1


Board -2025 -Mtg -03-Doc 00a


Gavi Alliance Board Meeting
3-4 December 2025
Global Health Campus, Geneva, Switzerland

Wednesday 3 December: 08.30 -18.00 Board Meeting Day One
Thursday 4 December: 08.30-17.00 Board Meeting Day Two

Quorum: 14

Document List

No. Document
00a Document list
00b Agenda
01a Declarations of interest
01b Minutes from 24-2 5 July 2025
01c No Objection Consent Decisions
01d Consent Agenda
01e Workplan
0 2a CEO’s report, incl. collaboration with partners and Gavi Leap update – To follow
02b Strategy, Programmes and Partnerships: Progress, Risks and Challenges
0 3 Replenishment update, incl . financial instruments – To follow
04 Financial Update, incl . forecasts, Secretariat and Partner Budgets
0 5a 2026-
2030 Strategy : Follow up on Gavi 6.0 Recalibration Retreat including
recalibration programme reductions
05b 2026-2030 Strategy : Country Vaccine Budgets (including Portfolio Optimisation
and Prioritisation) – To follow
05c 2026-2030 Strategy : Market Shaping Strategy
06 Committee Chair and IFFIm Board reports – To follo w
0 7 Joint Alliance Update on Country Delivery
08 Country Programmes: Nigeria, Papua New Guinea and Venezuela
0 9 Gavi Support for 9 -Valent Human Papillomavirus (HPV) Vaccine

Board-2025-Mtg -0 3-Doc 00b 1

Gavi Alliance Board Meeting
3-4 December 2025
Global Health Campus , Geneva, Switzerland

Monday 1 December – Tuesday 2 December : Pre-Board meetings
Wednesday 3 December: 08. 30-18. 00 Board Meeting Day One
Thursday 4 December : 08.30 -17 .00 Board Meeting Day Two

Quorum: 14




A genda REVISED














Next Board Meeting : 25 -26 March 2026 (Board Retreat)
1 -2 July 2026
9 -10 December 2026




---
Brenda Killen , Director, Governance and Secretary to the Board, +41 22 909 66 80, bkillen@gavi.org
Melissa Wolfe, Acting Head, Governance, +41 22 909 78 20, mwolfe@gavi.org
Please note that the Board meeting will be recorded and a transcription of the full proceedings will be made.
T his recording and transcript ion will be used as an aid to minute the meeting.




Board-2025-Mtg -0 3-Doc 00b 2

Pre-Board Meetings – Monday 1 December 202 5
Schedule Meeting Room
11.0 0-1 2.0 0 o Unaffiliated Recruitment Committee meeting Marula
14.00- 18.00 o Governance Committee meeting Banyan






Pre-Board Meetings – Tuesday 2 December 2025
Schedule Meeting Room
10.00- 11.00 o Human Resources Subcommittee meeting Marula
10.30-11. 30 o Live Data Showcase (Option 1) Dashboard Room
(7 th Floor)
1 2.00- 13.30 o Joint Technical Briefing: Gavi Board and GPEI Polio Oversight
Board Forum

14.00- 14.45 o Live Data Showcase (Option 2) Dashboard Room
(7
th Floor)
14.00- 16.15 o Implementing Country Caucus meeting Baobab
1 4.45- 16.15 o Meeting of Gavi Donor Constituency Banyan
16. 30-18.00
o Joint Implementing Country Caucus and Gavi Donors meeting Banyan
19.00- 20.30 o Meeting of IFFIm Donors Crowne
Plaza Hotel

1

Board -2025 -Mtg -03-Doc 01a

Gavi Alliance Board Meeting
3-4 December 2025
Global Health Campus, Geneva, Switzerland

Wednesday 3 December : 08.30 -18.00 Board Meeting Day One
Thursday 4 December : 08.30-17. 00 Board Meeting Day Two

Quorum: 14
Declarations of Interest
Declarations
Section 5.5 of the Conflicts of Interest Policy for Governance Bodies states “Members involved
in decision-making processes on behalf of Gavi must take appropriate action to ensure
disclosure of Interests and Conflicts of Interest and take the necessary action in respect
thereof.”

Section 6.2 of the Conflicts of Interest Policy for Governance Bodies further states, “The duty
to disclose [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 by members of the Board on their most recent annual
statements .

Board members:
Member
Organisational Interests Financial/Personal/Advisor Int/
Others







José Manuel Barroso,
Chair


















None












Hult – EF (Education First) (Visiting
Professor and Chair of Advisory
Council) ; Goldman Sachs (Chair of
International Advisors – from 1 April
2023) ; Princeton University School of
Public Policy, LISD (Member of the
Advisory Council –from 1 April 2023) ;
CAPRI, Center for Asia Pacific
Resilience and Innovation (Member of
the International Advisory Council from
1 April 2023) ; Catholic University of
Portugal (Visiting Professor at the
Institute of Political Studies and Director
of the Centre for European Studies) ;
The EUROPEAUM (Board Member) ;
WPL Women Political Leaders
(Advisory Board Member) ; Jean Monnet
Foundation for Europe (Honorary
Committee Member); Global
Commission on Modern Slavery and

Board -202 5-Mtg -01 1
Minutes

Gavi Alliance Board Meeting
24 -25 July 202 5
Geneva , Switzerland

1. Chair’s report

1.1 Noting that the meeting had been duly convened and finding a quorum of
members present, the meeting commenced at 10 :20 Geneva time on
24 July 202 5. Prof José Manuel Barroso, Board Chair, chaired the meeting.

1.2 The Chair welcomed new Board and Alternate members attending their first
Board meeting, namely: Ana de Pro Gonzalo , An na Sedgley , Su e Graves ,
Jeremy Farrar, Mark Lloyd, and David Peacock . He a lso welcomed Mr Syed
Waqar -Ul -Hassan, Secretary of Health of Pakistan, as Alternate Board
member -elect for the EMRO constituency.

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

1.4 The Board noted its minutes from 4-5 December 2024 (Doc 01b) which were
approved by no objection on 16 April 2025 .

1.5 The Chair referred to the consent agenda (Doc 01 d) where nine
recommendations were presented for consideration. At the request of the Chair,
Brenda Killen, Director, Governance and Secretary to the Board , presented the
consent agenda decisions.

1.6 The Chair noted the Board workplan (Doc 01 e).

1.7 The Chair reported that during the closed session on the morning of 24 July
202 5, the Board had reaffirmed , based on the discussions at the Board retreat
that took place immediately before the Board meeting on 22 -23 July 2025 , that
the Board had achieved its objectives of recalibrating Gavi 6.0 in line with
resources currently available, and had review ed amended recommendations
that would be presented to the Board for decision .

1.8 The Chair also reported that the Board had received an update on progress on
the Secretariat review and reduction in operating expenses , as well as an
update on the Board Chair search process.

1.9 The Chair referred to the Global Summit : Health and Prosperity Through
Immunisation event and the outlook for Gavi’s mission, highlighting th e success
of the summit which witnessed a widespread recognition of the value of Gavi.
He noted that while Gavi did not achieve its target of US$ 11.9 billion, it secured
more than 80% of its initial ask, with more pledges expected to come.

1


Board-2025-Mtg- 03-Doc 01c
Report to the Board
3-4 December 202 5

Subject No -Objection Consent Decisions
Agenda item 01 c
Category For Information

Since the July 202 5 B oard meeting, five decisions have been circulated electronically
for approval by no- objection consent in line with Sections 11 and 12 of the Board and
Board Committee Operating Procedures.
1) On 7 August 202 5, Board M embers were invited to consider approv al of the
appointment of an Alternate Board Member .

No objections were received prior to the end of 1 9 August 202 5 and the following
decision was therefore entered into the record:
In accordance with Section 12.4 of the Board and Board Committee Operating
Procedures, on a no- objection basis, the Gavi Alliance Board:

Appointed Fleur Davies as Alternate Board Member representing Australia on
the donor constituency cluster anchored by the United States in the seat formerly
held by Lucas de Toca of Australia, effective immediately and until 31 December
2025;


2) On 16 September 2025 , Board Members were invited to consider approval of the
appointment of an Alternate Board Member .

No objections were received prior to the end of 26 September 202 5 and the
following decision was therefore entered into the record:

In accordance with Section 12.4 of the Board and Board Committee Operating
Procedures, on a no- objection basis, the Gavi Alliance Board:

Appointed Kristen Chenier as Alternate Board Member representing Canada on
the donor constituency cluster anchored by the United Kingdom in the seat formerly
held by Mellissa Hisko of Canada, effective 30 September 2025 and until 15 June
2026.


3) On 19 September 202 5, Board Members were invited to consider approval of the
appointment of a n Alternate Board Member .

No objections were received prior to the end of 1 October 202 5 and the following
decision was therefore entered into the record:

1


Board-2025- Mtg-03-Doc 01d
Report to the Board
3-4 December 202 5

Subject Consent Agen da – as at 1 December 202 5
Agenda item 01 d
Category For Decision

Section A : Introduction
Five recommendations are being presented to the Board under the Consent Agenda
for consideration. Detailed information on the items can be found in the relevant
Committee papers in a dedicated folder on BoardEffect at:
https://gavi.boardeffect.co.uk/workrooms/6459/resources/313819
Section B: Actions Requested of the Board
The Gavi Alliance Board is requested to consider the following recommendations from
the Gavi Alliance Governance Committee and the Gavi Alliance Audit and Finance
Committee .
Decision One – Waiver to Independent Review Committee (IRC) TOR: Gavi 6.0
Transition and Reprogramming of Country Applications Post Recalibrations
The Gavi Alliance Governance Committee recommend s to the G avi Alliance Board
that it:
Waive the requirement for an independent review for the reprogramming and no- cost
extension of HSS funding for countries with existing IRC approvals to support their
transition into consolidated funding levers and aligned grant cycles in 2026.
Decision Two – Reappointment of Independent Review Committee (IRC)
members
The Gavi Alliance Governance Committee recommend s to the Gavi Alliance Board
that it:
Reappoint the IRC members listed below for a further three- year term from March
2026 until March 2029.
• Abdul -Aziz Mohammed
• Andrew Azman
• Edward Ouko
• Emmanuelle Espié
• Eusèbe Hounsokou
• Henry Stanley Katamba
• Jean- Paul Paolo
• Jean- Pierre Matwanga

Board -2025- Mtg-03-Doc 0 1d-Annex A 1

Gavi Alliance
Audit and Investigations Terms of Reference
Version 7.0



DOCUMENT ADMINISTRATION



VERSION
NUMBER APPROVAL PROCESS DATE
1.0 Prepared by: Internal Audit
Approved by: Gavi Audit and Finance
Committee 11 April 2012
2.0 Reviewed and recommended by: Gavi
Audit and Finance Committee 22 April 2013
Approved by: Gavi Alliance Board 11 June 2013
3.0 Revised by: Audit and Investigations
Reviewed and recommended by: Gavi
Audit and Finance Committee 6 November 2015
Approved by: Gavi Alliance Board 2 December 2015
4.0 Revised by: Audit and Investigations
Reviewed and recommended by: Gavi
Audit and Finance Committee 25 April 2019
Approved by: Gavi Alliance Board 26 June 2019
5.0 Revised by: Audit and Investigations
Reviewed and recommended by: Gavi
Audit and Finance Committee 22 June 2020
Approved by: Gavi Alliance Board 24 June 2020
6.0 Revised by: Audit and Investigations
Reviewed and recommended by: Gavi
Audit and Finance Committee 30 November 2022
Approved by: Gavi Alliance Board 7 December 2022
7.0 Revised by: Audit and Investigations
Reviewed and recommended by: Gavi
Audit and Finance Committee 8 October 2025
Approved by: Gavi Alliance Board

Classified as Internal #
Gavi Alliance Board Workplan
Gavi Board Paper MarchJulyDecMar/Apr JuneNov/Dec Mar/Apr JuneNov/Dec
A.Strategy/Performance/Risk/MEL CEO's Report CEO's Report
DiscussionDiscussion DiscussionDiscussion DiscussionDiscussion 2021-2025 Strategy Strategy, Programmes and Partnerships: Progress, Risks and Challenges Discussion Market Shaping Retrospective Strategy, Programmes and Partnerships: Progress, Risks and Challenges
Information Foundational Fund Strategy, Programmes and Partnerships: Progress, Risks and ChallengesDiscussionDiscussion DiscussionDiscussion DiscussionDiscussion Private Sector and Innovation Strategy TBD Decision Risk and Assurance Report Risk and Assurance ReportDecisionDecisionDecision 2026-2030 Strategy Strategy, Programmes and Partnerships: Progress, Risks and Challenges Discussion DiscussionDiscussionDiscussion DiscussionDiscussion Vaccine Envelopes TBD6.0 Measurement Framework (targets) TBD Decision Market Shaping Strategy TBD DecisionFragile & Humanitarian Approach update TBDDecision B.Vaccines & SustainablityTyphoid TBD Pneumococcal AMC (Advance Market Commitment) TBD Vaccine Investment Strategy Vaccine Investment Strategy DecisionDecision Gavi's role in Global Health Security TBD
InformationDay Zero Facility - First Response Fund (Annual Report provided for information) Annex to TBD or as an appendixInformationInformationInformation African Vaccine Manufacturing Accelerator TBD InformationInformationInformation VaccinesMalaria TBD InformationInformation InformationInformation InformationInformation HPV SPP Paper, Annex InformationInformation Ebola TBD Yellow Fever TBD Mpox TBD RSV mAbs Revised Investment Case Decision Dengue Revised Investment Case Decision Tuberulosis Revised Investment case (2029) HepE Revised Investment Case Decision C.PolicyTransparency and Accountability Policy TBD Fragility, Emergencies and Refugees Policy TBD Prioritisation Mechanism for Gavi's Support to Countries TBD Evaluation Policy TBDDecision Speak Up Policy Consent Agenda Sustainable Investment and Investment Policy TBD Donations / Gift Policy TBDDecision Vaccine Procurement Policy TBD - subset of Market Shaping Strategy GuidanceDecision Vaccine Donations Policy TBD GuidanceDecision D.Country ProgrammesJoint Alliance Update on Country Programmes Joint Alliance Update
DiscussionDiscussion DiscussionDiscussion DiscussionDiscussion Strategic Partnership with India Strategic Partnerships with India Information E.Finance/Audit & InvestigationsAnnual Accounts Annual Financial ReportNo-objectionDecisionDecision Financial Forecast Financial Update, including forecast DecisionDecision DecisionDecision DecisionDecisionPartners' Engagement Framework and Secretariat Budget Financial Update, including forecast DecisionDecisionDecision Programme Funding Policy Consent AgendaTreasury Governance Policy Consent Agenda Treasury Risk Management Policy Consent Agenda Independent Auditor Selection and Evaluation Policy Consent Agenda Audit & Investigations Report Audit & Investigations Report InformationInformationInformation F.GovernanceBoard Chair Appointment Consent Agenda Decision Board Vice Chair Appointment Consent Agenda Decision Committee Chair Appointments Consent AgendaDecisionDecision Board and Committee Appointments Consent Agenda Decision IRC Appointments Consent Agenda CEO Appointment Consent AgendaDecision Secretary Appointment Consent Agenda Treasurer AppointmentConsent AgendaAppointment of MD A&I Consent Agenda Amendments to Governance Documents (Statutes, By-Laws, Committee Charters) Consent Agenda Decision IRC Terms of Reference TBD Audit & Investigations Terms of Reference Consent Agenda Update on collaboration with other Organisations Update on collaboration with other Organisations (TBD) HR Sub-Committee TBD G.ReportingCommittee Chair Reports Committee Chair and IFFIm Board reportsInformationInformation InformationInformation InformationInformation IFFIm Chair Reports Committee Chair and IFFIm Board reports InformationInformation InformationInformation InformationInformation Replenishment/Resource Mobilisaton Resource Mobilisation Update HR Report Closed Session
InformationInformationInformation Annual Report on Implementation of the Gender Policy Annex to Strategy paper InformationInformationInformation Board and Committee minutes Annex to Board pack/On BE as additional materials Information
Information InformationInformation InformationInformation H. Technical Briefing Sessions/Deep Dives
2028
2026 2027
Last updated - 19 November 2025
Next Board Meetings: 25-26 March 2026 (Retreat)
1-2 July 2026
9-10 December 2026
Board-2025-Mtg-03-Doc 01e

Board-2025-Mtg- 03-Doc 02a-FR 1
Rapport au Conseil d’administration
3 -4 d?cembre 2025

Rapport de la directrice exécutive
Le 26 novembre 2025

Chers membres du Conseil d’administration,

L’année écoulée a été marquée par une transformation profonde et des
changements soudains pour Gavi, alors que les institutions de la santé mondiale
traversent l’une des plus grandes crises de leur histoire.

Lorsque j’ai rejoint Gavi en 2024, il apparaissait nettement que les bouleversements
de la pandémie de COVID -19 avaient laissé derrière eux un environnement
opérationnel complexe et en évolution rapide pour ces institutions. Dans ce contexte,
Gavi avait qu atre défis ? relever :
• réaliser les objectifs programmatiques de Gavi 5.0/5.1 ;
• préparer la période Gavi 6.0 ;
• organiser sa reconstitution des ressources ;
• renforcer son Secrétariat et lancer une réforme audacieuse avec son nouveau
modèle opérationnel pour les pays.

En cette fin d’année 2025, le moment est opportun pour un bilan de nos progrès sur
chacun de ces fronts. À l’approche de notre réunion du 3 décembre, où nous
discuterons plus en détail de ces défis, accomplissements et occasions, j’espère que
ce rapport sera informatif et jettera les bases de discussions fructueuses.

Comme cela est devenu l’habitude, ce rapport est divisé en trois parties faisant une
synthèse des documents plus détaillés qui vous ont été remis.

La première partie fait état de mes réflexions sur le contexte et les principaux défis
auxquels est confrontée Gavi et les pays qu’elle soutient. La deuxième partie expose
un sommaire des résultats programmatiques de Gavi et des risques, à l’approche de
la clôture de la période Gavi 5.0/5.1. La troisième partie traite de l’état d’avancement
des réorientations stratégiques et opérationnelles au sein du Secrétariat de Gavi,
notamment l’initiative Gavi Leap et l’examen et la restructuration du Secrétariat, alors
que nous finalisons nos préparatifs pour le lancement de notre stratégie 6.0
recalibrée.

Ces préparatifs se poursuivent au moment même où je rédige ces lignes, avec
l’achèvement de plusieurs processus critiques liés à la stratégie 6.0, notamment une
projection ascendante de la demande de vaccins, des décisions techniques sur le
recalibrage et l’intensification de la communication sur le changement entourant le
nouveau modèle opérationnel pour les pays de Gavi.
Ce travail est rendu possible par les nombreux changements apportés aux méthodes
de travail et à la structure du Secrétariat, que nous avons déjà institutionnalisés à

Board-2025-Mtg- 03-Doc 02a 1
Report to the Board
3 -4 December 202 5

Report of the Chief Executive Officer
26 November 2025

Dear Members of the Board,

The past year has been a period of profound and rapid transformation and change
for Gavi, amidst one of the most challenging periods for global health institutions in
living memory.

When I joined Gavi in 2024 it was clear that the upheaval of the COVID -19 pandemic
had given way to a complex and rapidly evolving operating context for global health
institutions. Against this backdrop, the challenge for Gavi was fourfold:
• Deliver against Gavi’s 5.0/5.1 programmatic objectives;
• Prepare for the Gavi 6.0 period;
• Deliver Gavi’s replenishment;
• Build a stronger Gavi Secretariat and usher in bold reform with our new
country operating model.

As 2025 draws to a close, we now have a perfect opportunity to take stock of our
progress on each of these fronts. And as we prepare to meet on 3 December to
discuss challenges, achievements and opportunities in greater detail, it is my hope
that this report will help inform and set the scene for our discussions.

As is now customary, the three parts of this report provide a high- level overview of
several of the more detailed Board papers that have been submitted for your
consideration.

The first part of the report contains my reflections on the context and key challenges
faced by Gavi and Gavi -supported countries. The second part summarizes Gavi’s
programmatic results and risks as we close out the Gavi 5.0/5.1period. The third part
discu sses the status of planned strategic and operational shifts within the Gavi
Secretariat, encompassing the Gavi Leap and the Secretariat review and
restructuring, as we finalise our preparations for the delivery of our recalibrated 6.0
strategy.

Those preparations are ongoing even as I draft this report, with various critical 6.0-
related processes closing, including a bottom -up vaccine demand forecast; technical
decisions on recalibration; and intensified change communication around Gavi’s new
cou ntry operating model.
This work is enabled by the many changes to the Secretariat’s working practices and
structure that we have already institutionalised through the Gavi Leap. The third part
of this report contains a comprehensive overview of these changes, which will put the
Secretariat in the best possible position to respond with resilience and agility to what

Board-2025-Mtg- 03-Doc 02b 1
Report to the Board
3-4 December 202 5

Subject Strategy, Programmes and Partnerships: Progress, Risks and
Challenges
Agenda item 02 b
Category For Information
Executive Summary
This paper provides an update on the implementation of the Gavi 5.0/5.1 strategy,
programmes and partnerships and associated risks. It is informed by the WHO -
UNICEF estimates of national immunisation coverage (WUENIC) for 2024 released
in July 2025, and other quantitative and qualitative updates of strategy indicators for
which new data is available. The Alliance remains largely on track with its Gavi
5.0/5.1 targets. The cumulative target for routine introductions and breadth of
protection targets for Gavi 5.1 has been surpassed. While median time from
outbreak detection to response improved for all disease areas in 2024, the Alliance
remains off track to detect and respond to outbreaks within indicator timelines. The
Alliance continues progress on its three Gavi 5.1 ‘must -wins’ - the revitalisation of
the human papillomavirus (HPV) vaccine programme remains on track to reach 86
million girls by end of 2025; rollout of the malaria programme is also on track with
24 countries having introduced the vaccine wit h one more scheduled in 2025. Good
progress has also been made on the zero- dose must-win with 5% reduction in the
number of zero- dose children. There has been further acceleration of programming
for the Big Catch- Up, with 60% more children reached in Quarter 2 (Q2) than Q1
2025 although still unlikely to fully reach the ambitions of the programme. The
Alliance is off track to reach targets on number of zero- dose children, coverage
targets for the third dose of diphtheria, tetanus and pertussis - containing vaccine
(DTP3) and first dose of measles containing vaccine (MCV1), and geographic equity
of immunisation. Except for six countries receiving waivers, all countries met their
co- financing obligations despite record contributions in 2024. The Alliance is
advancing the Gavi Leap and Lusaka Agenda largely via the Joint Committee
Working Group through deeper collaboration with k ey partners driving joint
initiatives, internal reforms, and country -level action to drive Gavi 6.0.
Action Requested of the Board
This report is for information only.
Next steps/timeline
The next progress update to the Board in July 2026 will cover an update on mission
indicators and any new data available on remaining strategic goal indicators for
Gavi 5.1.
P revious Board Committee or Board deliberations related to this topic
This paper is one of a series of regular biannual updates to the PPC and Board.

Board-2025-Mtg-03-Doc 02b-Annex A 1
Report to the Board
3-4 December 202 5
Annex A: Technical report on Gavi 5.0/5.1 indicators
This is a technical report providing definitions of and progress against Mission and
Strategy Goal indicators in the Gavi 5.0/5.1 measurement framework. The technical
report is populated based on available data and updated bi -annually. The newly
available data for 2023 included in this report relates to Mission Goals M2, M3, M4,
M5, and M6, and Strategy Goals 1, 2, and 3.2.
Note on target trajectories:
In the below graphs, the dotted lines represent the projected annual trajectory that was
forecasted when we set 2025 targets with the PPC/Board in May 2021; our assumption
was that coverage would return to 2019 coverage levels in 2021, with the exception of
India which would take until 2022. This was noted in a footnote in the PPC paper on
the 5.0 Measurement Framework at the time (PPC -2021- Mtg-2-Doc 04):
To account for COVID -19- related disruptions and recovery, it is assumed that vaccine
coverage returns to 2019 levels by 2021, with the exception of India, which we assume
returns to 2019 levels in 2022 and sub- national three doses of pneumococcal
conjugate vaccine (PCV3) scale up takes an additional year.

Gavi 5.0 Mission Indicators
M.1: Under -five mortality rate – Updated April 2025

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

The under -five mortality rate in the 57
lower -income countries supported by
Gavi fell from 58.6 to 51.3 deaths per
1,000 live births between 2019 and 2023
– a 12% reduction from baseline. We
have thus exceeded our Mission target of
a 10% reduction by 2025. Est imates for
2024 will be available in early 2026.

Board-2025- Mtg-03-Doc 02b-Annex B 1
Report to the Board
3-4 December 202 5
Annex B: Human Papillomavirus (HPV) revitalisation detailed update
Section 1: Executive Summary
The HPV vaccine programme has made significant progress in achieving the
revitalisation strategy’s objectives: i) accelerate quality introductions; ii) rapidly
improve global and national coverage; and iii) generate long- term programmatic
sustainability by integrating HPV vaccination into routine delivery mechanisms and
Primary Health Care (PHC). The HPV revitalisation remains on track to achieve the
Must -Win objectives, including 86 million girls vaccinated by the end of 2025. As HPV
revitalisation is a Mu st-Win priority during Gavi 5.1, the Board has requested bi -annual
updates. This annex provides updates on HPV scorecard performance and
implementation of the strategic shifts supporting the revitalisation goal for the period
between July and October 2025.
Section 2: Programme Status (Update to the HPV Scorecard)
Under the HPV measurement framework, the scorecard is used to monitor progress
at the Impact, Outcome, and Output levels. All indicators are on track to be achieved
by the end of 2025, with four already achieved. As of 2024, over 59.8 million girls have
been fully immunised with the HPV vaccine through Gavi support.
Figure 1: Performance against HPV Scorecard Indicators in Gavi 5.1

Section 3: HPV revitalisation updates & strategic shifts
3.1 Vaccine Introductions, applications, and switches
Since the last update to the Board in July 2025, Pakistan, Ghana, Tajikistan, Cuba,
and Angola launched their national programmes, while Malawi and Mozambique
conducted multi -age cohort (MAC) campaigns. In Gavi 5.1, there have been a total of
25 routine programme introductions and 24 MAC launches, with a strong pipeline of
Performance against HPV Scorecard indicators in Gavi 5.1–Dec 2025 Board
Impact Cervical cancer deaths averted (from 2014 )
Outcomes
New HPV launches (from 2021 )
HPVC coverage in Gavi 57 (annual figures )
Girls fully immunized (from 2014 )
Outputs
HPV applications approved by IRC (from 2021 )2
% HPV VIG /Ops disbursed (from 2021 )3
Number of HPV countries with TCA contracted 4
Number of countries supporting HPV with HSS 5,6
NA, no t app lica ble . R rou tine , M mu lt i -ag e c oho rt (MAC ). 1Relative to 20 19 co verage ba seline (4%) 2Exc lu des a pplic atio ns that may b e approv ed th rou gh altern ativ e rev ie w mec han is ms . 3Cumulative disb urs ed for VIG /Ops v s Ga vi 5.0/5.1 fore cas t . Future disbu rs ements may ch ange d ue to up dates to 5.0/5.1 fore cas t . InDec ember 20 22 the Board app ro ved an ad dition al US $10m for VIG+Ops+switch , he nce the lower c umulativ e disburse me nts agains t 5.0/5.1 totals in 20 21 an d 20 22 . 4Cou ntries start to be in clude d in the to ta l whe n fun ds are contracted .Include s activities that are fun ded thro ugh either TCA c eilings o r the T CA res erv e . 5New or rep rog rammed HS S fund in g for HPV per the Dec ember 20 22 Boa rd de cision on the HPV re la unch . Note th at three of the se c ou ntries drew on HSS ex plic itly for HPV in 20 22 (Ken ya , Si er ra Le one , an d L ao PDR ), for ac tivitie s to oc cur in 20 23 . 6Curre ntly o n track relativ e to targ et . HPV working group an d HSIS team are closely mon itorin g and ad dre ssing ris k of d elays e merging whe re interest in HSS funding h as bee n s low to materia lize into ap plic ation s .
No update Significant delays / chall enges On track Moderate delays / chall enges
Cumulativeto 2024 Target(2025 ) Cumulativeto 2023
1.4m
27R, 28M
21% (+ 17pp1)
86M
8
40%
30
7
14R, 12M2
*
*
Status Cumulativeto date
22
56%
34
14
18R, 15M
*
*
16%
>27.3M
>605k
22
100%
35
23
96%
47
17
25R, 24M
* >1.2M
25%>59.8M
16

Board-2025- Mtg-03-Doc 02b-Annex C 1
Report to the Board
3-4 December 202 5
Annex C: Malaria implementation update
Section 1 - Executive summary
The Malaria Vaccine Programme (MVP), a ‘must win’ for Gavi 5.1, is advancing in
response to strong country demand, meeting 2024 targets and remaining on track for
2025. Gavi’s Independent Review Committee (IRC) has recommended 26 countries
for sub- national introduction of the vaccine, with 15 of these also approved for scale-
up in moderate and high malaria transmission areas . Through October, 24 countries
have introduced the malaria vaccine, of which 8 have scaled up. Two additional
countries are actively preparing for , respectively, introduction and scale-up in 2025.
As countries steadily scale up programmes, Gavi and Alliance Partners continue to
support countries in improving coverage, addressing challenges, and identifying
lessons and good practices. Most countries have continued to increase the uptake of
the vaccines, including using innovati ve strategies for integrated service delivery and
increasing community demand for and uptake of the vaccine. The programme also
continues to advance its learning agenda, wrapping its support for a case- control study
in the pilot countries and supporting im plementation research in seven countries. This
annex describes programme performance and learning for the MVP. Details on the
increased global health institutions collaboration are included in Annex F.
Section 2 - Country implementation


2.1 Progress update through October 2025

The Malaria Vaccine Programme (MVP) continues to make rapid progress against its
milestones and the vaccine roll out remains among the most rapid in Gavi’s history.
30 countries have formally expressed interest in introducing malaria vaccines. To date,
26 new introduction applications have been recommended for approval by the Gavi
Independent Review Committee ( IRC). In addition, 15 countries have also been

Board-2025- Mtg-03-Doc 02b-Annex D 1
Report to the Board
3-4 December 202 5
Annex D: Update on Implementation of the Gender Policy

In 2020, the Gavi Board approved a new gender policy which sought to contribute to
achievement of Gavi 5.0 by:
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 differences 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 programs and wellbeing

Since 2020, the Alliance has significantly advanced implementation of the gender
policy, enhanced understanding of gender -related barriers to immunisation,
particularly among zero- dose and under-immunized children, and improved the quality
of gender -responsive programming. This has been a journey that has required
continuous learning and iterative approaches, and has underscored that effective
gender integration extends beyond frontline service delivery, requiring systemic policy
reforms, inclusive leadership, and targeted interventions for caregivers, adolescents,
and health workers. While many grant applications early in the strategic period did not
address gender related barriers, this has steadily improved and from 2024, all Health
Systems Strengthening (HSS) and Equity Accelerator Fund (EAF) grant applications
have included gender -responsive activities. This progress has been further reinforced
by the introduction of specialised Gender Technical Assistance (TA) in 2025 that has
helped build country under standing and capacity, accelerated implementation, and
strengthened evidence generation and learning. This paper summarises key
achievements, challenges, and future goals in implementing the policy. It highlights
the actions taken based on key learnings, as well as the steps initiated to embed and
institutionalise those insights for sustained improvement.

How has Gavi progressed in operationali sing the Gender Policy?

Country Applications

Over the past four years, Gavi has seen a notable shift in the integration of gender
considerations within country grant applications, all of which are now informed by
gender analyses (94% in 2023 to 100% in 2024 and 2025) and include interventions
aimed a t removing barriers for caregivers adolescents, and health workers (88% in
2023 to 100% in 2024). Examples of Gavi -supported gender -responsive immunisation
interventions have included:
• Mobile strategies and gender -responsive planning
Ethiopia: mobile outreach in conflict -affected areas, gender -responsive planning,
capacity building for health workers, and integrated nutrition messaging.

Board-2025- Mtg-03-Doc 02b-Annex E 1
Report to the Board
3-4 December 202 5
Annex E : Detailed progress update on Taskforce

Please refer to the pre -read materials uploaded for the
Closed Session

Board-2025- Mtg-03-Doc 02b-Annex F 1
Report to the Board
3-4 December 202 5
Annex F: Information on the Joint Committee Working Group ( JCWG), Gavi -Global
Fund Taskforce, Africa Centres for Diseases Control and Prevention (Africa CDC) ,
Global Polio Eradication Initiative ( GPEI) and other partnerships
While the Alliance has a well -established collaborative model through its core and
expanded partners, this annex focuses specifically on Gavi’s strategic partnerships
outside the Alliance that advance global health and immunisation objectives at large.
In particular, it highlights collaborations with global health initiatives (GHIs) such as
GPEI, the Global Fund to Fight AIDS Tuberculosis and Malaria (The Global Fund) ,
and the Global Financing Facility (GFF) ; with upstream research and development
actors su ch as the Coalition for Epidemic Preparedness Innovation ( CEPI); and with
regional institutions such as Africa CDC. The following sections provide an overview
of these engagements, beginning with the JCWG and subsequent collaboration
mechanisms such as the joint Gavi -Global Fund Taskforce.
1. JCWG and collaboration with Global Fund and the GFF
1.1. The sixth and final meeting of the JCWG was held 30 September 2025. The
agenda covered a review of the JCWG process over the last year, an update
from each of the three workstreams on their work, a forward look, and
reflections and lessons from the JCWG process. The pre- read slide deck for
JCWG6, together with the notes of the meeting, will serve as the final report for
the effort (further details can be found in Appendix 3 in BoardEffect).
1.2. The three workstreams – malaria, Health Systems Strengthening (HSS )/
Resilient and Sustainable Systems for Health (RSSH ), and country
engagement – are continuing to make progress, both at a global level, for
example through aligning programme guidance to countries; in specific
technical areas such as waste management and human resources for health;
and at country level; for example the joint malaria vaccination and bed net
campaign in Ethiopia; collaboration on supply chain, especially a warehouse in
Guinea; and Health Management Informat ion System (HMIS) in Chad.
1.3. The governance bodies of the three GHIs have agreed that the JCWG will
sunset after twelve months. Its work will be continued in various ways, including
through the joint Gavi -Global Fund Taskforce and through separate tri and
bilateral collaborations betw een Gavi, the Global Fund and GFF. The GHIs will
also continue to engage with other initiatives under the Lusaka Agenda. While
not all JCWG initiatives are captured within the Taskforce scope, most are
embedded into Taskforce workplans wherever possible. R emaining JCWG
items that fall outside the current scope will continue to be progressed in
parallel , including work in Wave 1 countries.
2. Gavi -Global Fund Taskforce
2.1. Building on the foundations laid with the JCWG, 19 joint initiatives have been
identified, spanning four key areas: Strategy, Policy & Programmes, Enabling
Functions, Resource Mobilisation, and Governance. These have been mapped

Board-2025- Mtg-03-Doc 02b-Annex G 1
Report to the Board
3-4 December 202 5
A nnex G: Independent Review Committee (IRC)
Applications reviewed during the Gavi 5.0/5.1 strategic period (2021- 2025)
The Gavi 5.0 strategic period (2021– 2025) has been shaped by the global disruption
caused by the C OVID-19 (C -19) pandemic, which significantly disrupted immunisation
delivery efforts and planning. As a result, the implementation of the 2018 Vaccine
Investment Strategy (VIS), which expanded the portfolio of Gavi -supported vaccines,
was temporarily paused and only resumed midway through the period. These
contextual shifts are reflected in the application patterns reviewed by the Independent
Review Committee ( IRC) (see Figure 4).
To date, the IRC has reviewed a total of 677
1 applications for Gavi support during
the Gavi 5.0 period —representing a substantial increase compared to previous
strategic cycles. Of these, 630 applications (92%) were approved , while 47 (8%)
were recommended for re- review, highlighting the consistently high quality of
submissions assessed throughout the period (see Figure 1) .

Figure 1: IRC reviewed applications (application volumes and financial data) overview 2021 - 2025
Application volumes were relatively low during the outset of the strategic period,
largely due to the global focus on C -19. Activity increased significantly in 2023 and
2024, reflecting a shift in programme priorities. The early pandemic phase was
dominated by COVAX cold chain equipment (CCE) reviews, followed by a pivot in
2022 toward Targeted Country Assistance (TCA) and Equity Accelerator Funding
(EAF). Since 2023, there has been a resurgence of previously deferred Full Portfolio
1 This figure does not yet include applications expected during the November IRC and other time-sensitive reviews.
The total number of applications is projected to exceed 700 by the end of the year.

1


Board-2025-Mtg- 03-Doc 03
Classified as Internal
Report to the Board
3-4 December 2025
Subject Replenishment update, including financial instruments
Agenda item 03
Category For Information

Executive Summary
The purpose of this paper i s to provide an update on Gavi’s replenishment efforts,
including the conversion of new pledges and other resources into secured
resources, and the operationalisation of new financial instruments. Intensive efforts
are underway to transform pledges into binding grant agreements, with over
US$ 2.9 billion already secured through pledge conversions and assured financial
resources. Additional resource mobilisation channels —including new sovereign and
non- sovereign pledges, reallocation of unutilised balances, and income from
financial instruments—have yielded over US$ 445 million in the past months
bringing close to US $ 9. 5 b illio n of resources advancing towards the US$ 1 0 billion
expenditure recalibration target. F urther opportunities are being actively pursued.
The Secretariat is also advancing the implementation of innovative financing
mechanisms, such as the extension of the European Investment Bank’s facility and
the launch of the Innovation Scale Up Facility, to diversify funding and accelerate
impact.
Action Requested of the Board
This report is for information only.
Next steps/timeline
The Secretariat will continue to convert outstanding pledges and financial
commitments into binding agreements, pursue additional resource mobili sation
opportunities, and advance the operationalis ation of new financial instruments.
Times have never been more challenging, requiring redoubled efforts and
persistence. Progress updates and any required Board actions will be provided at
future meetings as key milestones are reached.
Previous Board Committee or Board deliberations related to this topic
In July 2025 Board meeting book: Doc 04 – Update from the Global Summit:
Health and Prosperity through Immunisation
In Dec 2024 Board meeting book: Doc 12 – Road to Replenishment

Board-2025-Mtg- 03-Doc 03-Annex A 1
Report to the Board
3-4 December 202 5

Annex A : Innovative Financial Instruments in Gavi 6.0

Graph 1: Innovative Financial Instruments in Gavi 6.0

1


Board-2025-Mtg- 03-Doc 04
Report to the Board
3-4 Decem ber 2025
Subject Financial Update , including forecast s, Secretariat and Partners
budgets
Agenda item 04
Category For Decision

Executive Summary
This paper presents the updated Financial Forecast s for (i) Gavi 5.1 (2021- 2025)
and (ii) Gavi 6.0 (2026- 2030) prepared in line with the July 2025 Board recalibration
targets and subsequent operationalisation guidance from the Programme and Policy
Committee (PPC) , and (iii) the 2026 and 2027 annual budgets for Secretariat
Operating Expenditure and Partner programmes not covered by the Programme
Funding Policy for Gavi Board approval based on recommendation from the Audit
and Finance Committee (AFC).
Gavi 5.1 forecast (2021- 2025)
The Gavi 5.1 consolidated forecast confirms financial flexibility with US$ 94 million
available for future investment and assumed to be carried forward to Gavi 6.0 .
There are limited changes to underlying forecasts for the remaining months of 2025 .
Country demand remains strong , and with the risk of disbursement delays
incorporated into the prior forecast (reflecting the potential impact on country
delivery capacity of reduced global health funding) only partly materialis ing,
expenditure estimates have increased by US$ 110 million .
Gavi 6.0 forecast (2026- 2030)
The Global Summit in June 2025 mobilis ed US$ 9 .0 billion in resources and with
additional opportunities identified, the S ecretariat is forecasting Gavi 6.0 resources
of US$ 10 billion . In July , the Board r ecalibrated Gavi 6.0 expenditure to
US$ 10 billion . Gavi r etains its ambition to fundraise the full US$ 11.9 billion
required to deliver the Gavi 6.0 strategy .
T he Secretariat is operationalising the recalibrat ion priorities , incorporating
guidance from the October 2025 meeting of the PPC. This forecast provides an
update on Qualifying Resources now at US$ 8.5 billion as well as changes to
programmatic expenditure envelopes, noting that the overall Gavi 6.0 forecast
(that is US$ 10.0 billion forecast resources and US$ 10 .0 billion forecast
expenditures ) remains unchanged.
2026 and 2027 Annual Operating Budgets
The Secretariat Budget request is US$ 166.3 million for 2026 and
US$ 138.4 million for 202 7 and t he budgets have been prepared based on the
ongoing Secretariat Review, including the additional initiatives being implemented
to reflect the outcome of the July 2025 Board recalibration. As a number of these
initiatives will be implemented throughout 2026, the full annualised benefit

Board-2025-Mtg- 03-Doc 04-Annex A
1
Report to the Board
3-4 December 2025
Annex A : Financial Forecast Additional Info

1. Gavi 5.1 v23 financial forecast: Additional Expenditure Detail
1 .1
With the enhancements to actual and forecast reporting being implemented
through the 2025/26 reporting cycles, additional forecast details are provided
through standard automated tables / dashboards, with direct online access
provided to AFC members .
1 .2
In addition, granular details of Gavi expenditure for the 2021 –2025 period which
are not yet accessible in the standard automated tables ( e.g. Figure 4 annual
expenditure for each programme) continue to be explained in the Figures and
explanatory commentary below until the corresponding automated tables are
accessible .
Figure 1: Gavi 5.1 consolidated financial statement



Board-2025-Mtg- 03-Doc 04-Annex A
2
Report to the Board
3-4 December 2025
2. Gavi 5.1 Qualifying Resources : US$ 18 million higher
a) Direct contributions Direct contributions have decreased by US$ 65
million with some expected donor payments moving from 2025 to 2026.
b) Investment Income Overall, investment income is US$ 78 million higher
than the prior forecast driven by both actual and forecast returns from the
LTIP (US$ 15 million) and higher interest rates and higher cash balances
on the short -term portfolio (US$ 63 million).
c) Repurposed funds are US$ 5 million higher, reflecting the increased C19
forecast in line with country demand (following a COVID -19 surge in Asian
countries during 2025) .
d) IFFIm proceeds remain aligned with prior forecast expectations .


3. Gavi 5.1 expenditure is increasing by US$ 110 million versus the prior
forecast, driven primarily by increases in vaccine expenditure and immunisation
support, as a result of execution risk adjustments in the prior forecast of
US$ 214 million ( US$ 159 million for vaccines procurement and US$ 55 m illion
for immunisation support , linked to the impact on delivery capacity of global
health funding uncertainty ) only partially materialising .
Vaccine expenditure is US $ 68 million above the prior forecast, with lower
programmatic expenditures (US$ 91 million lower) partly offsetting the increase
from the removal of the execution risk adjustment (US$ 159 million higher ), as
set out below :
a) R outine vaccine p rocurement forecast is US$ 29 million lower driven
primarily by Rota supply disruptions and HPV Ethiopia shipments delayed
from 2025 to 2026 due to lower absorption
b) Preventive campaign vaccine p rocurement forecast is US$ 29 million
lower, principally from lower Yellow Fever disbursements due to the paused
Ethiopia decision letter and the achievement of higher manufacturing
volume tiers, driving a lower average price, as well as the pausing of the
Bangladesh JEV launch.
c) Outbreak reactive campaign vaccine procurement forecast is
US$ 6 million lower , driven by small variations in disbursement timing
across Typhoid and PCV support (with Typhoid offset by slightly increased
preventive campaign support).
d) Other vaccine procurement forecast is US$ 132 million higher driven by
the removal of the portfolio level adjustment of US$1 59 million in the prior
forecast (which reflected the risk of disbursement delays in 2025 given the
impact of the global health funding context on country programme capacity
delivery ), replaced by a smaller portfolio level adjustment of US$ 25 million,

1


Board- 2025-Mtg-03-Doc 05a

Report to the Board
3-4 December 2025
Subject Follow up on Gavi 6.0 Recalibration Retreat including
recalibration programme reductions
Agenda item 05a
Category For Decision

Executive Su mmary
At its July 2025 retreat, the Board provided a steer on recalibrat ion of Gavi 6.0
priorities in response to a US$ 3.0 billion funding gap following the Global
Summit, informed by an assessment of impact on health, equity, sustainability and
vaccine market outcomes , and other considerations. This paper provides an
overview of the outcomes and implications of the Gavi 6.0 recalibration and
subsequent follow -ups. The recalibrat ion preserves the integrity of the Gavi 6.0
strategy while reducing scope of the four strategic goals and funding for Partner and
Gavi Secretariat support . The overall health impact loss versus the original Gavi 6.0
strategy could approach one million future deaths averted. Following the Board
retreat, the Secretariat further assessed the implications of the recalibration choices
and is actioning the outcomes of the recalibration and the related July 2025 Board
meeting decisions :
Strategic Goal 1
• The scoping/pacing of vaccine programmes (malaria, measles/measles - rubella
hexavalent, inactivated polio vaccine) was refined through consultations.
• The design of ‘Country Vaccine Budgets’ ( CVB ; previously referred to as
‘vaccine envelopes’) is planned for December 2025 Board approval based on a
recommendation from a dedicated CVB Task Team chaired by Programme and
Policy Committee (PPC) chair .
• To free up additional funding for CVB , the PPC recommended to reduce the
financial forecast for vaccine stockpiles for outbreak response and to fund co-
financing waivers through the Fragile & Humanitarian (F&H) approach.
• The Secretariat will apply a prudent approach to approvals for new vaccine
support that have been paused since May 2025 and new country applications
expected until the new Gavi funding model has been clarified.
Strategic Goal 2
• The 22% 1 reduction of the support through the consolidated cash grant points
to the need for countries to prioritise across the objectives of the Board -
approved Gavi 6.0 Health System Strategy. Country cash funding caps and
1Considers the full ‘consolidated cash envelopes including Health System Strengthening-like support, immunisation
cash support for new vaccine introductions or campaigns and technical assistance moving into consolidated cash
envelope
2 At the retreat, agreement was reached on deprioritisation choices resulting in ~US$ 3.12 billion cost
reduction which was updated following the retreat to factor interdependencies not automatically captured at the
retreat

Board-2025- Mtg-03-Doc 05a-Annex A 1
Report to the Board
3-4 December 2025
Annex A: Caps and floors for the Health Systems and Immunisation Strengthening
(HSIS) allocation formula
1. Background and principles
The Board- approved H ealth Systems and I mmunisation Strengthening (HSIS) policy ,
includes a formula that produces an allocation of health system strengthening (HSS)
and technical assistance funding by considering health system performance, financial
capacity, and population. However, it does not fully address the risk of under -allocation
to very small countries or over -allocation to large ones. To mitigate these imbalances,
Gavi has historically applied floors (minimum allocations) and caps (maximum
allocations) to ensure both an equitable and practical funding distribution. A summary
of historical caps and floors is provided in Table 1.

Table 1: Caps and floors per strategic period
Strategic
Period
Total Envelope (Original
budget) Caps Floors
Gavi 4.0
US $ 2 billion (US $ 1.3 billion
Health Systems Strengthening
– HSS * + US $ 200 million
Cold Chain Equipment - CCE
+ ~US $ 4 00 million Targeted
Country Assistance - TCA)
US $ 100 million HSS
+ TCA (as needed) +
CCE US
$ 3 million HSS
+ TCA (as needed) +
CCE
Gavi
5.0/5.1 US
$ 2.2 billion (HSS, Equity
Accelerator Funding - EAF,
CCE)** + US $ 550 million TCA None, but US
$ 25
million maximum TCA
US $ 8 million (US $ 3
million HSS, US$ 1
million EAF) + US $ 3.5
million TCA + US $ 0.5
million CCE
Gavi 6.0
US $ 1.488 billion (HSS, EAF,
CCE, Technical Assistance -
TA)
TBD TBD
* 4.0: Final HSS disbursement amount = US $ 1.43 billion
** 5.0/5.1: Includes ~ US$ 1.2 billion HSS + ~ US$ 0.5 billion EAF + ~ US$ 0.2 billion CCEOP + ~ US$ 0.2 billion for India and ITU

Funding floors and caps
1 were in place in Gavi 4.0, however, caps were removed in
Gavi 5.0, reflecting the period’s higher overall funding availability and the strategic
focus on the zero- dose agenda, which appropriately concentrated resources in Gavi’s
High Impact Country (HIC) segment. Given the more constrained funding envelope for
HSS and technical assistance support in Gavi 6.0, the Secretariat has reviewed the
retention of a floor and the re -introduction of a cap. Th is review has been guided by a
set of principles aimed at maintaining equitable allocations , sustainability, and
impact and developed in consultation with the Health Systems Strategy Technical
Advisory Group (HSS TAG) .

Floors should ensure that smaller countries receive a meaningful level of funding—
sufficient both to justify applying for support and to cover essential health system
1 Some countries such as India and Nigeria had caps in practice even before then as part of Board approved
special strategies.

Gavi Alliance
Fragility, Emergencies and
Displaced Populations Policy

DO

CUMENT ADMINISTRATION
VERSION
NUMBER APPROVAL PROCESS DATE
1.0 Prepared by: Aurélia Nguyen
Reviewed by: Programme and
Policy Committee 17 October 2012
Approved by: Gavi Alliance Board 5 December 2012
Effective from: 1 January 2013
2.0
Reviewed and recommended by:
Programme and Policy Committee 12 May 2017
Approved by: Gavi Alliance Board 15 June 2017
Effective from: 1 July 2017
3.0 Reviewed by: Programme and
Policy Committee 3 May 2018
Approved by: Gavi Alliance Board 7 June 2018
Effective from: 7 June 2018
4.0 Reviewed by: Programme and
Policy Committee 19 May 2022
Approved by: Gavi Alliance Board 23 June 2022
Effective from: 1 July 2022
5.0 Reviewed by: Programme and
Policy Committee 29 October 2025
Approved by: Gavi Alliance Board
3 December 2025
Effective from: 1 January 2026

Board-2025-Mtg-03-Doc 05a-Annex B

Gavi Alliance
Fragility, Emergencies and
Displaced Populations Policy

DO

CUMENT ADMINISTRATION
VERSION
NUMBER APPROVAL PROCESS DATE
1.0 Prepared by: Aurélia Nguyen
Reviewed by: Programme and
Policy Committee 17 October 2012
Approved by: Gavi Alliance Board 5 December 2012
Effective from: 1 January 2013
2.0
Reviewed and recommended by:
Programme and Policy Committee 12 May 2017
Approved by: Gavi Alliance Board 15 June 2017
Effective from: 1 July 2017
3.0 Reviewed by: Programme and
Policy Committee 3 May 2018
Approved by: Gavi Alliance Board 7 June 2018
Effective from: 7 June 2018
4.0 Reviewed by: Programme and
Policy Committee 19 May 2022
Approved by: Gavi Alliance Board 23 June 2022
Effective from: 1 July 2022
5.0 Reviewed by: Programme and
Policy Committee 29 October 2025
Approved by: Gavi Alliance Board
3 December 2025
Effective from: 1 January 2026

Board-2025-Mtg-03-Doc 05a-Annex C

gavi.org Annex D
Operationalising Gavi 6.0
recalibration outcomes
Additional analyses for Board
December 2025 Doc 05a - Annex D
1. Proposed refined cost reductions to vaccine programmes (SG1)
2. Proposed mitigations to reduce Country Vaccine Budgets funding gap
3. Health impact assumptions and estimates – post recalibration
4. Cash allocation by country segment – post recalibration
5. Co - financing implications – post recalibrationContent
2
Doc 05a - Annex D

Level Function/Intervention area Specific output/area of work Indicators (Criteria: Time-bound, Measurable & Scope) Sub-Indicator / Nested Indicator Data Sources
1.1 Development of policies and
operational guidance needed by
countries to adopt global
immunisation strategies  e.g. SAGE
recommendations, regulatory
guidance. 1.1.1 > Percentage of normative and operational guidance documents for which
technical resources were developed for adaptation and implementation at
regional and country levels To be reported by
Alliance Partners
1.2 Availability of, access to, and
uptake of regional/country adapted
normative and operational guidance
necessary for effective programmes 1.2.1 > Number of countries supported in adapting, updating, implementing
global guidance and immunisation tools (e.g., EVM, Thrive 360, EPI Review)
per year. To be reported by
Alliance Partners
2.1 Escalation of risks and issue
resolution for Gavi 6.0 priorities 2.1.1 > Percentage of countries supported to monitor and identify risks to Gavi
6.0 immunisation priorities 2.1.1.a > Percentage of country-level risks escalated to partner-led regional groups
with active mitigation plans To be reported by
Alliance Partners
2.2 Coordinated efforts, including key
stakeholder engagement, at global-
regional-country level as per Gavi 6.0
goals and IA2030 immunisation
agenda 2.2.1 > Number of Gavi-elgible countries where partners provide global/regional
technical and strategic advocacy support related to Gavi 6.0 priorities To be reported by
Alliance Partners
2.2.2 > Number of outbreak-related global/regional coordination mechanisms
that are activated annually by [WHO grade] per [vaccine-preventable
disease] 2.2.2.a > Percentage of outbreak-related coordination mechanisms with outbreak-
specific action plans developed on time. To be reported by
Alliance Partners
2.2.3 > Number of immunisation-relevant global/regional coordination
mechanisms (including Gavi Alliance and governance mechanisms) where
the partner contributes through a defined advisory, lead, co-lead or
participatory role annually To be reported by
Alliance Partners
2.3 Engagement on development of
Gavi Alliance strategy, policies, and
guidelines, and engagement with
Gavi Alliance governance
mechanisms N/A Measurement for this area of work will be done through indicator 2.2.3 in
the "Partnership, advocacy, strategy, governance" section of the
Framework To be reported by
Alliance Partners
2.4 Provide support for country
ownership and transition planning
through global/regional technical
expertise 2.4.1 > Percentage of countries with expected advocacy and immunisation
financing technical assistance outputs, aligned with sustainable
immunisation financing outcomes, completed on time To be reported by
Alliance Partners
2.5 Foster participation and
meaningful engagement of civil
society partners in addressing
immunisation barriers through
regional and global platforms 2.5.1 > Number of global or regional advocacy mechanisms, platforms, forums,
or advocacy initiatives where civil society partners are included by
[partner] as stakeholders with a defined role to contribute to immunisaton
and vaccinaction discussions. To be reported by
Alliance PartnersGlobal/
Regional 1. Normative Guidance and Public
Health Goods Global/
Regional 2. Partnership, advocacy, strategy,
governance Page 1 of 3
Partnerships Accountability Framework - Global and Regional Foundations

Board-2025-Mtg- 03-Doc 05c 1
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3-4 December 202 5

Subject 2026 -2030 Strategy: Market Shaping Strategy
Agenda item 05c
Category For Guidance
Executive Summary
The Board’s guidance on key elements of a Market Shaping Strategy for Gavi
6.0 (MSS6.0), to be approved in mid-2026 , will ensure it fit s with the Gavi 6.0
strategy and Strategic Goal 4 (SG4) , while accounting for recalibration outcomes.
Important trade -off decisions are anticipated to balance the proposed priorities of
optimising affordability and supply security without backsliding on market health
and specifically to balance reduced weighted average prices (WAP) of vaccines with
acceptable levels of regionally diverse supply security and sustainable markets in
the long term. The proposed priority of anticipatory shaping of future markets for
Vaccine Investment Strategy (VIS) - endorsed vaccines and vaccines against
outbreak, epidemic and pandemic (OEP) diseases, aims to ensure successful future
introductions and supply availability.
Gavi’s Programme and Policy Committee (PPC) has provided guidance on the
MSS6.0 framework . The MSS6.0 framework was developed in collaboration with
market shaping Square Group partners Gates Foundation, UNICEF Supply Division
and World Health Organisation Immunization, Vaccines and Biologicals department.
Secretariat teams, additional PPC members and Alliance partners - International
Federation of Pharmaceutical Manufacturers & Associations (IFPMA), Developing
Country Vaccine Manufacturers Network (DCVMN), Africa CDC (A -CDC) ,
Implementing and donor countries - were consulted.
Action Requested of the Board
The Gavi Alliance Board is requested to provide guidance on:
a) Interrelated Strategic Priorities (SPs) 1 & 2 , and their associated Target
Outcomes (TOs), specifically the increased focus on optimising for affordability
of vaccine costs (SP1) balanced with the imperative to maintain access, supply
security and market health (SP2);
b) Two proposed direct enablers supporting SPs 1 and 2, specifically:
i) Revision of the Healthy Markets Framework, with expansion of Supply
Security definitions, to better evaluate trade- offs between SPs 1 & 2; and
ii) A Procurement Framework to be articulated within MSS6.0; and
c) The ambition for SP3 as specific to Vaccine Investment Strategy (VIS) -
endorsed vaccines and vaccines against select outbreak-, epidemic - and
pandemic -prone (OEP) diseases, and the associated TOs and proposed
enablers.
The Gavi Alliance Board is requested to note that Gavi’s Board Chair is convening
the MSDC in an advisory capacity for a time -limited period to provide guidance on

Board-2025- Mtg-03-Doc 05c-Annex A 1
Report to the Board
3-4 December 202 5
Annex A: Implications/Anticipated impact
Risk implication and mitigation, including information on the risks of inaction
• A stronger focus on affordability of vaccine programme costs will most likely bring
trade- offs on several market health dimensions, notably supply dynamics and
geopolitical and health security exposure, with increased exposure to vaccine
supply shortages i n the near and long terms. These risks will be managed through
market shaping roadmaps where minimally acceptable conditions for each
vaccine market (including a more granular treatment of supply security concepts
within the Healthy Market Framework) and a ccompanying risk mitigating actions
will be established, followed by systematic monitoring to ensure conditions remain
acceptable. Future Supplier Base (FSB) assessments are an important process
to identify and track individual supplier and portfolio- level risks, such as over -
reliance on individual suppliers. These assessments involve periodic reviews of
the status of each supplier, evaluating both their business sustainability and their
criticality to the overall health of the Gavi market, as well as consi deration for
potential impact of market strategies on suppliers, ensuring that any changes do
not inadvertently undermine supply security. The insights gained from these
reviews directly inform roadmap strategies and risk mitigation actions, supporting
a m ore resilient and balanced vaccine supplier base. In the absence of stronger
focus on affordability, fewer lives will be saved with the available vaccine
procurement funding.
• Prioritising country leadership in the approach to realising target savings brings
the risk of failing to achieve the full value of the target savings and not maximising
health impact per dollar. This risk is mitigated through a multi -faceted approach to
a chieving the target savings including the design of the country vaccine budget
framework and improved evidence for countries to make cost -conscious product
choices, in tandem with procurement strategies bringing an increased emphasis
on affordability. Taki ng a “top down” approach that does not prioritise country
leadership would be misaligned with Alliance principles. Only in cases where
minimum levels of supply security would be compromised would the Alliance
propose this approach, implemented as part of V POP.
• The country vaccine budget framework will be designed to support countries make
cost conscious product choices yet there will be scenarios where countries may
make trade- offs within their budgets to use higher priced products that may not
fully maximise health impact per dollar according to external evaluations. VPOP
will monitor this.
• Countries may not choose to switch to use of lower priced products due to the
logistical and resource requirements of physically planning, organising and
implementing a switch from one vaccine product to another that may have different
programmatic require ments. This risk is mitigated through ensuring that countries
have access to the evidence that provides a balanced view of the benefits of
switching to a lower priced product.

Board-2025- Mtg-03-Doc 05c-Annex B 1
Report to the Board
3-4 December 202 5

Annex B: Market Shaping Strategy high- level summary
A high -level summary of the key elements of the proposed MSS 6.0 is depicted below including the linkages between SG4
objectives, and the proposed MSS 6.0 strategic priorities, target outcomes, and strategic enablers to achieve them .

Board-2025- Mtg-03-Doc 05c-Annex C 1
Report to the Board
3-4 December 202 5
Annex C: Trends and influences on market shaping
An analysis of vaccine market trends was performed to support the development of
the MSS6.0 and enable the market shaping strategy for Gavi 6.0 to be designed to
proactively address important evolutions and changes observed and/or projected.
The number of vaccines available to countries with Gavi support continues to increase
(trend #1), among these vaccines many countries have introduced Gavi -supported
programmes that are programmatically established using specific vaccines (trend #2)
that were selected by countries (trend #3) whether by presentation or vaccine type or
both. Changes to the Gavi model in Gavi 6.0 including country vaccine procurement
budgets and increased co- financing obligations (trend #4) combined with a significant
proportio n of demand coming from less predictable markets (trend #5) will create a
period of unpredictable demand that is more difficult for suppliers to manage. The
number of suppliers of vaccine to Gavi and their characteristics continues to evolve
(trend #6). Vaccine pricing in Gavi markets has variably decreased or increased in
different markets (trend #7) and in several markets the product price differential has
significantly increased with large price gaps between the lowest and highest priced
products (trend #8). The number of imbalances or threats to supply meeting demand
has continued (trend #9), requiring ongoing attention to market health to prevent
interruptions to vaccination. Finally, suppliers face structural challenges (trend #10)
that may pose risks to Gavi markets.
Trend #1: Gavi support is anticipated to be available for an increasing number
of vaccines.
Since the advent of Gavi, the number of vaccines available to countries has increased
substantially. By the end of the Gavi 6.0 strategic period Gavi support could be
available for up to 25 vaccines (Figure 1). Compared to previous periods, countries
face increasingly complex decisions regarding which vaccines to prioriti se and
introduce. The increasing number of vaccines available to introduce also carries
financial implications, as the cost per fully immunised child continues to increase
(~140% from Gavi 4.0 to Gavi 5.0/5.1) at a difficult pace that is challenging for
countries to meet.

Board-2025- Mtg-03-Doc 05c-Annex D 1
Report to the Board
3-4 December 202 5
Annex D: Glossary of market shaping terms
This glossary has been developed to provide a common reference point for
terminology used in Gavi’s vaccine market shaping work. It is intended to support
clarity and consistency in the way technical concepts, strategic approaches, and
market dynamics are described and understood and to serve as a resource for PPC
and Board members engaged in discussions and decision- making related to vaccine
market shaping.
The terms included in Table 1 reflect both widely recogni sed definitions and those
tailored to the specific context of Gavi’s work.
Table 1: Market shaping terms and definitions
Term Definition
Access The ability of countries to obtain appropriate vaccines in a timely,
affordable, and sustainable manner.
Affordability
The extent to which vaccine prices and associated programmatic
costs of delivery are within the financial reach of countries and
Gavi, considering both immediate budgets and long- term
sustainability.
Buffer Stock
A reserve of vaccine product held at a country level to ensure
programme continuity during periods of demand surge, supply
delays, or other emergencies.
Demand
Forecasting The process of estimating future country vaccine needs based
on demographic data, disease burden, policy decisions,
availability of financial resources and programmatic capacity.
Developer,
manufacturer,
supplier
Organi sations involved in different stages of vaccine
development and production: Developer designs and tests new
vaccine candidates; Manufacturer or Supplier are used
interchangeably for an organisation that produces licensed
vaccines at scale and sells them to procurers . One entity can
serve in multiple or all roles.
Domestic
Procurement
Under specific circumstances, Gavi funding may be used by
Gavi-supported countries to procure locally produced vaccines,
subject to normal country co- financing obligations and other
conditions described in the policy. Also referred to as self -
procurement in the past.
Future
supplier base
The process of building a comprehensive view of supplier
profiles and portfolios, identifying risks to supply availability and
affordability, interventions to support capabilities and
sustainability), and influencing the environment (e.g., mitigation
of risks of over -reliance on single NRAs, inputting to discussions
on local/regional manufacturing hubs, aligning with other
procurement entities on supply risks, manage impact of
pandemics on market health), and improving alignment between
support for vaccine development and market strategies.

1 Board-2025-Mtg-03-AFC Committee Chair Report
Report to the Board
3-4 December 202 5
Subject Audit & Finance Committee Chair Report
Category For Information
Section A: Introduction
•This report provides the Board with an overview of the activities of the Audit &
Finance Committee ( AFC) since the Committee Chair last reported to the Board
in July 202 5.
• Since the last Board meeting, the AFC has convened two times: in Geneva on
7- 8 October , and virtually on 10 November . During these meetings, the AFC
addressed recurring matters in accordance with the standard workplan for Gavi
5.1, the remaining activities of the Office of the COVAX Facility and the Gavi
6.0 recalibration.
• Additionally, the following topic s were discussed in closed sessions: the
Secretariat review, the finance function review and evaluation, the Risk function
review and evaluation, A&I fun ction evaluation and Managing director
performance.
• Finally, as part of the programme of the October meeting the AFC attended
several Technical Briefing Sessions on Grant Management Reform, FX
Hedging, Outcome of Gavi 6.0 recalibration and the Gavi 6.0 Financial forecast .
• Subjects reviewed are noted under Section B .
• AFC recommendations to the Board are attached as Annex es A and B.
Section B: Subjects reviewed
1.Financial Update
1.1. Financial Instruments
•T

he AFC was briefed on Innovative finance tools and the current instrument
portfolio including the Middle -Income Countries Financing Facility (MFF)
and its criteria for eligibility and extension of the facility until June 2026.
1.2. Management Reporting
• The AFC was presented with an update on 1H20 25 Financial performance
as well as with Q3 Management reporting. T he AFC now has access to an
interactive dashboard with drill down capability which provides further detail
on financial performance by programme and by country.

1


Board-2025- Mtg-03-EAC Committee Chair Report
Report to the Board
3-4 December 202 5

Subject Evaluation Advisory Committee Chair Report
Category For Information
Section A: Introduction
• This report provides the Board with an overview of the activities of the
Evaluation Advisory Committee ( EAC) since the Committee Chair last reported
to the Board on 25 July 202 5.
• The EAC held an in- person meeting on 17-18 September 2025 . The EAC
provided formal guidance on the Gavi 5.1 evaluation workplan, the draft 6.0
evaluation workplan (2026- 2030) and the Evaluation Function Review process
and collaboration with the Global Fund .
• In relation to the Gavi 5.1 evaluation workplan ( see Annex A) , findings from two
recent centrally managed evaluations, zero- dose (ZD) Evaluation Phase 2 and
COVAX Evaluation Phase 2, both rated by the EAC as “fully meeting or
exceeding Gavi quality standards”, are being actively used and disseminated.
o ZD Evaluation Phase 2: The Evaluation Management Response (EMR)
has been finalised and was published alongside the report in August
2025. Findings have informed Alliance Partners and Performance Team
(APPT) discussions and guided Gavi 6.0 design, including funding
architecture reform, Health Systems Strategy (HSS), Partners’
Engagement Framework (PEF) refinement, Fragile and Humanitarian
(F&H) approach, and integration of ZD indicators into performance
frameworks. In addition to the March 2025 dissemination event, follow-
up efforts have included an internal promotional video, an American
Evaluation Association (AEA) blog post, a Gavi VaccinesWork article, an
abstract submission to the UK Evaluation Society (UKES) 2026
conference, and a forthcoming manuscript on methodological,
operational and strategic lessons.
o COVAX Phase 2 (Joint Evaluation): The Evaluation Management
Response (EMR) is being finalised and will soon be published alongside
the report on Gavi’s website. Findings have been used in WHO Interim
Medical Countermeasures Network (i -MCM- Net) meetings, lectures at
the London School of Ec onomics (LSE), and Gavi 6.0 operationalisation,
including Pandemic Prevention, Preparedness and Response (PPPR),
Global Health Security, Partners’ Engagement Framework (PEF)
refinement, and informing the WHO Pandemic Agreem ent and ongoing
i - MCM -Network. In addition to the forthcoming publication of the report
on Gavi’s website, dissemination efforts include a country -level learning
event in April 2025 and two manuscripts on lessons from the joint
evaluation process to inform future evaluations, and cross -country

1


Board-2025- Mtg-03-Governance Committee Chair Report
Report to the Board
3-4 December 202 5

Subject Governance Committee Chair Report
Category For Information
Section A: Introduction
• This report provides the Board with an overview of the activities of the
Governance Committee (GC) and key governance- related outcomes since the
Committee Chair last reported to the Board in July 2025. It reflects deliberations
from the July 2025 GC in-person meeting and the GC meeting held virtually on
9 October 2025.
• Over this period, the GC has focused on strengthening governance processes,
advancing ethics and compliance reforms, progressing work related to Board
and Committee membership, Board leadership succession including for both
the Board Chair and Vice- Chair, clarifying oversight of innovative financing
instruments , and governance of partnership mechanisms. Several workstreams
have been rescheduled for 2026 such as the Evaluation Function Review due
to dependencies with broader institutional reforms, including the Gavi –Global
Fund Task Force.
• The GC considered a series of Board and Committee leader ship proposals and
agreed on recommendations for submission to the Board consent agenda.
• The Governance Committee Chair report is attached in the form of a
presentation as Annex A .
Section B: Key Governance Committee Outcomes
1. Strengthening Implementing Country Representation
The GC reviewed feedback from extensive consultations with Implementing
Country (IC) representatives. ICs expressed a clear preference to retain the
current regional representation model rather than shifting to alignment with
Programme Segments, as had been previously considered. They also
highlighted the need for broader governance reforms to strengthen their role
in Gavi’s decision -making processes. M eanwhile , the board chair has
requested Mr. Omar Abdi and Deena Shiff to continue consultations with IC
members of the Board on ways to amplify the voice of the IC in GAVI governing
bodies .
These issues will be incorporated into the external Board Evaluation planned
for early 2026, with interim steps to expand IC leadership opportunities,
including through the Unaffiliated Recruitment Subcommittee.

1 Board-2025-Mtg-03-Investment Committee Chair Report
Report to the Board
3-4 December 202 5
Subject Investment Committee Chair Report
Category For Information
Section A: Introduction
•This report provides the Board with (1) an overview of year -to -date investment
performance results through 30 September ; and (2) a summary of recent
activities.
• The long- term portfolio delivered a year -to -date return +10.1% . While the
absolute return is solid, relative to the policy benchmark, the long- term portfolio
lagged by – 2.1%. The year-to -date net investment income generated by the
long- term portfolio is US$ 143 million.
• The portfolio has four key allocations: Equity, Fixed Income, Diversif iers and
Private Assets. Two allocations are major drivers of underperformance: Fixed
Income and Diversifiers.
• The Fixed Income allocation underperformed its market benchmark + 6.6%
versus +8.0%. A weaker U.S. dollar hurt the Fixed Income allocation as the
Fixed Income allocation has less non- U.S. exposure relative to its benchmark.
A current priority for the Investments team is to find strategies with non- U.S.
exposure for the portfolio and access additional fixed income opportunity sets.
• Diversifiers underperformed its market benchmark –0.1% versus +7.0% . Two
strategies – trend following and relative value commodities - contributed
significantly to the underperformance . The Investment team focused on
sourcing additional first -class strategies to broaden sources of returns.
• The Committee brought forward its asset allocation review from February to
November in light of the Global Summit outcome and current market conditions.
While the long- term allocation targets remain intact, the Committee opted to
take a more defensive posture going into 2026.
• The Investment Committee approved an updated Investment Policy (“Policy”)
and Asset Allocation Statement (“Statement”) . The key change to the Policy is
embedding a new sustainable investment framework in conjunction with the
retirement of the Sustainable Investment P olicy. The Statement includes tighter
risk limits , such as lower exposure limits to individual strategies and firms .
Anne xes B and C include the clean copies.
A

nnexes
Annex A : Investment Committee Chair report
Annex B : Investment Policy
Annex C : Asset Allocation Statement

1 Board-2025-Mtg-03-IFFIm Chair Report
Report to the Board
3-4 December 202 5
Subject IFFIm Chair Report
Category For Information
Section A: Introduction
•This report provides the Board with an overview of the activities of the IFFIm
Board since the Board meeting in July 202 5.
•D

uring the 2021– 2025 period, IFFIm provided a total of US$ 3.3 billion to
support Gavi programmes. Of this amount, US$ 2.3 billion was directed toward
Gavi core funding, while US$ 975 million supported the COVAX AMC. Th is
funding has been instrumental in enabling Gavi to maintain momentum in
immunisation efforts and respond to urgent global health needs during a period
of unprecedented challenges.
• S

ince its inception in 2006, IFFIm has provided approximately 16% of the
resources Gavi has provided to countries , underscoring its critical role in the
Alliance’s financing model. By frontloading donor commitments, IFFIm has
enabled 154 million children to be immunised ahead of the receipt of donor
contributions , demonstrating the unique value of this instrument in accelerating
impact and saving lives.
• Look

ing ahead to the Gavi 6.0 strategic period, assured resources currently
stand at US$ 655 million .
•R

ecent replenishment discussions have been encouraging. To date,
US$ 800 million in new commitments have been secured from Australia,
Canada, Italy, Spain, and the United Kingdom , with grant agreements currently
in process. Furthermore, the replenishment meetings in Brussels have
generated positive momentum, and discussions with both current and
prospective donors are ongoing to further strengthen IFFIm’s capacity to deliver
on its mandate to support Gavi. As always, IFFIm Board members are available
to answer any questions or provide information to donors.
• A

s Gavi transitions to a new strategic period , IFFIm remains a key instrument
in its financial toolkit. IFFIm’s ability to frontload resources , scale immunisation
efforts in response to urgent or unexpected needs , and shape vaccine markets
more effectively will continue to be vital for achieving strategic objectives. A
recent example of IFFIm’s contribution to market shaping is its having enabled
Gavi’s advance payment for the R21/Matrix -M malaria vaccine. Th is generat ed
US$ 90 million in savings for Gavi, equivalent to more than 30 million additional
doses , sufficient to fully vaccinat e nearly 7 million more children with the malaria
vaccine over the next five years. By providing predictable funding IFFIm

1


Board -2025 -Mtg -03-PPC Committee Chair Report
Report to the Board
3-4 December 202 5

Subject Programme and Policy Committee Chair Report
Category For Information
Section A: Introduction
• This report provides the Board with an overview of the activities of the
Programme and Policy Committee (PPC) since the Committee Chair last
reported to the Board in July 2025 .
• The PPC held an in-person meeting on 29 -30 October 2025. During the
meeting, the Committee discussed a number of important topics for the Alliance
and agreed on recommendations which are being put forward to the Board at
its 3-4 December 2025 meeting for consideration.
• At the meeting on 29 -30 October, under the Follow -up on Gavi 6.0 recalibration
agenda item, the PPC endorsed the establishment of a Task Team to convene
immediately after the PPC meeting , in order to develop recommendations for
the Board in December 2025 on the Country Vaccine Budgets (CVB s) on the
design and allocation approach , including to develop: a) the definition of
guaranteed programmes, and b) the approach for discretionary allocation). The
PPC approved the appointment of the PPC Chair as Chair of t he Task Team
and endorsed the composition of the CVB Task Team, which includes
representatives from WHO, UNICEF, the Gates Foundation, the World Bank,
the Implementing Countries Constituency, the Donors Constituency, Civil
Society Organi sations (CSOs), research and technical health institutes, and
independent experts.
• Under the same agenda item , the PPC highlighted an urgent need to review
and provide guidance to the Board, in advance of the December 2025 Board
meeting, on the market shaping savings committed for Gavi 6.0 under
Strategic Goal 4 (“Ensure healthy markets for vaccines and related products ”)
including with respect to the US$ 150 million requested by the Board at its
Retreat in July 2025 and the US$ 140 million of higher risk savings requested
by the Board in April 2024) . The PPC requested that the Board Chair consider
the best governance pathway to provide this guidance , and the Board Chair ,
Professor Barroso , has requested that the Market Sensitive Decisions
Committee ( MSDC ) members meet in an advisory capacity on a time limited
basis , to provide guidance on trade -offs and risks linked to expected savings
under Strategic Goal 4 .
• The PPC Chair report is attached in the form of a presentation as Annex A and
the PPC recommendations to the Board are attached as Annex B.

gavi.org
JOINT ALLIANCE UPDATE
ON COUNTRY DELIVERY
BOARD MEETING
Thabani Maphosa
Ephrem Lemango
Kate O’Brien
3-4 December 2025, Geneva, Switzerland
List of acronyms
1. AT –Accelerated Transition
2. BCU –Big Catch -up
3. BD HepB –Hepatitis B vaccine birth dose
4. CCE/ CCEOP – Cold chain equipment optimisation platform
5. CSO –Civil Society Organisations
6. CDS –Covid -19 Delivery Strengthening
7. CRS –Congenital rubella syndrome
8. DHS –Demographic and health surveys
9. DRC –Democratic Republic of Congo
10. DTP3 –Third dose of diphtheria, tetanus and pertussis -
containing vaccine
11. EAF –Equity Accelerator Fund
12. ELTRACO –Eligibility, Transition and Co -financing
13. eLMIS –Electronic Logistics Management Information System
14. EPI –Expanded Programme on Immunisation
15. F&C –Fragile & Conflict Countries
16. FED –Fragility, Emergencies and Displaced Populations policy
17. FMoH –Federal Ministry of Health
18. GMRs – Grant Management Requirements
19. Hexa – Hexavalent vaccine
20. HSS – Health Systems Strengthening
21. HI – High Impact Countries
22. HPV – Human Papilloma Virus
23. INGOs – International Non- governmental Organisations
24. IRC – Independent Review Committee
25. LMC – Leadership, management & Coordination
26. MAC – Multi -age cohort
27. MCV1 – First dose of measles containing vaccine
28. MICs – Middle -Income Countries
29. MMR – Mumps, Measles, Rubella
30. MOH – Ministry of Health
31. NITAG – National Immunisation Technical Advisory
Groups
32. OOC – One- off costs
33. PEF – Partners engagement framework
34. PCV – Pneumococcal conjugate vaccine
35. PIRI - Periodic Intensification of Routine Immunisation
36. RI – Routine immunisation
37. R+MAC – Routine + Multi -age cohort
38. Rota – Rotavirus
39. SDG -PF – Sustainable Development
Goals Programme for Results
40. SIAs – Supplemental immunisation
activities
41. SIDs – Small Island Development
States
42. TA – Technical Assistance
43. TCA – Targeted Country Assistance
44. VCF – Vaccine Catalytic Financing
45. WUENIC - WHO/UNICEF Estimates of
National Immunisation Coverage
46. ZD – Zero- dose
47. ZDC – Zero- dose children
48. ZIP – Zero- dose Implementation
Programme
Board Meeting, 3- 4 December 2025 2

1


Board-2025-Mtg- 03-Doc 08

Report to the Board
3-4 Decem ber 202 5
Subject Country Delivery : Nigeria , Papua New Guinea and Venezuela
Agenda item 08
Category For Decision

Executive Summary
The purpose of this paper is to seek an approval from the Gavi Board for a hybrid
Eligibility, Transition and Co -financing (ELTRACO) policy application in 2026 to
Papua New Guinea (PNG) and a full ELTRACO policy to Nigeria in 2026, and to
PNG in 202 8.
PNG and Nigeria will conclude their bespoke strategies in 2027 and 2028
respectively. The Secretariat has analysed the implications of these shifts and based
on consult ations with Nigeria’s Federal Ministry of Health, National Primary Health
Care Development Agency (NPHCDA), the Government of PNG, Alliance Partners,
donors and the Gavi Secretariat, has developed options for supporting Nigeria and
PNG in Gavi 6.0. The recommended approach reflects guidance from the
Programme and Policy Committee ( PPC) from its May 2025 meeting.
In addition, this paper also seeks an approval from the Gavi Board to continue Gavi’s
support to Venezuela due to lack of published classification data since 2014.
Action Requested of the Board
The Gavi Alliance Programme and Policy Committee recommend ed to the Gavi
Alliance Board that it:
a) Approve that Nigeria sunsets its bespoke strategy on 31 December 2025 and
return s to the preparatory transition phase from 01 January 2026, in full
alignment with the ELTRACO policy ;
b) Approve that Papua New Guinea has a phased sunsetting of its bespoke
strategy whereby on 01 January 2026 it will be recognised as a Small Island
Developing State (SIDS) 1 which part ly will apply for its vaccine portfolio ,
however, it will maintain its current cash allocation to the initial end date of the
bespoke strategy 31 December 2027 . This grandfathering arrangement is a
blend of the bespoke strategy and the new classification (SIDS) , hereby termed
the hybrid ELTRACO policy application;
c) Approve th at the Gavi Secretariat leverages the WHO EPI review and the Gavi
programmatic and financial audit instead of an external review of PNG’s strategy ;
and

1 Eligibility and Transition Policy Section 2: https://www.gavi.org/sites/default/files/programmes -impact/our -
impact/02_Gavi -Eligibility-and-Transition-Policy -60.pdf

Board-2025-Mtg- 03-Doc 08-Annex A
1

Report to the Board
3 -4 December 2025
Annex A: Detailed costings for Nigeria

Routine Vaccine Volumes from Multi Year Approvals
An t i g e n 2026 2027 2028 2029 2030 Grand Total
HP V 2,818,094 2,956,927 2,915,191 2,905,994 2,936,904 14,533,110
IP V 13,246,405 13,877,840 13,876,810 14,021,678 14,091,315 69,114,048
Malaria 1,061,448 1,078,857 1,088,131 1,098,429 1,105,336 5,432,201
ME N A 10,276,197 10,742,048 10,736,269 10,848,351 10,902,228 53,505,093
MR 16,646,984 14,801,532 14,789,758 14,944,157 15,018,375 76,200,806
PCV 19,331,019 20,166,171 20,165,196 20,375,712 20,476,906 100,515,004
Pentavalent 20,033,965 20,899,487 20,898,476 21,116,647 21,221,521 104,170,096
Ro t a 20,033,965 20,899,487 20,898,476 21,116,647 21,221,521 104,170,096

Campaign Vaccine Volumes from Financial Forecast Version 23
An t i g e n 2026 2027 2028 2029 2030 Grand Total
MR 16,395,244 16,807,365 33,202,609
OCV 15,000,000 15,000,000 30,000,000

Price fractions – Special Strategy
An t i g e n 2026 2027 2028 2029 2030
HP V 0.736 0.824 0.912 1 1
IP V 0 0 0 0 0.5
MAL 0.475 0.65 0.825 1 1
ME N A 0.7308 0.7308 0.7308 1 1
MR Routine 0.4545 0.6363 0.8181 1 1
MR Campaign 0.2 0.2 0.2 1 1
OCV Campaign 0.2 0.2 0.2 1 1
PCV 0.872 0.936 1 1 1
P E N TA 1 1 1 1 1
RV 0.871 0.914 0.957 1 1

Price fractions – ELTRACO P reparatory Transition
An t i g e n 2026 2027 2028 2029 2030
HP V 0.7452 0.8 0.8 0.8 0.8
IP V 0 0 0 0 0.1408
MAL 0.4127 0.5365 0.6975 0.8 0.8
ME N A 0.7372 0.8 0.8 0.8 0.8
MR Routine 0.3117 0.3584 0.4122 0.474 0.5451
MR Campaign 0.1 0.1 0.1 0.1 0.1
OCV Campaign 0.1 0.1 0.1 0.1 0.1
PCV 0.8 0.8 0.8 0.8 0.8
P E N TA 0.8 0.8 0.8 0.8 0.8
RV 0.8 0.8 0.8 0.8 0.8

Board-2025-Mtg- 03-Doc 09 1
Report to the Board
3-4 December 202 5

Subject Gavi Support for 9 -Valent Human Papillomavirus (HPV) Vaccine
Agenda item 09
Category For Decision

Executive Summary
The purpose of this paper is to propose to the G avi Alliance Board that it approves
the inclusion of higher valency HPV vaccines (defined as 9- valent or higher, and
hereafter referred to as HPV9) on the Gavi product menu. It is estimated that with
the option of HPV9 on Gavi’s product menu, and in a scenario of maximum adoption
of HPV9 vaccines, an incremental 170,000- 190,000 lives could be saved as a result
of HPV9 adoption over Gavi 6.0, attributable to its broader protection . T he pr oposed
inclusion of HPV9 could increase the vaccine procurement cost by US $ 20 -45 million
over Gavi 6.0, from the v23 Gavi financial forecast, due to higher unit cost . However,
t he additional cost associated with HPV9 would not result in an increase in Gavi’s
total budget, as HPV vaccines, a l ong with all other routine vaccines, would be part
of the new, fixed Country Vaccine Budgets, assuming they are approved (see Doc
05b) . Alliance Partners (HPV Market Shaping Subgroup) , and the Programme and
Policy Committee ( PPC) were consulted on the analysis and recommendation.
Action Requested of the Board
The Gavi Alliance Programme and Policy Committee recommend ed to the Gavi
Alliance Board that it:
Approve the inclusion of higher valency HPV vaccines (such as HPV9) on Gavi’s
product menu, subject to a second manufacturer’s dossier being accepted for WHO
Prequalification review (currently anticipated in 2026) , in line with the market
condition agreed by Alliance Partners, and Product Portfolio Management principles
being met.
Next steps/timeline
HPV9 will be assessed under Gavi’s Product Portfolio Management principles (see
Annex B) and added to the product menu once a second manufacturer’s dossier
has been accepted for WHO Prequalification review with studies underway to
generate evidence to support 1 dose schedule (currently anticipated in 2026), in line
with the market condition agreed by Alliance Partners to encourage long- term
competition and supply security.

Board-2025-Mtg- 03-Doc 09-Annex A 1
Report to the Board
3-4 December 202 5
Annex A : Overview of the revised governance pathways
• The graph below illustrates the revised governance pathways as approved by
the Gavi Board in July 2025
1. The red boxes and arrow highlight the
governance pathway followed for the evaluation of HPV9+ vaccines.



1 See Annex B for further details on the Product Portfolio Management (PPM) Principles

Board-2025-Mtg- 03-Doc 09-Annex B 1
Report to the Board
3-4 December 202 5
A nnex B: Gavi’s Product Portfolio Management (PPM) Principles 1
• Following the Vaccine Investment Strategy (VIS) and the funding approval of a new
disease by the Gavi Board, the decision on which new vaccine(s) to include in the
Gavi portfolio is informed by analyses of their impact, cost and cold chain
requirements, am ongst other attributes. However, beyond the disease approved
by the Gavi Board, the decision does not specify which specific product
presentation(s) are to be offered to countries and then procured through Gavi’s
procurement agencies.
• Where a Board decision exists (i.e., VIS decisions or other vaccine investment
decisions by the Board), the PPM principles guide the Gavi Secretariat for adding
a new vaccine presentation or product to the Gavi “product menu”. The Market
Shaping team is responsible for assessing these principles, with support from
relevant Secretariat teams and other partners as needed.
The PPM principles are:
1. The new vaccine presentation or product must be consistent with WHO
Strategic Group of Experts on Immunization (SAGE) recommendation(s) and
WHO position paper (where one exists) for the related antigen.
2. The new vaccine presentation or product must be WHO prequalified, unless a
compelling reason to make an exception exists (e.g. a new
product/presentation may be added to the menu when WHO prequalification is
anticipated to enable advanced country switch pl anning (i.e. for programmatic
and/or cost reasons) and timely access to this product/presentation as soon as
possible after WHO prequalification).
3. The new vaccine presentation or product must have a reliable supply base.
Adding the new presentation or product to Gavi’s product menu should
contribute to an environment of consistent, uninterrupted supply. The product
should be manufactured by a reliabl e supplier and be available in sufficient
quantities to contribute to the supply base without creating risks to supply
security.
4. The estimated costs of the new vaccine presentation or immunisation related
product should be within the range of the current fully -loaded, wastage adjusted
vaccine costs to immunise an individual and should account for any increased
procurement costs that are commensurate with evidence- based benefits of the
new vaccine presentation or product and/or with decreased costs in vaccine
delivery.
5. The new vaccine presentation or product must be likely to be able to meet
country demand and preferences. Where required to avoid supply security risks
or to further other market shaping objectives, a new presentation may be added
to replace an existing one (e.g. a 2 -dose vial presentation may be replaced by
a 5- dose vial presentation, rather than expanding the market to include both
presentations).
1 As approved by the Gavi Board in the Supply and Procurement Strategy 2016-20 in June 2016.

Board- 2025-Mtg- 03-Doc 10 1
Report to the Board
3 -4 December 202 5

Subject African Vaccine Manufacturing Accelerator (AVMA)
Agenda item 10
Category For Decision

Executive Summary
This paper provides an update on the African Vaccine Manufacturing Accelerator
(AVMA), having been recently tabled at the Programme and Policy Committee in
October 2025, subsequent to extensive consultations with manufacturers, investors,
and partners. One year after launch, AVMA has achieved strong manufacturer
engagement , with 13 technology transfer agreements and 18 AVMA Expressions of
Interest (EOI) submissions. Three African vaccine manufacturers are projected to
achieve WHO prequalification within five years . Anticipated challenges have also
materiali s ed including regulatory delays pushing first disbursements to 2026 and
reduced near -term procurement volumes following Gavi 6.0 recalibration. The Board
is requested to provide guidance on programming approximately US$ 176 million in
additional pledges above the Board- approved US$ 1 billion ceiling, with the potential
of utilising the 2026/ 2027 “Course Correction” for optimal allocation within the
instrument . The Board is also asked to provide guidance on the option to task the
Secretariat with developing additional options for deploying AVMA resources in
support of Gavi 6.0 objectives for consideration in June 2026. Lastly, the Board is
requested to approve amendments to AVMA's terms by giving three additional
vaccines AVMA priority designation.
Action Requested of the Board
The Gavi Alliance Programme and Policy Committee recommended to the Gavi
Alliance Board that it:
A pprove the amendments to the key terms of AVMA as set out in Annex A to Doc
10 to add tuberculosis, mpox and respiratory syncytial virus (RSV) to the list of
Priority Vaccines.

The Gavi Alliance Board is also requested to provide guidance on:
a) the proposed approach to reprogramming the additional pledges to AVMA:
i. retain additional resources within AVMA and rais e the Board -approved
ceiling; and
ii. use the planned 2026/ 7 course correction process to consider any further
changes to the key terms of AVMA ; and
b) whether the Secretariat should develop additional options to deploy AVMA’s
funding in support of Gavi 6.0 objectives for consideration.

Board-2025- Mtg-03-Doc 10-Annex A 1
Report to the Board
3-4 December 202 5
Annex A : Amended AVMA Key Terms
T his Annex provides an updated overview of key terms of the AVMA approved by the
Gavi Board ( Board-2024- Mtg-02 -Doc 11b- Annex A: AVMA Base Proposal ) which
themselves were updated from ( Board-2023-Mtg-04- Doc 10b - Annex A: AVMA Key
Terms ).
2025 Updates are shown in bold underline , and are restricted to three additions to the
list of priority vaccines overleaf.
Design
element
Proposal


Size Funding requirement of US$ 750-
1,000 million – with the upper
end of the range set to accommodate an ambitious outcome for
African products in terms of number of incentivised manufacturers
and their commercial volumes

Scope All Gavi Alliance supported vaccines (with differences in
payments, see “Incentives”), fill & finish-
only (i.e. drug product),
and “end- to- end” drug substance + drug product.

Duration To be launched in June 2024
with a proposed duration of 10 years (payments can continue for a period beyond the 10- year mark,
depending on tender lengths) 1

Eligibility Vaccine
Type: Qualifying Vaccine that is WHO Prequalified
Manufacturing Type:
i) The Qualifying Vaccine is Fully Manufactured on the
African continent;
or
ii) Fill & Finish of the Qualifying Vaccine is carried out in a
manufacturing facility on the African continent that is
Controlled by the holder of the WHO Pre- Qualification
of the Qualifying Vaccine.

Procure- ment
pathway Via successful Gavi
-UNICEF tenders and fulfil all other eligibility
criteria
A potential AU pooled procurement mechanism may be
accommodated in the future, subject to determination in line with
AVMA’s governance arrangements)

Incentives

Structure • Milestone payment at WHO Prequalification
• Per -dose accelerator payment, paid per dose,
upon delivery of UNICEF tender

1


Board-2025-Mtg- 03-Doc 11
Report to the Board
3-4 December 202 5

Subject Ethics, Risk and Compliance Office update
Agenda item 11
Category For Decision

Executive Summary
The purpose of this paper is to request to the Gavi Alliance Board that it approve: (i)
the 2025 Annual Risk and Assurance Report attached as Annex A and (ii) the Code
of Conduct and Ethics for Governance Officials attached as Annex B.
The 2025 Annual Risk and Assurance Report has been reviewed and recommended
for approval by the Audit & Finance Committee (AFC ) and has also been reviewed
by the Programme & Policy Committee (PPC).
The Code of Ethics and Conduct for Governance Officials has been reviewed and
recommended for approval by the Governance Committee.
Action Requested of the Board
The Gavi Alliance Board is requested to:
a) Approve the 2025 Annual Risk and Assurance Report attached as Annex A to
Doc 1 1; and
b) Approve the Code of Ethics and Conduct for Governance Officials attached as
Annex B to Doc 11 .
Next steps/timeline
Following the Board’s approval:
• The 2025 Annual Risk and Assurance Report will be published on Gavi’s intranet
and website; and
• The Code of Ethics and Conduct for Governance Officials will be effective as of
1 January 202 6.
P revious Board Committee or Board deliberations related to this topic
A draft Annual Risk and Assurance Report 2025 w as provided to the AFC and PPC
for their October 2025 meetings .
A draft Code of Ethics and Conduct for Governance Officials was provided to the
Governance Committee for its October 2025 meeting.

September 2025
gavi.org
Annual Risk and
Assurance Report
2025Doc 11 - Annex A
Contents
1 The report 3
Foreword from Gavi’s Chief Executive Officer 4
Introduction 5
Summary of 2025 strategic risks 6
2025 strategic risk landscape 8
Risk dimensions Programmatic – country level 9
Programmatic – coverage and outbreaks 10
Engagement with partners 11
Secretariat operations 12 2 Appendices 13
1.1 Gavi Alliance risk compass 14
1.2 Strategic risk landscape and interdependencies 15
1.3 2025 top strategic risks 16
1.4 2024 retired strategic risks 26
2 Methodology 27
3 Acronyms 30
2
Cover image: Gavi/2025/Nipah Dennis
2025 Annual Risk and Assurance Report Doc 11 - Annex A

January 2026
gavi.org
—
Code of Ethics and Conduct
for Governance Officials Doc 11 - Annex B
2
Code of Ethics and Conduct for Governance Officials
Cover image: Gavi/2023/Ashraful Arefin
For any question in relation to this Code, please contact:
Brenda Killen
Director Governance
Bkillen@gavi.org
Maria Thestrup
Chief Ethics, Risk and
Compliance Officer
mthestrup@gavi.org
Adopted on: [date 2025]
Effective as of: 01 January 2026
Code of Ethics and Conduct for Governance Officials Doc 11 - Annex B

Board-2025-Mtg- 03-Doc 12 1
Report to the Board
3 -4 December 202 5

Subject Fiduciary Risk Assurance and Financial Management Capacity
Building
Agenda item 12
Category For Decision

Executive Summary
The purpose of this paper is to provide an update on the Strategic approach for
Fiduciary Risk Assurance and Financial Management Capacity Building programme
and associated investment . This paper outlines the revised approach to further
capitalise on the gains accrued to date, by extending the programme into Gavi 6.0.
The proposed investment of US$ 110 million will be for:
a) US$ 21 million for Capacity Building initiatives to support an increase in the
proportion of funds using country systems, and to deepen country ownership by
increasing the transfer of budgetary and financial management control to the
government.
b) US$ 47 million Assurance Costs to mitigate risks associated with transitioning
and supporting the use of country systems, consistent with risk appetite; and
c) US$ 42 million Programme Support Costs payable to enable partners indirect
cost recovery.
This topic was previously discussed at both the Programme and Policy Committee
meeting on 29- 30 October 2025 and the Audit and Finance Committee meeting on
10 November 2025. The Programme and Policy Committee recommended to the
Gavi Alliance Board that it approve this revised approach and investment.
Audit and Investigations’ recent findings highlighted the need for a differentiated
approach, an expansion in programmatic assurance, and greater value for money.
For the Gavi 6.0 strategic period , Gavi proposes to adapt its fiduciary risk assurance
and financial management capacity programme, by aligning with Gavi Leap
principles of sustainability and country ownership. This investment will result in an
increase of the quantum of Gavi funds channelled into national systems, support
country engagement and ownership, and expand assurance providers ’ scope to
cover fiduciary components, while ensuring value for money and maintaining
appropriate safeguards. This approach entails a moderate increase in overall risk
appetite, in part reflected by a net 33% reduction in the Financial Management and
Risk Assurance (FM&RA) funding compared to Gavi 5.0.
The shift requires a risk-intelligent approach – carefully managing increased
financial exposure – while strengthening accountability mechanisms, promoting
national ownership and programmatic flexibility, and enhancing institutional capacity
through capacity building .

Board-2025- Mtg-03-Doc 12-Annex A 1
Report to the Board
3-4 December 202 5
Annex A: Gavi 6.0’s Fiduciary Risk Assurance and F inancial Management Capacity
B uilding approach
Report
1. Impact and lessons from the Gavi 5.0 “ Strategic approach for Fiduciary
risk assurance and financial management capacity building”
1.1 In June 2021 the Board formally approved Gavi’s portfolio- wide “Fiduciary risk
assurance and financial management capacity building” programme, with a
funding envelope of US$ 164 million. Of this amount, approximately 55%
(US$ 90 million) was allocated to UNICEF and WHO and other non-
governmental partners, in order to fund their programme support costs and
indirect costs.
1
1.2 Between 2022 – 2025, this programme was implemented as Gavi’s Financial
Management and Risk Assurance (FM&RA) approach. In November 2024, the
Audit and Finance Committee received a progress update that the FM&RA
programme was on track and achieved its pri mary objectives:
- Approximately 66% of Gavi’s portfolio using country systems (up from 49%
baseline at the end of Gavi 4.0). This consisted of 12 additional countries
shifting over to partially using systems (net total = 38 countries, with
1 additional country postponed due to political context);
- More than 54% of Gavi’s disbursements are currently disbursed to the
government or to hybrid systems (up from 29% baseline at the end of Gavi
4.0) . This represents a reversal as during the period 2016- 2020
approximately two thirds of Gavi’s funds were channelled to the Alliance
partners.
- Adequate mitigation of the additional risks associated with channelling
through funds through country systems. This was done by putting in place
assurance providers across 43 out of 58 Gavi countries to strengthen
compliance (up from a baseline of approximately 12 monitoring, fiscal or
equivalent agents, which were in place at the end of Gavi 4.0).
- Capacity building plans were drawn up, and ongoing strengthening activities
were underway in at least 33 countries – including supporting supreme audit
institutions.
1. 3 Though FM&RA 5.0 largely achieved its primary objectives, there were some
areas identified where limited assurance was obtained. This was illustrated in
from recent Audit and Investigations’ programme audits, which highlighted
several persistent risks across Gavi’s portfolio. An analysis of these in -country
1 Programme Support Costs – Such costs are consistent with the partners’ cost recovery principles, which
contribute towards covering an agreed apportioned share of the partners’ delivery , enabling them to deliver services
and general management support.

Board-2025-Mtg- 03-Doc 13 1
Report to the Board
3-4 December 202 5

Subject Audit & Investigations Report
Agenda item 13
Category For Information

Executive Summary
The purpose of this paper is to provide an annual report from the Managing Director,
Audit and Investigations (A&I), as required under A&I’s Terms of Reference
approved by the Board, and to confirm to the Board the organisational independence
of A&I. This annual report describes how A&I has fulfilled its Terms of Reference in
202 5; how it plans to undertake its 202 6 activity; and how it reports to a level within
the organisation that allows the activity to fulfil its responsibilities.
Throughout 2025, A&I has reported to the Audit and Finance Committee , which has
been delegated by the Board to oversee, review and monitor the operation of A&I.



Board-2025-Mtg- 03-Doc 13 2
Report to the Board
3 -4 December 202 5

Audit & Investigations Report
1. Conclusions
1.1 This report answers three questions , explaining how Audit and Investigations
(A&I) fulfilled its Terms of Reference in 2025; how A&I plans to undertake its
2026 activity; and whether A&I has the necessary independence.
1.2 How has A&I fulfilled its Terms of Reference in 2025? Audit and
Investigations ( A&I ) implemented its 202 5 workplan (approved by the Audit and
Finance Committee (AFC) in October 202 4 and adjusted in liaison with the AFC
throughout the year) , providing risk-based and objective assurance, advice and
insight to the AFC and senior management and assessing probity. In 2025 A&I
continued the trend for executing more audits which began in 2022 in response
to elevated and continuing risks, and provide d the accountability and counter -
fraud services which would be reasonably expected in the context of Gavi 5.1
and moving towards Gavi 6.0. A&I facilitated the A FC in executing its
responsibility to oversee, review and monitor the operation of the A&I function,
in support of the Board’s oversight responsibilities.
1. 3 How does A&I plan to undertake its 2026 activity? A&I prepared a work
plan for 202 6 on the basis of the resource reductions resulting from Wave 1 of
the Secretariat Review ; the Audit and Finance Committee discussed and
approved this plan in October 202 5 and will revisit it in February 2026 in view
of subsequent additional resource reductions resulting from Wave 2. The 202 6
plan meets the expectations of the Audit and Finance Committee by providing
appropriate audit and advisory assurance over Gavi -funded activities in
programme countries and over Secretariat activities, albeit over a longer time -
frame than has been possible in previous years due to resource reductions in
2026, and appropriate investigative and counter -fraud services. A&I does not
expect the revisited 2026 plan materially to change the level of assurance.
1.4 Can A&I confirm the necessary independence? A&I reports to the Board,
effecting this through routine reporting to the Audit and Finance Committee, and
to the CEO, and this reporting arrangement allows the activity to fulfil its
responsibilities. A&I confirms the necessary organisational independence.
2. How has A&I fulfilled its Terms of Reference in 2025?
2.1 A&I reports regularly to the AFC on the status of its workplan achievement and
brings all significant issues arising from its work to the attention of the AFC. In
this way A&I facilitates the AFC in executing its responsibility to oversee, review
and monitor the operation of the A&I function, in support of the Board’s
oversight responsibilities.
Secretariat -focused audits and advisory work
2.2 A&I’s internal and thematic audit and advisory work provides an assurance
and consulting activity designed to add value and improve the internal
operations of Gavi. It brings recommendations for improvement in

1


Board-2025-Mtg- 03-Doc 14

Report to the Board
3-4 December 202 5

Subject Review of decisions
Agenda item 14
No paper

1


Board-2025-Mtg- 03-Doc 15

Report to the Board
3-4 December 202 5

Subject Any other business and Closing remarks
Agenda item 15
No paper

gavi.org
CONSENT AGENDA
BOARD MEETING
3-4 December 2025, Geneva, Switzerland
Decision 1: Consent Agenda: Waiver to
Independent Review Committee (IRC) TOR: Gavi
6.0 Transition and Reprogramming of Country
Applications Post Recalibrations
The Gavi Alliance Governance Committee recommends to the Gavi Alliance Board that it:
Waive
the requirement for an independent review for the reprogramming and no- cost extension of
HSS funding for countries with existing IRC approvals to support their transition into consolidated
funding levers and aligned grant cycles in 2026.
Board Meeting, 3- 4 December 2025 2

gavi.org
Dr Sania Nishtar
GENEVA, SWITZERLAND
3 DECEMBER 2025
HPV vaccine introduction, Angola
November 2025
Gavi/2025/Wilson Photographer
CEO Board
Update
CEO Board Update
2Board Meeting, 3– 4 December 2025
Gavi 6.0 & Gavi Leap:
embracing the future Operating context:
challenges & opportunities Gavi 5.0/5.1 performance:
strategic & programmatic performance
?Operating context: impact on Gavi
and implementing countries
• Conflict, fragility & risk: global risk
elevated; global economic picture
mixed; new opportunities, technology
& innovations to address challenges
• Replenishment outcomes:
Targeting US$ 10 billion for Gavi 6.0 ? Mission indicators: strong
performance, on track (except
reaching zero -dose children);
strategy indicators: most on track
(except DTP3 & MCV1 coverage)
• Must -wins: record- breaking progress
of revitalised HPV vaccine
programme (reached target of
86m girls by end 2025 ahead of
schedule); 25 malaria vaccine
applications approved; funding fully
committed for “The Big Catch -up” to
restore routine immunisation • Gavi Leap reforms: Secretariat
transformed for agility, efficiency,
country focus
• Simplification: grant
management reform to ease
country burden
• Secretariat transformation :
leadership structure, SLT,
decision -making, delivery
architecture
• Partnerships: stronger
collaboration with Alliance
partners, Global Fund, GPEI
• Recalibration: getting ready
to deliver in challenging context

gavi.org
REPLENISHMENT UPDATES,
INCLUDING FINANCIAL
INSTRUMENTS
BOARD MEETING
Marie-Ange Saraka- Ya o
3 -4 December 2025, Geneva, Switzerland
2
Close to US$ 9.5 billion successfully mobilisedtowards the
recalibration US$ 10 billion goal
Mobilised resources
US$ 9.5 billion
Recalibration
$6bn
$3bn
$1bn
New pledges
(including IFFIm) Assured
resources
committed
Resource mobilization and conversion
• Following the Global Summit and with strong donor support, close to
US$ 9.5 billion mobilised toward US$ 10 billion goal
• Commitments from sovereign donors, foundations, partners via direct
funding, IFFIm, Matching Fund
Conversion to secured resources
• Efforts underway to convert pledges and other assured resources into binding
grant agreements, typically 80% conversion within 12 months
• Due to political volatility, this process requires sustained, intensive country -
level engagement for conversion to stay on track
• US$ 2.9 billion already secured through signed agreements (new grants +
PVP reallocations)
• Work continues to finalise agreements for ~US$ 800 million in new IFFIm
pledges from five donors
US$ 10 billion target
• Over US$ 445 million alreadymobilised towards US$1 billion additional
resource target for Gavi 6.0 set by the Board bring us to nearly
US$ 9.5 billion for Gavi 6.0
US$10 billions

gavi.org
FINANCIAL UPDATE, INCLUDING FORECASTS,
SECRETARIAT AND PARTNER BUDGETS
BOARD MEETING
François Note
3-4 December 2025, Geneva, Switzerland
Classified as Internal
2 Board Meeting, 3-4 December 2025
?Gavi 5.1 ending with strong demand for immunisation
? Gavi 6.0 addressing tighter resources with recalibration and country vaccine & cash budgets
? Secretariat Operating Expense down through Secretariat Review waves 1 & 2
Gavi 5.1: 2021-2025
Budget reflects Secretariat Review
waves 1 & 2 (one third smaller
1), as
aligned with AFC
5- year project ions in line with Board
Recalibration (full annualised savings
from 2027)
Gavi 6.0: 2026-2030 Secretariat OPEX
Key Forecast and Budget Highlights
Expected slowdown in
country demand only partially
materialised
Expenditure expected
US$ 110 million higher
Net available funds for Gavi
6.0 now at US$ 94 million
(down from US$ 185 million in
July) Forecast consistent with Board
recalibration assumptions
(US$ 10 billion resources;
US$ 10 billion expenses)
Qualifying Resources US $ 8.5 billion,
opportunities identified to bridge
gap to US$ 10 billion
Expenditure includes programmatic
changes from technical
consultations and PPC
(remaining
within recalibrated cost envelope)
1 33% lower Secretariat annual costs by 2027, compared to 2025 budget baseline

gavi.org
FOLLOW UP ON GAVI 6.0
RECALIBRATION RETREAT
INCLUDING RECALIBRATION
PROGRAMME REDUCTIONS
BOARD MEETING
An Vermeersch
Johannes Ahrendts
3-4 December 2025, Geneva, Switzerland
Recalibration outcomes and follow up post Board retreat
• The Board identified savings totaling
~US$ 3 billion, across all four 6.0
strategic goals – while retaining Gavi’s
ability to deliver impact and the integrity
of the Gavi 6.0 strategy
• At the subsequent Board meeting in
July, formal decisions made (e.g.
Health Systems Strategy, ELTRACO
policies)
• Board requested follow up on several
items for December Board meeting
July Retreat outcomes (summary)
Follow up (not exhaustive)
• Articulating implications from
recalibration, bringing a holistic picture
• Pressure testing reductions across
vaccine programmes
• Setting up a dedicated Country Vaccine
Budgets (CVB) Task Team as per PPC
recommendation, chaired by PPC chair
Board Meeting, 3- 4 December 2025 2

gavi.org
COUNTRY VACCINE BUDGETS
(INCLUDING PORTFOLIO
OPTIMISATION AND
PRIORITISATION)
BOARD MEETING
Marta Tufet Bayona
3-4 December 2025, Geneva, Switzerland
Programme and Policy Committee Meeting, 29-30 October 2025
July Board retreat provided in-principle steer on ‘Country
V accine Budgets ’ (CVB) in Gavi 6.0
2
CVBs are country -specific budgets for Gavi vaccine support in Gavi 6.0
Objectives
aligned to Gavi 6.0
Strategic Goals
Principles
Continuity of support Simplicity Country flexibility
Ensure equitable access to vaccines
Protect market health
Improve financial and programmatic sustainability
Maximise health impact and
value for money Minimise risk of disruptive
outbreaks
Board Meeting, 3- 4 December 2025

gavi.org
MARKET SHAPING STRATEGY
BOARD MEETING
Dominic Hein
3-4 December 2025, Geneva, Switzerland
Market shaping will operate in a changing environment
that is driving evolutions for Gavi 6.0
2 Board Meeting, 3-4 December 2025
•Long -term assured financing and predictable, high demand have been the primary forces shaping
markets for Gavi -supported vaccines
• Financial constraints leading to Gavi 6.0 recalibration decisions will strain this model, as there is an
absolute reduction in the available funding for vaccine procurement and procured vaccine volumes
• MSS6.0 will work, in tandem with operationalisation of Country Vaccine Budgets (CVB), towards
realising US$ 500 million in price -related reductions (SG4 recalibration) to Gavi’s vaccine procurement
budget in 6.0
• During Gavi 5.0, an increasing number of lower priced products became available, but there has been
limited country uptake of these products to date
PPC acknowledged that MSS6.0 and its implementation will require difficult trade- offs to ensure short-term actions do not
compromise long- termimperative of regionally diversified supply and sustainable markets that serve Gavi supported and
transitioned countries’ needs

gavi.org
JOINT ALLIANCE UPDATE
ON COUNTRY DELIVERY
BOARD MEETING
Thabani Maphosa
Ephrem Lemango
Kate O’Brien
3 -4 December 2025, Geneva, Switzerland
The Alliance delivering results together: Gavi 5.0/5.1
(2021-2025) in numbers
US$ 1.03 billionUS$ 1.01 billion US$ 1.53 billion
279
1 million
~60 2 million 2+ billion
unique children reached with
routine immunisation by end 2024 girls reached with HPV vaccine by
end 2024 Doses delivered via COVAX
in approved health system
strengthening (HSS) support in co-
financing payments in approved COVID-19 vaccine
delivery support
Source: Gavi Secretariat Monitoring and Performance Management Framework (MPM). 1. Total number of unique children reached with routine immunisation between 2000 to 2020 is 951 million, between 2021 and 2024 is 279 million, totaling 1.2 billion cumulatively.
2. Total number of girls reached between 2014 and 2020 is 6.66 million, and between 2021 and 2024 is 53.16 million, totaling 59. 8 million cumulatively
Board Meeting, 3-4 December 2025
2

gavi.org
COUNTRY DELIVERY: NIGERIA, PAPUA NEW GUINEA
AND VENEZUELA
BOARD MEETING
Thabani Maphosa
3-4 December 2025, Geneva, Switzerland
Nigeriarecommended to sunset bespoke strategy and re- enter into preparatory
transition phase through full application of ELTRACO from 1 January 2026
Option 3: Full ELTRACO:
Sunset bespoke strategy
and apply ELTRACO rules from 2026 Option 4: Continue with
revision of bespoke
strategy with tailored cash and vaccine envelope
Vaccination goals
and Programmatic priorities A
Monitoring &
Accountability C Revise Strategy monitoring tools and adopt revised
Accountability Framework
Resourcing (Cash)
B Tailored
envelope
1
Proposed option, supported
by PPC members in May 2025
Resourcing (Vaccines) B Tailored
envelope
1
Apply updated ELTRACO shifts as of 2026
Option 1: Status quo:
Maintain existing bespoke strategy until it concludes
Maintain Strategy monitoring tools until 2028 and revised Accountability Framework
Maintain current HSS envelope
until 2028, then potentially apply Gavi 6.0 cash allocation
Maintain AT status until 2028, ELTRACO could apply thereafter Option 2: Hybrid ELTRACO:
Maintain cash envelope
under bespoke strategy until it concludes; apply vaccines support as per revised
ELTRACO rules from 2026
Strategic goals and targets would be revised
Maintain strategy goals and
priorities until 2028; then potentially revert Align goals based on FPP
priorities Align goals based on FPP
priorities
Maintain current HSS envelope until 2028, then apply Gavi 6.0
cash allocation
Apply updated ELTRACO shifts as of 2026 Apply Gavi 6.0 consolidated
cash and TCA allocation
Apply Gavi monitoring
tools including revised AF Apply Gavi monitoring
tools including revised
AF
Benefits Least costly option for Gavi
Financial relief for NigeriaStrategy streamlined into Gavi
policy Investments optimised
towards RI
Risks High risk of not meeting zero-dose targets due to high cost Revisit cash envelope in 2027 under
grant reform agenda Limited availability of Gavi
resources Perpetuate bespoke
strategies

Board-2025-Mtg- 03-Doc 09 1
Report to the Board
3-4 December 202 5

Subject Gavi Support for 9 -Valent Human Papillomavirus (HPV) Vaccine
Agenda item 09
Category For Decision

Executive Summary
The purpose of this paper is to propose to the G avi Alliance Board that it approves
the inclusion of higher valency HPV vaccines (defined as 9- valent or higher, and
hereafter referred to as HPV9) on the Gavi product menu. It is estimated that with
the option of HPV9 on Gavi’s product menu, and in a scenario of maximum adoption
of HPV9 vaccines, an incremental 170,000- 190,000 lives could be saved as a result
of HPV9 adoption over Gavi 6.0, attributable to its broader protection . T he pr oposed
inclusion of HPV9 could increase the vaccine procurement cost by US $ 20 -45 million
over Gavi 6.0, from the v23 Gavi financial forecast, due to higher unit cost . However,
t he additional cost associated with HPV9 would not result in an increase in Gavi’s
total budget, as HPV vaccines, a l ong with all other routine vaccines, would be part
of the new, fixed Country Vaccine Budgets, assuming they are approved (see Doc
05b) . Alliance Partners (HPV Market Shaping Subgroup) , and the Programme and
Policy Committee ( PPC) were consulted on the analysis and recommendation.
Action Requested of the Board
The Gavi Alliance Programme and Policy Committee recommend ed to the Gavi
Alliance Board that it:
Approve the inclusion of higher valency HPV vaccines (such as HPV9) on Gavi’s
product menu, subject to a second manufacturer’s dossier being accepted for WHO
Prequalification review (currently anticipated in 2026) , in line with the market
condition agreed by Alliance Partners, and Product Portfolio Management principles
being met.
Next steps/timeline
HPV9 will be assessed under Gavi’s Product Portfolio Management principles (see
Annex B) and added to the product menu once a second manufacturer’s dossier
has been accepted for WHO Prequalification review with studies underway to
generate evidence to support 1 dose schedule (currently anticipated in 2026), in line
with the market condition agreed by Alliance Partners to encourage long- term
competition and supply security.

gavi.org
AFRICAN VACCINE MANUFACTURING
ACCELERATOR (AVMA)
BOARD MEETING
Marie-Ange Saraka Yao
3 -4 December 2025, Geneva, Switzerland
2 2
Objective A
A sustainable, African vaccine
manufacturing base that is
contributory to healthy global
vaccine markets
Objective B
Improved African pandemic
and outbreak vaccine
supply resilience
>0.7 bn
of capacity in a pandemic
3 or more
technologies
>0.8 bn
Doses supported
At least 4
Vaccine manufacturers
With a set of cautious, evidence -
based, and reasonable key targets: Two main objectives: Two distinct payment systems to support vaccine
manufacturers on the African continent:
 Payment for an
AV M A
priority vaccine or on a
priority platform with WHO
PQ
 Payments from US$ 10
million up toUS$ 25 million
Milestone Payment
Accelerator
Payment
 To p -up payment per
dose following award in
UNICEF tender
 Between US$ 0.30 and
US $ 0.50 per dose
US$ 250 M
in total for Milestone
Payments
US$ 750 M
in total for
Accelerator
Payments
AVMA is a pre-funded 10 -year financial instrument with two
objectives – backed by ~US$ 1,176 million of donor pledges
Board Meeting, 3- 4 December 2025

gavi.org
ETHICS, RISK AND
COMPLIANCE OFFICE
UPDATE
BOARD MEETING
Maria Thestrup
3-4 December 2025, Geneva, Switzerland
2025 Annual
Risk and
Assurance
Report

gavi.org
FIDUCIARY RISK ASSURANCE AND FINANCIAL
MANAGEMENT CAPACITY BUILDING
BOARD MEETING
François Note
Edmund Grove
3-4 December 2025, Geneva, Switzerland
Baseline at endof Gavi 4.0 Target end of
Gavi 5.0 Baseline at endof Gavi 4.0 At end of
Gavi 5.0
Government is now our primary recipient due to FM&RA 5.0
28
(41% )
US$ 0.5 billion(29%)
40
(59% )
Through partners
Hybrid & Government
19
( 33% )
US$ 1.3 billion
(71%)
58
Number of countries, by funding channel
During Gavi 5.0, FM&RA helped to establish assurance mechanisms across 43 countries (up from ~12 baseline).
13 countries progressed to partially/ fully using country systems by Q2 2025 and 2 backslid. It is anticipated that 1 more c
ountry will progress by the start of Gavi 6.0.
Excluding: COVAX Delivery Support and MICS grants. Data source: Q2 2025 UCS UpdateUS$
1.0
billion (
46 %)
Disbursements to country systems by fund amount
39
(67%)
68
US$ 1.3 billion(54%)
US$ 2.3 billion
US$ 1.8 billion
2 Board Meeting, 3-
4 December 2025

gavi.org
AUDIT & INVESTIGATIONS REPORT
BOARD MEETING
Lucy Elliott
3-4 December 2025, Geneva, Switzerland
2 Board Meeting, 3-4 December 2025
How has A&I fulfilled its To R in 2025?
Overseen, reviewed and monitored by the Audit and Finance Committee
• Recommendations for improvement in governance,
risk management and control in the Secretariat and
Gavi implementing countries
• Reinforced country accountability
• Audit quality
AFC -approved work plan of country -
and secretariat -focused audits
• US$ 48.7 million identified since 2009
• US$ 45.5 million repaid as at the last report to the AFC
• Objective is full recovery
Identification of misuse following
country audits
• Fraud risk assessment of AVMA
• Advice to management
• Policy and procedure updates
Preventive counter -fraud work
• Appropriate treatment of reports Confidential misconduct reporting
• Accountability Investigative activity