communicate and deliver a substantial future role in PPR .
Secondly, a key lesson is that risk -tolerant , liquid resources are critical for
equitable vaccine access for lower -income countries in emergencies . Gavi?s
financial tools and capacity to innovate at pace can play a role in future responses .
Thirdly , Gavi has a core role in addressing inadequate manufacturing diversit y in
the face of COVID -19 , and calls for support to African vaccine manufacturing .
Gavi?s experience in market -shaping for vaccines should be leveraged to inform
the intentional design of a vaccine ecosystem that support s the sustainability of
African manufacturing facilities , and the health of the global ma rket more broadly.
Board g uidance is requested on three actions Gavi would like to take in the
next six months as part of the articulation of Gavi 5.1 to help mainstream
these strengths into the global health architecture:
? Ensure the provision of epidemic and pandemic vaccines as a core co mponent
of PPR , are recognised and embedded in discussions at the WHO, G20 and
G7 . That the resulting architecture reflects and enables the Gavi Alliances?
expanded contribution to PPR, reflecting learning from the COVID -19
response.
? Incorporate PPR considerations and innovations, including financing
instruments and support to the manufacturing agenda, into Gavi 5.1 .
? Work proactively with partners, including the African Union (A U), to set out a
position on how Gavi can support sustainable manufacturing in Africa.
SUBJECT : GAVI ?S POTENTIAL ROLE IN PANDEMIC PREPAREDNESS
RESPONSE
Agenda item: 06
Category: For Guidance
Report to the Board
22 -23 June 2022

Report to the Board
Board -2022 -Mtg -02-Doc 06 -Annex A

Annex A: Gavi Alliance: an end -to -end approach, delivering PPR through core functions, leaving no one behind

1

Board -2022 -Mtg -02-Doc 07


Section A: Executive Summary
Gavi?s Fragility, Emergencies, Refugees (FER) Policy , approved in 2017, provides
programmatic flexibilities and higher funding to cater for the unique challenges that
a growing number of countries in Gavi?s portfolio are facing . This includ es
protracted conflict, exacerbated impact of climate change , health emergencies,
and large influx of refugees.
Informed by an external evaluation and extensive consultations , t he policy has
been revised to align with the goals of Gavi 5.0 , focusing on sustainably reaching
zero -dose and under -immunised childre n. Th is paper present s the updated
Fragility, Emergencies and Displaced Populations (FED) Policy for the Board?s
approval , highlighting the key changes in the revised policy .
While the external evaluation found the current policy was largely relevant, the
revi sed FED policy addresses the policy issues identified in the evaluation . In
particular, t he revised policy has adapted the methodology to identify the list of
countries experiencing chronic fragility and highlight ed a long -term bespoke
approach , using all Gavi?s funding, programmes, and processes, to maintain and
strengthen immunisation coverage in these countries. Gavi?s role and ambition in
acute emergencies is better articulated and support has been expanded from
refugees to ensure provision of immunisation for displaced populations. As a result,
the name of the policy is now changed to Fragility, Emergencies and Displaced
Populations Policy .
At its meeting in May 2022, the Programme and Policy Committee ( PPC ) reviewed
the proposed new policy , highlighti ng it provides better clarity, address es issues
that were previously missing, and strengthen s the ability to be responsive in volatile
contexts. The PPC commended the consultative process followed to review the
policy , particularly the external, independen t evaluation and comprehensive
stakeholder engagement.
With 40% of zero dose children concentrated in fragile settings, the FED policy is
one part of Gavi?s broader organisational response to cater for the unique
challenges brought about by fragility and conflict. Operationally, a dedicated team
focusing on fragile and conflict -affected countries has been created, with increased
prioritisation , higher risk appetite and differentiated engagement. Efforts are also
underway to cement partnership s with key humanitarian, civil society , and local
actors, enabling integrated delivery of services to the most vulnerable populations.
SUBJECT : REVIEW OF FRAGILITY , E MERGENCIES , R EFUGEES
POLICY
Agenda item: 07
Category: For Decision
Report to the Board
22 -23 June 2022

 

 

Board -2022 -Mtg -02-Doc 07 -Annex A

Gavi Alliance
Fragility, Emergencies and
Displaced Populations Policy
Version 2.0


DOCUMENT ADMINISTRATION



VERSION
NUMBER APPROVAL PROCESS DATE
1.0 Prepared by: Aur?lia Nguyen
Reviewed by: Programme and Policy
Committee 17 October 2012
Approv ed by: Gavi Alliance Board

5 December 2012
Effective from: 1 January 2013
2.0
Reviewed and recommended by:
Programme and Policy Committee

12 May 2017
Approv ed by: Gavi Alliance Board

15 June 2017
Effective from: 1 July 2017
3.0 Reviewed by: Programme and Policy
Committee 3 May 2018
Approved by: Gavi Alliance Board 7 June 2018
Effective from: 7 June 2018
4.0 Reviewed by: Programme and Policy
Committee 18-19 May 2022
Approved b y: Gavi Alliance Board 22 -23 June 2022
Effective from 1 July 2022
Next review: At the request of the Board





2
Board -2022 -Mtg -02-Doc 07 -Annex A

Gavi Alliance
Fragility, Emergencies and Displaced
Populations Policy
1. Rationale
1.1. Gavi ? Alliance?s goal is to save lives and protect people?s health by increasing
equitable and sustainable use of vaccines.
1.2. Fragile environments, insecurity, conflict, and emergencies create disruption to
vaccination uptake and inequitable service provision. Access to l arge p arts of the
population, often including displaced communities is a big challenge, leaving many
least protected against vaccine preventable diseases. These circumstances can
destabilise countries or subregions and disrupt infrastructure and resources
needed to provide routine and preventative care such as vaccination. While
immunisation is one part of a broader issue, r ealising the goals of Gavi Alliance
and Immunisation Agenda 2030 is challenging in these environments and pose
significant risks to Alliance investments.
1.3. To deliver Gavi Alliance vision of achieving equity in immunisation and closing
immunity gaps in these settings, a higher risk appetite and a flexible, tailored
approach of support is required . This is facilitated through differentiated
interv entions, particularly subnational and community -based, to respond to the
challenges in each setting. A coordinated approach, through the humanitarian
development peace nexus, that brings together different actors, leveraging their
comparative advantage, is a key enabler to any progress. Innovations suited for
the specific challenges faced in settings affected by fragility and emergencies,
including in grant management also play a strong role.
2. Purpose
2.1. The purpose of this policy is to:
a. Chronic Fragilit y: Set out prioritisation criteria to determine which countries
can benefit from a flexible, tailored approach to maintain and strengthen
immunisation coverage . Through differentiated support, countries experiencing
chronic fragility challenges can systematically identify and reach zero dose
children and missed communities with the full course of vaccines, as a critical
step towards integrated Primary Health Care (PHC) and other essential
services.

b. Acute Emergencies: Provide timebound, flexible and timely support to protect
lives in acute time -limited emergencies by sustaining routine immunisation
services and preventing increase in vaccine preventable diseases and
outbreaks.

c. Displaced Populations : Ensure s the provision and suitability of Gavi?s
support to reaching displaced populations.

 

 

 

1



Board -2022 -Mtg -02-Doc 08
Report to the Board
22 -23 June 202 2


Section A: Executive Summary
Context
Malaria remains one of the deadliest diseases for children under five years old,
particularly those living in communities facing multiple deprivation s and exclusion.
In 2020 al one, there were an estimated 241 million malaria cases in 85 malaria
endemic countries increasing from 227 million in 2019, with the WHO Af rican
Region accounting for most of the increase. Approximately 96% of malaria cases
and deaths globally in 2020 were in 29 countries ? out of which 2 8 are Gavi -eligible
countries. In December 2021, the Gavi Alliance Board approved support
(US$ 155.7 million for the 2022 -2025 period) for a malaria vaccine programme to
enable the introduction of malaria vaccines as part of a comprehensive approach
to malaria control in malaria -endemic countries. The Board also requested the
Secretariat and Alliance part ners to coordinate with countries, the Global Fund and
other malaria stakeholders to design and implement a malaria vaccine programme
including key consideration s such as country eligibility, optimal mix of malaria
interventions, allocation of scar ce suppl y and country financing . Concurrent to the
ongoing design of Gavi?s malaria vaccine programme, the Malaria Vaccine
Implementation Programme (MVIP) continues to evaluate various aspects of
programme implementation in Ghana, Malawi and Kenya.
Question s this paper addresses
What progress has been made in the design of the malaria vaccine programme?
Conclusions
The d esign of Gavi?s malaria vaccine programme has advanced : the framework
for the allocation of limited vaccine supply is on course to be finalised in June 2022 ;
malaria vaccine funding guidelines are being developed and will be integrated with
the new Gavi Application Funding guidelines and launched in July 2022; guidelines
for country co -financing of the malaria vaccine are being prepared as part of the
Funding Policy Review and will be presented and finalised by the Programme and
Policy Committee ( PPC ) and Board at the end of 2022; and market shaping work
progress es with the market shaping roadmap and UNICEF S upply Division tender
to both be completed in Q3 2022. Additionally, implementation of the MVIP
continues and provide s valuable lessons to inform programme design for broader
scale -up of the vaccine.
SUBJECT : UPDATE ON MALARIA VACCINE PROGRAMME
Agenda item: 08
Category: For Guidance

1



Board -2022 -Mtg -02-Doc 09


Section A: Executive Summary
Context
In December 2020 , the Gavi Board approved the Middle -Income Countr ies (MICs)
Approach to address intra - and inter -country in equities in former - and select never -
Gavi eligible countries . In view of the COVID -19 pandemic , the Board approved a
phased implementation and requested that the Secretariat come back in June
2022 to elaborate on how best to continue to deliver against the MICs Approach
objectives for the remainder of Gavi 5.0, alongside whether country eligibility
shoul d be expanded to include all never Gavi -eligible upper middle -income
countries (UMICs) with gross national income (GNI) p.c. (per capita) under
US$ 6,000. In response to requests from the Pro gramme and Policy Committee
(PPC ) and countries , the Secretariat also explored how Gavi could resp ond to the
needs of fragile MICs .
Questions this paper addresses
1. How best to continue to deliver the MICs Approach for the re st of Gavi 5.0
2. Whether to expand eligibility to include all UMICs under US $ 6,000 GNI p.c
3. If Gavi should have a rules -based approa ch to supporting fragile MICs
4. If Venezuela should be treated as eligible under the MICs Approach
Conclusions
This paper presents the PPC?s recommendation to the Gavi Board on how best to
continue to deliver the MICs Approach for the remainder of Gavi 5.0, maintaining
the focus on preventing and mitigating backsliding and strengthening sustainable
immunisation programmes whilst elaborating on how to driv e sustainable new
vaccin e introductions. In discussions, the PPC confirmed key tenets of the MICs
Approach, underscoring the importance of sustainability and of responding to
country needs . The PPC agreed that now is not the right time to expand eligibility
to include all UMICs under US$?6,000 GNI p.c. but rather to allow countries
reclassified as lower -middle income countries ( LMICs) due to falls in GNI to
become eligible for the MICs Approach. This paper also presents the PPC?s
recommendation for a rules -based approach un der which s upport could be
provided to fragile eligible -MICs. Finally, following validation of the approach taken
SUBJECT : GAVI?S APPROACH TO ENGAGEMENT WITH FORMER AND
NEVER -ELIGIBLE MIDDLE -INCOME COUNTRIES (MIC S)
Agenda item: 09
Category: For Decision
Report to the Board
22 -23 June 2022

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Re port to the Board

Board -2022 -Mtg -02-Doc 09 -Annex A
Annex A: Implications/Anticipated impact
Risk implication and mitigation: There are two key risks to the MICs Approach.
The first is that the Secretariat does not have the capacity to deliver successfull y
given limited bandwidth. This is mitigated through the resources for implementation
designated within the MICs Approach budget. Without these resources, the MICs
Approach would not be able to reach its full potential.
The second risk is the continued unc ertainty around the COVID -19 pandemic and
its impact on countries , potentially limiting the extent to which they are able to
engage . This is mitigated by building and strengthening the enabling environment,
investing at the regional and global level to address common challenges and
shared bottlenecks, while standing ready to deploy targeted and catalytic tools at
the country level.
Ris k of inaction: As of early 2021, c ountries have started to express renewed
interest in the introduction of PCV, rotavirus and HPV vaccine s. With out the
support through the MICs Approach , there is a risk that these introductions are not
achieved, as countri es would have less support to overcome the barriers impeding
progress. Should these introductions be achieved, there is a risk that they are less
sustainable and equitable than they could otherwise be with support through the
MICs Approach, with marginalis ed and vulnerable population subgroups most at
risk of being left behind.
Without the support through the MICs Approach t here is also a risk of further
backsliding in routine immunisation coverage in former -Gavi countries that would
undermine prior investments and achievements. There is also a risk that the zero -
dose population in former -Gavi countries would remain unreached , and potentially
even continue to grow larger.
Impact on countries: The MICs Approach is critical to helping build the
ecosystems necessary to introduce life -saving vaccines and sustain immunisation
programme performance. When combined with targeted and c atalytic tools, t he
Secretariat believes that the MICs Approach could drive the sustainable and
equitable introduction of 8 -10 new vaccines by 2025, reaching 4 million -6 million
new children or adolescents. It could also help contribute toward the restorat ion of
routine immunisation coverage in former -Gavi countries following the significant
impact incurred within the context of the pandemic. W ith its specific focus on
reaching zero -dose children in reinforcement of routine immunisation services, the
MICs Approach could reduce the overall number of zero -dose children in former -
Gavi countries by 15%, equivalent to approximately 230,000 children.
Finally, the MICs Approach could also have a significant impact on the lives of
children in fragile MICs subject to countries meeting the conditions and receiving
support .
Impact on Alliance: The Alliance continues to be strained amid the COVID -19
pandemi c and may have limited capacity to implement the MICs Approach. This is
mitigated by the provision of support , accessible to partners at the country and
regional level , to enable delivery of the MICs Approach.

Report to the Board
Board -2022 -Mtg -02-Doc 09 -Annex B 1
Annex B: Paragraphs referenced in decision point (b) on the MICs Approach , as
amended by discussions at the PPC
4. MICs Approach engagement 1
4.1 This section presents how best to continue t o deliver against the two
MICs Approach objectives for the remainder of Gavi 5.0 , fine -tuning the
approach already approved by elaborating on the support to prevent and
mitigate backsliding and bring ing additional emphasis to the objective to drive
the sustainable introduction of new vaccines 2. This does not mean losing sight
of any potential future ambitions but takes a pragmatic view on what can be
achieved in the time available , alongside recognis ing that the MICs Approach
is, as a whole , a learning agenda.
4.2 The approach respond s to the needs expressed by countries. It is results -
orientated , designed to work in partnership with countries toward a
shared objective of fostering sustainable and equitable immunisation
programmes . It works to l ev erag e the capacities in MICs , supporting countries
to have a greater impact with available domestic resources and to catalyse new
resources for immunisation while not creat ing dependencies . The approach
draws on Gavi?s comparative adva ntages and leverages the Alliance?s
strengths to address key barriers to new vaccine introductions and
challenges to sustainable and equitable immunisation programmes . It
presents the interventions determined to have the greatest impact with the
resources available w hilst recognising ongoing challenges . Support is targeted
and catalytic , combining targeted country -facing support with investments
that work to affect system -level change where multiple countries face
similar challenges . The MICs Approach works with a clear focus on
sustainability across all investments , working not only with Ministries of Health
but with all relevant stakeholders, including Ministries of Finance and
subnational authorities . As part of the learning agenda, it also seeks to find
compleme ntarity between the two MICs Approach objectives with a ll
investments clearly aligned to the MICs ToC ( see Appendix 3).
4.3 The Approach is first comprised of three Foundational Building Block s,
designed to address country challenges in all countries eligible under the
MICs Approach by sustainably address ing shared barriers to new va ccine
introductions , the drivers of backsliding , and risks to immunisation programme
sustainability including ensuring sufficient and sustainable health financing ,
thus working towards both MICs Approach objectives . The building blocks
reflect the MICs Approach?s ambition to find new ways to deliver sustainable
results by generating momentum and build ing and strengthen ing the enabling
environment . Efforts will be tailored to country needs and will include country
advocacy to galvanis e political commitment for sustainable and equitable
RI across MICs , u sing the convening power of the Alliance to bring together
immunisation leaders and promote evidence and best practice on immunisation

1 The MICs Approach does not currently include support for COVID -19 vaccines. Future potential
support on COVID -19 vaccines is currently a topic for PPC and Board discussion . 2 Introducing these vaccines not only saves lives through vaccination but also contributes to wider global
health priorities , e.g. reducing antimicrobial resistance with the introduction of PCV .

1
Report to the Board
Board -2022 -Mtg -02-Doc 09 -Annex C
Annex C: Paragraphs referenced in decision point (d) on the rules under which
support could be provided to fragile MICs
7. Responding to the needs of fragile MICs
7.1 The MICs Approach presented by the Secretariat to the Board in December
2020 was not designed to respond to the needs of fragile MICs and therefore
did not include support to help affected countries maintain critical routine
immunisation programmes during times of great difficulty. At that time, when
the Board reviewed and approved the MICs Approach, the PPC Chair
reported that several PPC members had suggested the Secretariat further
explore how to work with fragile MICs 1. Since then, global events including
conflict and economic crises have brought the challenges faced by affected
countries into alarming focus and several MICs experiencing situations of crisis
have approached Gavi for support.
7.2 Accordingly, the Secretariat developed and presented a s pecific proposal to
support fragile MICs, alongside two country requests for support, to the PPC in
May 2022 for consideration. Following PPC feedback at that meeting, the
Secretariat has subsequently worked to define a more distinct set of rules
under whi ch dedicated support could be provided to MICs that face
challenges caused by fragility, emergencies and displaced persons . This
rules -based approach ringfences potential support within clear boundaries that
speak to Gavi?s model and the Alliance?s compara tive advantages and
determines the conditions under which countries that are eligible under the
MICs approach can receive dedicated support towards maintaining critical
routine immunisation programmes .
7.3 A rules -based approach to responding to the needs of fragile MICs
7.4 To be considered for dedicated support as a ?fragile MIC?, the country must
first be eligible under the MICs Approach 2. Countries that are not eligible
under the MICs Approach would not be supported. The country must then also
meet all the fo llowing conditions :
? First, the country must fall within the classification for settings of
chronic fragility, acute emergencies and/or hosting displaced
populations as set out in Gavi?s Fragility, Emergencies and Displaced
Populations (FED) Policy,
? Second, there must be an evidence -based demonstration of a time -
limited need , against which Gavi is best placed to respond in line with the
Alliance?s comparative advantages, and
? Third, the country has given a clear commitment to sustain funding for
immunisation following the end of any Gavi support, thereby avoiding
creating dependencies in line with Gavi?s development model.

1 Board meeting, December 2020 https://www.gavi.org/sites/default/files/board/minutes/2020/Board -
2020 -Mtg -06 -Minutes.pdf 2 i.e., a former -Gavi country, a never -Gavi LMIC or an IDA -eligible economy

Board -202 2-Mtg -02-Doc 10 1
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22 -23 June 20 22

















SUBJECT: COMMITTEE CHAIR AND IFFIM BOARD REPORT S
Agenda item: 10
To follow

Board -202 2-Mtg -02-Doc 11 1
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22 -23 June 20 22

















SUBJECT: REVIEW OF DECISIONS
Agenda item: 11
No paper

Board -202 2-Mtg -02-Doc 12 1
Report to the Board
22 -23 June 20 22

















SUBJECT: CLOSING REMARKS AND REVIEW OF BOARD
WORKPLAN
Agenda item: 12
No paper

www.gavi.org
CONSENT AGENDA
BOARD MEETING
22-23 June 2022, Geneva, Switzerland
Reach every child
Recommendation 1: Consent Agenda: Board
Committee Chair Appointments
2
TheGavi Alliance Governance Committeerecommends tothe Gavi Alliance Boardthat
it :
Appoint Anne Schuchat asChair ofthe Programme andPolicy Committee effective
1 July 2022 anduntil 31December 2023.
Board meeting
22- 23 June 2022

Gavi

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