GAVI Alliance Board Meeting, 16-17 March 2010
Doc 01 ? Outstanding Minutes

FOR DECISION

GAVI Secretariat, 2 June 2010 1 The Board reviewed the minutes of the meeting in Hanoi (17 - 18 November 2009)
by email and a final version as circulated on 17 December 2009. They can be
found at http://www.gavialliance.org/resources/FINAL_Minutes_Nov_2009_for_web_posting.pdf .
The minutes of the two short teleconferences held during 2010 are enclosed. The
May retreat was not formally minuted ; so it s report will be reviewed and finalised
over em ail.

The Board is requested to formally approve the minutes of its meetings on:
? 17 - 18 November 2009
? 19 March 2010
? 20 April 2010

GAVI Alliance Board Meeting 19 March 2010
Teleconference DRAFT Minutes 1


Finding a quorum of members present 2
, the meeting commenced at 15.08 Geneva
time on 19 March 2010. The meeting was chaired by Mary Robinson.
1 Appointment of Board Members and Alternate Board Members
At its meeting on 17 March 2010, the Governance Committee requested the Board
to appoint the candidates it had nominated as board members and alternates (Doc
#1 in the board pack).

? The Governance Committee nominated five candidates for board service. The Governance Committee reviewed the processes used by organisations,
constituencies, and the recommendations of the Governance Committee
recruitment subcommittee to make candidate recommendations to the Board.

?
It was noted that the appointment of Anne Schuchat to the Research and Technical Health Institutes seat would increase by one the number of women
on the Board. This is a proactive step to improve the gender balance of the
Board.

DECISION
The GAVI Alliance Board:
1.1.
Appointed the following candidates for Representative Board
Member seats:

1
Binding Resolutions approved by the GAVI Alliance Board are listed in Attachment A. Decisions within the text
of the minutes are non-binding, ?plain English? actions agreed by the Board. 2
Board member participants are listed in Attachment B.

GAVI Alliance Board Meeting, 16 -17 June 2010 Doc 10 ? Resource Envelope

FOR DECISION

GAVI Secretariat, 2 June 2010 1

At the recent Programme and Policy Committee (PPC) meeting a number of
Board members suggested that it would be useful to have a discussion on the
balance between cash -based support (a variety of instruments and windows at
present) and vaccine support (vaccine procurement , programme support and
preparatory work ).

Noting that whilst keeping a vaccine focus, an integrated vision of vaccines and
system building has become core to the G AVI mission and a powerful tool for
fundraising, the right balance needs to be struck. The issue is in part highlighted
by the prioritisation discussions and by the decision before the Board on the use
of the remaining notional Health Systems Strengthening (HSS) funds. Two
decision s are presented for the Board?s consideration:

First, th e Board is asked to decide the funding share allocated to cash -based
programmes ? a dec ision that is necessary to conduct the prioritisation exercise
which the Board has re quested. Specifically, t he Board is request ed to consider
the following options for the maximum share of funding for cash -based
programmes in a given proposal round and to also consider as an alternative ,
option 4 - that a range be set (and what that range might be) given that there has
been considerable variance year on year to date, reflecting for example, country
demand, and vaccin e availability :
? Option 1: 15%
? Option 2: 20%
? Option 3: 25%
? Option 4: a. 10 -20% or b. 15 -25%
Second, t he Board is asked to decide how the notional US$ 179 million , which
has not yet been allocated to countries from the US$ 747 million estimated
spend ing for HSS , should be handled :
? Option 1: Remove from the forward projections for HSS ;
? Option 2: Retain for the existing HSS window, subject to availab ility of
funds and in line with maintaining the appropriate balance between
vaccine and cash programmes .

Resource Envelope and Spending between Cash -based
and Vaccine P rogram me s

Funding share
GAVI provides financial support in two broad areas :

1. Cash based programmes . This includes vaccine introduction grants to
co untries; I mmunisation Systems Support (rewards -based )); Health
Systems Strengthening Support; support to Civil Society.

GAVI Alliance Board Meeting, 16 -17 June 2010 Doc 11 ? HSS Resource Allocation

FOR DECISION

GAVI Secretariat, 2 June 2010 1
The Programme and Policy Committee is recommending a new method for
allocating the maximum grant an eligible country could receive through the Health
Systems Strengthening (HSS) programme. C ompatible with the four principles the
Prioritisation Task Team identified ( supporting nationally -defined priorities,
objectivity, transparency and feasibility ), the new formula better allocates funds
toward the countries with the greatest need , another key principle the Prioritisation
Task Team recommend ed for cash gran ts.

The Programme and Policy recommends to the Board that it:

? Endorse a new HSS resource allocation m ethod whereby the maximum
potential amount of funding would be:
o Based on an eligible country?s total population and weighted against a
graded gross nati onal income ( GNI ) scale.
o Never less than US $ 3 million.

Some countries are GAVI -eligible but not Platform -eligible. If a future decision is
made to make HSS funding available to these countries, the same formula will be
applied, however, there will need to be a ceiling ? i.e. a maximum possible grant.
The Secretariat recommends that this ceiling be equal to the largest possible
allocation for Platform -eligible countries 1.

A decision is needed now because work on preparing for the Platform is underway.
Health Systems Strengthening Resource Allocation

To set a reasonable and fair ceiling on the amount of funding a country could
potentially apply for from the Health Systems Strengthening (HSS) programme,
GAVI set the following formula :

? Countries with an annual GNI higher than US$ 365:
o $2.50 x number of newborn children per year

? Countries with an annual GNI lower than US$ 365:
o $5.00 x number of newborn children per year

This system has major advantages in terms of equity, predictability and
transparenc y. Countries appreciate this system , and it prevents situations where the
first to apply could be awarded a disproportionate amount of funding.

Given the Health Systems Funding Platform, it is appropriate to re -visit the allocation
method . T he PPC hope s to put in place a system that better allocates funds toward
the countries with the greatest need without sacrificing the advantages of the current
system. In doing so, it also did not want to signal entitlement to funding; c ountries
would still have to ju stify their requests through the usual application channels.

1 Health Syst ems Strengthening: Resource Allocation Paper presented at May 17 -18 PPC meeting

GAVI Alliance Board Meeting, 16 -17 June 2010 Doc 12 ? Financial Outlook

FOR INFORMATION

GAVI Secretariat, 2 June 2010 1
This document is provided for information only and includes:

? An overview of GAVI?s financing needs for the period 2010 -20
? A summary of the GAVI Alliance?s 2009 draft consolidat ed financial
statements

Financial Outlook


Financing needs through 20 20

An overview of financing needs through 2020 indicates a levelling -off of country demand
at approximately US$1.1 billion per year in the years from 2016. This reflects the
graduation of previously eligible countries , pentavalent price reductions and the
reduction of pneumococcal price s towards the AMC ?tail price? (see table below).

If more aggressive assumptions of price reductions and co -financing are factored in, the
demand would reduce to a level of approximately US$0.8 billion per year towards 2020
(see page 5) .

GAVI Alliance Board Meeting, 16 -17 June 2010 Doc 13 ? Programme Fund ing Polic y ? Concept Paper

FOR DECISION

GAVI Secretariat, 2 June 2010 1










GAVI?s Programme Funding Policy ? Concept Paper

Context
Increasing Country Demand

The success of the GAVI Alliance in making new and underused vaccines available
to children in the world?s poorest countries over the past ten years has transformed
this aspect of life -saving healthcare in the developing world, diminishing the inequity
in access to immunisation between these countries and the rest of the world.
Countries ? supported by Alliance partners ? have seized that opportunity, enabling
them to expand the coverage and range of key vaccines. Until recently, GAVI has
had sufficient resources to meet that growing demand.

Resourc e Constraints and Prioritisation

In the midst of global economic pressures that have limited the new resources the
Alliance expected to be available, in November 2009 ? for the first time ? the
Secretariat proposed and the Board agreed that resource con straints forced GAVI to
defer funding of country applications that had been recommended by its Independent
Review Committee (IRC) following its October 2009 meeting, until the prioritisation
process be approved. The Board launched a process under the guid ance of the
PPC to determine how it should prioritise IRC -recommended applications when
resources were insufficient to fund all such applications but also to develop principles
of prioritisation as good practice. A complementary consideration is measureme nt of
the resources deemed to be available for allocation amongst the prioritised
applications. A policy governing this area would supplement the policy on the cash
In the context of a resource -constrained environment, and at the Board?s request,
GAVI is establishing a system for prioritising country applications for funding. As
a complement to this, the Secretariat , with the input of the Programme and Policy
Committee and the guidance of the Audit and Finance Committee , has developed
a system for determining the amount of resources available for approval of new
applications. Collectively, these two components (prioritisation and resource
measurement ) could comprise GAVI?s Programme Funding Policy.

The Board is requested to:

? Approve the p roposed system for determining the amount available for
funding new programmes (page 4)

? Provide guidance t o the Secretariat regarding the o ther matters for
consideration as future additions to proposed system (page 6)

GAVI Alliance Board Meeting, 16 -17 June 2010 Do c 14 ? Fiduciary Risk Management

FOR INFORMATION

GAVI Secretariat , 2 June 2010 1
This document concerns GAVI?s approach to risk m anagement as seen from the
perspective of the recently established Internal Audit function and covers:
? GAVI?s current approach to risk management
? recent important improvements
? suggestions for further improvem ent

No requests are being made of the Board at this time .

Fiduciary Risk Management

Risk management is an important topic for GAVI. A breakdown in controls, especially
when it relates to cases of significant fraud or corruption, will hurt GAVI?s cause.
Similarly, if activities that are undertaken are inefficient or ineffective, outcomes will
be sub -optimal. Hence, GAVI has continually made this a priority.

Recent audits and inquiries from several donors have further reinforced the
importance of good ri sk management . At the same time, GAVI?s structure as a
partnership presents specific challenge s and opportunities as to how risk can be best
managed .

To further improve risk management, GAVI establish ed a one full time equivalent
(FTE) Internal Audit func tion and the current Director of Internal Audit started 1
November 2009 . This update is to inform the Board of Internal Audit?s current views
on GAVI?s approach to risk management.

GAVI?s Current Approach to Risk M anagement

The following is an overview o f the different risk areas GAVI deal s with on an
ongoing basis:

The Secretariat maintains an inventor y of the (35 or so) most significant risks and
mitigating controls (the ?Risk Register?). The Risk Register is discussed on a regular
basis among senior management and any identified possibilities for improvements
are followed up for implementation. At a more granular level, the Finance function
also maintains a very detailed inventory of risks and controls that concern GAVI?s
own internal financial accou nting and reporting processes .

GAVI Alliance Board Meeting , 16 -17 June 2010 Doc 15 ? Revi sed Docume nt Retention Policy

FOR DECISION


GAVI Secretariat, 2 June 2010 1

The Director of Internal Audit proposed to the Audit and Finance Committee that
it review several modest revisions to the Document Retention Policy.

The Audit and Finance Committee recommends to the Board that it:
? Approve the revised Document Retention Po licy .

Revised Document Retention Policy

The Board approved the document retention policy in June 2009 which governs the
preservation and, where applicable, permissible destruction of certain GAVI Alliance
documents 1. It is intended to meet recognised p ractices and accounting standards
for retention periods and to provide guidance on the circumstances which could
require longer or indefinite periods of document preservation.

Since its approval, the Director of Internal Audit has reviewed the policy and has
suggested that it reflect that he will maintain custody of internal audit records. In
addition, the retention periods of these records have been extended.

Also the names of certain archiving teams have been changed to reflect the new
Secretariat struc ture. (For example, ?Corporate Services Team? has been rolled into
the ?Finance & Operations Team.)

Given that the Board approved the original policy upon the Audit and Finance
Committee?s recommendation, the Committee reviewed the suggested changes and
found them fit for recommendation. 2 The Board is now requested to approve the
changes to the policy (a red -lined version of which is enclosed ).




















1 Resolution 9 from the 2 -3 June 2009 Minutes. 2 Section 4 from the 11 March 2010 Audit and Finance Committee Minutes

GAVI Alliance Board Meeting, 16-17 June 2010 Doc 16 ? Resource Mobilisation

FOR GUIDANCE

GAVI Secretariat, 2 June 2010 1
To save an additional 4.2 million lives and to have real impact on preventing
disabilities and chronic illness by 2015, the GAVI Alliance needs to raise US$ 4.3
billion over the next six years (2010 -2015). This entails raising an additional US$
2.6 billion ? beyond sustaining current levels of funding.

This resource challenge is significant but achievable if GAVI?s traditional
approach to resource mobilisation is re-engineered in ways described herein.
This paper presents the progress to date in implementing the strategies
approved by the GAVI Board in June 2009, lays out the Secretariat?s integrated
Communication, Advocacy and Resource Mobilisation (CARM) framework and
discusses quantitative targets for complementary resource mobilisation
approaches . These latter include traditional development assistance, innovative
finance and private finance. It is important to note that being able to draw down
on the level of Advance Market Commitment ( AMC) donor contributions is
contingent on a corresponding amount being spent by the GAVI Alliance. If the
GAVI portion of funds is not available, neither are the AMC donor funds to match
them.

Given the level of anticipated demand, total additional cash inflows of US$ 303
million will be required between 2010 and 2012 and US$ 776 million will be
required on average each year between 2013 and 2015 . W hile the se additional
funds will only start to be spent in two years time, pledges will be required in
2010, in order to allow GAVI to commit to new programmes . Followin g the
recommendation of donors at the High- Level Meeting on Financing Country
Demand in The Hague in March 2010, the GAVI Secretariat will organise a
pledging/light replenishment meeting in October 2010. This document clarifies
how an annually renewable, m ulti-year pledging mechanism would work and how
this would underpin responsible financing decisions.

Mobilising for GAVI?s success requires the support of all stakeholders. This
paper concludes with suggestions for enhanced Board support to GAVI?s
resource mobilisation strategy.


A Call to Action ? Resource Mobilisation 2010- 2015

GAVI faces historic demand from implementing countries at a time of unprecedented
fiscal constraints. Many of GAVI?s donors face major pressures on development
budgets due to difficult economic circumstances, other commitments to the
Millennium Development Goals (MDGs) and growing support to commit 0.7% of
national budgets to Official Development Assistanc e (ODA) targets. Some donors
have seen their budgets erode. M any are continuing to operate under extreme fiscal
pressure. Despite these challenges, most of GAVI?s historical donor base has
maintained or increased contributions to GAVI. This is due to GAVI? s ability to
produce evidence -based results that demonstrates a cost-effective, poverty -focused
approach to equity in immunisation access. These results, along with G AVI?s
innovative business model and cross -cutting impact on the MDGs, in particular the
health MDGs (4, 5 and 6), continue to galvanise and inspire its donor s.

GAVI Alliance Board Meeting, 16 -17 June 2010 Doc 17 ? Governance Committee Update

FOR INFORMATION

GAVI Secretariat, 2 June 2010 1

The Governance Committee of the GAVI Alliance Board has held two meetings
since the November 2009 board meeting. This paper provides a brief summary of
issues discussed.

Governance Committee Update

The Governance Committee is responsible for ensuring the smooth operations of
GAVI?s governance structure. It serves as a nominating body for new board
members, evaluates and oversees the functioning of other committees, and
develops and enforces key gove rnance policies. This is a summary of Governance
Committee activities as a result of its meetings on 17 March and 19 April:

Chair/Vice Chair Participation : The Governance Committee recommended the
Board amend the By -Laws to ensure that if a Representative Board Member is
appointed Chair or Vice Chair of the Board or of any Board Committee, that
individual will not express his/her applicable Eligible Organisation or Eligible
Constitue ncy viewpoint in deliberations nor participate in voting at any Board or
Board Committee meeting. The Board later approved this amendment.

Second Board Seat for CSOs : Governance Committee Member Alan Hinman
informed the Committee that the CSO constituency would request the Board to
create a second seat for the constituency. A paper on this issue is included in the
board pack (Doc 20).

Gender Policy Guidelines : The Governance Committee reviewed and
recommended to the Board a set of guidelines for integrating GAVI?s Gender Policy
into the Board ?s nominations process and, in particular, to assist the Board in
achieving greater gender balance . A paper on this issue is included in the board
pack (Doc 18).

Board Composition : The Committee nominated and the Board appointed two board
members and five alternate board members. Additional board member candidates
are being considered for nomination at the Committee?s 15 June meeting. These
nominations will be tabled to the Board in due course.

Committe e Composition : Committees were refreshed for the 2010 year. In
particular, the Board welcomed Gustavo Gonzalez -Canali as chair of the Programme
and Policy Committee and expressed its thanks to Sissel Hodne -Steen who chaired
the Committee since October 2008. Additional nominations will be tabled to the
Board in due course.

Board/Committee Self -Assessment: The self -assessments for the Board,
Executive Committee , and Governance Committee are being completed and the
results presented to the Board toward the conclusion of the June board meeting.
The initial rounds of self -assessment identified the value of better risk oversight,
crafting committee workplans, and im proving and expanding the board member
orientation process; each of these areas have or are being addressed by committees
and the Secretariat governance team.

GAVI Alliance Board Meeting, 16-17 June 2010
Doc 18 ? Guidelines on Board Gender Balance

FOR DECISION
Office of GAVI Alliance Board Chair,
2 June 2010 1 In November 2009 the GAVI Board and Governance Committee each discussed a
need to establish guidelines for integrating GAVI?s Gender Policy into the Board
nominations process in order to achiev e gender balance in Board membership.

The Governance Committe e considered a Chair?s paper containing the draft
Guidelines on GAVI Alliance Board Gender Balance at their meeting on 17 March.
After making some small amendments, the Governance Committee approved these
Guidelines and now recommended them to the Board.

The G uidelines aim to:
o clarify the terms of the Governance Committee?s mandate to bring the
nominations process into compliance with the Gender Policy;
o specify procedures for both the achievement and maintenance of a
gender - balanced Board;
o set expectati ons for nominating entities.

The Governance Committee decided that guidelines on establishing and
maintaining gender balance on the Board would contain the following key elements :
? The ratio at which gender balance will be reached is set at 60 - 40.
? Gender b alance will be calculated separately for Board Members and
Alternate Board Members.
? The implementation date of the Guidelines will commence with vacancies
occurring as of 1 January 2011 (in other words, candidates that may be
considered starting with the D ecember 2010 vacancies).
? New appointments to the B oard shall have both male and female nominees.
The nominees from the under - represented gender will receive preference for
the position, until gender balance targets have been achieved (unless the
exception s clause is invoked).
? A margin of appreciation can be applied under an exceptions approval
procedure.

The Governance Committee recommends that the Board approve the Guidelines for
adoption and inclusion as an Annex to the GAVI Gender Policy .



Guidelines on the GAVI Alliance Board Gender Balance

Background

In July 2008, the Board adopted GAVI?s Gender Policy which requires GAVI to
?apply a gender perspective to all its work? and states that ?gender balance in all
areas of GAVI work should be ensured, including throughout the governance
structures, to the extent possible, as well as through staffing (all level) and
consultancies.?

GAVI Alliance Board Meeting, 16-17 June 2010 Doc 19 ? Nominations

FOR DECISION

GAVI Secretariat, 17 June 2010
The Governance Committee requests the Board to:
? Appoint the nominees to their respective roles on the Board or Executive
Committee

Nominations

Nominees to the Board

The Governance Committee nominated the following candidates for appointment to
the Board:

? Amie Batson,
1 Deputy Assistant Administrator for Global Health at the United
States Agency for International Development as Board Member representing
donor country governments USA/Canada/Australia to succeed Gloria Steele
? Toupta Boguena,
2 Minister of Health for the Republic of Chad as Board
Member representing developing country governments in the seat formerly
held by Tedros Ghebreyesus
? Sian Clayden,
3 Vice President, Office of the President, and Head of the
Government Affairs and Public Policy Department of GSK Biologicals as
Alternate Board Member to Jean St?phenne representing the industrialised
country vaccine industry to succeed Patrick Florent
? Rajeev Venkayya,
4 Director of Global Health Delivery for the Bill & Melinda
Gates Foundation as Alternate Board Member to Jaime Sepulveda
representing the Gates Foundation to succeed Steve Landry

Nominees to the Executive Committee

The Governance Committee nominated the following candidates for appointment to
the Executive Committee:

? Gustavo Gonzalez-Canali,
5 representing donor country governments to
succeed Gloria Steele
? Guillermo Gonz?lez Gonz?lez,
2 representing developing country
governments in the seat formerly held by Tatul Hakobyan


1 Effective immediately and until 30 June 2011 2 Effective immediately and until 30 June 2013 3 Effective immediately and until 31 May 2011 4 Effective immediately and until his successor is elected and qualified 5 Effective immediately and until 1 December 2010 ?

FOR INFORMATION

CEO report to the Board

June 2010

Introduction
This report focuses mainly on the key decisions we need to take at this Board. This
meeting brings together a series of choices and policies asked fo r by the Board in 2009.
The decisions we take at this board will det ermine our ?ask? for the upcoming resource
mobilisation meeting and also determine how we continue to support (or not)
recommended country proposals. These high level decisions will determine whether
children in developing countries will be vaccinated, or not.
There have been a number of important devel opments since our meeting in Hanoi in
November; it has been a busy six months, not least as we lead into the MDG summit in
September and ensure t hat the contribution which imm unisation and the Alliance can
make is recognised. All of us will hav e welcomed the announcement at GAVI?s tenth
anniversary at the World Economic Forum by Bill and Melinda Gates of a decade of
vaccines, with a ten-year commi tment of an additional $10 billion to research, develop
and deliver vaccines. We were pleased t hat the first pneumococcal vaccine supply
agreements under the Advance Market Co mmitment have been signed. We have made
significant progress on the health systems funding platform, with the Board?s approval in
April, followed by approval by the Board of the Global Fund to Fight AIDS, Tuberculosis
and Malaria, and approval of our first programme in Nepal. The Netherlands hosted a
successful donors? meeting in March, w here donors decided to gather again around the
time of the MDG Summit in order to give GAVI a firmer financial basis upon which to
plan. Our retreat in May helped set our strat egic directions for the next five years.
We have continued to raise the profile of immunisation and of the Alliance in key
forums, such as at the World Economic Foru m, the UN Secretary General?s retreat on
women and children?s health in New York in April, the Women Deliver Conference in
Washington DC, and ? we antici pate ? the G8 Summit in Muskoka later this month. In
these and other places, we are making the ca se for GAVI?s strong contribution to the
task of improving women and children?s health. This gives us the means to help shape
the global debate, ensure our ef forts are increasingly integrated with those of others,
and raise funds.
However all this is set against a developing global financial crisis that emerged in 2008
? the worst recession in at least a generatio n ? with the consequent economic and fiscal
challenges for our donors and implementing count ries alike. The decisions that the
Board has before it this m onth in Geneva are in part about responding prudently to
these challenges, while at the same time ? as we agreed at the Board retreat ?
maintaining our ambition and therefore our momentum.

GAVI Alliance Board Meeting, 16 -17 June 2010 Do c 20 ? CSO Representation on the Board

FOR DECISION

2 June 2010 1
Because of the important role that civil society plays in immunisation and the GAVI
Alliance, the CSO constituency believes that there should be two civil society seats
on the GAVI Alliance Board ? one representing Northern (industrialised country)
CSOs and the other representing Southern (developing country) CSOs.

The Governance Committee will consider this request during its meeting on 15 June
2010 so it can advise the Board. Should the Governance Committee recommend a
new seat be created, there may be implications for the GAVI statutes and by -laws,
which the Secretariat understands some Board members may need to consult on
within their organisations and constituencies. To facilitate this , the paper for the
Governance Committee is also provided for the Board . It contains the following :

? A letter from Faruque Ahmed (CSO board member) and Alan Hinman (CSO
alternate board member) requesting that there be two Civil Society seats on
the Board ? main text
? An outline of the activities the Secretariat is engaged in with CSO s. This was
requested by the Board Chair during discussion of this issue at the 17 March
Governance Committee ? Annex 1 .
? Advice from General Counsel on adding a second CSO seat ? Annex 2 .

Civil S ociety C onstituency R epresentation on the Board

Letter from the civil society c onstituency

Dear GAVI Alliance Governance Committee Members,

On behalf of the GAVI Alliance Civil Society Constituency, we wanted to apprise you
of recent activities of Civil Society with respect to the GAVI Alliance and its mission.

Civil Society is playing a major role in immunisation s around the world and in the
activities of the GAVI Alliance. Civil Society delivers a high proportion of rural h ealth
care (including immunisation s) in the developing countries with the greatest
challenges; Civil Society has unique connections with the community and the
population at large, particularly those who are hard to reach; and Civil Society
Organisation s (C SOs) can be important advocates in resource mobili sation at
national and international levels. In addition, as GAVI has no official country
presence, CSOs can provide important feedback about the situation on the ground
that can inform discussions on key policy issues such as prioriti sation , co -financing,
supp ly strategy, etc.

1. Case studies have been carried out in 4 countries receiving Type B CSO
funding: Afghanistan, Democratic Republic of Congo, Ethiopia, and
Pakistan .1 In Afghanistan, the Health Systems Strengthening Coordinator in
the Ministry of Public Health said that ?It is the CSOs who are the only ones
operating at the field and in the rural areas. While in the beginning each CSO
had its own coping mechanism and way of solving problems, under the
1 http://www.gavialliance.org/resources/GAVI_CSO_case_studies_20.04.2010.pdf

GAVI Alliance Board Meeting, 16-17 June 2010
Doc 21 ? Approving the Annual Accounts

FOR DECISION

GAVI Secretariat, 2 June 2010 1 Because of differences in the governance and audit calendars, the Board does not
meet at a convenient time to consider and approve the annual financial statements.
Further, the Statutes forbid delegation to the Executive Committee. The result
would be sp ecial phone meetings each year to make this approval.

The Audit and Finance Committee reviewed options to streamline the process and
in order of preference recommended to:

1. Amend the S tatutes to a llow a d elegation to the EC to approve the accounts .

2. Ame nd the By - Laws to a llow n o o bjection v oting by the Board .

The Governance Committee would need to consider the governance implications of
these options in order to advise the Board.

The Board is requested to:
? Consider and, if thought fit, act on the reco mmendation of the Governance
Committee which may be determined on 15 June 2010 .

Approving the Annual Accounts

Each year, the Audit and Finance Committee reviews and the Board approves the
annual financial statements. Typically, six to seven months are needed to prepare
and audit the financials since the Alliance consolidates the financial positions of
affiliated entities such as the IFFIm Company. The treasurers and boards of those
entities must themselves complete their audit processes before the Alliance audit
can conclude.

In a normal year, the Board meets twice: once in June and again in November or
December. Unfortunately, neither date fits with the audit calendar. The June date
occurs too early for the accounts to be ready. On the other hand , the financial
statements cannot wait to be approved during the Board?s second meeting, as the
Alliance has reporting responsibilities to certain donors by the end of September
each year.
Normally, to address time sensitive issues, the Board makes delegations to the
Executive Committee allowing it to act on its behalf between board meetings.
However, the Statutes state that ?the Board may delegate its powers?except that no
committee or person shall be delegated the power to?approve the annual
a
ccounts.? 1

Therefore, the Board cannot delegate this task to the EC and, should
nothing change, will need to meet by telephone in September each year in order to
approve the accounts.
On 25 May, the Audit and Finance Committee considered some remedial options for
s
treamlining board approval. They are listed here for consideration.

1
Article 14

GAVI Alliance Board Meeting, 16 -17 June 2010 Doc 22 ? Appointment of Officers

FOR DECISION

GAVI Secretariat , 2 June 2010 1
The offices of Treasurer and Secretary are currently vacant. The Board is
requested to appoint:
? Barry Greene as Treasurer effective immediately
? Debbie Adams as Secretary effective 1 August 2010

Appointment of Officers

The By -Laws provide for the offices of CEO, Treasurer and Secretary. 1 On 29 -30
October 2008, the Board appointed Julian Lob -Levyt as CEO 2, Alice P. Albright as
Treasurer, Lisa Jacobs as Secretary, and Ke vin Klock as Assistant Secretary. 3

Since then, Ms Albright and Ms Jacobs have departed GAVI and their former offices
are vacant. The individuals proposed below are their successors at the Secretariat
and are thus recommended for the officer positions.

Barry Greene as Treasurer

Barry Greene is Managing Director, Finance & Operations and joined GAVI in
February 2010. His career spans the commercial and cause -driven sectors with over
thirty years? experience in finance, general management and consulting. Barry brings
to GAVI considerable knowledge of development financing from his immediately
prior role as Chief Financial Officer of the Global Fund to fight AIDS, Tuberculosis
and Malaria. He was integral to the development of the Global Fund?s financial
ma nagement, fundraising and grant making for more than seven years from its
inception in 2002.

Drawing on a background in business restructuring acquired while training with
Pricewaterhouse Coopers, Barry?s initial post -qualification years were devoted to t he
successful turnaround of a group of manufacturing companies in Ireland. Following
that, he moved to Switzerland as general manager of a financial consultancy firm
and later was Chief Executive of an internet enterprise. His desire to apply business
acum en to the advancement of global needs led him to the World Wide Fund for
Nature where he was responsible for financial planning and corporate marketing. He
developed and implemented WWF?s corporate Conservation Partner initiative and
managed other innovati ve fundraising mechanisms.

An Irish citizen, Barry is a Fellow of the Institute of Chartered Accountants.

Debbie Adams as Secretary

Debbie Adams will join GAVI as Head of Governance on 1 August 2010. Currently,
she is Director of Law & Governance and S ecretary of the Board at the London
Development Agency (LDA), one of the nine Regional Development Agencies set up
1 Article 6 2 Resolution 15 3 Resolution 16

FOR DECISION

The Executive Committee approved India for DTP-HepB-Hib pentavalent vaccine
in July 2009 with an overall commitment for US$ 165 million through 2011. Until
recently the Indian Government has indica ted that it is reconsidering plans to
introduce pentavalent vaccine; GAVI indica ted to the Government that we would
seek the views of the Board at its June meeting as to whether the $165 million
should be reallocated. The latest communication from the Government proposes
that the vaccine should be introduced in la te 2010 in five states instead of the
original ten.

The Board is asked to decide from among the following options:
? Option 1: Reallocate $165 million to other countries, and invite India to
resubmit a new proposal when ready
? Option 2: Agree to the proposal to fund introduction in a limited number of
states. This would entail asking India for a new plan which includes
costing in the five states. The balance would be reallocated to other
countries
? Option 3: Leave the India programme as it stands

GAVI support to India

India has the largest population and disease burden of any GAVI-eligible country.
GAVI has made a significant commitment to India with mixed results. Our support
for injection safety has catalysed the adopt ion of a national policy enabling India to
sustain the use of safe injection practi ces entirely with its own resources. The
introduction of Hepatitis B on the other hand has been slow.

In November 2007, the Board approved a new financial ceiling of US$ 350 million
until 2011 which subsumed all the previous approvals.
1 India applied for DTP-HepB-
Hib pentavalent vaccine, and the Executive Committee approved $165 million in July
2009.
2 As India had yet to receive cabinet approval to roll out pentavalent vaccine,
UNICEF Supply Division was advised not to sh ip the vaccines until GAVI received a
formal communication from India indicating internal approval.

Summary of communications between GAVI and the Indian Government
on the proposed introduction of pentavalent vaccine

? In December 2009, the Government al erted GAVI that the introduction of
penta was likely to be delayed because of a Public Interest Litigation (PIL),
filed in the Delhi High Court against t he introduction of new vaccines citing the
lack of disease burden as one of the key factors.

? In February 2010, India wr ote to GAVI stating, ?several procedural issues and
approvals are involved before introduction of pentavalent vaccine as part of
the routine immunisation programme. It will take us 4 months to finalise the
matter? .
3

1 Section 17 of the 28-29 November 2007 Board Minutes 2 Section 2 of the 30 July 2009 Executive Committee Minutes 3 Letter received by Execut ive Office on 12 February 2010

GAVI Alliance Board Meeting, 16 -17 June 2010 Doc 03 ? GAVI Alliance Strategy 2011 -2015

FOR DECISION

GAVI Secretariat, 2 June 2010 1


Drawing on discussion at the Board retreat (11 -12 May) and discussion and
recommendation of the Executive Committee (20 May), a ?final? draft of the GAVI
Alliance Strategy 2011 -2015 has been prepared for Board approval.

In addition, a draft concept note outlining the process for developing a comprehensive
business plan for the five -year strategic period has been prepared for information.

The Board is requested to:

? Appro ve the final str ategy matrix



GAVI Alliance Strategy 2011 -2015

In the period 2007 -2010, GAVI underwent a number of significant changes including a change
to its operational model and consolidation of its governance structure. Several fundamental
policies and programmes were implemented, including co -financing, gender, eligibility and
graduation. Resource mobilisation and vaccine investment strateg ies were developed, as well
as a platform for the introduction of new vaccines (Accelerated Vaccine Introduction ). Further,
GAVI supported health systems strengthening and ci vil society organisations for the first time.
Furthermore, on 1 January 2009, the GAVI Alliance was established as an autonomous
international organisation in Switzerland with privileges and immunities under a new Swiss Host
State Act.

With the impending end of the GAVI Alliance 2007 -2010 strategic planning period , in November
2009 the GAVI Alliance Board agreed to develop its second five year strategy and in so doing
review its strategic goals, operating principles and the application of its business model. The
new strategy is intended to cover the period of 2011 -2015 ? providing a framework for the future
deliverables and laying the groundwork for the a chievement of the GAVI Alliance? s aspirations
beyond 2015.

The change in governance structure has provided GAVI with the opportunity to consolidate its
strategic and budget planning processes. This will allow for increased accountability and
improved coordination.

Strategy 2011 -2015

Oversight

In November 2009, the Board endorsed a detailed pla n, timeline, and evaluation of resource
needs to support the strategy development process. It was agreed that the process would be
undertaken by the GAVI Secretariat under the coordination of the Deputy CEO and oversight of
the Executive Committee acting o n behalf of the Board.

GAVI Alliance Board Meeting, 16 -17 June 2010 Doc 04 ? 2009 Work Plan Information/Update

FOR INFORMATION

GAVI Secretariat, 2 June 2010 1

This document is being provided for information only. It is a consolidated report on
the 2009 work plan, within the GAVI Alliance 2007 -10 Strategy. It is based on the
reporting provided by WHO, UNICEF, World Bank and the GAVI Secretariat. No
requests are being made of the Board.

2009 Work Plan Information/Update

The GAVI Alliance 2007 -10 strategy has four strategic goals .

1. Contribute to strengthening the capacity of the health system to deliver
immunisation and other health services in a sustainable manner .

2. Accelerate the uptake and use of underused and new vaccines and associated
technologies and improve vaccine supply security .

3. Increase the predictability and sustainability of long -term financ ing for national
immunisation programmes .

4. Increase and assess the added value of GAVI as a public -private global health
partnership through improved efficiency, increased advocacy and continued
innovation .

For the 2007 -2010 strategic plan the Alliance developed a work plan to fund activities
implemented by multilateral partner agencies (primarily WHO, UNICEF and the World
Bank) and the GAVI Secretariat in support of the strategic goals. This work plan, in t he
form of a logical framework (available at http://www.gavialliance.org/documents )
contains over 100 activities in any given year, organised under 17 outputs ? with a total
budget of US$297m over the fou r year period. Activities and corresponding budgets
were developed on an annual basis in 2007 and 2008 and on a bi -annual basis for
2009 -10. For the purposes of this report, these activities are reported against 17
outputs 1.

The first part provides some of the highlights of the 2009 work plan under each output
(that covers the period 2007 -10) and an assessment (by traffic light 2) of where we are,
against the 2009 deliverables/targets of the relevant outputs .3 The second section of
this report summarises the financial implementation of 2009 funds by the Secretariat
1 The areas of Health Systems Strengthening and the Accelerating Vaccine Introduction Initiative (AVI) are broken
down into further sub -outputs
2 Green: ?Met? the deliverable/targets or that progress is ?on track? in line with the main activities/deliverables;
Amber/Yellow: ?No t met? ?although progress has been made in some areas the main activities/deliverables have not
been met ; Red: ?Major slippage? ? significant delays in 2009 3 This is denoted in the report by a 2 digit number. A sub -output has a 3 digit number.

FOR INFORMATION

The Programme and Policy Committee (PPC) of the GAVI Alliance Board has held
four meetings since the December 2009 board meeting. This paper provides a brief
summary of issues discussed.

The Board will be requested to approve the PPC?s recommendations with regard to
prioritisation, co-financing, health systems strengthening programme allocations,
and the advance market commitment.
Programme and Policy Committee Update
December 2009 ? June 2010

The Programme & Policy Committee (PPC) serv es as the principal advisory body to
the board on all GAVI programme areas and leads the development of new policies.
It is staffed by high-level technical experts from partner organisations and
constituencies, with knowle dge in areas such as epidemiology, public health,
research, health systems and financing. Over the course of the reporting period, the
chairing function of the committee passed from Sissel Hodne-Steen of Norway to
Gustavo Gonzalez-Canali from France. The committee held two face-to-face
meetings and two teleconferences since De cember 2009. Actions taken by the PPC
and key discussion items from all three meetings are summarised below.

Policies Endorsed for Board approval

Prioritisation policy: The PPC endorsed the scope of work and appointed a time-
limited task team to develop a policy on prioritisation in February 2010. The policy
was endorsed in May 2010 for presentation to the board in June 2010 (see Doc 09).

Co-financing: In February 2010, the PPC endor sed the scope of work and
appointed a time-limited task team to review the policy on co-financing and propose
revisions, if necessary. The work of the task team is divided into two phases ? the
first focusing on policy objectives and the sec ond in implementation. Objectives,
principles and a definition of ?financ ial sustainability? have been endorsed for
presentation to the June 2010 board (see Doc 07).

Supply strategy: In February 2010, the PPC endor sed the scope of work and
appointed a time-limited task team to re view and update GAVI?s vaccine supply
strategy looking specifically at innovativ e procurement strategies and how to achieve
the best value for money, while ensuring suffi cient supply. The work of this team
will commence in June 2010.

Advance market commitment (AMC): The PPC reviewed policy options to
address the impact of the November 2009 board decisions (eligibility, graduation and
funding pause) on the demand forecasts for pneumococcal vaccines that underlie
the AMC. An endor sed option is being presented to the June 2010 board (see Doc
08).

Health systems strengthening : The PPC recommend moving forward with the
platform, informing a board decision tak en in April 2010. Further, a system for

GAVI Alliance Board Meeting, 16 -17 June 2010 Do c 06 ? AVI Prog ress Report

FOR INFORMATION

GAVI Secretariat , 2 June 2010 1

At the request of GAVI Board members, the Secretariat was asked to provide an
update on the Accelerated Vaccine Introduction (AVI) initiative

Accelerated Vaccine Introduction Progress Report

The objective of AVI is to drive the sustainable introduction of rotavirus vaccine and
pneumococcal conjugate vaccine (PCV) in GAVI -eligible countries. Initial t argets
were set for 44 countries to launch rotavirus vaccines and 42 countries to launch
PCV by 2015 1. The longer term scope for AVI is to establish an organisational
platform to support the introduction of future vaccines 2.

AVI Structure and Management

The management of AVI is conducted by the AVI Management Team (AMT) which
consists of representatives of WHO, UNICEF Supply Division (UNICEF SD) ,
UNICEF Program Division (UNICEF PD) , and the AVI Technical Assistance
Consortium (AVI TAC 3) led by the GAVI Secretariat . The AMT operates through bi -
weekly teleconferences ; with more in depth anal ysis and work carried out by sub
teams .4 (see Annex 1 for more details )

Activities are consolidated between the aforementioned organi sations through an
integrated workplan and activities are grouped into five high level work streams 5
(see Annex 2):

? Generate informed country decisions
? Ensure sufficient supply
? Secure financing
? Facilitate country introductions
? Establish platform for sustained use

AVI?s objective is primarily to deliver health impact through accelerating introduction
and uptake of new v accines. The ability of AVI to achieve this objective is affected
by internal and external factors, whose impact is reflected in adjust ment s to the work
plan and if necessary, to the objectives too .

The remainder of this report will provide short brief ings on each of the high level
work streams referenced above.
1 In view of the funding situation, the targets may need to be assessed and if necessary changed by the Board 2 As per the Vaccine Implementation Strategy (VIS) implementation plan endorsed by the Board on 29 -30
October 2008, subject to separate approvals of funding. (Section 11 of the Minutes) 3 A consortium of PATH, Johns Hopkins University (JHU), US Centers for Disease Control and Prevention (CDC)
and others 4 Supplemental information on this and other aspects of AVI operation is available from the Secretariat upon
request. 5 The AVI work streams are synonymous with the outcomes of the Strategic Goal 2 in the GAVI Work -plan

GAVI Alliance Board Meeting, 16 -17 June 2010 Doc 07 ? Co -financing Policy R evision

FOR DECISION
GAVI Secretariat, 2 June 2010 1
































Co -financing Policy Revision: Principles and Objectives

Background and Overview
When approving GAVI?s co -financing policy the Board requested a review after two
years of implementation . The current co -financing policy objective underwent several
iterations with involvement by several expert advisory groups before it was finalised .
The final policy objective of the current policy ? to ?increase demand and access to
underused and new vaccines? while ?promoting nati onal ownership in the decision
making process? - differed from the Board?s original objective for developing the policy
for countries ?to gradually assume financial responsibility to purchase the vaccine at the
target price?.

The Board requested a review of GAVI?s co -financing policy after two years of
implementation. The Programme and Policy Committee (PPC) is overseeing the
policy revision and recommends that GAVI retain the following working definition of
financial sustainability as originally approved by the Board in 200N W

Although self -sufficiency is the ultimate goal, in the nearer term sustainable
financing is the ability of a country to mobilise and efficiently use domestic and
supplementary external resources on a reliable basis to achieve current and future
target levels of immuni sation performance.

Based on various analyses and extensive consultations across the Alliance and
tak ing into account GAVI?s new graduation policy , the PPC would like to request the
Board to approve certain co -financing objectives and principles . Pending board
approval of the proposed objective and principles, a second stage of work will define
policy optio ns for country groupings; co -financing levels and trajectories over time; the
default mechanism; and risk management.

The Programme and Policy Committee requests the Board approve the following:

? Overarching Policy Objective: To put countries on a traject ory towards financial
sustainability in order to prepare them for phasing out of GAVI support for new
vaccines, recognising that the time frame for attaining financial sustainability
will vary across countries.

? Intermediate Objective (for countries with a long timeframe for achieving
financial sustainability) : To enhance country ownership of vaccine financing.

? Policy Principles :
o To be transparent, fair, and feasible to implement;
o To build on existing systems and processes;
o To requi re all countries to contribute to new vaccine support,;
o To ensure that country co -financing of new vaccines represents new and
additional financing and does not displace financing from other vaccines;
o To provide countries with a long term planning horizon.

GAVI Alliance Board Meeting, 16 -17 June 2010 Doc 08 ? Next Steps on the Pneumococcal AMC

FOR DECISION

GAVI Secretariat , 2 June 2010 1
The decision to consider the recommendations of the October IRC after a
prioritisation exercise coupled with the new eligibility/graduation policies have
adversely affected the Strategic Demand Forecast (SDFs) for pneumococcal
vaccines and, consequently th e AMC programme in that the target demand of 200
million doses may not be reached .
The Programme and Policy Committee considered strategies for addressing this
issue with the PPC recommending to the Board that it:
? Approve grandfathering of the AMC deal to include all currently GAVI
eligible countries (2003 definition). These countries will be able to access
pneumococcal vaccines through GAVI at the AMC terms and conditions and
have access to AMC funding. However, graduated countries will need to
completely self finance the vaccine price (tail price) once GAVI support has
ended. Also, all countries must have achieved the DTP3 coverage above
70% in order to purchase under the AMC agreements.
? Approve channe lling through the GAVI Alliance from the World Bank the
AMC funding for purchase of pneumococcal vaccines for India.
It is important to highlight that, while these issues must be addressed, they are only
relevant in the context where:
1. GAVI is able to raise sufficient funding to meet country demand and thus
ensure maximum utili sation of the AMC funds.
2. India adopts pneumo within the expected timeframe.

Next Steps on the Pneumococcal AMC:
Accounting for the New Context
When the AMC was conceived, there were certain prevailing assumptions built into
the mod el. First, the model accounted for all countries that have been eligible for
GAVI support since 2003. Second, it assumed applications that were
programmatically and financially sound would be approved for funding; in other
words, would not have to be vet ted through a prioritisation process in a resource
constrained environment.

Times have changed. The board decisions of November 2009 with regard to
postponement of approval of the most recent In dependent Review Committee?s
recommendations (October 2009 ) and the newly adopted eligibility/graduation
policies have had an impact on the Strategic Demand Forecast for pneumococcal
vaccines and, consequently on the AMC programme.

The Programme and Policy Committee along with the Policy and Performance Team
wit hin the Secretariat have discussed ways to mitigate these factors and this paper
presents recommendations for the Board?s consideration. The Audit and Finance
Committee was also informed of the PPC?s recommendations.

GAVI Alliance Board Meeting 16 -17 June 2010 Doc 09 ? Prioritisation Mechanism

FOR DECISION

GAVI Secretariat, 2 June 2010 1


















GAVI Alliance Pilot P rioritisation Mechanism

Background

Current demand and resource forecasts suggest that GAVI faces a large fiscal deficit
in coming years if it intends to fully fund its ambition . Since GAVI may not be able to
fund all technically sound proposals for all vaccines in the current portfolio and/or
cash -based programmes at its November 2009 meeting the Board agreed that criteria
should be developed under the oversight of the Programme and Policy Committee and
submitted to the Board (or Executive Committee) for approval .1 The Board directed
that a ranking of vaccines to guide decisions about the portfolio and rules for deciding
which countr y proposals recommended for funding by the IRC should be funded in a
particular application round when resources are constrained.

A major objective of the new prioritisation mechanism is to inform decisions on the
twenty IRC -recommended proposals awaiti ng the Board?s consideration since October
2009.

1 Section 14 of the 17 -18 November 2009 Minutes
The Board requested that a prioritisation mechanism be developed during 2010 to
help inform future funding decisions on New Vaccine Support (NVS) and cash -based
programme country proposals recommended by Independent Review Committee
(IRC). The Programme a nd Policy Committee (PPC) took responsibility for
developing this mechanism and appointed a time -limited task team to guide the
analytical work, which was carried out by the Secretariat. The PPC reached
consensus on all aspects of the mechanism including the principles, objectives, and
criteria/indicators that should govern, direct and define the pilot phase of the
mechanism, as well as several rules and procedures necessary to implement the
pilot.

Concurrent with this, the PPC recommends that the Allia nce continue preparatory
activities for the four ?new? vaccines (HPV, JE, rubella and typhoid) and only open
new applications windows following the pilot period of the proposed prioritisation
mechanism and the definition of the 2011 -2015 GAVI Strategy, and subject to funding
availability.

Therefore the Programme and Policy Committee requests the Board to :
? Approve the GAVI Alliance Pilot Prioritisation Mechanism (Annex 1).

Also note that the PPC recommended that GAVI should f und the centrally
administered Yellow Fever emergency stockpile in the amount of approximately
US$22 million for the period 2011 -20 13, given its potential impact . This will be
referred to the Audit and Finance Committee for financial review and the Executi ve
Committee f or approval in July.


.

GAVI Alliance Board Meeting, 16 -17 June 2010 FINAL M INUTES


1




GAVI Alliance Board M eeting
16 -17 June 2010
Geneva , Switzerland

FINAL MINUTES 1

Finding a quorum of members present 2, the meeting commenced at 9.51 on 16 June
2010. Mary Robinson, Chair of the GAVI Alliance Board , chaired the meeting.

The Cha ir noted that on the ?Day of the African Child? there are achievements to
celebrate , and referred to that day?s media release accompanying the launch of the
GAVI Annual Progress Report . She welcomed the new board members and
alternates who were attending their first Board Meeting, and invited Rajeev
Venkayya, the Governance Committee?s nominee to serve as alternate for the Bill &
Melinda Gates Foundation, to participate at the Chair?s invitation until his formal
appointment was approved . The Chair recognis ed this would be the final meeting for
Gloria Steele and Julian Schweitzer and thanked them for their leadership and
service .

Next t he Chair welcomed Debbie Adams, the shortly to be appointed Head of
Governance and thanked Assistant Secretary Kevin Klock and the Secretariat
governance team for their stewardship. Finally , the Chair advised the Board that
Cyrus S. Poonawalla, Chairman & Managing Director of the Serum Institute of India
was unable to deliver his planned address due to a family bereavement bu t he was
invited to make a presentation at a future meeting.

The Board considered approval of outstanding minutes (Doc #1 in the board pack).

DECISION
The GAVI Alliance Board:
? Approved the minutes of its meetings on :
o 17 -18 November 2009
o 19 March 2010
o 20 April 2010

1 CEO Report
Julian Lob -Levyt, Chief Executive Officer, delivered a presentation on the state of the
GAVI Alliance (Doc #2). He contextualised GAVI?s achievements to date : in the last
10 years, GAVI has accelerated new vaccine introduction in o ver 70 of the poorest
countries, immunised 257 million children, improved vaccination safety, and
prevented 5.4 million future deaths.
1 Binding Resolutions approved by the GAVI Alliance Board are list ed in Attachment A. Decisions within the text
of the minutes are non -binding, ?plain English? actions agreed by the Board. 2 Board member participants are listed in Attachment B.