Board -2020 -Mtg -6-Doc 00a




G avi Alliance Board Meeting
15 -17 December 2020
Virtual Meeting

Tuesday 15 December : 13.30 -16.00 Geneva Time Closed Session
Tuesday 15 December : 16.15 -18.30 Geneva Time
Wednesday 16 December : 14.00 -18. 15 Geneva Time
Thursday 17 December : 14.00 -18. 30 Geneva Time
Quor um: 14

Document list ? UPDATED

No. Document
00a Document list
00b Agenda
01a Declarations of interest
01b Minutes from 24 -25 June 2020
01c Minutes from 30 July 2020
01d Minutes from 29 -30 September 2020 (To follow)
01 e No Objection Consen t D ecisions
01f Consent Agenda
01g Consent Agenda: Gavi 5.0: Measurement Framewor k
01h Workplan
02a Financial Update, including forecast
02b Partners ? Engagement Framework & Secretariat Bud get 2021 -2022
03 Committee Chair and IFFIm Bo ard reports
04 CEO?s Re port
05 a Strategy , Programmes and Partnerships and calibration of Gavi 5.0
05b Accelerating efforts to reach zero -dose children and missed communities in Gavi 5.0
06 Risk Managemen t Update
07 Gavi ?s approach to engagem ent with f ormer and never -eligible Middle -Income
Countries (MICs)
08 COVAX Facility operationalisation and vaccine programme
09 AMC Resource Mobilisat ion
10 COVAX AMC Support to India
11 Review of decisions ? No pape r
12 Clos ing remarks ? No paper

Board -2020 -Mtg -6-Doc 00b








G avi Alliance Board Meeting
15-17 December 2020
Virtual Meeting



Tuesday 15 December: 1 3.30 -18.30 Geneva Time
Wednesday 16 December : 14.00 -18.15 Geneva Time
Thursday 17 December : 14.00 -18. 30 Geneva Time
Quorum: 14



Agend a - UPDATED








Next Board Me eting s: Marc h or April 202 1, T BD (Board Retreat)
23 -24 June 202 1, Geneva
1-2 December 202 1, Geneva

---
Brenda Killen , Director, Governance and Secretary t o the Board, +41 22 9 09 6680 , bkillen @gavi.org
Joanne Goetz , Head, Governa nce, + 41 22 90 9 6 544, jgoetz@gavi.org
Please note that the Board meeting will be recorded. This recording will be used as an aid to minute t he meeting .
A transcr iptio n of the full proceedings will not normally be made . Shou ld a tra nsc riptio n be made it wil l be used
only as an aid to minute the meeting .




Boar d-2020 -Mtg-6-Doc 00b 2

Board M eeting - DAY ONE ? Tuesday 15 December 2020

Item Sub ject Action Schedule

Closed Session: For Board Members and Alternate Board
Members only
13.30 -16.00
Break 16.00 -16.15
1 Chair?s report
? Declarations of interest
? Minutes
? No Objection Cons ent Decisions
? Co nsent Agenda 1
? Action Sheet
? Wor kplan
Ngozi Okonjo -Iweala, Board Chair
DECISION 16.15 -16.30
2 Finance
Dav id Sidwe ll, Chair, Audit and Finance Committee
Anuradh a Gupta, De pu ty CE O
Assietou Diouf, Managing Director , Finance & Operations

The two separate papers listed below will be taken as one
discussion:

2a Financial Update, including forecas t

2b Partners ? Engagement Framework &Secretariat Budget
2021 -2022
DECISION 16. 30-17.30
3 Comm ittee Chair and IFFIm Board reports
? Governance Committee ? Sarah Goulding
? Audit and Finance Committee ? David Sidwell
? Inve stmen t Committee ? Stephen Zinser
? Programme and Policy Committee ? Helen Re es
? Evalua tion Advisory Comm ittee ? Nina Sch walbe
? IFFIm Com pany ? Cyrus Ardalan
17.30 -18. 30








1 Any Board member can ask that an y item be removed from the consent agenda for f urth er dis cussion. S hould
there be any such request, the relevant discussion will take place on Day Three of the Board meetin g,
immedia tely precedin g th e R evie w of Decisi ons.

Bo ard -2020 -Mt g-6-Doc 0 1a




Gavi Alliance Board Meeting
15 -17 December 2020
Virtual Meeting
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 processes on b ehalf 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 isclo se [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 mbers of the Boar d on their most recent annual
statements:
Board members:
Member Org anisational Interest s

Financial/Personal/Advisor Int /
Others
Ngozi Okonjo -Iweala , Chair None
Board Member, Twitter; Boar d
Member, Standard Chartered
Bank; Board Chair, African Risk
Capac ity ; Co -Chair, The Global
Commission on the Economy and
Climate; Co -Chair, Lumos; Fellow,
Harvard; Non -resident Fellow,
Brookings; Board Member,
Carnegie Endowment for
International Peace; 1 of the 4
Envoys, AU Special Envoy for
COVID -19; Board Member , The B-
Te am; Board Member, Asia
Infrastructure Investment Bank;
Board Member, International
Advisory Board ? Japan
International Cooperation Agency
(JICA); Board Chair, African
University of Sci ence and
Technology; Member, IMF
External Advisory Group; Mem ber,
Eco no mic Advisory Council for
South African President Cyril
Ramaphosa ; WHO Special Envoy,
Access to COVID -19 Tools (ACT)
Accelerator ;
Gavi -appointed special adviser

Board -2020 -Mtg -03 1
Minutes




Gavi Alliance Board Meeting
24 -25 June 2020
Virtual meeting


1. Chair?s Report

1.1 Finding a quorum of members present, the meeting commenced at 14.10 Geneva
time on 24 June 2020. Dr Ngozi Okonjo -Iweala, Board Chair, chaired the meeting.

1.2 The Chair welcomed two new Board and Alternate Board members, who would be
appointed at this meeting , as well as Nina Schwalbe, Chair of the Evaluation
Advisory Committee, Cyrus Ardalan, Chair of the International Finance Facility for
Immunisation (IFFIm) and other directors of the IFFIm Board.

1.3 In addition, the Chair noted the participation as an Obser ver of Dr Lia Tadesse,
Federal Minister of Health of Ethiopia , who will soon be replacing
Dr Amir Aman Hagos as Board member .

1.4 Standing declarations of interest were tabled to the Board (Doc 01a in the Board
pack ).

1.5 The Board noted its minutes from 4-5 December 2019 (Doc 01b) , 19 March 2020
(Doc 01c) and 11 May 2020 (Doc 01d) which were appr oved by no objection on
18 Februa ry 2020, 11 May 2020 and 22 June 2020 respectively. The Board also
noted decisions approved by them by no -objection consent on 12 May 2020 (Doc
01e) namely appointments to the Board and Board Committees .

1.6 The Chair referred to the consent agenda (Doc 01f) where eight recommendations
were being presented to the Board for consideration . No requests had been
received to place any of the consent agenda items on the main agenda. The
decisions would be presented at the end of the meeting during the Review of
Decisions.

1.7 She noted the Board workplan (Doc 01i) and highlighted that it is now more
detailed and extends out to 2025. She flagged that the workplan is indicative and
subject to change in light of the current global context.

1.8 The Chair referred to the eventful first half of 2020 which was marked by a very
successful replenishment, noting however that the COVID -19 pandemic has
brought unprecedented challenges at the global level. She referred to the
economic impact of the pandemic particularly in Africa and underlined the
necessity to strengthen health system s in developing and developed countries.
 

Board -2020 -Mtg -04 1
Minutes



Gavi Alliance Board Meeting
30 Ju ly 2020
Virtual meeting


1. Chair?s Report

1.1 Finding a quorum of members present, the meeting commenced at 14.1 4 Geneva
time on 30 July 2020. Dr Ngozi Okonjo -Iweala, Board Chair, chaired the meeting.

1.2 The Chair welcomed the Board to t his exceptional Board meeting, noting the
importance of the Board c oming to an agreement on the decisions being presented
in relation to the COVAX ( COVID -19 Vaccine Global Access ) Facility structure and
governance and the COVAX AMC ( Advanced Market Commitment ).

1.3 Standing declarations of interest were tabled to the Board (Doc 01a in the Board
pack ).

1.4 It was noted that Item 2 would be discussed after Item 4 as per the Revised
Agenda share d with the Board in advance of the meeting.

------

3. Financial Forecast

3.1 David Sidwell, Audit and Finance Committee (AFC) Chair, presented this item,
informing the Board that the AFC had looked at a revised financial forecast for
2020 -2021 and r eviewed the assumptions underpinning the forecast .

3.2 He noted the forecast refle cts the outcome of the replenishment and implications
from COVID -19 including decisions taken by the Board in 2020 to support
countries through initiatives such as H ealth System Strengthening reprogramming,
UNICE F pre -financing and the rescheduling of vaccine campaigns. He further
noted the forecast will be updated as additional decisions are made by the Gavi
Board in relation to the COVAX Facility, COVAX AMC and any new Gavi 5.0
strategic investments as presently the forecast does not r eflect any amounts
related to these with exception of COVAX AMC and COVAX Facility administrative
costs which are being presented to the Gavi Board for consideration at this
meeting .

3.3 Mr Sidwell reported that the full impact of delayed vaccine introdu ctions and
campaigns remains uncertain but it is anticipated that additional expenditures will
be required to maintain and restore routine immunisation programmes.

3.4 Referring to an estimate of resources and expenditures , Mr Sidwell reported the
availa ble amount for strategic investments is US$ 368 million for 2016 -2020 and

1



Board -2020 -Mtg -6-Doc 01d
Report to the Board
15 -17 December 20 20

















SUBJECT: MINUTES FROM 29 -30 S EPTEMBER 2020
Agenda item: 01d
To follow

1



Board -2020 -Mtg -3-Doc 01e
Report to the Board
15 -17 December 2020
Classified as Internal



Since the June 2020 Board meeting, four decision s ha ve been circulated to the
Board electronically for approval by no -objection consent in line with Section 11 of
the Board and Committee Operating Procedures .

1) On 30 July 2020 , Board members were invited to consider approval of the
appointment of a Board member and Market -Sensitive Decisions
Committee member .

No objections were received prior to the end of 12 August 2020 and the
following decision was therefore entered into the record:

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

a) Appointed Lia Tadesse of Ethiopia as Board Member representing the
implementing country constituency in the seat currently held by Amir Aman
Ha gos of Ethiopia, effective immediately and until 31 December 2020; and

b) Appointed Lia Tadesse (Board Member) to the Market -Sensitive
Decisions Committee, effective immediately and until 31 December 2020.

2) On 10 August 2020 Board members were invited to consider approval of the
2019 Gavi Alliance Annual Financial Report and the 2019 Gavi Alliance
Statut ory Financial Statements .

No objections were received prior to the end of 20 August 2020 and the
following decision was therefore entered into the record:

In accordance with Section 11.1 of the Board and Committee Operating
Procedures, on a no -objection basis, the Gavi Alliance Board:

Approved the 2019 Gavi Alliance Annual Financial Report and the 2019 Gavi
Alliance Statutory Financial Statements.?




SUBJECT: NO -OBJECTION CONSENT DECISIONS
Agenda item: 01e
Category: For information

1



Board -2020 -Mtg -6-Doc 01f
Report to the Board
15 -17 December 2020

Section A: Introduction
Seven recommendations are being presented to the Board under the Consent
Agenda for consideration. Detailed information on each of the items can be found
in the relevant Committee paper in a dedicated folder on BoardEffect at :
https://gavi.boardeffect.co.uk/workrooms/6459/resources/61954
Section B: Actions requested of the Board
The Gavi Alliance Board is requested to consider the following recommendations
from the Gavi Alliance Governance Committee , Finance and Audit Committee and
Programme and Policy Committee .
Decision One ? Board and Board Committee member appointments
Governance Committee recommendation to be shared with the Board after
Governance Committee meeting of 10 December 2020.
Decision Two ? Independent Review Committee appointments
Governance Committee recommendation to be shared with the Board after
Governance Committee meeting of 10 December 2020 .
Decision Three ? Review of Annexes to Operating Procedures
Go vernance Committee recommendation to be shared with the Board after
Governance Committee meeting of 10 December 2020.
Decision Four ? COVAX Facilty Terms of Reference
Governance Committee recommendation to be shared with the Board after
Governance Committe e meeting of 10 December 2020.




SUBJECT: CONSENT AGENDA
Agenda item: 01 f
Category: For Decision

Gavi Alliance
Programme Funding Policy
Version 4.0



Board -2020 -Mtg -6-Doc 01f -Annex A

DOCUMENT ADMINISTRATION



VERSION
NUMBER APPROVAL PROCESS DATE
1.0 Barry Greene, Managing Director,
Finance and Operations


Reviewed by: Gavi Programme and
Policy Committee 19 May 2010
Reviewed by: Gavi Audit and
Finance Committee 25 May 2010
Approv ed by: Gavi Alliance Board 17 June 20 10
Effective from: 17 June 20 10
2.0 Reviewed by: Gavi Audit and
Finance Committee 24 Ma rch 201 1
Approv ed by: Gavi Alliance Board 8 July 20 11
Effective from: 8 July 20 11
Section 3.5
and Annex 1
Reviewed by: Gavi Audit and
Finance Committee 11 April 201 2
Approv ed by: Gavi Alliance Board 13 June 20 12
Effective from: 13 June 20 12
Section 4
and
Annex 1
Reviewed by: Gavi Audit and
Finance Committee 11 April 201 2
Approv ed by: Gavi Alliance Board 13 June 20 12
Effective from: 13 June 20 12
Annex 1 Reviewed and recommended by:
Gavi Audit and Finance Committee 10 October 201 3
Approv ed by: Gavi Alliance Board 22 November 20 13
Effective from: 22 November 20 13
3.0 Reviewed and recommended by:
Gavi Audit and Finance Committee 6 November 2015
Approved by: Gavi Alliance Board 2 December 2015
Section 3.6
and Annex 1
Reviewed and recommended by:
Gavi Audit and Finance Committee 21 October 2016
Approved by: Gavi Alliance Board 7 December 2016
Effective from: 7 December 2016
Section 4.1
and Annex 1
Reviewed and recommended by:
Gavi Audit and Finance Committee 12 June 2017
Approved by: Gavi Alliance Board 14 June 2017
Effective from: 1 January 2018
Sectons 3, 5
and Annex 1
Reviewed and recommended by:
Gavi Audit and Finance Committee 21 October 2020
Approved by: Gavi Alliance Board 15 December 2020
Effective from: 1 January 2021

Report to the Board
Board -2020 -Mtg -6-Doc 01f -Annex B
Annex B: Changes to the Programme Funding Policy (as submitted to the 21 October
2020 Audit and Finance Committee meeting )
A: Executive Summary
? As Gavi operationalises the Portfolio Management re -design as part of the Gavi
5.0 Strategy, amendments to the Programme Funding Policy are required. These
changes were introduced at the 23 July 2020 Audit and Finance Committee (AFC)
meeting.
? This report outlines the changes to Portfolio management re -design and necessary
updates to the Programme Funding Policy needed to operationalise these and
requests the AFC to recommend that the Board approves these changes.
? To that end, as included in the Decision point section already, we ask that the AFC
recommend for Gavi Board Alliance approval:
o The inclusion of selected Partners? Engagement Framework (PEF)
components: Technical Country Assistance (TCA), Strategic Focus Areas
(SFA) and Foundational Support (SF) under the scope of the Programme
Funding Policy (PFP)
o The multi -year approval of support for programmes under the scope of the PFP
B: Overview of Gavi 5.0 portfolio management re -design
1. Update on Portfolio management re -design
1.1. As previously outlined in the July 2020 AFC paper, as part of the
operationalisation of Gavi 5.0, the Board has called upon the Secretariat to review
and improve Gavi?s portfolio management processes (i.e. the processes of
providing grants to countries) wi th the objective to make them more differentiated,
efficient, simpler and hence, a successful platform to deliver on the Gavi 5.0 goals
and objectives.
1.2. Through a highly consultative process, several key shifts have been identified
and shared with the Prog ramme and Policy Committee (October 2019, May
2020) as well as the Board (on the side -lines of December 2019 Board) with
general agreement in principle to the proposed shifts.
1.3. As described in the July 2020 AFC paper, these shifts include grounding Gavi?s
support to countries in a single strategic ?Theory of Change? and support
application across all streams of support. There will also be greater alignment
across portfolio planning, review and approval for Health System and
Immunisation Strengthening (HSIS) , vaccine support and TCA; moving to a
single integrated process with TCA brought in line with other programmatic
funding. Importantly, there will be continued reliance on an independent review
of applications by the Independent Review Committee (IRC) with more
differentiation of the modalities of review. The level of Secretariat engagement
would be more deliberately differentiated by countries? programmatic risk profile,
portfolio level impact on reaching zero -dose children and missed communities

1



Board -2020 -Mtg -6-Doc 01g


Section A: Executive Summary
Context
Building on discussions at the October 2019 , May 2020 and October 2020
Programme and Policy Committee (PPC) and July 2020 Board meetings 1, the
Board is requested to approve proposed mission and strategy performance
monitoring indicators for the 2021 -2025 strategy. An Alliance Technical Working
Group (TWG) h as advised on the indicators, with many developed jointly with the
Immunization Agenda 2030 (IA2030) Monitoring & Evaluation (M&E) Taskforce.
An iterative process with consultations to vet indicators has included consultations
with countries, partners, Civ il Society Organisations and other Alliance
stakeholders at the Gavi 5.0 Countries and Partners Retreat .
Questions this paper addresses
What mission and strategy indicators are proposed for monitoring Gavi Alliance
performance on the 2021 -2025 strategy , and how do they fit within the broader
Gavi 5.0 learning system ?
Section B: Facts and Data
Facts and Data
1.1 Proposed Gavi 5.0 mission and strategy performance indicators are
intended to measure progress towards the goals and objectives as
described in the Gavi 5.0 strategy framework ?one -pager? (Annex B),
approved by the Board in June 2019. They focus on key portfolio -level
impacts, outcomes or outputs , with shared Alliance accountability .
1.2 Indicator development emphasised connecting indicators to th e design of
the Gavi 2021 -2025 strategy. The Monitoring & Evaluation (M&E) team has
worked with Secretariat programme teams, in consultation with Alliance
stakeholders, to think through the Gavi 5.0 Theory of Change (TOC) (Annex
E) to identify the outputs or outcomes that must be measured to understand
progress towards the Strategy Goals. Consultations during the Gavi 5.0
Countries and Partners Retreat on 25 -27 February 2020 provided useful

1 Doc 06 October 2019 PPC ; Doc 07 May 2020 PPC; Doc 05 October 2020 PPC; and Doc 02 July
2020 Board meetings.
SUBJECT : GAVI 5.0: MEASUREMENT FRAMEWORK
Agenda item: 01g
Category: For Decision
Report to the Board
15-17 December 2020

Report to the Board
Board -2020 -Mtg -6-Doc 01g -Annex A
Annex A: Implications and Anticipated Impact

Risk
To help the Gavi Alliance Board assess the extent to which the 2021 -2025 strategy is
on track, the proposed strategy performance indicators have been developed to
provide annual information on the performance of the strategy. The indicators rely on
data that are available or can be made available without substantial financial costs or
burden on countries. Given these constraints and the limited number of indicators,
these performa nce indicators will not provide a full picture of strategy implementation
and performance. The Gavi 5.0 Learning System will seek to address this, by ensuring
coordinated development of strategy implementation indicators, evaluations, and
other assessments to supplement the strategy performance indicators. The proposed
Learning Hubs would also provide a unique opportunity for deeper monitoring and
learning in targeted areas, providing insights that are not feasible to generate at
portfolio level. These othe r sources of information are also important for monitoring
the unintended consequences of the Alliance focusing on a relatively small number of
strategy performance indicators.
Impact on countries
The indicators have an important impact on countries in the sense that they focus
Alliance -wide efforts on specific measurable outcomes or processes. However, as the
indicators are closely tied to the expected activities and strategy objectives of the
2021 -2025 Gavi Alliance strategy, this is appropriate.
The ind icators do not have a large impact in terms of imposing additional reporting
burden on countries. Most indicators can be tracked with existing globally available
data sources. A limited number of indicators will require new measurement and/or
reporting fro m countries, however most of these indicators have been developed for
the IA2030 M&E Framework as part of its core set of indicators deemed necessary for
countries to monitor to track their performance on the IA2030 strategic priorities. Two
proposed Gavi 5.0 strategy performance indicators not included in the IA2030 global
core indicator set will require measurement and reporting from countries: (1) number
of immunisation sessions and (2) reach of preventive measles campaigns. Tracking
planned and conducte d immunisation sessions is common across countries but the
inclusion of this indicator in the Gavi 5.0 measurement framework will require new
country reporting, most likely through the WHO/UNICEF Joint Reporting Form.
Monitoring the reach of preventive mea sles campaigns requires post campaign
coverage surveys, which are already required for Gavi -supported supplemental
immunisation activities. More generally, the need to target resources subnationally to
improve equity in immunisation will require on -going e fforts to strengthen country data
systems.
Impact on Alliance
Several new indicators, including timeliness of outbreak detection and response,
number of immunisation sessions, stock availability at facility level, and
implementation of tailored plans to o vercome demand barriers will require guidance
and support to countries to ensure they can be measured and reported. Additionally,
ongoing support to countries is required to improve data quality of subnational

Report to the Board
Board -2020 -Mtg -6-Doc 01g -Annex B

Annex B: Gavi 5.0 Strategy One -Pager

Report to the Board
Board -2020 -Mtg -6-Doc 01g -Annex C

Annex C: Gavi 5.0 Strategy Indicator Dashboard
 

Report to the Board
Board -2020 -Mtg -6-Doc 01g -Annex D

Annex D: Summary of Gavi 5.0 Strategy Indicator Definitions
Table of Contents
Table 1: Summary Descriptions and Use Cases for Mission Indicators ..................... 2
Table 2: Summary Descriptions and Use Cases for Strategy Goal 1 Indicators ........ 3
Table 3: Summary Descriptions and Use Cases for Strategy Goal 2 Indicators ........ 5
Table 4: Summary Descriptions and Use Cases for Strategy Goal 3 Indicators ........ 7
Table 5: Summary Descriptions and Use Case s for Strategy Goal 4 Indicators ........ 8


Report to the Board
Board -2020 -Mtg -6-Doc 01g -Annex D

Table 1: Summary Descriptions and Use Cases for Mission Indicators
MISSION INDICATORS
ID Indicator What would be
measured How it would be used
M.1 Under -5 mortality
rate
Average probability of a
child born in any of the
Gavi -supported countries
dying before they reach
the age of five.
Communicate Gavi?s
contribution to child
mortality reduction and
alignment with
Sustainable
Development Goal 3.
M.2 Future deaths
averted 1
Number of anticipated
future deaths prevented
as a result of vaccination
with Gavi -funded vaccines
in the countries we
support
Estimate the impact of
Gavi -supported
vaccinations in terms of
averting future deaths
from vaccine -
preventable diseases.
M.3 Future DALYs
averted
Number of disability -
adjusted life years
(DALYs) averted as a
result of vaccination with
Gavi -supported vaccines.
Demonstrate impact of
Gavi -supported vaccines
on morbidity, and
mortality .
M.4
Reduction in zero -
dose children
(Equity indicator)
Number of zero -dose
children relative to the
number at baseline.
A measure of equity
giving an indication of
the reach of routine
immunisation ser vices to
missed communities.
M.5
Unique children
immunised with
Gavi support
Number of children
immunised with the last
recommended dose of a
Gavi -supported vaccine
delivered through routine
systems
Demonstrate reach of
Gavi supported vaccines
through routine
immunisation systems.
M.6
Economic benefits
generated through
Gavi -supported
immunisations
Calculated as cost -of -
illness (COI) averted. COI
includes treatment and
transport costs, caretaker
wages and productivity
loss due to disability and
premature death.
Demonstrate impact of
Gavi -supported vaccines
beyond health benefits
to include the direct and
indirect economic
benefits of averting
illness, death and long -
term disability.
1 Indicators underlined are included in the 2020 -2025 Investment Opportunity and will be used, in part,
to report on progress towards meeting commitments made in 2021 -2025 Investment opportunity.

Report to the Board
Board -2020 -Mtg -6-Doc 01g -Annex E

Annex E: Draft Gavi 5.0 Theory of Change and Learning Priorities
The overarching Gavi 5.0 Theory of Change (TOC) shows the causal pathways
activated by the key intervention areas that drive the overall strategy. This key tool will
be used to guide measurement, programmatic activities, and Alliance -wide
understanding of Gavi.
On the far left of the TOC, seven key levers are shown. These are the domains in
which the Alliance can influence shifts and outcomes across the program cycle. These
levers are operationalized through two key intervention areas at country level. Health
System and Immunization Strengthening (HSIS) grants and vaccine supply
investments are supported by program support (including technical assist ance), as
well as through advocacy, coordination, and accountability. The levers and
intervention areas are the key link between the Alliance and country -level outcomes.
The causal pathways are articulated through the inputs, outputs/intermediate
outcomes , and outcomes columns. The boxes marked with the green 5.0 circle
represent the key shifts involved with Gavi 5.0. The arrows along the causal pathways
represent the points of evaluability along the causal pathway.
Element Definition
Levers Alliance Voice, Resource Mobilization, Learning, Programmatic
and Policy Alignment, Differentiated Engagement, Partnerships,
and Innovation
These are the areas and mechanisms through which the
Alliance can operate to catalyse and deliver support to achieve
Gavi?s objectives. Any of these levers can be pulled alone or in
combination to operationalize activities under the intervention
areas and at both the secretariat and country levels.
Intervention
Areas
Country Engagement & Dialogue, TCA, Financial Support,
Advocacy, SFA Initiatives
Everything done by the alliance should be visible in these broad
intervention areas, and within the vaccines and HSIS domains
? Country Engagement & Dialogue includes coordination
of core partners (WHO, World Bank, CDC) and
expanded partners to help country efforts to improve
immunization coverage. Activities in this area focus on
transparent processes, facilitation, convening, and
information sharing.
? Programme Support (TCA and Financial Support)
includes bot h the direct funding provided to countries as
well as targeted country assistance to meet specific
country needs
? Advocacy includes building and sustaining global
political commitment for immuni sation

Classified as Internal #
Gavi Alliance Board Workplan
Gavi Board Paper Type Mar/Apr June Nov/Dec Mar/Apr June Nov/Dec Mar/Apr June Nov/Dec Mar/Apr June Nov/Dec Mar/Apr June Nov/Dec
A.Strategy/Performance/Risk/MELCEO's Report CEO's Report Discussion 2021-2025 Strategy 2021-2025 Strategy, Partnerships and Programmes Discussion Discussion Discussion Discussion Discussion Discussion Discussion Discussion Discussion Discussion Discussion 2021-2025 Strategy Gavi 5.0 Decision Measurement Framework (Targets & Indicators) Measurement Framework Decision Decision Decision Funding Policies* Gavi 5.0: Operationalisation Decision Decision Decision Innovation (including private sector partnerships) TBD TBD Middle Income Countries (MICs) TBD Decision Decision Civil Society and Community Engagement Approach TBD TBD TBD VPD Surveillance TBD Decision Decision Risk and Asurance Report Risk and Assurance Report Decision Decision Decision Decision Decision Decision B.Vaccines & SustainablityTyphoid TBD Information Information Pneumococcal AMC (Advance Market Commitment) TBD Information Inactivated Polio Vaccine (IPV) co-financing approach TBD TBD TBD Malaria TBD Information Information Guidance Update on vaccines for epidemic preparedness and response TBD Discussion Discussion Vaccine Investment Strategy TBD Decision Decision Decision Decision COVAX Development (details TBC) TBD Decision Decision Decision C.PolicyFragility, Emergencies, Refugees Policy TBD Decision Decision Supply & Procurement Strategy Review of Gavi's Supply and Procurement Strategy Decision Decision Transparency and Accountability Policy Decision D.Country ProgrammesNigeria TBD Information Information Information Information Information Information PNG TBD Information Information Strategic Partnership with India TBD Decision Guidance Decision Post-Transition Support (e.g. Angola, Timor-Leste) TBD Information Fiduciary risk assurance and financial management capacity building TBD Decision Decision E.Finance/Audit & Investigations Annual Accounts Annual Financial Report Decision Decision Decision Decision Decision Decision Financial Forecast Financial Update, including forecast Decision Decision Decision Decision Decision Decision Budget Financial Update, including forecast Decision Decision Decision Decision Decision Decision Audit & Investigations Report Audit & Investigations Report Information Information Information Information Information Information F.GovernanceBoard Chair Appointment Board Chair Appointment Decision Board Vice Chair Appointment Consent Agenda Decision Decision Decision Decision Committee Chair Appointments Consent Agenda Decision Decision Decision Decision Decision Decision Board and Committee Appointments Consent Agenda Decision Decision Decision Decision Decision IRC Appointments Consent Agenda Decision CEO Appointment Consent Agenda Decision Decision Secretary Appointment Consent Agenda Decision Treasurer Appointment Consent Agenda Decision Amendments to Governance Documents (Statutes, By-Laws, Committee Charters) Consent Agenda Decision IRC Terms of Reference TBD Decision Audit & Investigations Terms of Reference TBD Decision G.ReportingCommittee Chair Reports Committee Chair and IFFIm Board reports Information Information Information Information Information Information Information Information Information Information Information IFFIm Chair Reports Committee Chair and IFFIm Board reports Information Information Information Information Information Information Information Information Information Information Information Replenishment/Resource Mobilisaton TBD Discussion HR Report Closed Session Information Information Information Information Information Information Annual Report on Implementation of the Gender Policy TBD Information Information Information Information Information Information CEPI Progress Report Annex to Board pack/On BE as additional materials Information Information Information Information Information Information Information Information Information Information Information Board and Committee minutes Annex to Board pack/On BE as additional materials Information Information Information Information Information Information Information Information Information Information Information H. Pre-Board Technical Briefing SessionsTBCTBC
*Includes Eligiblity & Transition Policy, Co-Financing Policy, HSIS Support Framework, CCEOP
Last updated - 2 December 2020
Next Board Meetings : March/April 2021, TBD (Board Retreat) 23-24 June 2021, Geneva 1-2 December 2021, Geneva
2021 2022 2023 2024 2025 Gavi 5.0
Board-2020-Mtg-6-Doc 01h

 

 

Board -2020 -Mtg -6-Doc 02a 1


Section A: Executive Summary
At its July meeting, the Gavi Alliance Board reviewed the latest forecasts reflecting
the successful outcome of the Global Vaccine Summit and Gavi?s immediate three
pillared response to the COVID -19 pandemic : (a) providing immediate support to
help countri es respond to the pandemic; (b) maintaining, restoring and
strengthening immunisation services; and (c) responding to the fiscal impact on
immunisation services .
For its 5.0 strategy ( 2021 -2025 ), the Alliance has made equity the organising
principle in order to ensure zero -dose children and missed communities are
reached with a full course of vaccines . As detailed in Paper 5b , zero -dose children
in Gavi -supported countries have far worse health outcomes - they account for
nearly 50% of deaths from vac cine preventable diseases (VPDs) despite being
only 13% of the population 1. With C OVID -19 exacerbating inequities , the Alliance
hopes to accelerate early progress from Gavi 4.0 in reaching zero -dose children
and missed communities, build a foundation for equitable primary healthcare
(PHC), and prevent avoidable child deaths and disease outbreaks that entail
reactive investments. This is a critical step towards achieving the vision of the
Sustainable Development Goals to Leave No One Behind and achieve univ ersal
health coverage .
In September 2020, the forecasts indicated a net available for future investments
of US$ 1 ,662 million for the strategic period 2021 -2025. Based on the latest
estimates, the net available resources have been re -assessed at US$ 1 ,167
million , following the consideration of September Board decisions on COVID -19
delivery cost , updated projections of programmatic expenditures and re allocation
of some pledge s to the COVAX facility in line with donor?s indications. The
forecasts process ha s been significantly impacted by the uncertainty and the
complexity created by COVID -19 . Programmatic expenditures are likely to vary as
the situation evolves and more accura te data is collected. At US$ 1,167 million,
the projected net available resource s for 2021 -2025 are sufficient to fund the
investments presented to the Board for approval at this meeting (US$ 743 million
as detailed below ), leaving an envelope of US$ 424 million available for future
Board decisions .
The successful replenishment has meant the Alliance has more resources to invest
in its goal to leave no one behind with immunisation. As a result, the forecast has

1 Gavi internal analysis based on immunisation coverage and burden of disease estimates from WHO, IHME
and other sources .
SUBJECT : FINANCIAL UPDATE, INCLUDING FORECAST
Agenda item: 02a
Category: For Decision
Report to the Board
15-17 December 2020

 

 

1

Report to the Board

Board -2020 -Mtg -6-Doc 02a -Annex A
Annex A: Implications/Anticipated impact

1. Impact on countries

1.1 Approval of the Financial Forecast will enable funding to be allotted to
programmes throughout 2021, in accordance with the Programme Funding
Policy.

2. Risk implication and mitigation, including information on the risks of
inaction

2.1 Determination of Gavi?s financial capacity to approve the recommended
decisions relies on the current Financial Forecast. Risks that may impact the
reliability of financial forecast are described below, as well as the mitigation
strategies in place to address these risks.

2.2 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 at the London
Replenishment Meeting) or, where hedged, at the hedge rate. Pledges are
hedged progressively, and pledges repres enting approximatel y 65% of
2021 -2025 Assured Resources are not yet hedged. 2021 pledges are hedged,
2022 pledges are hedged at approximately 80% and the 2023 -2025 pledges
are unhedged. We still need confirmation that the agreements are signed, we
also ne ed clarification on the amounts and an estimate of the payments
schedule.

2.3 Gavi?s eight -month Cash and Investments Reserve provides a cushion for
adverse fluctuations in resources and expenditures. Gavi can also decline or
defer funding requests based on r esource availability.

3. Risks associated with the financial forecast and mitigations

Factors that may impact the expenditure forecast include:

3.1 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 oft en dependent 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
significantly.

3.2 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
prepara tion.

1


Report to the Board


Board -2020 -Mtg -6-Doc 02a -Annex B
Annex B: Terminology and rounding
Terms used in this paper have the meanings described below, and are relevant to
Gavi?s Board Approved Programme Funding Policy:
a) Assured Resources comprise:
? Cash and investments of Gavi, in the amount that exceeds the Cash and
Investments Reserve (see (g) below)
? Expected proceeds from IFFIm, based on existing donor pledges
? Expected AMC and any other contributions that are contingent on
programmatic expenditu re included in the expenditure forecast
? Confirmed direct contributions to GAVI Alliance that are pledged under
already -signed agreements or otherwise confirmed in writing.
? Projected investment income
b) Allowance for Further Direct Contributions (for the purpose of approving
funding decisions): An allowance for further expected direct contributions
from existing donors who have not confirmed their pledges for each year,
based on current overall contribution levels. The allowance is mandated by
the Pro gramme Funding Policy and is important towards enabling
programme funding decisions to be made while pledges have yet to be
completed for particular years. The allowance assumes that in years where
currently confirmed direct contributions total less than t he current level,
further contributions will bring the total to that level.
c) Qualifying Resources : The sum of Assured Resources and the Allowance for
Further Direct Contributions (i.e. (a) plus (b) above) .
d) Existing Programmes : Country programmes (for vaccine and cash -based
programmes and investment cases) that have already been approved for
support by Gavi, the Partners? Engagement Framework and the Secretariat
budget.
e) New Requests : Projected demand from country applica tions that are
currently being recommended by the Independent Review Committee for
approval.
f) Expected Future Requests: Projected demand from countries expected to
request Gavi support in the future for the currently approved portfolio of
vaccines and cash -based programmes. It does not include any additional
vaccines that Gavi may consider for support in the future.
g) Cash and Investments Reserve : The reserve required by the Programme
Funding Policy to be maintained at a minimum equalling eight months of
expected annual expenditures.

1



Board -2020 -Mtg -6-Doc 02b
Report to the Board
15-17 December 2020

Section A: Executive Summary

Context

This paper requests the Gavi Alliance Board to approve the bi -annual budget
related to the Partners? Engagement Framework (PEF) and the Secretariat
Resources for the fiscal years 2021 and 2022 , subsequent to the Audit and
Finance Committee (AFC) recommendation .

In light of the COVID -19 pandemic, t he Board has reinforced the priorities for Gavi
5.0 to ensure that we leave no one behind with immunisation and address the
country challenges brought about by the pandemic. Therefore, recalibrated
priorities include m aintaining, restoring and strengthening immunisation reaching
zero -dose children and missed communities , and s upporting the timely delivery of
COVID -19 vaccines .

Safeguarding domestic financing for immunisation in a fiscally constrained
environment to achieve these strategic priorities, all of Gavi?s levers will have to be
used, including additional investments in Health Systems Strengthening (as per
Doc 05b) , Partners Engagement Framework (PEF), and Secretariat Resources.
This paper specifically addresses the additional resources requested for PEF and
the Secretariat .

To deliver this ambitious agenda will require new skills, new capabilities, new
partnership s and new resources, therefore, t he budget for PEF and the Secretariat
over the 5 years of the next strategic periodic will increase by 19 % (variance
between Gavi 5.0 and Gavi 4.0 budgeted expenditure - excluding Post Tran sition
Support ).

PEF: total budgeted amount for Gavi 5.0 stands at US$ 1,231 million, a 14%
increase compared to Gavi 4.0 budgeted expenditure . (When excluding Post
Transition Support, which is getting phased out - the underlined growth is 19%).
An additional US$ 60 million is being proposed for partners to support delivery of
COVID -19 vaccines in Gavi AMC 92 economies outside PEF as part of the
US$ 150 million COVID delivery cost approved by the Board .

Secretariat: total budgeted amount for Gavi 5.0 stands at US$ 648 million , also a
19% increase compared to Gavi 4.0 budgeted expenditure.
SUBJECT : PARTNERS? ENGAGEMENT FRAMEWORK &
SECRETARIAT BUDGET 2021 -2020
Agenda item: 02 b
Category: For Decision

1

Report to the Board
Board -2020 -Mtg -6-Doc 02b -Annex A
Annex A : Implications/Anticipated impact

1. Impact on countries

1.1 Overall, the Ministry of Health in Gavi countries have the primary responsibility
for delivering on Gavi programmes. The GEF deliverables and associated
activities are intended to support this implementation and delivery on the goals.

1.2 Through the Joint Appraisal process, countries identify their technical
assistance needs, which form the basis of the partner proposals for activities
to be funded through the PEF component of the GEF. This creates more
country ownership and visibility for countries on the work -streams being
implemented, allowing better coordination of activities and better alignment
with Gavi funded programmes.

2. Impact on the Alliance

2.1 WHO and UNICEF will remain core partners of the Alliance, continue to
provide substantial assistance funded by Gavi and engage with Gavi as true
partners. However, as the PEF TCA intends to leverage the capacity of a
broader set of partner institutions, the Alliance model which at Gavi?s inception
relied solely on WHO and UNICEF as implementing partners is de facto
evolving towards a broader diversity of partners providing assistance to
countries.

3. Risk implication and mitigation, includin g information on the risks of
inaction

3.1. PEF: the 2021 and 2022 PEF budget is dependent on countries demand for
technical assistance as well as partners? capacity to provide the required
technical support to sustainably address coverage and equity challenges and
support the strengthening of immunisation programmes. Partner capacity is
recognised as a top risk for the Alliance due to Covid -19 impact and is being
actively monitored.

3.2. Secretariat: the 2021 and 2022 Secretariat budget includes the cost of
the additional resources as per the result of the organi sational review and
associated one -off expenditure as well as additional one -off expenditure
related to the Covid -19 impact based on best estimates available at the time
of the preparation of the 2 021 and 2022 budget. The Secretariat will continue
to monitor the situation and reflect an updated estimate in the upcoming
updates.

3.3. Foreign exchange risk: a large portion of the Secretariat expenditure is
incurred in CHF. The foreign exchange rate assumptions used to develop the
2021 and 2022 budget is USD/CHF 1.1 (informed by the current rate) which
can of course change and would have a corresponding impact on this
expenditure. The Secretariat will monitor the situation and include the impact
in fu ture updates.

1



Board -2020 -Mtg -6-Doc 04

Report to the Board
15 -17 December 2020


8 December 2020

Dear Board members ,
I look forward to seeing you all by Zoom next week. We have a particularly full
agenda, and we will also have the difficult task of seeing off our wonderful Board
Chair during her last formal Board meeting. As a result, this is a meeting where I
will particularly miss the in -person time ? in the room, and during breaks and
meals ? more than ever. But given the con tinued severe epidemiologic state of
affairs with COVID -19, we will have to do the best with the situation we have.
Progress under Gavi 4.0
We are now finishing five years of intensive work on Gavi 4.0. When we first
launched the 4.0 strategy, it was the most ambitious undertaking in the Alliance?s
history. I am pleased to share that based on 2019 data ? the most valid measure
of our 4.0 performance ? we have already met or are on a glide path to meet all
of our mission indicators. 1 While I am proud to sh are this news, we must also
recognise that the real and lasting implications of COVID -19 on these hard -fought
gains are yet to be seen.
Since 2015, the Vaccine Alliance has helped countries reach 259 million children
through routine immunisation with Gavi -supported vaccines, inherently
decreasing the number of ?zero -dose? children by 1.7 million (14%), and averting
5.4 million future deaths and 255 million future DALYs. The under -five mortality
rate in Gavi -supported countries has fallen below 55 per 1,000 live births, already
exceeding our 2020 target. Breadth of protection has nearly doubled since 2015,
and inactivated polio vaccine (IPV) coverage has ramped up significantly
following improved vaccine supply; countries are now preparing to introduce a
sec ond dose. Economic situations in particular countries and then the global
economic downturn due to COVID -19 led us to lower our target for the number of
1 Mission indicators: (1) Under -five mortality rate: MET; (2) Future deaths prevented: MET; (3) Future DALYs
averted: MET; (4) Unique children immunised: ON TRACK; (5) Vaccines sustained after Gavi support ends:
ON TRACK. Final data for 2020 will not be ava ilable until August 2021.
Report of the Chief Executive Officer

1




Board -2020 -Mtg -4-Doc 04
Rapport au Conseil
d?administration
15 -17 d?cembre 2020


Le 8 d?cembre 2020

Chers membres du Conseil d'administration,
J'ai h?te de vous retrouver tous sur Zoom la semaine prochaine. Le programme
de cette r?union est particuli?rement charg? , et notre t?che sera d?autant plus
difficile sachant qu?il s?agira la derni?re r?union officielle du Conseil
d?administration sous la direction de notre merveilleuse Pr?sidente. Je regretterai
donc encore plus que cette r?union ne puisse avoir lieu en pr?sentiel ; je
regretterai de ne pouvoir passer du temps pour des ?changes informels dans la
salle de r?union, au cours des pauses et des repas. Mais nous devons nous
adapter compte tenu de la gravit? de la situation ?pid?miologique de la COVID -
19 .
Progr?s r?alis?s dans le cadre de Gavi 4.0
Nous arrivons maintenant au terme de cinq ann?es de travail intensif dans le
cadre de la strat?gie 4.0 de Gavi . Lorsque nous avons lanc? cette strat?gie, il
s'agissait de l'entreprise la plus ambitieuse de l'histoire de l'Alliance. Je suis
heureux de vous annoncer que, sur la base des donn?es de 2019 ? les plus
pertinentes pour ?valuer les r?sultats de notre strat?gie 4.0 - nous avons d?j?
attei nt ou sommes en passe d'atteindre tous les indicateurs de performance
relatifs ? notre mission. 1 Je suis fier de partager cette information , mais nous
devons toutefois attendre de voir les cons?quences ? long terme de la COVID -19
sur ces gains durement ac quis.

Depuis 2015, l'Alliance du Vaccin a aid? les pays ? vacciner syst?matiquement
259 millions d'enfants avec les vaccins soutenus par Gavi, ce qui a permis de
r?duire de 1,7 million (14%) le nombre d'enfants "z?ro dose", et d'?viter ? terme
5,4 millions de d?c?s et la perte de 255 millions d?ann?es de vie en bonne sant?
(mesur?e en DALY) . Dans les pays b?n?ficiant du soutien de Gavi , le taux de
1 Indicateurs relatifs ? notre mission : (1) Taux de mortalit? chez les enfants de moins de cinq ans : ATTEINT ;
(2) Nombre de d?c?s ?vit?s ? terme : ATTEINT ; (3) Nombre d?ann?es de vie en bonne sant? gagn?es :
ATTEINT ; (4) Nom bre d?enfants vaccin ?s : EN BONNE VOIE ; (5) Vaccinations maintenues apr?s l?arr?t du
soutien de Gavi : EN BONNE VOIE . Les donn?es d?finitives pour 2020 ne seront pas disponibles avant ao?t
2021.
Rapport du Directeur ex?cutif

1



Board -2020 -Mtg -6-Doc 05a

Section A: Executive Summary
This is the tenth report to the Board on progress in implementing the Gavi
4.0 strategy and associated risks 1. Data for most of the strategic indicators is
available up to 2019, i.e. until just before the COVID -19 pandemic started. As such,
currently available data provides the best possible picture of the Alliance?s
progress over the 2016 -2020 strategic period pr ior to the impact of the
pandemic. In addition, this paper also addresses the key shifts in Gavi 5.0
priorities in the context of COVID -19 and the successful replenishment, and
implications on the operationalisation of Gavi 5.0.
Gavi 4.0 has seen more chil dren protected against vaccine -preventable
diseases than ever before. In the first four years of Gavi 4.0, countries have
immunised 259 million unique children with Gavi support. The number of zero -dose
children in Gavi -eligible countries decreased by 14% since 2015 and under -five
mortality has dropped to an all -time low of 55/1,000 live births in 2019.
However, in 2020, the last year of Gavi 4.0, COVID -19 has caused large -scale
disruption of immunisation services , health systems and economies, putting
yea rs of progress at risk and affecting marginalised populations disproportionately.
Evidently, we expect COVID -19 to have strong implications on performance in
the last year of the current strategy and on Gavi 5.0 .
Gavi has been reflecting on the recalibration of its strategic priorities for the
coming strategic period in light of the pandemic and the successful
replenishment. Acknowledging that leaving no one behind with immunisation and
Gavi?s strategic goals and objectives for the next strategic period are more relevant
than ever, the Board at its September meeting and the PPC at its subsequent
meeting confirmed the following recalibrated priorities for Gavi 5.0:
? Maintaining, restoring and strengthening immunisation , including
catching up on chi ldren who missed their timely vaccinations because of
disrupted services ,
? Reaching zero -dose children and missed communities to advance
Gavi?s ambitious equity agenda, rendered even more urgent by COVID -19
which has thrust millions more into deep poverty, exacerbating inequities
and gender disparities ,

1 Associated risks refer to top risks described in the 2020 Risk & Assurance Report (See Doc 06).
SUBJECT : STRATEGY, PROGRAMME S AND PARTNERSHIPS:
PROGRESS, RISKS AND CHALLENGES
Agenda item: 05a
Category: For Guidance
Report to the Board
15-17 December 2020

Re port to the Report to the Board
Board -2020 -Mtg -6-Doc 05a -Annex A

Annex A : Updated Alliance KPI Dashboard
BOARD & COM M ITTEE ATTENDANCE
GENDER BALANCE
Partners3
1
2
3
4
5
6
7
SFA/PEF ACHIEVEM ENTS
CSO ENGAGEM ENT
PLEDGE CONVERSION
DONOR ENGAGEM ENT IN COUNTRY
END 2019TARGET: N/A EVALUATION ALIGNM ENT
END 2019TARGET: N/A COUNTRY REPORTING
END 2015TARGET: 85%
55%
END 2019TARGET: 50%
END 2019TARGET: 100%
END 2019TARGET: N/A
END 2019TARGET: 95%
Governance4
1
Secretariat & partners1
2
4
5
6
VACCINE INTRODUCTIONS
END 2019TARGET: 56 NEW VACCINE COVERAGE
END 2019TARGET: 90%
END 2019TARGET: 90% HSS PROPOSAL QUALITY
END 2019TARGET: 100% HSS FUND UTILISATION
END 2019TARGET: 75% HSS GRANT TARGETS
END 2019TARGET: 50% 34%
Secretariat
OPERATIONAL DEM AND FORECAST
PROGRAM M E FINANCE FORECAST
SPEED OF CASH GRANT DISBURSEM ENTS
END 2019 TARGET: 9 months AUDITS ON TRACK
END 2019TARGET: 80% RISK M ANAGEM ENT PLAN PROGRESS
END 2019TARGET: 60% OPERATING EFFICIENCY
TARGET: N/A?
END 2019 TARGET: +/-10%
END 2019TARGET: +/-10%
1
2
2016 ?2020 INDICATORS ALLIANCE PROGRESS
4
Gavi BoardUPDATED: 29 April 2020
PARTNER GROUP PEF
PEF
CSO
DONORS
DONORS
COUNTRIES
TCA ACTIVITIES ON TRACK
0 EVALUATIONS
Health system strengtheningTargeted country assistanceStrategic focus areaPartners' engagement frameworkCivil society organization
HSSTCASFAPEFCSO
END 2019TARGET: 90% 88%
END 2019TARGET: 40%
71%
82%
END 2018BASELINE: 25
END 2018BASELINE: 96%
END 2018BASELINE : 10%
END 2018BASELINE: 50%
END 2018BASELINE: 58%
2018BASELINE : 50%
END 2018BASELINE: 11.5 months
END 2018BASELINE :18 %
END 2018BASELINE : 87%
2017BASELINE $283k:
END 2018BASELINE : -10%
END 2018BASELINE : -19%
END 201 8 BASELINE: 32 %
END 2018BASELINE :89 %
END 2018BASELINE : 59%
END 2018BASELINE : 95%
END 2018BASELINE : 94%
END 2018BASELINE : 5
2017BASELINE : 92%
END 2018BASELINE : 87%
END 201 8 BASELINE : 42%
ON TRACKMODERATE DELAYS / CHALLENGESSIGNIFICANT DELAYS / CHALLENGES
11
TRACKING TREND ONLY
50%
95%
313
94% 61%
88%
96%
-6%
14%
278K
NO UPDATE AT THIS REPORTING PERIOD
3M EASLES CAM PAIGN COVERAGE
10.5months
4
5
6
3
2
1
2
45%
59
86%
No update
+17%
99% No update
NB: Graphics not drawn to scale

Re port to the Report to the Board
Board - 2020 - Mtg - 6-Doc 05a -Annex B

Annex B: 2016 -2020 Strategy progress dashboard with original indicator
definitions
2
3
Improve sustainability3 Market shaping4 Accelerate vaccines1 Strengthen capacity2
2016 ?2020 INDICATORS STRATEGY PROGRESS
5
Gavi BoardUPDATED: 28 September 2020
1
EQUITY: GEOGRAPHIC DISTRIBUTION
ROUTINE IM M UNISATION COVERAGE 1
2
3
4
5
EFFECTIVE VACCINE M ANAGEM ENT
DATA QUALITY
PENTA1 COVERAGE & DROP -OUT
INTEGRATED HEALTH SERVICE DELIVERY
CIVIL SOCIETY ENGAGEM ENT
2
3
4
1
COUNTRY INVESTM ENT IN VACCINES
COUNTRIES ON TRACK TO TRANSITION
INSTITUTIONAL CAPACITY
CO-FINANCING COM M ITMENTS
2
3
4
1
VACCINE PRICE REDUCTION
VACCINE INNOVATION
HEALTHY M ARKET DYNAM ICS
SUPPLY SECURITY
Measles -containing vaccine 1 stdose Percentage pointPentavalent 1 stdose Pentavalent 3 rddose
MCV1
PPPenta1Penta3
CURRENT: + 1PP 2020 TARGETPENTA3 84%MCV1:83% 2015 BASELINEPENTA3: 79% MCV1:78%
CURRENT: + 1PP 2020 TARGET 26% 2015 BASELINE16%
2020 TARGET43%** 2015 BASELINE16%
2020 TARGET 39% 2015 BASELINE29%
2020 TARGETPENTA1: 88% DROP-OUT: 3% 2015 BASELINEPENTA1: 84% DROP-OUT: 6%
2020 TARGET100% 2015 BASELINEN/A 2020 TARGET55%
2020 TARGET100% 2020 TARGET11/11
$15.57 2020 TARGET N/A1
2020 TARGET 10
2020 TARGET 6/11
55%2020 TARGET43%**
2020 TARGET **
2015 BASELINE45%
2020 TARGET 75% 2015 BASELINE63%
2015 BASELINEN/A
2015 BASELINEN/A
2015 BASELINE85% 2015 BASELINE7/11
2015 BASELINE$20
2015 BASELINE0
2015 BASELINE1/11
BREADTH OF PROTECTION
PENTA381%
CURRENT: + 1PP 2020 TARGET 63% 2015 BASELINE30%
24% MCV181%
45%
21%
8/11
10
3/11 4EQUITY: WEALTH
CURRENT: + 1PP 2020 TARGET 45% 2015 BASELINE35%5EQUITY: M ATERNAL EDUCATION
CURRENT: + 1PP 2020 TARGET 40% 2015 BASELINE30%
ON TRACKMODERATE DELAYS / CHALLENGESSIGNIFICANT DELAYS / CHALLENGES
7
NO UPDATE AT THIS REPORTING PERIOD
29
35%
32%
44%
1Not published due to commercial sensitivity** Revised baselines and targets Approved by the Board in November 2018 NB: Graphics not drawn to scale
Indicators reported as originally defined
16%
TRACKING TREND ONLY/ DATA INCONCLUSIVE2
67%
65%
98%
56%
87% 7PP

Report to the Board

Board -2020 -Mtg -6-Doc 05a -Annex C 1
Annex C: Annual rep ort on implementation of the gender policy
Section A: Introduction
This report is an update on progress made in 20 20 on imp lementing Gavi?s new
programm e focused gender policy , as well as providing updates on advancing gender
equality in Gavi?s broader work .
Gavi?s Gender Policy seeks to identify and overcome gender related barriers to reach
zero -dose and under immunised communities with the full range of vaccines. This
encompasses: 1) Identifying and addressing underlying gender -related barriers faced
specifically by caregivers, adolescents , and health workers 2) In the specific pockets
where they exist, overcoming diffe rences in immunisation coverage between girls and
boys. 3 ) Encouraging and advocating for women?s and girls? full and equal participation
in decision -making related to health and health programmes.
Given the immense challenges of the COVID -19 pandemic , ine quities in vulnerable
communities, including gender related barriers, have in many settings been
exacerbated making implementation of the gender policy even more relevant. As such,
gender equality is a high priority area for Gavi , with the significant milestone of
updating the gender policy , coming into force on 1 July 2020 . Building on existing
collaboration with partners at global, regional , and country levels, the Secretariat has
begun sociali sing the updated Gender Policy . By the beginning of the fourth quarter ,
the new Demand, Communities & Gender team was up to strength , and with the roll
out of new guidance and the development of capacity building activities , the
Secretariat and Alliance capacity will rapidly grow . This report highlights progress
made towards achieving Gavi?s gender goals in 2020.
Section B: Gender Policy at a glance
1. Gender Policy at a glance
1.1 Gavi has had a Gender policy since 2008 . Following an external evaluat ion in
2018 -2019 and a highly consultative policy review process , the approved and
updated policy came into effect on 1 July 2020 .
1.2 Gavi?s new gender strategy recognises that overcoming gender related barriers
is an essential step in reaching zero dose and under immuni sed children . A
strong gender focus is now a guiding principle of the Gavi 5.0 strategy with an
Alliance -wide principle to be ?gender focused? and a specific objective within
Goal 2 on strengthening health systems , to identify and address gender -related
barrie rs to immunisation.
1.3 The policy provides the framework and principles for Gavi?s programmatic
engagement on gender, including support for vaccines, health systems and
technical assistance. It is underpinned by a theory of change and a
monitoring framework (See Annex 1 ), that highlights the importance of
overcoming gender related barriers t hrough the ? Understand, advocate,
identify, reach, learn, partner ? framework.

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Board -2020 -Mtg -6-Doc 05b

Section A: Executive Summary
Context
The Alliance has made equity the organising principle of Gavi 5.0 , with an acute
focus on reaching zero -dose and under -immunised 1 children with immunisation.
This is also a key priority for the global community Immunization Agenda 2030,
which was endorsed by the World Health Assembly in May 2020. Despite a 50%
increase in the number of children being reached by routine immunisation since
2000, 10.6 million children still receive no routine vaccines each year in Gavi -
suppo rted countries . Without action, thi s would mean that over 50 million more
children would be missed by 2025. These children are disproportionately clustered
in marginalised communities which are typically among the poorest , with less
access to health and other government services and far wor se health outcomes.
Two thirds of zero -dose children live in households which are below the poverty
line and 50% of deaths from vaccine -preventable diseases in Gavi -supported
countries occur among zero -dose children , although they account for only
13% of c hildren . These communities are also often politically marginalised , face
systemic economic, social and cultural disadvantages and are home to acute
gender disparities. These are precisely the communities which must be prioritised
to achieve the vision of t he Sustainable Development Goals to leave no one
behind .
At its September meeting, t he Board reaffirmed that the Alliance?s focus on
equity is more important than ever in the context of the COVID -19 pandemic,
which has exacerbated existing inequities and increased the number of zero -dose
and under -immunised children. The Board endorsed the need to provide
additional Health Systems Strengthening (HSS) support to countries to
accelerate progress on equity and asked that the Programme & Policy
Committee (PPC) review and recommend the appropriate level of investment. The
Secretariat presented a set of options and trade -offs to the PPC in October . There
was clear agreement among PPC members that additional investments will be
needed to accelerate and sustain progress on reaching zero -dose and under -
immunised children and missed communities in the context of COVID -19. Having
considered potential options, the PPC recommended to increase the level of
HSS support by US$ 500 million to US$ 1.7 billion and funding to partners
1 Zero -dose children are defined for operational purposes as those not receiving a first dose of diphtheria -
tetanus -pertussis (DTP) containing vaccine; under -immunised are those not receiving a full course of three
doses of DTP -containing vaccine .
SUBJECT : ACCELERATING EFFORTS TO REACH ZERO -DOSE
CHILDREN AND MISSED COMMUNITIES IN GAVI 5.0
Agenda item: 05b
Category: For Decision
Report to the Board
15-17 December 2020

1


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Board -2020 -Mtg -6-Doc 05b -Annex A
An nex A: Theory of change for reaching zero -dose and under -immunised children and missed communities

Report to the Board
Board -2020 -Mtg -6-Doc 05b -Annex B 1
Annex B: Areas highlighted by the PPC to be further addressed in the Board
paper and / or during operationalisation
Cross -Alliance approach needed to operationalise the equity agenda: The Secretariat
and partners will create a cross -Alliance working team (and which does not duplicate
the work of existing bodies) to further operationalise the approach to reach zero -dose
children and missed communities
The proposed amo unts of additional investment may not be sufficient: Currently, there
is limited data on the additional costs of reaching zero -dose children which can be
very high in certain contexts. Recognising this, the PPC underlined the importance of
remaining flexib le. The Secretariat would report back to the PPC and Board
periodically on the progress and impact of this funding, and whether any adjustment
is needed to the amount
The Alliance to ensure integration of the core HSS, additional HSS being allocated for
eq uity and TCA to implement the equity agenda: Equity is the organising principle for
all Alliance support to countries and the Board paper will reflect how all these levers
come together at country level to support progress on equity including how redesigned
portfolio management processes would help countries plan all Gavi support in an
integrated way as part of full portfolio planning. As described in PPC Doc 03a, each
country will develop a theory of change to identify the outcomes it seeks to ach ieve,
the activities that will be needed to achieve this and how the full set of Gavi support
will be used for this. Countries will have a single budget and workplan which will
include all Gavi support.
Partners should be capacitated to deliver on Gavi 5.0 while responding to COVID -19:
The PEF MT will engage on how best to allocate the proposed PEF resources in Gavi
5.0, noting the heightened current resource requirements in the context of COVID and
the need to keep the PEF forecast flexible. The PEF MT can recommend to the Board
an adjustment to the overall PEF envelope in future years if this is deemed necessary.
Countries to be provided with more transparency on the support they receive through
PEF: Allocation of TCA funding will be linked to the HSS allo cation formula in Gavi
5.0, providing more transparency to countries on how countries? TCA funding levels
are determined relative to their HSS allocation. The principle of countries setting the
objectives and priorities for TA, and choosing appropriate par tners, will remain intact
in Gavi 5.0. As part of changes to portfolio management processes, multi -year
approvals of TCA will be implemented so both countries and partners have more
predictability of funding levels.
The Alliance to work with other partners within and beyond the health space to jointly
invest in reaching zero -dose children and missed communities as an entry point to
strengthen PHC: The Alliance has expanded the number of partners it works with very
significantly in Gavi 4.0 including partner s within and outside the health space. With
the focus on missed communities, the Alliance will seek to work systematically with
other development financing institutions to ensure they also prioritise these
communities for delivery of other PHC services, an d to expand partnerships with other
actors outside the health space who have a comparative advantage in identifying and
reaching missed communities (e.g. the Secretariat is currently working to develop
framework agreements with multiple humanitarian organ isations to facilitate

1



PPC - 2020 - Mtg - 2 - Doc 03b Report to the
Programme and Policy Committee
28 - 29 October 2020

Section A: Executive Summary
Context
E quity is the organising principle of Gavi 5.0, and the Alliance has made reaching
zero - dose ch ildren and missed communities (which are also home to many under -
immunised children) with a full course of vaccines our paramount commo n priority.
This builds on the coverage and equity agenda during Gavi 4.0 : s ince 2015,
c ountries have reduced the number of zero - dose children 1
by 14% , following five
years of stagnation in Gavi 3.0 . However , with 10.6 million children remaining
deprived of even a single dose of the basic diphtheria - tetanus - pertussis ( DTP )
containing vaccine every year in Gavi - supported countries, much remains to be
done . After a successful replenishment, the Alliance has more resources to invest
in its goal to l eave no one behind with immunisation, scale up promising models of
pro - equity programming at sub - national level initiated during Gavi 4.0 and help
countries to accelerate progress .
T he COVID - 19 pandemic has created unprecedented disruption resulting in ma ny
more zero - dose and under - immunised children, with a disproportionate impact on
poor and marginalised populations. It also means countries are facing higher cost s
as they adapt services to follow new safety protocols , intensify community
engagement to rebuild trust and catch up missed children. The Alliance has
stepped up to support countries in mounting an immediate response to COVID - 19,
and is now pivoting to mai ntain, restore and strengthen immunisation services.
Countries are reprogramm ing Gavi support from their health system strengthening
(HSS) and Partners? Engagement Framework (PEF) budgets to meet these needs .
As b oth HSS and PEF budgets are currently set t o decline in Gavi 5.0 , with HSS
declining by ~ US$ 200 million , t his risks undermining efforts to accelerate progress
on equity unless additional resources are made available to countries .
Questions this paper addresses
1. How will the Alliance support countries to reach zero - dose children and
missed communities, building on progress in Gavi 4.0?
2. How has COVID - 19 affected immunisation and equity and h ow is the
Alliance supporting countries to respond ?

1
Zero - dose children are d efined for operational purposes as those not receiving a first dose of
diphtheria - tetanus - pertussis (DTP) containing vaccine ; under - immunised are those not receiving a
full course of three doses of DTP - containing vaccine SUBJECT : ACCELERATING EFFORTS TO REACH ZERO - DOSE
CHILDREN AND MISSED COMMUNITIES IN GAVI 5.0
Agenda item: 0 3 b
Category: For Decision
Doc 05b - Annex C

1



Board -2020 -Mtg -6-Doc 06


Section A: Executive Summary
Context
The Gavi Board has ultimate responsibility for risk oversight in the Alliance and is
responsible for agreeing on overall risk appetite and understanding and agreeing
the most significant risks and related mitigation. It therefore receives an annual
comprehensive Risk & Assurance Report .
Questions this paper addresses
The Risk & Assurance Report discusses the most critical risks that could potentially
have an impact on the ability of the Alliance to achieve its mission and strategic
goals . This year?s report presents a reframed set of 16 top risks in the conte xt of
Gavi 5.0, the COVID -19 pandemic and the COVAX Facility. The report has been
reviewed and recommended for approval by the Audit & Finance Committee
(AFC). The Gavi Alliance Board is requested to approve the report attached as
Annex A and to provide gu idance on the questions outlined below.
Conclusions
This year?s report shows that Gavi?s overall risk profile has increased across the
board, with nine top risks from last year having increased , one new risk and one
having decreased. While inherently risks are heightened, mitigating these risks and
obtaining assurance over the effectiveness of mitigation is now more complicated
due to COVID -19 related restrictions and affected capacities. As a result, the Gav i
Alliance Board needs to acknowledge that Gavi will be operating with a riskier
strategy in a riskier world, and it will be critical to reflect this in a recalibrated risk
appetite (i.e. consciously accepting for some risks that they may materialise as pa rt
of pursuing our mission) and to continue to actively monitor and re -assess risks as
they change or our understanding of them evolves. Section 2.3 of the report
therefore includes suggestions on how to recalibrate risk appetite, which can serve
(together with the Gavi Alliance Board?s guidance on this) as the basis for a
subsequent update of Gavi?s Risk Appetite Statement to further specify and codify
Gavi?s risk appetite for the Gavi 5.0 strategic period .


SUBJECT : RISK MANAGEMENT UPDATE
Agenda item: 06
Category: For Decision
Report to the Board
15 -17 Dec ember 2020

Gavi

1



Board -2020 -Mtg -6-Doc 07

Section A: Executive Summary
Context
In June 2019 , the Board agreed to institutionalise Gavi?s support to former Gavi -
eligible countries and requested the Secretariat to explore options for working with
select never -Gavi eligible middle -income countries (MICs). The development of
th is MICs Appro ach was paused in June 2020 as a result of the pandemic but,
given its pertinence to the delivery of Gavi 5.0, the Board requested the Secretariat
bring it back for decision in December 2020. This paper seeks Board approval
on the proposed MICs Approach as recommended by the PPC .
Questions this paper addresses
? Why is a MICs Approach pertinent to the delivery of Gavi 5.0 , and what are the
objectives, scope of country eligibility, and funds required ?
? In view of the impact of COVID -19, h ow should the Alliance engage in MICs ?
Conclusions
Backsliding in vaccine coverage and the absence of key vaccines in both former
Gavi -eligible (hereafter ?former -Gavi?) countries and select never -Gavi eligible
(hereafter ?never -Gavi?) MICs pose a direct threat to the successful delivery of Gavi
5.0. This paper thus proposes for approval a dedicated MICs Approach , endorsed
by the PPC, to prevent backsliding in former -Gavi countries and to drive the
sustainable introduction of key missing vaccines in former -Gavi countries and
select never -Gavi MICs . But t he impact of the pandemic on both countries and the
Alliance means that trade -offs are required . Hence a gradual engagement that ,
through a distinct equity lens , gives priority to preventing and mitigating backsliding
in former -Gavi countries and to strengthening relationships in never -Gavi MICs to
prepare for future more substantive engagement is recommended . Exceptional
support may also be o ffered to ensure successful introductions of key vaccines, or
to lay the groundwork for their future introduction. The Secretariat will return to the
Board in June 2022 with the full suite of MICs support . A pproval is requested of
the already earmarked 3% of Gavi 5.0 planned expenditure (US$ 281 million), with
a proposed spend of up to 25% in the first 18 months . In reviewing th is proposal ,
which it endorsed, the PPC requested the Secretariat to further consider how
fragil e MICs might be supported , to develop a Theory of Change for the MICs
SUBJECT :
GAVI?S APPROACH TO ENGAGEMENT WITH FORMER
AND NEVER -ELIGIBLE MIDDLE -INCOME COUNTRIES
(MICS)
Agenda item: 07
Category: For Decision
Report to the Board
15-17 December 2020

1



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Board -2020 -Mtg -6-Doc 07 -Annex A
Annex A: Implications/Anticipated impact

Risk implication and mitigation: There are two key risks of the proposed MICs
Approach. The first is that the Secretariat does not have the capacity to deliver
successfully, given limited bandwidth across existing core Gavi and COVAX
activities. This is mitigated through a gradual, targe ted approach in the next 18
months, the request for two full time equivalents (FTEs), and the identification of
synergies with the COVAX Facility, as all never -Gavi MICs proposed for near -term
engagement are in the 92 economies engaged in the Advance Marke t
Commitment. Without additional resources, the Secretariat will not be able to roll
out the MICs Approach and it would need to be deprioritised .

The second risk is that a focus on COVID -19 vaccine introduction detracts from
the routine immunisation agend a, which is critical in these countries. Gavi will
prioritise the backsliding agenda in former Gavi -eligible countries, and, where
relevant, use COVID -19 as an entry point for a broader immunisation agenda in
both former and never Gavi -eligible countries.

Risk of inaction: If the Secretariat does not begin targeted engagement with MICs
now, there is a risk of further backsliding on routine immunisation in former Gavi -
eligible countries that would undermine the critical work done to date. There is also
risk that former and n ever Gavi -eligible countries are not prepared to introduce
lifesaving pneumococcal conjugate, rotavirus, and human papillomavirus vaccines
once the acute phase of the pandemic has subsided.

Impact on countries: The proposed Approach is critical to helpin g MICs mitigate
reductions in routine immunisation coverage and start to build the ecosystems
necessary to introduce new vaccines, especially for zero -dose children and missed
communities.

Impact on Alliance: The Alliance is significantly stretched by CO VID -19 and may
have limited capacity to implement the proposed MICs Approach. This is mitigated
by the provision of resources, accessible to partners, to enable delivery of the MICs
Approach.

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Board -2020 -Mtg -6-Doc 07 -Annex B
Annex B : Paragraphs referenced in decision points for the MICs Approach

Paragraphs 4.1 -4.5 of Document 04 to October 2020 PPC
4.1 In light of COVID -19, it is proposed that the MICs Approach be implemented
gradually , recognising that in the next 18 months, most countries , the
Secretariat and the Alliance will not have capacity to engage beyond
responding to the COVID -19 pandemic and introducing new COVID -19
vaccines . The primary focus over the next 18 months will be on
preventing and mitigating backsliding in former -Gavi countries , whil st
prioritising countries with large numbers of zero -dose children 1.
4.2 Support for former -Gavi countries
(a) Primary focus: Preventing and mitigating backsliding. Two Pillars of
support originally presented to the Board in June 2020 are proposed for
initial engagement with former -Gavi countries , namely political will
building and enhanc ing the immunisation ecosystem . The
Secretariat also proposes to deploy some targeted interventions to
meet the increased need s in former -Gavi countries . Engagements would
only focus on countries where there are meaningful opportunities to
deliver impact and would thus not take place in all countries. Activities
could include 2:
? Advocating to keep routine vaccinatio n on the political agenda
in a way that prioritises equity , including by bringing the voices of
the marginalised to the table.
? Providing technical assistance to help countries re -establish
routine immunisation services by developing plans to
communicate and engage communities towards the resumption of
safe vaccination services, rebuilding confidence in the system, and
designing strategies for identifying and catching up missed
communities.
? Targeted interventions to restore coverage and catch up missed
children, while fostering integrated service delivery and promoting
supportive innovations (e.g. digital tools).
? Fostering peer -to -peer learning through, for example, the Learning
Network for Countries in Transition (LNCT) , th e Vaccine
Procurement Practitioner?s Network (VPPN), and regional networks
such as the Pan American Health Organization (PAHO) Revolving
Fund (RF) , disseminating examples of best practice s on returning to
fully functioning routine immunisation services.
(b) Secondary focus: L ay ing the groundwork for future successful
introductions of PCV, rotavirus , and HPV vaccines by l everaging
1 Four former -Gavi countries have notable numbers of zero -dose children: Angola, India, Indonesia, and
Ukraine. Data from WUENIC, 2018. 2 This draws on Gavi?s ?Maintain, Restore and Strengthen? guidance (October 2020).

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Board -2020 -Mtg -6-Doc 07 -Annex C 1
Annex C: Summary of support proposed under the MICs Approach
Figure 1: Summary of initial engagement (January 2021 ? June 2022)

Country grouping 1
Former
Gavi -eligible
countries
Never Gavi -
eligible LMICs
Additional
never Gavi -
eligible & IDA -
eligible
economies
Indicative funding
allocation during
initial engagement
# countries in scope 2
17 3 11
(10 with
potential
engagement) 4
11
(9 with
potential
engagement) 5

Proposed
Activities
Preventing &
mitigating
backsliding
? ? ? ~US $ 60 million
Laying the
groundwork
for new
vaccine
intro duction s,
& responding
to country
intros of PCV,
rotavirus &
HPV 6
? ? ? ~US $ 10 million
Indicative funding
allocation during initial
engagement
~90% ~10%

Indicative Secretariat
resourcing during initial
engagement
2 FTEs
No additional resources at this
time; engagement via the
COVAX Facility


1 See Appendix 3 for the list of countries within each category. 2 Numbers of countries based on list of Gavi transitioned countries as of October 2020 and 2019 World Bank
country groups by income. Available online here:
http s://datahelpdesk.worldbank.org/knowledgebase/articles/906519 -world -bank -country -and -lending -groups .
Accessed October 2020. 3 Additional countries to be added pending transition over the next 5 years. 4 One economy, Federated States of Micronesia, is techni cally in scope but has no missing introductions
and so no initial activities are planned. 5 Two economies, Fiji and Marshall Islands, are technically in scope but have with no missing introductions
and so no initial activities are planned. 6 Activities related to new vaccine introductions will only be undertaken in countries that are missing at least
one of PCV, rotavirus or HPV vaccines.

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Board -2020 -Mtg -6-Doc 07 -Annex D 1
Annex D: Draft Theory of Change for the MICs Approach





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Board -2020 -Mtg -6-Doc 07 -Annex D 2
The theory of change (ToC) presented above is a high -level work -in-progress draft
for directional guidance from the Board. The aim of the MICs draft ToC is to
provide the Board with a picture of the MICs approach as currently
developed, acknowledging that the ToC is still a work in progress and will be
detailed in further stages. Given the deferral of the new vaccine introduction
agenda until June 2022, th e draft focuses largely on the backsliding objective. A
final, comprehensive ToC covering both objectives w ill be brought to the Board in
June 2022 , informed by the learning agenda and developed in collaboration with
key stakeholders . The draft ToC includes the following components:
Levers: The MICs approach will leverage, to varying extents, all of the inputs and
levers in Gavi ?s sphere of control , as laid out in the Gavi 5.0 ToC. For example, the
MICs Approach will look to mobilize resources towards immunisation, leverage
existing and new partnerships towards the MICs objectives, and to innovate
through the Innovative Financing Facility (in the longer term), all while taking a
continuous Alliance -learning approach to understand how best to engage
successfully in MICs.
Key interventions areas: Specific i nterventions will be developed and detailed
based on country needs and consul tations with partners and stakeholder s. Initially
these are expected to fall into in four categories: advocacy and political will building
(e.g., advocating to keep routine vaccination on the political agenda in a way that
prioritises equity, including by bringing the voices of the marginalised to the table) ;
technical assistance and support to enhance the immuni sation ecosystem (e.g.,
developing plans to communicate and engage communities towards the
resumption of safe vaccinations services) ; targeted inte rventions (e.g., restoring
coverage and catching up missed children via integrated service delivery and
innovations) ; and, in the longer term, an Innovative Financing Facility for
procurement. All of these interventions will take an explicit equity lens, p rioriti sing
missed communities and zero -dose children where relevant. In addition, these
interventions will be catalytic, aiming to mobilize additional resources towards the
MICs goals from domestic and other sources.
Outputs: These interventions are expe cted to lead to political commitment to
equitable vaccination; developed plans and strategies to maintain, restore, and
strengthen coverage, starting with missed communities; and strengthened
government capacity to deliver equitable immunisation programmes in the MICs
targeted by the Approach . In addition, t he Innovative Financing Facility, when it is
operationalized, will contribute, alongside other interventions, to increased access
to vaccines at sustainable prices. The intervention areas will work together to
generate these outputs: for example, the combination of advocacy alongside
catalytic targeted interventions will incentivize governments to contribute additio nal
resources to preventing and mitigating backsliding, thus strengthening political
commitment for equitable immunisation.
MICs objectives and outcomes: Ultimately, these interventions and outputs
contribute to the achievement of the two objectives laid o ut in the MICs Approach:
preventing and mitigating backsliding in former -Gavi countries, and supporting the
sustainable introduction of new vaccines in former and select never -Gavi

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Board -2020 -Mtg -6-Doc 07 -Annex E 1
Annex E : Draft Learning Agenda
In order to ensure that the MICs Approach is fit -for -purpose in its design, effective
in its implementation, and able to adapt in a timely way, a formal learning agenda
will accompany the implementation of the MICs Approach over the course of
Gavi 5.0.

Th is learning agenda will be informed by a clear set of use cases and key
priorities/questions, presented in draft form below. Following any additional
guidance from the Board, these use cases and questions will be further refined
and then used to develop a detailed learning agenda aligned with the broader Gavi
5.0 Learning System. The final learning agenda will be developed in close
collaboration with, and building on the experiences of, Alliance partners, and will
seek to formalise Alliance learning to date , while taking a forward -looking view at
how both past and future learning can inform the MICs Approach. Key questions
of strategic importance to the Board will be answered through the most appropriate
and robust methods 1, designed in coordination with Ga vi?s Measurement,
Evaluation, and Learning Unit, and following any guidance from the Evaluation
Advisory Committee as relevant. The learning agenda will also inform regular
updates to the Board on the MICs Approach.
Figure 4: Draft use cases and key questio ns:
Use cases
(under development)
Gavi 5.0 Learning Priority
Questions
(under development)
Additional detailed questions
(under development)
? To ensure that the planned MICs
Approach is relevant and
addresses the drivers of the
challenges identified (by 2021 for
backsliding, 2022 for full Approach)
? To support countries to
understand the root causes of
backsliding and barriers to
sustainable and equitable
introductions, and what is needed
to overco me them (by 2021 for
backsliding, 2022 for full Approach)
? To confirm if the support we are
providing through MICs is effective
and sufficient, recognizing the
heterogeneity of MICs contexts
(Ongoing, mid -term review 2023)
o If yes, can we deliver the same
outcomes more efficiently ?
o If no, is the policy or the
implementation the
bottleneck ?
o How can we adapt and
improve ?
Backsliding: Is there any
indication of backsliding on
coverag e in countries? If
so, what are the key drivers?
? How and why do drops in coverage exacerbate
inequities?
New vaccine
introductions: What are the
key enablers or bottlenecks
to equitable and sustainable
new vaccine introductions?
? How can new vaccines be introduced in a way that
reduces inequities?
? What can we learn from COVAX engagement on what it
takes to successfully introduce new vaccines in MICs?
? What can we learn from the targeted piloting of some
aspects of the Innovative F inancing Facility?
COVID -19: What is the level
of disruption and impact on
routine immunisation (RI)?
How well is Gavi responding
to support countries to
maintain, restore and
strengthen routine
immunisation / ease
disruption?
? How are the drivers of backsliding different in the COVID -
19 context?
? How have the barriers to sustainable and equitable new
vaccine introductions changed in light of COVID -19?
? What can we learn from the Alliance?s experience of
implementing MR&S in Gavi -eligible countries that is
relevant to MICs?
1 E.g., Monitoring, evaluation, portfolio level analytics, implementation research.

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Board -2020 -Mtg -6-Doc 08


Section A: Summary
Context
The COVID -19 pandemic continues to spr ead across the world, and with over 50
million people infected and 1. 5 million deaths, the ongoing crisis is having a
profound impact on people?s health and liv elihoods and their health worldwide . In
addition, r ecent COVID -19 vaccine trial preliminary successes have put an even
greater spotlight on vaccines as a solution to the pandemic, and the COVAX
Facility (?the Facility?) as the mechanism to achieve global access , ensuring that
low - and lower middle -income economies, as well as other IDA -eligible e conomies,
have access to COVID -19 vaccines at the same time as all wealthier economies.
Since Septembe r 2020 , the Secretariat has been working tirelessly to
operationalise the Facility, continuing to engage manufacturers, self -financing
economies, and AMC -elig ible economies, representing the principles of
collaboration and solidarity in response to COVID -19. Currently 189 countries are
committed or eligible to receive doses through the Facility, representing 90% of the
world?s population. The COVAX Facility portfolio currently includes three vaccines ,
and to date t he AMC has fundraised US$ 2.1 billion.
The Gavi Board serves as the decision -making body for the COVAX Facility. In
September, t he Board approved interim terms of reference for COVAX Facility
bodies, the allocation of US$ 150 million from core resources to prepare the 92
AMC -eligible participants (?AMC92 ?) to deliver COVID -19 vaccines , and the cost -
sharing approach to vaccine procurement for the AMC92 .
Following the pri nciple of safeguarding Gavi?s assets and reputation, the Facility is
being designed to avoid risk where possible, and residual risks are being actively
monitored and mitigated. However , it is also understood that operating at this
magnitude and speed carri es risks, and failure of establishing a successful Facility
will also affect Gavi?s overall reputation. Some key risks are outlined in this paper
and a full overview is included in section 3 of the Risk & Assurance Report ( see
Doc 06 ). The Gavi Secretariat, including the Office of the COVAX Facility, under
the guidance of the Board, continues to seek the right balance to successfully
deliver on the promise o f the Facility while minimising risks to Gavi core resources
and programmes.


SUBJECT: COVAX FACILITY OPERATIONALISA TION AND VACCINE
PROGRAMME
Agenda item: 08
Category: For Decision
Report to the Board
15 -17 December 2020

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Board -2020 -Mtg -6-Doc 08-Annex A

Annex A : Implications/Anticipated impact
? Risk implication and mitigation, including information on the risks of
inaction
Risks associated with the Facility are set out in the paper and in Section 3 of the
Risk & Assurance Report (see Doc 06 ).
? Impact on countries
The failure of the Facility to provide up to 2 billion doses of COVID -19 vaccines
by the end of 2021 will impact equitable access to COVID -19 vaccines, in
particular for low er -income economies.
? Impact on Alliance
The full Alliance is invested in the success of the COVAX Facility and the
COVAX AMC, with Gavi also seeking secondments to ensure that is it fully
leveraging the expertise from acro ss the Alliance partners and stakeholders .
? Legal and governance implications
Gavi, as the legal entity of the Facility is entering into the commitments with
participants and manufacturers and ultimately bears any exposure whether
financial, programmatic or reputational.
The key legal risk has been identified as the SFPs not entering into supply
agreements, while Gavi will have to comply with its commitment to pay for the
firm order commitments to manufacturers. I n that context, i t is worth noting that,
once Gavi exercises its option under its advance purchase agreement (APA)
with the relevant manufacturer (on the basis of the exercise of options by the
SFPs un der the optional model ), Gavi?s options in the APA effectively become
firm order commitments before the SFPs have entered into their supply
contracts with th e relevant manufacturer or procurement agent . This window
represents a potential liability for Gavi.
While a number of SFPs under the committed model have procured a
guarantee, in many instances, the guarantee has been issued by the relevant
SFP?s Ministry of Finance or Ministry of Health, which rep resents the same
sovereign risk as that of the original non -payment. By contrast, t he SFPs under
the optional model do not have a guarantee to cover for the failure to enter into
a supply agreement after they have exercised their option to procure the
vacc ines.

Gavi is working with Citi group to address this risk through such mitigants as
requiring SFPs to put money in escrow (which would require an amendment to
the ir existing commitment agreement with Gavi ) or to obtain a standby letter of
credit (which the relevant SFP would have to pay for), or requiring Gavi to
procure a breach of contract guarantee f rom the Multilateral Investment
Guarantee Agency ( MIGA ) for certain countries within MIGA?s scope of
coverage, as well as a liquidity facility on top (given that claiming under MIGA?s
guarantee requires taking the defaulting country through an arbitration process
and obtaining a favourable arbitral award ).

1

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Board -2020 -Mtg -6-Doc 08 -Annex B

Annex B: COVAX Budget 2021 and three -year forecast
Section A: Summary
1.1 This objective of this paper is to present the Office of the COVAX Facility
budget for 2021 and Forecast 2022 and 2023 to the Board for approval .

1.2 The July Board meeting approved US$ 8.4 million seed funding to enable the
setting up of the Office of the Covax Facility. It was agreed that t hese costs
would ultimately be funded by the SFP contributions and AMC funds.

1.3 A three year budget has been prepared for the expected life of the Facility ( a
three year facility was outlined in the terms and conditions for the SFPs). This
budget will be funded by the upfront payments of SFPs and Gavi COVAX
AMC funds.

1.4 Total Facility operating c osts are forecast to be US $ 135 million over the three
years.

1.5 The budget Facility costs for 2021 are US $ 55 m illion of which US $ 23 m illion
are staff/ consultants/ professional fees.

1.6 An estimate has been made to identify (where possible) and allocate costs of
the Facility to SFP and AMC participants. New processes are being
introduced and new risk mitigation measures established some specifically to
support the new SFPs. It is therefor e expected that more of the Facility costs
will be funded by SFPs than the AMC. An initial estimated split of costs of
70% SFP and 30% AMC has been made and a more accurate assessment
will be made as the Facility design is finalised and operationalised.

1.7 The 2021 budget has been recommended for approval by the AFC .
Section B: Office of the COVAX Facility Budget
2.1 The table below provides a summary of the COVAX operational ex penditure
budget for 202 1 along with projections for 202 2 and 202 3.

?
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Board -2020 -Mtg -8-Doc 08-Annex C 1

Annex C: COVAX Reporting Framework
Section A: Overview of the draft COVAX Reporting Framework
The Gavi Secretariat, in consultation with other stakeholders, is developing a Monitoring,
Evaluation and Learning (MEL) approach intended to cover both the COVAX Facility and
COVAX AMC 1.
The proposed MEL approach is holistic in nature, spanning from inputs through to impact
across the COVAX Facility and COVAX AMC . It is intended to support both accountability
and learning agendas and is complementary to the Secretariat?s Risk Management and
Assurance work . The proposal builds upon the lessons learned from the pneumococcal
Advance Market Commitment (A MC ) framework in term s of M&E approach and methods ,
making adaptations as necessary. The draft MEL approach includes the following:
? A core COVAX theory of change (with complementary, more detailed theories of
change forthcoming) ;
? A comprehensive set of performance and learning metrics ;
? A proposed Annual COVAX monitoring report;
? A multi -stage evaluation approach, to be informed by a COVAX Facility and
COVAX AMC Evaluation design, evaluability and baseline study commissioned at
an early stage ; and
? Country reporting requir ements for COVAX AMC eligible countries accessing Gavi
/ COVAX support (vaccines, cold chain equipment and additional technical
assistance) to monitor performance and facilitate learning over time.
It is hoped that a good quality and robust MEL approach a nd COVAX Reporting
Framework that speak to both learning and accountability needs will ultimately benefit
Gavi, broader ACT -A partners, donors and participants as well.
The draft COVAX Reporting Framework consists of topline performance metrics to be
shared regularly with the Gavi Board and COVAX Governance bodies. Where relevant,
we propose to integrate metrics and data sources made available by our partners (namely
CEPI , WHO and UNICEF ).
The MEL approach and COV AX Reporting Framework are drafts at present, due in large
part to several design and operational aspects of the COVAX Facility and COVAX AMC
still under development. As such, the draft COVAX Reporting Framework does not yet
include proposed baselines nor targets and flags certain indicators as still in development
phase / under discussion (TBC). Furthermore, as we evolve our understanding of the
different vaccine presentations themselves in terms of efficacy and beyond, we may have
to revisit certain assum ption s we have built into our theories of change and impact metrics.
1 Note that Gavi?s broader response to COVID -19 (for example, flexibilities introduced or exemptions granted in
response to the pandemic) is included as a specific theme under the proposed Gavi 5.0 learning priorities (as presented
in Annex E of Paper 1g) and will be complementary in nature.

Gavi
COVAX Facility Risk Framework
Citi Banking, Capital Markets & Advisory:
Global Public Sector Group
Strictly Private and Confidential
November 25, 2020

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Board -2020 -Mtg -6-Doc 09


Section A: Introduction and summary
This paper presents the strategy for the Gavi COVAX AMC replenishment. In doing
so, it presents the fundraising status to date following the launch of the COVAX
AMC at the Global Vaccine Summit in June 2020. With the prospect of COVID -19
vaccines being available in implementing countries early next year, it hig hlights the
need for immediate financing to accelerate and secure doses of the vaccines to
tackle the acute phase of the pandemic in the 92 AMC eligible economies (see
Annex A) , protecting the most vulnerable and helping to restart the world economy .
Final ly, it lays out the plan for the replenishment , including the narrative, the
funding scenarios, and the campaign .
: The hope for equitable access for AMC 92 economies
1.1 The COVID -19 pandemic has had a devastating impact : at least 50 million
people worldwide have been infected , with 1. 5 million deaths , and the
pandemic accelerating in many countries . T he world economy will shrink by
nearly USD 6 trillion this year alone , with negative growth in 150 countries ,
including in sub -Saharan Africa for the first time in quarter of a century . 1.6
billion students have missed school because of the pandemic, and 150
million people will be pushed into extreme poverty by 2021 .
1.2 To fast track a global solution, u nder the umbrella of Access to COVID -19
Tools (ACT) Accelerator, Gavi, the Vaccine Alliance has created the
COVAX Facility and the Gavi C OVAX AMC with our CEPI (Coalition for
Epidemic Preparedness Innovations) and WHO partners with one central
goal : to get effective, safe COVI D-19 vaccines to all participants regardless
of wealth on the same urgent timeline.
1.3 The Gavi Covax AMC has been set up as an innovative finance mechanism
to frontload financing of procurement of at least 1 billion vaccine doses for
low er income countries in record time . It draws upon Gavi?s experience of
rolling out increasing numbers of vaccines and reaching more people and
children over the years: >800m through routine immunisation, and >1bn
people through campaigns, mainly agains t diseases of epidemic potential.
In addition, Gavi and its partners ha ve increasingly expanded and
strengthened the health systems infrastructure to roll out vaccines. Most
importantly Gavi ?s unique experience in innovative financing, market
shaping and procurement at scale of vaccines and cold chains can be key
SUBJECT: AMC RESOURCE MOBILISATION
Agenda item: 09
Category: For Information
Report to the Board
15 -17 December 2020

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Board -2020 -Mtg -6-Doc 09-Annex A

Annex A : AMC eligible economies
? Low income : Afghanistan, Benin, Burkina Faso, Burundi, Central African
Republic, Chad, Congo, Dem. Rep., Eritrea, Ethiopia, Gambia, The Guinea,
Guinea -Bissau, Haiti, Korea, Dem. People's Rep., Liberia, Madagascar,
Malawi, Mali, Mozambique, Nepal, Niger, Rwanda, Sierra Leone, Somalia,
South Sudan, Syrian Arab Republic, Tajikistan, Tanzania, Togo, Uganda,
Yemen, Rep.,
? Lower -middle income : Angola, Algeria, Bangladesh, Bhutan, Bolivia, Cabo
Verde, C ambodia, Cameroon, Comoros, Congo, Rep. C?te d'Ivoire, Djibouti,
Egypt, Arab Rep., El Salvador, Eswatini, Ghana, Honduras, India, Indonesia,
Kenya, Kiribati, Kyrgyz Republic Lao PDR, Lesotho, Mauritania, Micronesia,
Fed. Sts., Moldova, Mongolia, Morocco, M yanmar, Nicaragua, Nigeria,
Pakistan, Papua New Guinea, Philippines, S?o Tom? and Principe, Senegal,
Solomon Islands, Sri Lanka, Sudan, Timor -Leste, Tunisia, Ukraine,
Uzbekistan, Vanuatu, Vietnam, West Bank and Gaza, Zambia, Zimbabwe
? Additional IDA eligibl e: Dominica, Fiji, Grenada, Guyana, Kosovo, Maldives,
Marshall Islands, Samoa, St. Lucia, St. Vincent and the Grenadines, Tonga,
Tuvalu.

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Board -2020 -Mtg -6-Doc 09-Annex B

Annex B: Pledges to the Gavi COVAX AMC

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Board -2020 -Mtg -6-Doc 10


Section A: Executive Summary
Context
In September 2020, the Gavi Alliance Board requested that the Secretariat present
the proposed approach for Gavi COVAX Advance Market Commitment (AMC)
support to India for COVID -19 vaccines and delivery at its next meeting in
December 2020. It recognised t hat India, given its large population size, second
largest number of COVID -19 cases in the world, contracting economy and role as
a global vaccine supplier, merits a tailored approach, recognising that the 92
economies included in the AMC (AMC92) include c ountries with Gross National
Income (GNI) per capita (p.c.) of similar value or higher than India (see Table 1 ).
Further, given that India accounts for 17% of the world population (35% of the
total COVAX AMC participants? population) , continuing COVID -19 cases in
India would pose a risk to global efforts to stop the pandemic.

Table 1
Country GNI 1 Population 2
India 2,130 1,380, 004, 000
Indonesia 4,050 273, 52 4,000
Nigeria 2,030 206,1 40 ,000

In October 2020, the Programme and Policy Committee (PPC) was requested to
provide guidance on the level of appropriate support within the presented
parameters and further conversations with the Government of India should take
place to align on a proposed package of support to be presented at the December
Board for approval .

Questions this paper addresses
? What is the appropriate level of support of COVAX AMC doses for India ?
? What is the appropriate level of delivery support for India?


1 2019 GNI pc constant USD ( WB Atlas) 2 World Bank 2020 Population projections
SUBJECT : COVAX AMC SUPPORT TO INDIA
Agenda item: 07
Category: For Decision
Report to the Board
15-17 December 2020

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Board -2020 -Mtg -6-Doc 10-Annex A

Annex A

Table 1 ? Scenarios & implications for range of potential AMC support to India
(estimated)
Scenario % of AMC
support to
India 1
# doses to
India 2
Funding to
India 3
% India
population
covered 4
% AMC 91
population
covered 5
Low end of
range
10% ~95 - 125
million
~US$ 66 5
million
~3 -5% ~17 -22 %
High end of
range
20% ~190 - 250
million
~US$ 1.3
billion
~7 -9% ~15-20 %
Pro -rata (for
reference
only)
35% ~330 - 440
million
~US$ 2.3
billion
~12 -16 % ~12 -16 %

Table 2 ? Allocation of US $ 150 million in delivery support (CCE and TA) to
AMC 91
Current Scenario Amount Allocated
Cold Chain Equipment US $ 50 million
Technical Support US $ 60 million
CCE Reserve (e.g. UCC Support) US $ 10 million
Total Alloacted US $ 120 million
Amount held pending India COVAX AMC Board decision US $ 30 million

Low range scenario
US $ 15 m illion (10% of total allocation)
High range scenario
US $ 30 mill ion (20% of total allocation)
Currently estimated Govt needs for TA
above US $ 27 million for preparedness,
planning and delivering for COVID -19
vaccine rollout
The Government of India has already
submitted its needs for urgent TA and CCE
surpassing the maximum envelop e. The
Gov ernment has already mobili sed funds
domestically to supplement CCE , but gaps
remain .
Allocating US $ 15 million would not allow
for urgent gap filling of TA or CCE needs
Allocating US $ 30 million would allow for
similar pro rata allocation of prioritised
AMC56


1 AMC donor -funded doses , and implied estimated funds (actual funding amount will depend on
dose price) . Does not accou nt for cost -sharing . Does not include Buffer. 2 Ranges b ased on base case and high er price resource mobilization scenarios, as presented in
Paper 8. 3 Assumes indicative average fully loaded price of US$ 5.2 - 7 per dose , plus compensation scheme
estimated at US$0.10/dose . Actual price, and thus amount of funding allocated, will vary based on
available technologies. 4 Assumes 2 dose regimen . 5 Assumes 2 dose regimen .

1



Board -2020 -Mtg -6-Doc 11
Report to the Board
15 -17 December 20 20

















SUBJECT: REVIEW OF DECISIONS
Agenda item: 11
No paper

www.gavi.org
FINANCE
BOARD MEETING
Assietou Diouf
15-17 December 2020, Virtual Meeting
Board meeting
15-17 December 2020
EXECUTIVE SUMMARY
Sufficient Resources to fund current and future Board decisions for 5.0
Qualifying
Resources
Expenditures
Net available for
future investments
Investments for
Decision Today
US$ 9.5 bn
US$ 9.2 bn
US$ 0.3 bn
US$ 10.4 bn
US$ 9.3 bn
US$ 0.7 bn
US$ 0.4 bn
2016-2020 2021-2025
1. 2016-2020 Gavi 4.0
? Delivered within 1% budget despite
COVID-19
2. 2021-2025 Gavi 5.0
? Successful replenishment and US$ 1.2 bn
still available for future investments
3. Proposed Investments
? US$ 0.7 bn prioritised
4. Secretariat
5. Partners? Engagement Framework (PEF)
6. Recommendations
2
Excluding COVAX AMC and Self Financing
resources & expenditures

www.gavi.org
Reach every child
Gavi?s approach to
engagement with former
and never-eligible Middle
Income Countries (MICs)
BOARD MEETING
Santiago Cornejo
15-17 December 2020, Virtual Meeting
The objectives of the MICs Approach address key threats to
sustainability and equity, which are core to Gavi 5.0
2
Board meeting
15-17 December 2020
1. Over the first 6 months of the year. Preliminary data. W HO Administrative Data Estimates for DTP3, November
2020. 2. Includes never-Gavi MICs with GNI p.c. $6,000 and additional never-Gavi IDA eligible economies.
Note: In this presentation, the acronyms ?MIC?, ?LMIC?, and ?UMIC? , and the word ?countries? include economies
that are not UN member states.
Challenges
MICs Objectives
Given the relevance of these threats to the successful delivery of Gavi 5.0, it is critical to
move forward on the MICs agenda now
.
Risk of backsliding, heightened by the pandemic,
threatens Gavi legacy and exacerbates inequities
? E.g., 8 former Gavis have seen a decrease in
number of children vaccinated in 2020 vs. 2019
1
Prevent and mitigate
backsliding in former Gavi-
eligible countries
Drive sustainable
introductions of key
missing vaccines in former
and never Gavi-eligible
countries
MICs are missing critical vaccine introductions , and
never-Gavis lag behind former-Gavis with similar income
levels
? E.g., 8 never-Gavi MICs are missing all three of
PCV, rotavirus, and HPV vaccines, and 11 are
missing two of the three
2

www.gavi.org
Reach every child
COVAX FACILITY
OPERATIONALISATION AND
VACCINE PROGRAMME
BOARD MEETING
Aur?lia Nguyen
15-17 December 2020, Virtual Meeting
COVAX Facility Update
2
Board meeting
15-17 December 2020