1


Board -2024 -Mtg -03-Doc 00a


Gavi Alliance Board Meeting
4-5 December 2024
Hilton Bali Resort, Bali, Indonesia

Monday 2 and Tuesday 3 December: Field Visits & Pre -Board meetings
Wednesday 4 December : 08.30 -18.00 Board Meeting Day One
Thursday 5 December : 08.30 -18.00 Board Meeting Day Two

Quorum: 14


Document List

No. Document
00a Document list
00b Agenda
01a Declarations of interest
01b Minutes from 6-7 June 2024
01c No Objection Consent Decisions
01d Consent Agenda
01e Workplan
0 2 Country Presentation: Indonesia – No paper
03a CEO’s Report – To follow
03b Strategy, Programmes and Partnerships
04 Joint Alliance Update on Country Delivery
0 5 Committee Chair and IFFIm Board reports – To follow
06 Gavi 6.0 Operationalisation - Getting ready to deliver on the next strategic period
06a Health Systems Strategy
06b Funding Policy Review
0 6bi HSIS Policy
06bii Eligibility, Transition and Co -financing, including Catalytic Phase
0 6c Gavi 6.0 Measurement Framework

Board -202 4-Mtg -03-Doc 00b 1

Gavi Alliance Board Meeting
4-5 December 2024
Hilton Bali Resort, Bali, Indonesia

Monday 2 and Tuesday 3 December: Field Visits & Pre -Board meetings
Wednesday 4 December : 08.30 -18. 00 Board M eeting Day One
Thursday 5 December : 08.30 -18.00 Board M eeting Day Two

Quorum: 14



A genda - UPDATED














Next Board Meeting : 9-10 April 2025 (Board Retreat)
25-26 June 2025
3-4 December 2025
---
Brenda Killen , Director, Governance and Secretary to the Board, +41 22 909 6680, bkillen@gavi.org
Joanne Goetz , Head, Governance, +41 22 909 6544, jgoetz@gavi.org
Please note that the Board meeting will be recorded. This recording will be used as an aid to minute the
meeting. A transcription of the full proceedings will not normally be made. Should a transcription be made it
will be used only as an aid to minute the meeting.

1

Board -2024 -Mtg -03 -Doc 01a

Gavi Alliance Board Meeting
4-5 December 2024
Hilton Bali Resort, Bali, Indonesia

Monday 2 and Tuesday 3 December: Field Visits & Pre -Board meetings
Wednesday 4 December: 08.30 -18.00 Board Meeting Day One
Thursday 5 December: 08.30 -18.00 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 M ember 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 z Princeton
School of Public Policy, LISD (Member
of the Advisory Council –from 01 April
2023) ; CAPRI, Center for AsiazPacific
Resilience and Innovation (Member of
the International Advisory Council from
01 April 2023) ; Catholic University of
Portugal (Visiting Professor at the
Institute of Political Studies and Director
of theCentre for Eu ropean Studies) ;
The EUROPEAUM (Board Member) ;
WPLzWomen Political Leaders
(Advisory Board Member) ; Jean Monnet
Foundation for Europe (Honorary
Committee Member) ; Global

Board -202 4-Mtg -02 1
Minutes

Gavi Alliance Board Meeting
6-7 June 2024
Crowne Plaza H otel, 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. 05 Geneva time on
6 June 202 4. Prof Jos é Manuel Barroso, Board Chair, chaired the meeting.

1.2 The Chair welcomed new Board and Alternate members attending their first
Board meeting, namely: Karen Soren sen and Minister Lyonpo Tandin
Wangchuk.

1.3 The Chair noted the All Chairs Group (ACG) meeting on 4 June 2024 during
which the members discussed the recommendations being brought forward to
the Board at this meeting and the CEO’s goals for 2024 . He noted the Gavi
Implementing Country Caucus meeting on 5 June 2024 and highlighted the
exchange s of the Implementing Country Caucus with the CEO and the
Governance Committee in relation to strengthening their role and engagement
in Gavi governance and decision -making . He also acknowledged the work of
the Board Committees , noting that the Governance Committee had met earlier
in the week.

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

1.5 The Board noted its minutes from 6-7 December 2023 (Doc 01b) and 11
January 202 4 (Doc 01c) which were approved by no objection on 5 April 202 4
and 14 March 202 4, respectively . They also noted a number of decisions that
had been approved by no -objection consent since the December 2023 and
January 2024 Board meeting s (Doc 01d).

1.6 The Chair referred to the consent agenda (Doc 01e) where four
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.

1.7 The Chair noted the Board workplan (Doc 01f).

1.8 The Chair reported that during the closed session earlier that day, the Board
had discussed the CEO ’s 180 -day plan and objectives for the year . The Chair
also reported that he had informed the Board of the invitation from the Minister
of Health of Indonesia, H.E Budi Gunadi Sadikin , to host the Gavi Board
meeting in December 2024 in Indonesia , which the Chair had been pleased to
accept.

1


Board -2024 -Mtg -03 -Doc 01c

Report to the Board
4-5 December 2024

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

Since the June 2024 Board meeting, eight decisions have been circulated
electronically for approval by no -objection consent in line with Section s 11 and 12 of
the Board and Board Committee Operating Procedures.
1) On 9 July 2024 , Board Members were invited to consider approv al of the
appointment of an Alternate Board Member .

No objections were received prior to the end of 19 July 2024 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 Nadeem Mahbub of Pakistan as Alternate Board member
representing the implementing country constituency in the seat currently held by
Nadeem Jan of Pakistan, effective immediately and until 31 December 2026 .

2) On 5 Au gust 2024, Board Members were invited to consider approv al of the
reappointment of Appeals Tribunal Members .

No objections were received prior to the end of 15 August 2024 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:

a) Reappointed Chris de Cooker as a member of the Gavi Appeals Tribunal,
effective immediately for a term of three years;

b) Reappointed Claude Rouiller as a member of the Gavi Appeals Tribunal,
effective immediately for a term of three years;

c) Reappointed Jenny Schokkenbroek as a member of the Gavi Appeals
Tribunal, effective immediately for a term of three years; and

d) Reappointed Michael Wolf as a member of the Gavi Appeals Tribunal, effective
immediately for a term of three years.

1


Board -2024 -Mtg -03-Doc 01d

Report to the Board
4-5 December 2024

Subject Consent Agen da – as at 3 December 2024
Agenda item 01 d
Category For Decision

Section A : Introduction
Seven 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/282625
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 – Board Chair Recruitment

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

Endorse the amendments to the process for the appointment of Board Chair and that
in line with this amended process (Annex A to Doc 01d) , as read with Section 4.B of
the Governance Committee Charter that it:

a) Delegate to the Governance Committee the authority to set up and oversee the
process for the recruitment of a Board Chair to succeed Professor José Manuel
Barroso at the end of his term on 31 December 2025; and;

b) Delegate to the Governance Committee the authority to establish a Search
Committee for this purpose.

1 | P a g e

Classified as Internal




PROCESS FOR THE APPOINTMENT OF THE
BOARD CHAIR 1



Introduction

This document seeks to guide the Gavi Alliance Board in the fulfilment of its
function of appointing or reappointing the Board Chair (see also footnote below) .

The terms of reference exercised in the recruitment of the current Bo ard Chair is
included as Annex B for ease of reference and information with regard to the required
competencies, skills, experience and necessary attributes to fill this role.

It will usually fall on the Board Vice Chair to lead the appointment or
reappointment process, as the case may be, in co -ordination with the Governance
Committee and with the concordance of the Gavi Alliance Board.

While the process outlined in this document is based on good practice for the
appointment of a new Board Chair much of it is relevant for the reappointment of the
Board Chair , as set out in the section dealing specifically with the Board Chair
reappointment.

The first step in any process of appointment or reappointment of the Board Chair shall
be the:

• determination by the Board of whether it wishes to seek to replace the existing
Board Chair at the end of her/his first term and thereby proceed on a course for
the appointment of a new Board Chair; or
• determine from the current Board Chair through the Board Vice Chair on behalf
of the Board if there is interest on her/his part to remain in position for a second
term and thereby proceed on a course for reappointment .

This process should normally commence no later than nine months prior to the expiry
of the current Board Chair’s term with a view to:
1 This process contemplates not only the appointment process for the recruitment of a new Board Chair
but also the reappointment process that would naturally follow for the current Board Chair where the
Board has extended an invitation to the Board Chair inviting her/him to consider a reappointment for a
further term.

Annex B: Nineteen new members proposed to add to IRC expert
pool
The new recruits bring in varied expertise to the pool including the ability to review new vaccines such as Ebola and rabies.
# Names Current Position Nationality French -
speaking Gender Expertise
1 Amiri Abdallah Director, Advisory Services, Diamond Consulting Group Ugandan M Finance & Budget
2 Benjamin Nkowane Independent Consultant Zambian M HSS, MR
3 Carsten Mantel Managing Director/Co - Founder, MMGH Consulting German X M MR, HPV, Cholera, TCV, JE
4 Clément Jaidzeka Vaccines, Cold Chain Logistics Consultant Cameroonian,
USA X M Supply Chain
5 Federico Gerardo de Cosío Independent Consultant Mexican, USA X M HSS
6 Jean Jacques Mutabaruka Independent Consultant Rwandan X M Finance & Budget
7 Lea Gabriele Knopf Senior A dvisor One Health, GIZ Swiss X F Rabies & other vaccines
8 Laura Cartanya Llach Independent Consultant Spanish X F HSS, F&C
9 Louise C Ivers Professor, Global H ealth and S ocial M edicine, Harvard Irish, USA X F OCV, HPV, HSS, F&C
10 Marie Feler Independent Consultant French X F HSS, F&C
1 1 Marta Feletto Independent Consultant Italian X F HPV, Measles, Rubella, Malaria
1 2 Martin Andreas Mengel Independent Scientific Consultant German X M OCV
1 3 Ousseynou Badiane EPI Manager, Ministry of Health and Social Action Senegalese X M M R , HPV, other vaccines
1 4 Rachel Njeri Gitau Independent Consultant Kenyan F HSS & Health financing
1 5 Raj Kumar Independent Consultant Indian M HSS, HPV, OCV, other vaccines
1 6 Sibylle Herzig Van Wees Researcher/Assistant Professor, Global Health, Karolinska
Institute (Sweden) Swedish X F HPV
1 7 Sonali Kochhar Associate Professor, Department of Global Health,
University of Washington Indian F M R , Ebola, other vaccines
1 8 Tolbert Geewleh Nyenswah Affiliated Faculty, Center for Humanitarian Health,
Johns Hopkins Liberian, USA M HSS, Ebola, Polio, Outbreak
19 Wahid Majrooh Founder/ED, Afghanistan Center for Health & Peace Studies Afghani M HSS, F&C
Board Meeting, 4 - 5 December 2024
Doc 01d - Annex B

Annex C: Three existing members proposed to be extended for
third term
Members currently serving second term to be extended for an additional three - year term.
# Names Nationality Languages Gender Expertise
1 Blaise Bikandou Congolese French M
HSS, policy development, vaccine preventable diseases, epidemiology, health
programme management
2 Dah Cheikh Mauritanian French, Arabic M
HSS, vaccine campaigns, trainings
3 Elisabeth Paul Belgian French, Spanish F
Health systems and policies, health financing, performance - based financing, aid
effectiveness
Board Meeting, 4 - 5 December 2024 Doc 01d - Annex C

DOCUMENT ADMINIST RATION
VERSION
NUMBER APPROVAL PROCESS DATE
1.0 Prepared by: Governance
Approved by: Gavi Alliance Board 2 - 3 June 2009
2.0 Revised by: Law and Governance
Team March 2011
3.0 Revised by: Governance October 2020
Reviewed by: Governance Committee 10 December 2020
Approved by : Gavi Alliance Board 17 December 2020
4.0 Revised by: Legal 23 August 202 3
Reviewed by: Governance 23 August 202 3
Reviewed by: Governance Committee 30 August 202 3
Approved by: Gavi Alliance Board 11 September 202 3
5 .0 Revised by: Governance 25 July 2024
Reviewed by: Governance and Legal 31 July 2024
Reviewed by: Governance Committee
Approved by: Gavi Alliance Board Gavi Alliance
Delegation of Authority Policy
Version 5 .0
Doc 01d - Annex D




2
Gavi Alliance
Delegation of Authority Policy

1. Purpose
1.1 Pursuant to the G avi Alliance Statutes, the Board may delegate powers to the officers
of G avi Alliance (“ Gavi ” ) for the administration and management of the organisation.
1.2 This document is the Delegation of Authority Policy referenced in Section 17 of the
Board and Board Committee Operating Procedures ( the “ Operating Procedures ”)
setting out the Board’s approved delegation of authority .
1.3 The delegations of authority in this Policy are intended to meet good standards of
governance and foster effective collaboration between the Board, its Committees and
the Secretariat.
2. Definitions
2.1 “ Legal instrument ” means any document with a commitment by Gavi involving the
exchange of money or property, an obligation to perform services requiring payment
or use of Gavi resources, or the assumption of (potential) liability .
2.2 “ Officers ”: Section 24 of the Operating Procedures defines t he officers of G avi as
including its Chief Executive Officer, a Treasurer and a Secretary .
3. Standing d elegations
3.1 Standing delegations within this policy are subject to Article 14 of the G avi Statutes
which state s that “powers delegated by the Board will be exercised under the authority
and direction of the Board and any such delegation may be rescinded by the Board at
any time.”
General delegation and Legal i nstruments
3.2 Except for the matters set out in Article 14 of the Gavi Statutes, which cannot be
delegated, and s ubject to : (i) the requirements of this policy, including the limitations
set out in paragraph s 3.4 to 3. 8 below ; and (ii) the terms of any other delegation
granted by the Board from time to time , Officers have the authority individually to :
3.2.1 enter into any transaction ;
3.2.2 raise funds from donors to finance Gavi’s activities;
3.2.3 sign any Le gal instrument on behalf of G av i , as well as amending or terminating such
instrument ; and
3.2.4 manage the day - to - day operations of Gavi, including for the performance of the
functions and responsibilities listed in Sections 25 - 27 of the Operating Procedures and
undertake other responsibilities that may be assigned to them by the Board from time
to time .
Doc 01d - Annex a

December 202 4
INDEPENDENT REVIEW COMMITTEE
TERMS OF REFERENCE
1. P U RP O S E
The Independent Review Committee (“Committee” or “the IRC” ) is established by the Board
(“Board”) of the Gavi Alliance (“Gavi”) under Section 19 of the Operating Procedures to serve
as an independent, impartial group of experts seeking to guarantee the integrity and
consistency of an open and transparent funding process. The IRC is responsible for assessing
the strategic focus, technical soundness and impact of new funding requests in accordance
with policies adopted by the Gavi Board and Gavi’s programme funding guidelines. Through
its reviews, the IRC is responsible for advising on how Gavi investments can achieve the
greatest impact and contribute to the goals and objectives set out in the Gavi Alliance
strategy . The IRC is not deemed to be a committee of the Boa r d in that its primary role is
essentially an advisory function as contemplated under Article 19 of the Statutes. It is
empowered by the Board to undertake the responsibilities out l ined in these terms of
reference. It does have limited decision - making powers as outlined in these terms of
reference.
Words and expressions used in this terms of reference shall, unless the context requires
otherwise, have the meaning attributed to them in the Gavi Board and Board Committee
Operating Procedures .
2. M E M B E RS H I P
The membership, resources, responsibilities and authorities of the Committee to perform its
role effectively are stipulated in these terms of reference , which may be amended by the
Board as and when required or deemed necessary .
The selection of IRC members shall be conducted in an open and transparent manner and
guided by the following criteria: competence and independence; commitment and availability
to participate in meetings; past performance assessment (when available) ; absence of conflict
of interest ; and geographical and gender diversity ( in line with with Gavi’s Guiding Principles
on Gender Balance for Board and Committee Nominations ) .

Doc 01d - Annex E

Gavi Alliance
Programme Funding Policy
Version 6.0
DOCUMENT ADMINISTRATION
VERSION
NUMBER APPROVAL PROCESS DATE
1.0 Barry Greene, Managing Director,
Finance and Operations
Reviewed by: Gavi Programme and
Policy Committee 19 May 2010
Reviewed by: Gavi Audit and Finance
Committee 25 May 2010
Approv ed by: Gavi Alliance Board 17 June 20 10
Effective from: 17 June 20 10
2.0 Reviewed by: Gavi Audit and Finance
Committee 24 Ma rch 201 1
Approv ed by: Gavi Alliance Board 8 July 20 11
Effective from: 8 July 20 11
Section 3.5
and Annex 1 Reviewed by: Gavi Audit and Finance
Committee 11 April 201 2
Approv ed by: Gavi Alliance Board 13 June 20 12
Effective from: 13 June 20 12
Section 4
and Annex 1 Reviewed by: Gavi Audit and Finance
Committee 11 April 201 2
Approv ed by: Gavi Alliance Board 13 June 20 12
Effective from: 13 June 20 12
Annex 1 Reviewed and recommended by: Gavi
Audit and Finance Committee 10 October 201 3
Approv ed by: Gavi Alliance Board 22 November 20 13
Effective from: 22 November 20 13
3.0 Reviewed and recommended by:
Gavi Audit and Finance Committee 6 November 2015
Approved by: Gavi Alliance Board 2 December 2015
Section 3.6
and Annex 1 Reviewed and recommended by:
Gavi Audit and Finance Committee 21 October 2016
Approved by: Gavi Alliance Board 7 December 2016
Effective from: 7 December 2016
Section 4.1
and Annex 1 Reviewed and recommended by:
Gavi Audit and Finance Committee 12 June 2017
A pproved by: Gavi Alliance Board 14 June 2017
Effective from: 1 January 2018
4.0
Sect i ons 3, Reviewed and recommended by:
Gavi Audit and Finance Committee 21 October 2020
5 and Annex
1 A pproved by: Gavi Alliance Board 1 7 December 2020
Effective from: 1 January 2021
5.0
Annex 1 Reviewed and recommended by:
Gavi Audit and Finance Committee 19 October 2021
A pproved by: Gavi Alliance Board 2 December 202 1
Effective from: 2 December 2021
6.0 Reviewed and recommended by:
Gavi Audit and Finance Committee
Approved by: Gavi Alliance Board 27 November 2024
Xx December 2024 Doc 01d - Annex F

Classified as Internal #
Gavi Alliance Board Workplan
Gavi Board Paper Mar/Apr June Nov/Dec Mar/Apr June Nov/Dec Mar/Apr June Nov/Dec
A. Strategy/Performance/Risk/MEL
CEO's Report CEO's Report Discussion Discussion Discussion Discussion Discussion Discussion
2021-2025 Strategy Strategy, Programmes and Partnerships: Progress, Risks and Challenges
Discussion Discussion Discussion
Innovation TBD Information
Private Sector Engagement TBD Information
Civil Society and Community Engagement Approach TBD
Market Shaping Retrospective Strategy, Programmes and Partnerships: Progress, Risks and Challenges Information
Partners' Engagement Framework Strategy, Programmes and Partnerships: Progress, Risks and Challenges
Discussion Discussion Discussion Discussion Discussion Discussion
Disease Surveillance and Diagnostics in Gavi 5.0 TBD
Risk and Asurance Report Risk and Assurance Report Decision Decision Decision
2026-2030 Strategy Gavi 6.0 Operationalisation
Discussion Discussion Discussion
Funding Policy Review (Eligiblity, Transition & Co-financing, HSIS) TBD Decision
Health Systems strategy TBD Decision
Approach to Fragile, Conflict & Humanitarian Settings TBD Decision
Measurement Framework (Targets & Indicators) TBD Decision Decision
Partnerships Model for Gavi 6.0 TBD Decision
Market Shaping Strategy TBD Guidance
Decision
B. Vaccines & Sustainablity
Typhoid TBD
Pneumococcal AMC (Advance Market Commitment) TBD
Vaccine Investment Strategy Vaccine Investment Strategy
Gavi's role in Pandemic Prevention, Preparedness and Response TBD
Day Zero Facility - First Response Fund TBD Information Information Information
African Vaccine Manufacturing Accelerator TBD Decision Information Information Information
Vaccines
COVID-19 Vaccine Programme Update Country Programmes Delivery Update
RSV Investment Case TBD Decision
Malaria TBD Information Information Information Information Information Information
HPV TBD Information Information Information Information Information Information
Ebola TBD Information
Yellow Fever TBD Decision
Mpox TBD Information
Dengue TBD
Tuberulosis
TBD
C. Policy
Transparency and Accountability Policy TBD
Fragility, Emergencies and Refugees Policy TBD
Prioritisation Mechanism for Gavi's Support to Countries TBD Decision
Evaluation Policy TBD Decision
Vaccine Donations Policy TBD Guidance Decision
D. Country Programmes
Joint Alliance Update on Country Programmes Joint Alliance Update
Discussion Discussion Discussion Discussion Discussion Discussion
Nigeria TBD Decision
PNG TBD Decision
Strategic Partnership with India Strategic Partnerships with India Information
Fiduciary risk assurance and financial management capacity building
Fiduciary risk assurance and financial management capacity building Guidance
E. Finance/Audit & Investigations
Annual Accounts Annual Financial Report Decision Decision Decision
Financial Forecast Financial Update, including forecast Decision Decision Decision Decision Decision Decision
Partners' Engagement Framework and Secretariat Budget Financial Update, including forecast Decision Decision Decision
Programme Funding Policy Consent Agenda
Treasury Governance Policy Consent Agenda
Treasury Risk Management Policy Consent Agenda
Independent Auditor Selection and Evaluation Policy Consent Agenda
Audit & Investigations Report Audit & Investigations Report Information Information Information
F. Governance
Board Chair Appointment Consent Agenda Decision Decision
Board Vice Chair Appointment Consent Agenda Decision Decision
Committee Chair Appointments Consent Agenda Decision Decision
Board and Committee Appointments Consent Agenda Decision Decision
IRC Appointments Consent Agenda
CEO Appointment Consent Agenda Decision
Secretary Appointment Consent Agenda
Treasurer Appointment Consent Agenda
Appointment of MD A&I Consent Agenda
Amendments to Governance Documents (Statutes, By-Laws, Committee Charters) Consent Agenda
Evaluation Advisory Committee Terms of Reference Consent Agenda
IRC Terms of Reference Consent Agenda
Audit & Investigations Terms of Reference Consent Agenda
G. Reporting
Committee Chair Reports Committee Chair and IFFIm Board reports Information Information Information Information Information Information
IFFIm Chair Reports Committee Chair and IFFIm Board reports Information Information Information Information Information Information
Replenishment/Resource Mobilisaton Resource Mobilisation Update
Discussion
Collaboration with other organisations TBD Information
HR Report Closed Session Information Information Information Information Information Information
Annual Report on Implementation of the Gender Policy Annex to Strategy paper Information Information Information
Board and Committee minutes
Annex to Board pack/On BE as additional materials Information Information Information Information Information Information
H. Technical Briefing Sessions/Deep Dives
Evaluations Jan-25
Fragility & Humanitarian Approach Feb-25
Joint Session - Gavi and GPEI H2 2025 2026 2027Last updated - 20 November 2024
Next Board Meetings:
9-10 April 2025 (Retreat)
25-26 June 2025
3-4 December 2025 2025
Board-2024-Mtg-03-Doc 01e

1


Board-2024-Mtg- 03-Doc 02

Report to the Board
4-5 December 202 4

Subject Country Presentation: Indonesia
Agenda item 02
No paper

gavi.org
CEO'S REPORT,
INCLUDING
STRATEGY,
PROGRAMMES AND
PARTNERSHIPS
Update photo
To be completed
To be completed
BOARD MEETING
S ania Nishtar
4 -5 December 2024, Bali, Indonesia
Gavi/2024/Jjumba Martin
CEO Board Update
2
Embracing the future Operating context:
challenges and opportunities
Strategic and programmatic
performance
• Operating context: impact on
Gavi and implementing countries
• Conflict, fragility and risk: global
risk elevated; global economic
picture mixed;
new opportunities, technology and
innovations to address challenges
• Mission indicators: strong
performance, on track (except
reaching zero -dose children); most
Gavi 5.0/5.1 targets on track
(except DTP3 & MCV1 coverage)
• Must -wins: significant progress on
revitalised HPV vaccine
programme (on track to reach 86m
girls by end 2025); 23 malaria
vaccine applications approved;
funding for ‘The Big Catch -up’ fully
committed
• 180 -day plan achievements:
launched key reforms, initiatives
• 2025 priorities: Gavi 5.1 delivery,
getting ready for Gavi 6.0,
successful replenishment, build a
stronger Secretariat
• Getting ready for Gavi 6.0: five
workstreams to operationalise
strategic and operational shifts
• Building a stronger Secretariat :
leadership structure, SLT, decision -
making, delivery architecture
Board Meeting, 4 -5 December 2024

1


Board -2024 -Mtg -03 -Doc 03a _FR

Rapport pour le Conseil d’ administration
4-5 décembre 202 4

Rapport de la Directrice e xécutive
Le 27 novembre 2024

Chers membres du Conseil d'administration ,

Les six mois qui se sont écoulés depuis notre dernière rencontre ont été riches en
événements. Avant de nous réunir pour la dernière fois en 2024, je suis heureu se de
partager ce rapport qui nous guidera dans nos délibérations .

Je suis convaincue que, grâce à votre profonde connaissance, votre engagement et
votre grande expérience en tant que membres du Conseil d'administration , nous
parviendrons, comme toujours , à résoudre les questions qui se posent à nous , ce qui
permett ra à l'Alliance non seulement de mieux résister aux défis posés par un monde
de plus en plus incertain, mais aussi de mieux saisir les nouvelles occasions de faire
progresser l'équité en matière de vaccin ation au cours des mois et des années à venir.
Je tiens à vous remercier pour votre dévouement et pour le soutien que vous m'avez
apporté au cours des six premiers mois de mon mandat de Directrice exécutive.

Je voudrais également profiter de cette occasion pour remercier no tre hôte, le
gouvernement indonésien, pour son accueil et sa générosité. En nous offrant son
hospitalité, il nous permet de tenir cette réunion dans une atmosphère chaleureuse ,
dans laquelle nous pourrons non seulement mener nos discussions selon notre ordre
du jour, mais aussi constater les progrès spectaculaires réalisés dernièrement par
l'Indonésie en matière de vaccination depuis qu'elle a cessé de bénéficier du soutien
de Gavi. Je suis ravie de vous accueillir tous ici, en Indonésie.

Ce rapport s'articule en trois parties. La première présente le contexte dans lequel
évolue actuellement Gavi et les principaux problèmes rencontrés par notre
organisation et par les pays bénéficiaires de son aide au cours des six derniers mois.
La deuxième partie résume brièvement les résultats obtenus et les risques auxquels
sont exposés l es programmes de Gavi, à la lumière des données disponibles les plus
récentes. La troisième et dernière partie du rapport présente les mutations
stratégiques et opérationnel les programmées pour 2025 et au -delà , dans le cadre de
notre prochaine période stratégique , ou déjà en cours de réalisation .

En ce qui concerne les perspectives pour 2025, l’Alliance est en bonne voie pour
atteindre la plupart des objectifs de Gavi 5.0 et 5.1, sauf pour l’objectif relatif aux
enfants zéro dose et les objectif s de couverture avec trois dose s de vaccin contre la
diphtérie, le tétanos et la coqueluche (DTC3) et une première dose de vaccin
contenant la valence rougeo le (V CVR1). Nous travaillons dans un environnement de
plus en plus complexe, avec un nombre croissant d'enfants qui viv ent dans des
situations de conflit et de crise humanitaire. Nous sommes tournés vers l’avenir et
forts des enseignements importants tirés de Gavi 5.1 . La stratégie Gavi 6.0 a été

1


Board -2024 -Mtg -03 -Doc 03a

Report to the Board
4-5 December 202 4

Report of the Chief Executive Officer
27 November 2024

Dear Members of the Board ,

It has been an eventful six months since we last met. Before we meet for the final time
in 2024, I am happy to share this report to help guide our deliberations.

Your deep knowledge, commitment and experience as Board Members give me
confidence that, as always, we will resolve the questions before us in a manner that
will leave the Alliance not only more resilient to the challenges presented by an
increasingly unce rtain world, but also better able to seize new opportunities to advance
vaccine equity in the months and years ahead. I remain extremely grateful for your
dedication, and for the support you have given me over my first six months as CEO.

I would also like to take this opportunity to thank our gracious and accommodating
host, the Government of Indonesia. The government has done so much, and extended
such warm hospitality, to ensure that we are able to come together not only to
complete our core agenda, but also to witness the rapid progress on immunisation that
Indonesia has made since their transition from Gavi support. I very much look forward
to welcoming you all in person in Indonesia.

The report is structured into three main sections. In this first part of the report , I reflect
on the prevailing operating context and key challenges faced by Gavi and Gavi
implementing countries over the past six months. The second part of the report briefly
summarises Gavi’s programmatic results and risks, according to the most recent data
available. The third and final part of the report sets out the strategic and operational
shifts that are planned or already under way for 2025 and beyond into our next
strategic period.

As we look ahead to 2025, the Alliance remains on track with most of its Gavi 5.0/5.1
targets, with the exception of the target on zero -dose children and the coverage targets
for the third dose of diphtheria, tetanus and pertussis -containing vaccine (DTP3) and
first dose of measles -containing vaccine (MCV1) . We are operating in an increasing ly
complex environment , with increasing numbers of children living in conflict and
humanitarian settings. Looking ahead and following on the important lessons of Gavi
5.1, we have approved the Gavi 6.0 strategy and have now started in earnest to plan
for operationalisation in 2026 .

Of course , a top priority for me since the launch of our Investment Opportunity in June
has been our replenishment campaign and ensuring Gavi has the re sources we need
to deliver against our ambitious 6.0 strategy. We have an exceptional case to put
forward , and I have seen firsthand how our mission and track record for delivery

1


Board -2024 -Mtg -03 -Doc 03b
Report to the Board
4-5 December 2024


Subject Strategy, Programmes and Partnerships UPDATED
Agenda item 03b
Category For information Guidance

Executive Summary
This report provides a progress update on the implementation of the Gavi
5.0/5.1 strategy, programmes and partnerships and associated risks 1. It is
informed by the July release of WHO -UNICEF estimates of national immunisation
coverage (WUENIC) for 202 3. The Alliance remains on track with most of its
Gavi 5.0/5.1 targets , with the exception of the target on zero -dose children and
the coverage target s for the third dose of diphtheria, tetanus and pertussis -
containing vaccine (DTP3 ) and first dose of measles containing vaccine
(MCV1 ). The Alliance remains on track in supporting countries to reach
introduction targets for the Gavi 5.0/5.1 period. The number of vaccine
preventable disease (VPD) outbreaks remains very high , and timely detection
continues to prove a challenge . The Alliance continues to work on delivering its
three Gavi 5.1 ‘must -wins’ . The revitalisation of the human papillomavirus
vaccine (HPV) programme remains on track to reach 86 million girls by the end
of 2025 despite supply challenges. The rollout of the malaria programme is also
on track with 2 3 applications approved to date, in line with targets. Good progress
has also been made on reaching zero -dose children by accelerating
implementation of the Equity Accelerator Fund (EAF) and operationalising the Big
Catch -Up (BCU) ; however, this is yet to translate into accelerati ng progress on
reducing zero -dose children . Finally, Gavi is revising its Accountability Framework
(AF) and annual high -level review process with Nigeria, in line with the Lusaka
Agenda. This follows recommendations from the 2023 Gavi High -Level Mission to
update the AF and align it with Nigeria’s new Sector Wide Approach.
Action Requested of the Board
The Gavi Board is requested to provide guidance on the alignment of Gavi’s
Accountability Framework for Nigeria with Nigeria’s Sector Wide Approach
Monitoring & Evaluation framework .
Next steps/timeline
The next progress update on the implementation of Gavi 5.0/5.1 and associated
risks will be provided to the Board in June 202 5.
Previous PPC or Board deliberations related to this topic
This paper is one of a series of regular biannual updates to the PPC and Board.

1 Programmatic risks summarised in the Annual Risk and Assurance Report 2024 (see Doc 11 )

Board -2024 -Mtg -03 -Doc 03b -Annex A 1
Report to the Board
4-5 December 2024
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 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 the 2025 targets were set with the PPC/Board in May 2021; the
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 1:
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 it is
assume d returns to 2019 levels in 2022 and sub -national three doses of
pneumococcal conjugate vaccine (PCV3) scale up takes an additional year.

1 In October 2021 PPC meeting book: Doc 04 Gavi 5.0 Measurement Framework

Board -2024 -Mtg -03 -Doc 03b -Annex B 1
Report to the Board
4-5 December 2024
Annex B: Human Papillomavirus (HPV) revitalisation update
Section 1: Executive Summary

As HPV revitalisation remains a Must Win priority during Gavi 5.1, the Board has
requested bi -annual updates on progress. This annex updates on progress made
between May and October 2024, highlighting HPV scorecard performance, WHO
coverage estimates, and updates on implementation of the strategic shifts supporting
the revitalisation goal .

The ambitious aim of immunising 86 million girls by the end of 2025 remains on track.
In 2023, over 14 million girls were vaccinated with Gavi's support, compared to
13.3 million in the last decade bring the total number of fully immunised girls to
27.3 million since 2014, averting over 605,000 future cervical cancer deaths. HPV
vaccine coverage in Gavi -supported countries doubled from 8% in 2022 to 16% in
2023.16 routine programs and 14 multi -age cohort (MAC) campaigns have launched
as part of Gavi 5.1, wi th new introductions in large countries like Nigeria and
Bangladesh. Fourteen countries have transitioned from a two -dose to a single -dose
schedule. Five additional countries have had their applications for HPV support
approved since May 2024.

Establishment of 19 Partner Framework Agreements to facilitate rapid and fit -for -
purpose Targeted Country Assistance and the launch of seven integration learning
projects are recent successes that will bolster HPV revitali sation through 5.1 and into
6.0. To meet the 86 million target by 2025, continued focus is required on improving
coverage, launching large campaigns, and ensuring timely vaccine supply.

Section 2: Programme Status

The HPV vaccine programme has made significant progress in achieving the
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).

2.1. Update to the HPV Scorecard

Under the HPV measurement framework, the scorecard is used to monitor progress
at Impact, Outcome, and Output level. Current status shows that all indicators are on
track to be achieved by the end of 2025, but with a risk to achievement of the overall
indi cator for number of launches and VIG/Ops disbursement . Further details follow in
the referenced sections of this Annex.

Board -2024 -Mtg -03 -Doc 03b -Annex C 1
Report to the Board
4-5 December 2024
Annex C: Malaria Vaccine Programme Update

Section 1: Executive summary

The Malaria Vaccine Programme (MVP) is advancing rapidly and achieving key
milestones. The Gavi Independent Review Committee (IRC) has recommended a total
of 23 countries for approval for sub -national vaccine introduction, and seven of these
countries were also recommended for approval for their scale -up applications. With its
support of the successful rollout of RTS,S in eight countries and the second malaria
vaccine (R21) in four countries, the Gavi Alliance has continued to manage the malaria
vaccine market of two prequalified vaccines (RTS,S and R21) and supply is expected
to be able to meet demand with sufficient planning and allocation across the market 1.
These achievements are significant and reflect continuous efforts to integrat e malaria
vaccination into immunisation and malaria control programme approaches . Rapid
progress has also been accompanied with learnings on risk communication and
community engagement, sensitising populations on vaccines with unique schedules,
funding requirements for sub -national introductions , among others . These are being
addressed through targeted technical assistance and stronger partnerships and
forums .

The Alliance and expanded partners continue convene key coordination mechanisms
and provide extensive technical assistance (TA) to countries, covering application
development , vaccine planning and introduction, and strengthened uptake and service
delivery.

The Secretariat , in conjunction with Alliance partners, continues to adapt the scope
and design of the programme, based on Board direction for Gavi 6.0, World Health
Organization ( WHO ) guidance to counties on age -eligibility, and Gavi’s role in fostering
healthy markets. The Secretariat also continues to work closely with the Global Fund
to Fight AIDS, Tuberculosis and Malaria (Global Fund) to ensure a holistic approach
to malaria prevention .

The MVP learning agenda is advancing to gather operational evidence and address
priority questions to optimi se the impact of the MVP . Additionally, f our peer -learning
workshops have been conducted across Africa in 2024, fostering knowledge sharing
on vaccine introduction and scale -up, and emphasi sing cross -programmatic planning
between malaria and immuni sation programs.

This annex provide s detailed updates on country implementation and support (Section
2), Gavi’s scope of support and programme design (Section 3), and the MVP learning
agenda (Section 4). The collaboration between Gavi and the Global Fund around
malaria is further discussed i n Section 5 and agenda item 1 0.



1 Gavi's efforts to maintain a healthy market include ongoing dialogue with manufacturers, monitoring supply and
demand forecasts, and continuous implementation of product matching for new approvals.

Board -2024 -Mtg -03 -Doc 03b-Annex D 1
Report to the Board
4-5 December 2024
Annex D: Update on implementation of the Gavi Gender Policy
Section 1: Having a gender lens is central to Gavi 5.0/5.1

Gavi’s 5.0/5.1 Strategy recognises that overcoming gender -related barriers is
essential to reach zero -dose and under immunised children. Gender -focused is a
principle of the Strategy and Strategic Goal 2 includes a specific objective to identify
and address gender -related barriers as part of strengthening health systems to
increase equity in immunisation.

The overall objective of the Gavi Gender Policy is to identify and overcome gender
related barriers to reach zero -dose and under immuni sed children, individuals, and
communities with the full range of vaccines. This encompasses the following
objectives :

1. Focusing primarily on 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 ; and
3. Encouraging and advocating for women’s and girls’ full and equal participation in
decision -making related to health programmes and wellbeing .
The Policy provides the framework and principles for Gavi’s programmatic
engagement on gender, including through support for vaccines, health systems, and
technical assistance. It is underpinned by a theory of change that highlights six key
areas for action: understand, advocate, identify, reach, learn, and partner .
Section 2: How has Gavi progressed in operationalising the Gender Policy?

Over the past four years, there has been improvement in applications, many of which
are now designed based on gender analyses and focus, at a minimum, on removing
barriers for caregivers . While Gavi is exceeding its targets for the gender -related
strategy indicator - which measures the percentage of applications addressing gender -
related barriers - the robustness, detail, and quality of these applications and gender -
responsive programming still vary significantly across countries.
The priorities in 2024 to operationalise the Gender Policy were: i) Increase
understanding of Gavi stakeholders on how gender norms/responsibilities impact the
effectiveness of immunisation programming and build the skills and capacity to
effectively respond; ii) Invest in measurement in order to better track progress against
core gender indicators; and iii) Scale up country level gender technical expertise to
support the des ign, implementation and monitoring of robust gender responsive and
transformative immunisation programming.
Progress on the first priority to build the capacity across the Alliance , including
government and partners , to identify and address gender related barriers :

In 2024, Alliance partners developed and disseminated several new technical
guidance materials on gender or integrated gender into broader technical documents .

Board -2024 -Mtg -03 -Doc 03b -Annex E 1
Report to the Board
4-5 December 2024
Annex E: Private Sector Engagement Strategy update
Section 1: Background on private sector engagement at Gavi
Engagement with the private sector has been in Gavi’s DNA since its outset, initially
focusing on pharma ceutical companies and private donors to Gavi. The Gavi Matching
Fund was introduced in 2011 to catalyse greater private sector investment, such as
the partnership with La Caixa bank in Spain. In 2016, Gavi launched a new private
sector engagement pilot phase as well as INFUSE, its innovation platform, to explore
how to mobilise the expertise and innovations of the private sector , in addition to its
financial resources. A successful evaluation of this pilot phase led to the adoption in
2021 of Gavi’s Private Sector Engagement Strategy.
Section 2: Examples of outcomes so far
• Resource mobilisation : Since its inception, Gavi has raised over US$ 930 million
from the private sector and the Gavi Matching Fund, including US$ 602 million from
direct contributions from the private sector.
• Innovations : Since the launch of Innovation for Uptake, Scale and Equity in
Immunisation (INFUSE) in 2016, 2 5 PaceSetters (such as Zenysis, Simprints or
Nexleaf) have been selected through the platform. INFUSE has mobilised
investments and support from entities including Google.org, NEC, Tencent, UPS
Foundation.
• Supply chain : In collaboration with the UPS Foundation, Zipline’s drones have
delivered more than 1 9 million vaccine doses to hard -to -reach places in Ghana,
Kenya, Nigeria and Rwanda. Zipline’s aerial logistics contribute to strengthened
supply chains. Zipline deliveries are significantly cheaper than alternatives: on
average delivery cost per dose is ch eaper up to 40% than traditional last mile
delivery (evaluation under peer review). In addition, a patient at a Zipline -served
facility is 42% less likely t o miss a vaccination opportunity due to stockout.
• Demand : In India, the partnership with Unilever Lifebuoy reached 3.8 million
people and brought about a five -fold increase in handwashing with soap and a
>30% increase in uptake of rotavirus and measles vaccines among children under
two years . The partnership is now scaling to Indonesia.
• Data : Nexleaf Analytics is deploying state -of -the -art sensor technology to prevent
vaccine damage from excessive heat or cold. Today, Nexleaf monitors the vaccine
supply for 1 in 11 babies born globally each year and with more than 34,000
Remote -Temperature Monitoring Devices deplo yed. Nexleaf's ColdTrace system
has proven to reduce damage to vaccines by heat and cold by 67% in
Mozambique.
• Artificial Intelligence (AI) : Zenysis collaborates with Gavi in Pakistan and
Mozambique. It integrated and analysed 25 different data sources to produce the
clearest picture to date of Sindh’s ‘zero -dose’ children, and using analytical tools
and generative AI, created personalised micro plans that helped locate and

Board-2024-Mtg- 03-Doc 03b- Annex F
Report to the Board
4-5 December 2024


Annex F: Nigeria Accountability Framework
Executive Summary
This report provides an update on Gavi’s Accountability Framework (AF) for Nigeria,
reviewing the initial rationale to have such an AF, the progress that has been made
over time , focuses on key priorities such as reaching zero- dose children and vaccine
financing, the high- level review of the AF in 2023, and a proposal for future
improvements.
In line with the Lusaka Agenda, this report seeks the Board guidance on a proposal to
align the Accountability Framework with Nigeria’s Sector Wide Approach (SWAp)
Monitoring and Evaluation Framework.
This proposal is informed by the conclusions of the November 2023 high- level mission
to Nigeria, and further deliberations with Nigeria’s Federal Ministry of Health, National
Primary Health Care Development Agency (NPHCDA), Alliance Partners and Gavi
Secre tariat, including at the recent high- level mission held in Abuja as part of the
inaugural SWAp Joint Annual Review (JAR) meeting from 6-8 November 2024. The
proposal was discussed and commended by the Programme and Policy Committees
(PPC) on 20 November 2024 .
Section 1: Initial rationale for a Gavi Accountability F ramework with Nigeria
In 2017, Nigeria faced significant challenges with its transition from Gavi
support . With consistently low immunisation coverage rates, multiple outbreaks of
infectious diseases, poor health outcomes and a constrained macroeconomic
environment , the Board assessed that it would be unlikely that Nigeria could transition
successfully by end of 2021, as the transition policy required. This would pose a risk
not only to Nigeria, but to the region. T he Board asked the Secretariat to engage with
the country and Alliance partners to develop a tailored strategy for Nigeria’s transition
plan.
This led to the development of a bespoke Board-approved strategy for Nigeria
and an extension of Nigeria’s t ransition from 2021 to 2028. The Alliance supported
the N ational Primary Health Care Development Agency (NPHCDA) in developing the
National Strategy for Immunisation and Primary Health Care System Strengthening
(NSIPSS) for 2018 -2028. This strategy outlined a ten- year plan to strengthen
immunisation and primary health care and served as Gavi’s plan for transitioning
Nigeria from support by 2028. The Board’s approval of an extension of Nigeria’s
Accelerated Transition phase from Gavi support from 2021 to 2028 to align with
NSIPSS and for exceptional support to Nigeria was given in 2018 and was contingent
on meeting specific conditions, including the reimbursement of misused funds and
strong political commitment .
At the request of the Gavi Board, the Gavi Secret ariat was mandated to develop
an Accountability Framework to assess Nigeria’s progress . The Gavi Secretariat
and Alliance Partners, in consultation with the Government, developed this

gavi.org
JOINT ALLIANCE UPDATE
ON COUNTRY DELIVERY
BOARD MEETING
Thabani Maphosa
Kate O’Brien
Ephrem Lemango
4 -5 December 2024, Bali, Indonesia
List of acronyms
1. BCU –Big Catch -Up
2. CCE/CCEOP –Cold Chain Equipment / Optimisation Platform
3. CSO –Civil Society Organisations
4. CDS –COVID -19 Delivery Support
5. DHS –Demographic and Health Surveys
6. DRC –Democratic Republic of Congo
7. DTP3 –Third dose of diphtheria, tetanus and pertussis -
containing vaccine
8. EAF –Equity Accelerator Fund
9. ELTRACO –Gavi Alliance policies on Eligibility, Transition and
Co -financing
10. EPI –WHO Expanded Programme on Immunization
11. F&C –Fragile & Conflict Countries
12. FED –Fragility, Emergencies and Displaced Populations Policy
13. FMOH –Federal Ministry of Health
14. GMRs –Grant Management Requirements
15. HSS –Health System Strengthening support
16. HI –High Impact Countries
17. HPV – Human papillomavirus
18. IRC – Independent Review Committee
19. LMC – Gavi Alliance Leadership, Management &
Coordination workstream
20. MAC - Multi -Age Cohort
21. MCV1 – First dose of measles -containing vaccine
22. MICs – Middle -Income Countries
23. MOH – Ministry of Health
24. NITAG – National Immunization Technical Advisory Group
25. OOC – One -off costs
26. PEF – Partners’ Engagement Framework
27. PCV – Pneumococcal Conjugate Vaccine
28. PHC – Primary Health Care
29. PIRI - Periodic Intensification of Routine Immunisation
30. RI – Routine Immunisation
31. R+MAC – Routine + Multi -age cohort
32. Rota – Rotavirus
33. SIAs – Supplemental Immunisation Activities
34. TA – Technical Assistance
33. TCA – Targeted Country Assistance
34. UI – Under Immunised
35. UCC – Ultra -cold chain
36. VIGs – Vaccine Introduction Grants
37. VCF – Vaccine Catalytic Financing
38. WUENIC - WHO/UNICEF Estimates of
Immunization Coverage
39. ZD – Zero -dose
40. ZDC – Zero -dose children
41. ZIP – Zero -dose Implementation
Programme
Board Meeting, 4 -5 December 2024

1


Board-2024-Mtg-03-AFC Committee Chair Report
Report to the Board
4-5 December 2024

Subject Audit and Finance Committee Chair Report
Category For Information
Section A: Introduction
• This report provides the Board with an overview of the activities of the Audit
and Finance Committee (AFC) since the Committee Chair last reported to the
Board in June 2024.
• Since the last Board meeting, the AFC met two times (7- 8 October in
Washington DC and 27 November virtually) to consider Gavi recurring matters
in accordance with the standard workplan for Gavi 5.1 and the remaining
activities of the Office of the COVAX Facility , in addition to several technical
briefings mainly related to a holistic review of the treasury approach to certain
portfolios (AVMA and FR F) and the latest financial forecast for G avi 5.1.
• Subjects reviewed are noted under Section B and matters to be reviewed in
upcoming meetings are presented under Section C
• AFC recommendations to the Board are attached as Annex A.
Section B: Subjects reviewed
1. Financial Update
Management Reporting
• The AFC was presented with an update on 1H2024 Financial performance as
well as with Q3 Management reporting.
Financial Forecast (Gavi Core and COVAX AMC)
• T he Financial Forecasts recommended by the AFC for approval were
discussed by the AFC at both the October and November meetings (the report
below anticipates the approval of the updated forecast presented to the
November AFC). The forecasts were considered in the context of the Alliance
continuing to see a significant increase in country demand for Gavi support over
the course of the Gavi 5.1 strategic period. This is a testament to countries’
strong commitment to immunisation, and the important role of the Alliance in
supporting countries over the course of 5.1. Consequently, there is an
exceptionally high number of country applications for Gavi support expected for
the remainder of the strategic period.
• Therefore, the risk of higher programme expenditure (than Gavi 5.1 resources
available) highlighted in prior financial forecasts cycles by the Secretariat is
crystallising . The risk can (in part ) be mitigated through the utilisation of certain

1


Board-2024-Mtg- 03-Doc 05

Report to the Board
4-5 December 202 4

Subject Committee Chair and IFFIm Board reports
Agenda item 05
To follow

1


Board -2024 -Mtg -03-EAC Committee Chair Report
Report to the Board
4-5 December 2024

Subject Evaluation Advisory Committee Chair Report
Category For Information
Section A: Introduction
• This report provides the Board with an overview of the activities of , and
guidance provided by , the Evaluation Advisory Committee ( EAC ) since the
Committee Chair last reported to the Board in June 2024 .

• At the in -person EAC meeting held on 24 -26 September 2024, and during the
virtual meeting on 13 November 2024, the EAC offered guidance on: i) progress
on the commissioned /planned Gavi 5.1 centrali sed evaluations; ii) the proposed
evaluations of the African Vaccine Manufacturing Accelerator (AVMA) and the
Big Catch -Up; iii) centrali sed evaluation work planning for Gavi 6.0; iv) the
Evaluation Function Review; and v) EAC engagement in Gavi 5.1 evaluations.
Section B: Current evaluation portfolio
• The EAC discussed progress and findings from Phase 2 of the Zero -Dose
Evaluation . Key findings of / insights from this work included :

o There is s trong alignment on the Zero -Dose Agenda and its objectives
exists among core and expanded partners at the national level, but less
so at the subnational level within governments, reflecting a gap in
localised operational coherence ;
o In terms of partner coordination and joint planning, at the national level,
coordination structures, such as inter -agency committees and
government -led taskforces, facilitate regular partner engagement,
however, government capacity constraints and limited in -country
Secretariat presence hinder their functionality. Additionally, while
monitoring and accountability syste ms exist, they are unable to track
partner performance effectively and provide results -oriented data on
zer o-dose , resulting in limited external transparency over core partners’
activities and funds and restricted information -sharing between Alliance
partners ; and
o Full Portfolio Planning and the Partners ’ Engagement Framework have
enabled alignment and supported Civil Society Organisation
participation in zero -dose delivery but are criticised for being overly
complex, slow, and disproportionately influenced by core partners.

• The EAC noted th at the streamlined approach taken for this work appeared to
be characterised by agility to be responsive to emerging questions, and was
felt by Secretariat colleagues to have reduced evaluation burden . The EAC
recommended to consider this approach again for future evaluations, when
relevant.

1


Board -2024 -Mtg -03-Governance Committee Chair Report
Report to the Board
4-5 December 2024

Subject Governance Committee Chair Report
Category For Information
Section A: Introduction
• This report provides the Board with an update on the activities of the
Governance Committee (GC) since the last report to the Board by the
Committee Chair in June 2024 .
• The GC held an in-person meeting on 5 June 2024 and a virtual meeting on
1 October 2024 . The next meeting is scheduled for 3 December 2024 .
• In addition to routine business such as Board and Committee nominations, the
recruitment of Unaffiliated Board Members, and the governance risk matrix,
Committee discussions have focused on the following key topics: (i) the
upcoming Gavi Board Chair recruitment process; (ii) Strengthening the
Implementing Country Constituency ; (iii) the Evaluation Function Review ; (iv)
the Delegation of Authority Policy ; (v) the Collaboration with the Global
Financing Facility and Global Fund to Fight AIDS, Tuberculosis and Malaria;
and (vi) the Governance of the Africa n Vaccine Manufacturing Accelerator
(AVMA) and First Response Fund.
• At its meeting on 3 December 2024, the GC will review proposals for the Board
and Board Committee evaluation, discuss Consent Agenda guidelines,
examine the Terms of Reference (ToR) for the Independent Review Committee,
and continue discussions on the Boar d Chair recruitment, collaboration with
other global health organizations, and the evaluation function review.
• The GC Chair ’s report is attached as Annex A in the form of a presentation .

Annexes
Annex A : Governance Committee Chair report

1


Board-2024-Mtg-03-Investment Committee Chair Report
Report to the Board
4-5 December 2024

Subject Investment Committee Chair Report
Category For Information
Section A: Introduction
• This report provides the Board with an overview of the activities of the
Investment Committee (“Committee”) since the Committee Chair last reported
to the Board in June 2024. The Committee met 4 times in 2024. T hree key
topics in focus throughout the year include: (1) long- term portfolio performance;
(2) private assets ( private equity and real estate) fund recommendations; (3)
sustainable investment framework revision.
• All values are reported as of 30 September 2024. The long- term portfolio value
is US$ 1, 455 million including advanced contribution s and cash held at the
custodian, an increase of US$ 7 0 million to value last reported at the June 2024
board meeting. The long- term portfolio does not have cash inflows, so the
increase is solely related to performance.
• On a year -to -date basis ending on 30 September , the long-te rm portfolio
delivered +9.7% versus a policy benchmark return of + 10.2%, or -0.5% of
underperformance. During the year, the Investments team made
recommendations to exit several investment managers with weak performance
or other critical issues ( e.g., operational lapse), and recommended several new
investment managers to improve performance. For historical context, the long-
term portfolio delivered five consecutive calendar years of outperformance
(2019 through 2023). Over the 3 years’ and 5 years’ annuali sed bases, excess
performance remains strong at respectively 2.0% and 2.2%.
• Continued strength in the U.S. economy and excitement around artificial
intelligence helped buoy equity markets. Strong U.S. equity performance has
been narrowly based on key technology -oriented names although the base of
strength has broadened. C ooling inflation provided sufficient impetus for the
U.S. Federal Reserve’s decision to start cutting rates in September 2024, an
action that is supportive of risk assets . On the downside, geopolitical instability
and the U.S. fiscal deficit remain counterweights to the tailwinds previously
described. As a reminder, the long- term portfolio implementation is organi sed
for balanced risk so that it can weather various economic scenarios .
• Performance results across asset classes were mixed. On a year -to -date basis
ending 30 September 2024, fixed income (38 % of portfolio) was the strongest
performer on a relative basis, outperforming its market benchmark by + 2.6%.
Diversifiers (17% of portfolio) under performed its market benchmark by -5.4 %.
A trend- following systematic strategy contributed significantly to the
underperformance. Equities (44% of portfolio) trailed its market benchmark by
- 2.3% but strong performance from the asset class on an absolute basis helped
overall portfolio performance. Two investment managers with weaker

1


Board- 2024-Mtg -03-IFFIm Chair Report
Report to the Board
4-5 December 2024

Subject IFFIm Chair Report
Category For Information
Overview
• This report provides the Board with (1) an overview of IFFIm’s work to-date
supporting Gavi’s 2021 - 2025 strategic period and (2) a summary of anticipated
future capacity.
• IFFIm continues to be a valuable instrument in Gavi’s financial toolkit. Its flexible
model will be critical in the Gavi 6.0 strategic period, enabling Gavi and donors
to reliably deliver on Gavi’s ambitious goals for 2026- 2030.
• IFFIm raised US$ 1 billion in October 2024 through its most recent bond issue.
This is IFFIm’s largest single issue since its inaugural bond in 2006, and the
order book was four times oversubscribed.
• IFFIm has continued to receive an A+ rating from its largest donor – the United
Kingdom – in its periodic review of the effectiveness and efficiency of the
initiative in which it participates.
• Governance and administration priorities are on track, with new directors
onboarded and the special adviser to the IFFIm board recruited. Framing
IFFIm’s 2025 strategy for the transition to Gavi 6.0 continues.
• Annexed hereto, is the IFFIm Chair Report to be presented and discussed
during the forthcoming Gavi Board meeting.
Annex
Annex A: IFFIm Chair Report

1


Board -2024 -Mtg -03-PPC Committee Chair Report
Report to the Board
4-5 December 2024

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 June 2024 .
• The PPC held an in person meeting on 22 -24 October 2024 . 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 4 -5 December 2024 meeting for consideration.
• To follow up on discussions at the October 2024 meeting, the PPC reconvened
for a virtual meeting on 20 November 2024 to further discuss topics falling under
the Funding Policy Review and to consider an additional topic for
recommendation to the Board at this meeting on the update of the Prioritisation
Mechanism for Gavi’s Support to Countries . The PPC was also asked to
provide guidance on the Nigeria Accountability Framework.
• 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 es B and C .
Annexes
Annex A : PPC Chair report
Annex B : PPC recommendations to Gavi Alliance Board (October 2024)
Annex C : PPC recommendations to Gavi Alliance Board (November 2024)

Board -2024 -Mtg -03-Doc 0 6 1
Report to the Board
4-5 December 2024

Subject Gavi 6.0 Operationalisation: Getting Ready to Deliver on the
Next Strategic Period
Agenda item 06
Category For Guidance

Executive Summary
This paper provide s an update on the work to get ready for delivering on Gavi
6.0, following the Board ’s approval of the Alliance’s 2026 -2030 strategy in
June 2024. Building on feedback from the Programme and Policy Committee (PPC)
and Board at their May 2024 and June 2024 meetings respectively , the Secretariat
has initiated the operationalisation of the new strategy . It is organised around five
workstreams to ensure that the Alliance is ready to deliver on Gavi 6.0 from January
2026 onwards :
i. Development of a theory of change and measurement framework for Gavi
6.0;
ii. Finalisation of key Gavi 6.0 sub -strategies (including the Health Systems
strategy, a new approach to Fragile & Humanitarian settings and an update
of Gavi’s market shaping strategy);
iii. Update of Gavi’s programmatic policies (including Funding Policy Review);
iv. Evolution of the Alliance’s partnership approach; and
v. Evolution of the Secretariat’s operating model (including grant management
reform (EVOLVE ) and transformation of the Independent Review
Committee) .
The approach is informed by extensive consultations including technical expert
groups, countries and in -country partners.
Action Requested of the Board
The Gavi Alliance Board is requested to provide guidance on:
The Gavi 6.0 approach to Fragile and Humanitarian settings: the emerging direction
as described in Annex B to Doc 06, including the problem statements
Next steps/timeline
The work will advance across the workstreams as described in this paper. The
Board will be updated on overall progress on a bi-annual basis and be asked to
provide guidance or make decision s.

Board-2024-Mtg- 03-Doc 06 -Annex A 1
Report to the Board
4-5 December 202 4
Annex A: Overview of Gavi 6.0 workstreams, high- level plan for PPC/Board engagement and broader consultations
High -level approach to get us ready for Gavi 6.0 with five key
workstreams
1
Strategy / design finalisation
Development of Gavi 6.0
theory of change and
measurement framework
Finalisation of key sub -
strategies , including:
•Health Systems Strategy
•New approach to Fragile &
Humanitarian settings
•Market shaping strategy
Updates of Gavi’s programmatic
policies (Funding Policy Review), to
include:
•Eligibility and Transition Policies
(incl. MICs)
•Co -financing Policy
•Health Systems and Immunisation
Strengthening (HSIS) Policy
Beyond Funding Policy Review:
•Vaccine prioritisation & optimisation
•Vaccine donation policy
Policy
Implementation
Evolution of the partnership approach :
•Accelerate collaboration with GHIs in context of Lusaka agenda
•Update the Alliance partnership model, redesign PEF
Update of Secretariat operating model :
•Roll out grant management reform (EVOLVE) incl. tools for access to funding and
IRC transformation
•Operational effectiveness and efficiency initiatives
•Update of vaccine, programme funding and other operational guidelines
•Reprogramme HSS -like support in line with 6.0 objectives
•Country Delivery Initiative
1
2
3 4
5
Workstreams 1 -3 inform the design and implementation of workstreams 4 and 5

gavi.org
Annex B: Update on Gavi 6.0
Fragile & Humanitarian (F&H)
approach –emerging direction
and problem statements
BOARD MEETING
4 -5 December 2024, Bali, Indonesia
2
Agenda
1. Context and objectives of the Fragile
& Humanitarian (F&H) approach
2. Situational analysis
3. Questions and problem statements to
be addressed
Board Meeting, 4-5 December 2024

Board-2024-Mtg-03- Doc 06a 1
Report to the Board
4-5 December 2024

Subject Health Systems Strategy
Agenda item 06a
Category For Guidance

Executive Summary
The purpose of this paper is to seek guidance from the Board on the foundational
elements of Gavi’s first -ever Health Systems (HS) Strategy. The pr oposed HS
Strategy is detailed in Annex A and introduces a new theory of change with two
goals of equity and sustainability and six pillars guiding Gavi’s HS investments as
well as five shifts needed to deliver on it:
i. A systematic approach to differentiate health systems investments, with the
ultimate goal of ensuring programmatic sustainability ;
ii. Consolidation of health systems programming and planning for routine
immunisation alongside campaigns ;
iii. Harmonised ecosystem to catalyse innovation on health systems across and
beyond the Alliance;
iv. Strengthened partnerships and collaboration in country to implement a
PHC- driven approach to immunisation; and
v. Intentional measurement, monitoring and learning.
The HS Strategy has been informed by guidance received from the P rogramme and
Policy Committee in May 2024 and Board in June 2024 and by the PPC at its
October 2024 meeting and by consultations with countries and Alliance partners. It
has been co-developed with the Health Systems Strategy Technical Advisory Group
(TAG), which includes representatives from the World Health Organization (WHO),
UNICEF, World Bank, US Centers for Disease Control (CDC), Bill & Melinda Gates
Foundation, expanded partners including civil society organisations (CSOs), and the
Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund).
Action Requested of the Board
The Gavi Alliance Board is requested to provide guidance on :
a) the foundational elements of the Health Systems Strategy, including the
Theory of Change and key shifts attached as Annex A to Doc 06a.

Board -2024 -Mtg -03 -Doc 06a -Annex A 1
Report to the Board
4-5 December 202 4
Annex A: Draft Gavi 6.0 Health Systems Strategy
Executive Summary
Gavi’s first -ever Health Systems (HS) Strategy is designed to clarify both what the
Alliance seeks to achieve through its support for health systems and how it intends to
do so. The intent is to provide a holistic programmatic and operational framework
for countries, partners, and the Secretariat to guide programming, implementation
and monitoring of Gavi’s health systems investments.
The goals of the Alliance’s health systems strategy for Gavi 6.0 are to increase
the equity and sustainability of immunisation programmes in service of the overall
Alliance 6.0 strategy, in particular Strategic Goals 2 and 3 and linking to Strategic Goal
1. In doing so, it seeks to contribute to strengthening countries’ overall health system
by taking a primary healthcare (PHC) approach. The HS Strategy introduces a new
theory of change (ToC) which seeks to clarify how the Alliance will contribute to these
outcomes through investments in six pillars which align to WHO’s health systems
building blocks. The draft strategy identifies an initial set of priority investments and
activities under each pillar, which will be further refined as the HS Strategy is finalised
to ensure clarity on the key interventions Gavi seeks to prioritise with its resources.
The strategy also introduces five key shifts to deliver the theory of change: more
systematically differentiating its health systems investments by country context
(including in fragile and humanitarian settings) with the ultimate goal of achieving
programmatic sustainability at the point of transition; consolidating health systems
programming and funding levers; a more harmonised ecosystem to catalyse and scale
innovation; strengthened partnerships and collaboration on health systems across and
beyond the Alliance; and more intentional measurement, monitoring and learning of
health systems .
The draft HS Strategy includes early thinking on ‘how’ Gavi intends to deliver on the
goals. These will be further refined in the final strategy including operational shifts to
Gavi’s grant management architecture, system -related aspects of the approach in
fragile and humanitarian settings, relevant shifts to the partnership model, and
Secretariat ways of working.
Gavi 6.0 Health Systems Strategy
Context
The Gavi 6.0 (2026 -2030) strategy is the Alliance’s most ambitious to date aiming
to help countries immunise over 500 million people, introduce a broader portfolio of
vaccines along the life -course, and extend routine immunisation programmes to reach
missed communities and zero -dose and under -immunised children 1. All of these goals
will need to be delivered through health systems that are often stretched and face
critical capacity gaps . This is especially true in a context where many countries are
1 Zero -dose (or unimmunised) children are defined as those who have not received any routine vaccine defined for
operational purposes as those who lack the first dose of diphtheria -tetanus -pertussis containing vaccine. Missed
communities are home to cluster s of zero -dose and under -immunised children and often face multiple deprivations
and vulnerabilities, including lack of services, socio -economic inequities and gender related barriers.

Board -2024 -Mtg -03-Doc 06a -Annex B 1
Report to the Board
4-5 December 202 4
Annex B: Risks, potential implications, and mitigations
The Health Systems Strategy is designed to provide greater clarity on Gavi’s role in
health systems, increase the impact of its investments and allow better measurement
of progress. However, there are significant strategic and operational risks to its
impl ementation. In addition to the risks related to constrained funding and required
changes to the partnership model which are described in the main body of the paper,
several additional risks will need to be managed as the HS strategy is operationalised:
Risk that shifts in Gavi’s investment approach ha ve an adverse effect on
immunisation programme performance:
A key proposed shift in the health systems strategy is to more systematically
differentiate Gavi investments by country context including through greater focus on
catalytic health systems investments and a reduction in funding for operational or
recurrent costs as countries approach transition 1. While this approach will contribute
to long -term programmatic sustainability and will be phased over time to prevent
abrupt changes at country level, there remain significant risks that reduction in
Gavi support for operational activities could have a negative impact on
programme performance . The risks may be most acute in settings and programmes
that are more highly dependent on outreach and campaign strategies (and thus require
support for per diems, fuel, etc .), including remote settings with high number of zero -
dose, or school -based outreaches to delivery HPV vaccines. This reflects a tension in
the two strategic goals of the HS Strategy as equity and sustainability may be at odds
in particular contexts. The d ifferentiation framework with the HS Strategy intends to
identify the relative prioritisation of these goals across different country contexts,
rec ognising that achieving one may require trade -offs with the other. This risk will be
further mitigated through Gavi’s broader approach to programmatic sustainability and
emphasis on aligned financing and budget advocacy with countries to increase
domestic commitment for PHC.
Risk that shifts to Gavi’s funding architecture and approach may impact
programme outcomes
The consolidation of funding levers and greater alignment of Gavi funding to National
Immunisation Strategies or other PHC strategies represent a positive step towards
greater country ownership, simplicity, and alignment to the principles of the Lusaka
Age nda 2. Consolidated funding and planning and greater programmatic collaboration
with other health system funders also provides an important opportunity to more
closely align Gavi’s historic HSS programming and support for campaigns and new
vaccine introductions and identify efficiencies. This will be important to better target
and reach zero -dose communities, who may be reached through campaigns funded
across different initiatives (e.g. polio campaigns by GPEI) but are not always referred
to and followed -up through routine immunisation or reached by other PHC
1 Support for operational activities in fragile/conflict settings and initial self -financing countries will still be allowable
and necessary. 2 Funding against national immunisation strategies is aligned to the Lusaka Agenda priorities but may be in tension
with other efforts to align processes, application materials, and approaches with other funding institutions (e.g.
Global Fund).

Board -2024 -Mtg -03-Doc 0 6b 1
Report to the Board
4-5 December 2024

Subject Funding Policy Review
Agenda item 06b
Category For Information

Executive Summary
This paper provides an introduction to the review of Gavi’s core funding polices ,
namely the : a) Eligibility and Transition Policy; b) Co -Financing Policy (both policies
together are known by the acronym ELTRACO), and the c) Health Systems and
Immunisation Strengthening (HSIS) Policy. The Funding Policy Review (FPR)
proposes changes to programmatic policies needed to deliver on the Gavi 6.0
strategy (incl. the proposed new Health Systems Strategy ), providing important
inputs into the new end -to -end grants management approach (EVOLVE) and other
changes to the Secretariat operating model in 6.0 . The policy options outlined in
Docs 06bi and 06bii have been reviewed and recommended for approval by the
Programme and Policy Committee ( PPC ); and were informed by guidance from a n
FPR Task Team with representatives from the PPC and Board, and consultations
with countries, civil society organisations (CSOs) and vaccine manufacturers.
Technical guidance from Alliance partners was provided through an Alliance
Technical Team for the ELTRAC O policies and a Technical Advisory Group for the
HSIS Policy.
Action Requested of the Board
This report is for information only.
Next steps/timeline
At its December 2024 meeting, the Board will review policy options based on
recommendations from the PPC. Approved options will be incorporated into revised
policies submitted to the PPC and Board in May and June 2025, respectively.
Previous Board Committee or Board deliberations related to this topic
See Docs 06bi and 06bii for complete lists.

Board -2024 -Mtg -03-Doc 0 6bi 1
Report to the Board
4-5 December 2024

Subject Health Systems and Immunisation Strengthening Policy -
UPDATED
Agenda item 06bi
Category For Decision

Executive Summary
Th e purpose of this paper is to request that the Board approve a series of policy
options to update Gavi’s Health System s and Immunisation Strengthening (HSIS)
Policy for Gavi 6.0. The HSIS policy governs Gavi’s support for health systems, cold
chain equipment, and vaccine introduction, campaign, and switch support. It is being
updated to incorporate learnings from Gavi 5.0 and to align with Gavi ’s 6.0 strategy
(incl uding the proposed new Health Systems Strategy ). Th e policy options
recommended for approval are : i) the consolidat ion of funding levers to better align
programming an d simplify processes for countries ; ii) a new allocation formula for a
consolidated grant ; iii) necessary guardrails to protect key investments ; and
iv) options to promote co -investment from countries in health systems and cold
chain equipment . The se have been refined in consultation with the Health Systems
Strategy Technical Advisory group (TAG), countries , civil society organisations
(CSOs) and the Funding Policy Review Board Task Team. All of the options were
reviewed by the Programme and Policy Committee (PPC) in October and
November 2024 and recommended to the Board for approval.
At its meeting on 20 November 2024 , the PPC will review two additional
recommendations related to the consolidated cash grant for countries: a) potential
inclusion of the Partners ’ Engagement Framework (PEF) Targeted Country
Assistance (TCA) , and b) maintaining the 10% minimum allocation for Civil Society
Organisations (CSOs) .
If the PPC recommend s these options, an updated paper will be shared with the
Board on 27 November 2024 .
Action Requested of the Board
The Gavi Alliance Programme and Policy Committee recommends to the Gavi
Alliance Board:
1. With respect to the co nsolidation of funding levers , that it approve :
a) approve the consolidation of seven funding levers into one consolidated
cash grant, namely: i) Health Systems Strengthening (HSS); ii) Equity
Accelerator Funding (EAF); iii) operational support for predictable
campaigns; iv) Vaccine Introduction Grants (VIGs); v) predictable switch
grants; vi) Innovation Top -Up; and vii) Cold Chain Equipment Optimisation
Platform (CCEOP);

gavi.org
HEALTH SYSTEMS AND IMMUNISATION
STRENGTHENING POLICY
BOARD MEETING
Marta Tufet Bayona
4 -5 December 2024, Bali, Indonesia
Gavi is seeking approval to consolidate multiple
cash funding levers into one funding envelope
*Does not include funding for emergencies, including outbreak response
One consolidated cash grant for all health
systems and immunisation strengthening support*
Multiple funding levers for cash support
Health Systems
Strengthening
Vaccine Introduction
Grants
Equity Accelerator Fund
Operational support for
campaigns (M/MR Follow
up and other preventive
campaigns)
Switch Grant
Cold chain equipment
optimisation platform
Innovation top -up
From:
Partner’s Engagement Framework Targeted Country
Assistance
To: Proposal
Potential benefits:
+ Simplified processes
+ Reduced transaction
costs
+ Programmatic
efficiencies
Potential risks:
- Lower ability to target funding to
Gavi’s priorities
- Weak country planning capacity
- High level of effort for change
management
Portion of TCA (and potentially SFA) funds allocated
to core partners for key long -term country functions
before defining country ceilings
2 Board Meeting, 4 -5 December 2024

Board -2024 -Mtg -03 -Doc 06bi -Annex A - UPDATED 1
Report to the Board
4-5 December 202 4
Annex A: Risk implication and mitigation including for countries and the Alliance
This annex outlines the risks and proposed mitigation with the proposed shifts outlined
in Doc 06bi. The consolidation of funding levers comes with a set of risks that were
presented to the PPC in October 2024 after extensive stakeholder consultations to
identify ways in which to implement these changes and minimise risks for countries
and Gavi and its Alliance partners.
Key risks and mitigation measures are outlined in the table below:
Risk Mitigation measures
Prioritisation of activities within
a consolidated grant:
Governments face challenges
prioritising immunisation
activities within a single
application, especially those
with limited capacity or long -
term planning ability. This
could lead to missed
opportunities for integration or
increases in standalone
applicatio ns and siloed
programming, necessitating
frequent changes in priorities.
Although the risk is not increased by the action to consolidate
funding levers, there will be 24 antigens supported through
Gavi in 6.0 and various delivery modalities between RI and
campaigns. Gavi, together with Alliance partners, will
enhance cross -team and cross -organisational engagement,
to strengthen country capacity for planning their applications
and National Immunisation Strategy (NIS), to include
evidence -based vaccine prioritisation and portfolio
optimisation decisions and activities to support t hem.
Additionally, streamlined processes are being established
for reprogramming and differentiated application pathways,
allowing for necessary adjustments as programmatic and
country priorities evolve.
Fungibility of funding: With
consolidated funding,
countries may allocate
resources according to their
national objectives, which
may not always align with
Gavi’s priorities. There is a
risk of countries over -
allocating funds to certain
areas, such as campaigns,
potentially dive rting resources
from other critical activities.
Gavi will leverage various channels to ensure country
investments and planning align with both national and Gavi
strategic priorities. This includes detailed budgeting and
funding guidelines, implementing guardrails for a critical
priority, allocating only vaccine introduction and switch
grants, enhanced country engagement through data -driven
discussions during the strategy and application process.
Gavi is also clarifying Alliance roles and responsibilities to
ensure consistent support and implementing diff erent
transformation initiatives of the IRC including updates to the
terms of reference and piloting Secretariat led reviews.
Processes are set up to ensure disbursements reflect agreed
upon milestones and plans are adjusted to achieve agreed -
upon objectiv es effectively.
Inclusion of the Partners’
Engagement Framework
(PEF) Targeted Country
Assistance (TCA) within the
consolidated cash grant for
countries
Options for this consolidation , including risks are detailed in
Annex B. will be discussed by the PPC at its meeting on 20
November 2024.

Board -2024 -Mtg -03-Doc 06b i-Annex B 1
Report to the Board
4-5 December 202 4
Annex B: Consolidation : Partners’ Engagement Framework (PEF) Targeted Country
Assistance (TCA) and simplification opportunities
Part A: Consolidation of PEF TCA

1. Introduction
1.1 Partners’ Engagement Framework (PEF) 1 Targeted Country Assistance (TCA)
provides tailored country -level technical assistance to strengthen local
capacities and address unique challenges at national level. Technical
assistance needs identified by countries are intended to align with the
comparative strengths of partners in -country to help address immunisation
challenges and strengthen capacities in -country toward s sustainability or an
exist strategy where possible.
1.2 TCA is currently contracted by the Secretariat and implemented by core
Alliance ,2 and non -core partner organisations. 3 In 5.1 an average of 37% of
TCA funding across Gavi -eligible countries was allocated to long -term, core
Alliance partner staff support; with the remaining 63% allocated to short term
support in addition to other TCA catalytic activities. 4 These ratios may shift,
depending on country context (e.g. more long -term support in fragile vs core)
and transition status (e.g. more short -term activities in countries in accelerated
transition vs other transition phases).

1.3 The Funding Policy Review (FPR) identified several problem statements with
the current approach to PEF TCA: (a) separating TCA undermines country
ownership and flexibility in how to optimise use of Gavi resources based on
their needs, and (b) the current system means technical assistance is
implemented through multiple levers which leads to fragmentation, potential
duplication and inefficiency in both processes and programming. These issues
result in complex processes with high transaction costs for countri es, partners
and Secretariat , partner competition for funds and varying accountability
requirements.

1.4 Thus, a s part of the FPR’s simplification agenda and the recommendation by
the PPC to consolidate seven Gavi funding levers into one cash grant for
countries in 6.0, it was necessary to consider whether PEF TCA should be
consolidated too a nd if so, what options were available to facilitate this
1 PEF also includes two other funding levers: Foundational Support (FS) to support longer term functions of core
Alliance partners at global and regional levels, and Strategic Focus Areas (SFA) to address emerging global
health challenges and opportunities while enhancing learning and capacity building at global, regional and country
level. 2 WHO, UNICEF, World Bank, CDC/F 3 TCA aims to leverage the comparative advantage of more than 60 different partner organisations across Gavi
countries who provide technical assistance (TA) to countries, they can be local and global civil society organisations
(CSOs), private and other par tners. 4 Including activity specific technical assistance such for HPV, malaria, etc.

Board -2024 -Mtg -03-Doc 06bii 1

Report to the Board
4-5 December 2024

Subject Eligibility, Transition and Co -financing, including Catalytic
Phase - UPDATED
Agenda item 06 bii
Category For Decision

Executive Summary
This paper proposes to the Board a series of changes to Gavi’s Eligibility and
Transition and Co -financing (ELTRACO) policies for Gavi 6.0. Since 2008, Gavi’s
innovative ELTRACO model has raised over US$ 5 billion in domestic resources for
immunisation, driving financial and programmatic sustainability and supporting
19 countries to transition out of Gavi support. However, its future success is
threatened by several challenges, which are proposed to be addressed via six
strategic shifts, a support package f or Small Island Developing States (SIDS), and
a new Catalytic Phase. As per the Board’s guidance, the propos als seek to ensur e
sustainability and achiev e health impact, equity, and market shaping outcomes .
Their implementation will be accompanied by a Learning Agenda. The estimated
cost of the ELTRACO shifts , US$ 348 million, plus US$ 250 million for the Catalytic
Phase, is aligned with the Gavi 6.0 strategic costing estimate presented to the Board
in June 2024. The proposal to expedite support for new vacc ine introductions to
2025 would cost a further estimated US$ 9.5 million . Proposals were refined via
consultations with Alliance partners, implementing countries, CSOs , manufacturers,
and the Funding Policy Review Board Task Team .
The proposals were presented to the P rogramme and Policy Committee (PPC) in
October and November 2024 . At th ose at meeting s the PPC :
1. Recommended all proposals to the Board for approval ., except a proposal
regarding co -financing obligations whe n Gavi channels vaccines and support
directly through partners in emergency situations and humanitarian settings . This
will be discussed at the 20 November 2024 PPC meeting .
2. Requested the Secretariat estimate the cost of expediting the downward
adjustment in co -financing to 2025 for countries expected to benefit from this in
2026
3. Request ed the Secretariat put forward options for ad justing the rate of
co - financing increase for countries in Preparatory Transition , to be explored in
2025 as part of broader Gavi 6.0 recalibration exercises following replenishment .

Board -2024 -Mtg -03 -Doc 06b ii-Annex A 1
Report to the Board
4-5 December 202 4
Annex A : Implications/Anticipated impact
• Risk implication and mitigation, including information on the risks of
inaction
Gavi’s innovative Eligibility, Transition and Co -financing (ELTRACO) policies have
delivered enormous gains in sustainable immunisation. Yet macro -economic
challenges and growing vaccine portfolios challenge their future success. The
changes proposed in this paper seek to address these challenges, and have been
developed with the objectives of sustainability, health impact, equity, and market
shaping in mind. Without these proposals, it is possible that countries and the
Alliance would not see a continuation of their past successes, putting at risk Gavi’s
overall mission as well as children’s lives.
One of the ELTRACO proposals (Shift D) recommends providing countries in
Accelerated Transition (AT) Phase with eight year s of vaccine support for new
introductions, regardless of when during AT that vaccine is introduced , thereby
remaining Gavi -eligible for vaccine procurement support, including for Gavi
pricing, for that vaccine during the period . While historical pricing data indicate that
very few suppliers make price distinction s between Gavi -eligible and Former Gavi
countries , there is a remote scenario where one or more manufacturers change
their pricing strateg y and decline to offer the Gavi price for a Shift D -relevant
programme after a country has otherwise transitioned out of Accelerated
Transition , despite the Gavi -eligible nature of such programmes . For markets
where competitive dynamics are str ong and where some manufacturers already
offer price parity between Gavi -eligible and Former Gavi countries, the risk is
minimal and not likely to materialise. While t he risk is higher for dominant -supplier
markets , the risk profile decrease s even further as new entrants enter the market.
Equally Gavi’s , Middle -Income Countries Approach, introduced in Gavi 5.0/5.1,
has supported both former and never Gavi -eligible countries. Without its
continuation in Gavi 6.0, there is the risk that the breadth of protection gap in
middle income countries will persist . It could even worsen , with the future
availability of new vaccines against dengue and tuberculosis that are highly
relevant to these settings. With most global deaths from these diseases occurring
in MICs, uptake by these countries will be an important contributio n to realising
the potential worldwide impact of these new vaccines. Furthermore, removal of
the safety net of backsliding support for former -Gavi countries that have persistent
gaps or experience shocks that threaten their vaccination programme risks the
legacy of Gavi investment in these coun tries.
• Impact on countries
The proposals contained within this paper seek to support countries to continue
to build and maintain sustainable, high coverage, immunisation programmes.
Without these proposals, this objective could be put at risk. Furthermore, as part
of these proposals, the MICs Approach will be fully integrated into Gavi’s
ELTRACO model and will form the new ‘Catalytic Phase’, thereby ensuring a
seamless transition for countries as they move along t he Gavi support continuum.

Board -2024 -Mtg -03 -Doc 06b ii-Annex B 1
Report to the Board
4-5 December 2024
Annex B: Shift A scope conditions and assessment
Shift A background

Initial Self -Financing (ISF) countries currently co -finance most Gavi -supported
vaccines at US$ 0.20 per dose, thus shielding them from any product price differences.
This ‘de -linking’ of the amount of co -financing that a country pays from the actual cost
of a vaccine product reduces a country’s incentive to include price in product choice
decisions and can limit the competitive advantage of new lower -cost market entrants,
while also preventing ISF countries from realising the cost savings they could gain b y
switching to a less expensive product. This threatens countries’ long -term sustainable
access to affordable vaccines by jeopardising market health. To ensure vaccine
markets can sustainably serve Gavi -supported countries, it is important to address
deman d dynamics that negatively impact market health in a way that is 'country -
centric', i.e. with the interests of countries at the forefront.
Thus Shift A, by directly linking a country’s co -financing contribution to the actual price
of a vaccine product for ISF countries, is designed to encourage a diverse vaccine
supplier base which helps ensure that competitive dynamics can lead to favourable
price trends and ensure supply security. Shift A will establish price as a criterion in
country decision -making processes for new vaccine introductions and portfolio
optimisation, alongside other factors such as efficacy, safety, cold chain footprint, and
impact on coverage.

Shift A scope c onditions & assessment

To maximise shift A’s benefit without creating negative side -effects, its application will
be driven by the following two criteria:
1. The market is a full choice market
• Full choice markets : markets where countries can choose presentation and
product brand, so market share is primarily driven by country choice
• Restricted choice markets : markets where countries can choose presentation
but not product brand, allowing UNICEF to allocate demand volumes across
suppliers within each presentation
2. Application of Shift A will improve market health in a way that aligns with objectives
defined by vaccine market roadmaps and supports long -term programme
sustainability . Key market dimensions to be assessed for impact include
• Balanced demand and timely uptake of new products
• Supply availability and security
• Supplier diversity and long -term competition

Board -2024 -Mtg -03 -Doc 06bii -Annex C
Report to the Board
4-5 December 202 4
Annex C: Detailed costings for ELTRACO and a ssumptions
1. ELTRACO Shifts
The cost of the recommended ELTRACO options as proposed in t his paper is
US$ 348 million . This is broken down as follows.
Shift Parameter Value Cost
(M US $)
Total Cost
(M US $)
Shift A 0 M
Shift B 139 M
Eligibility Threshold update 2,300 122 M
One -time downwards adjustment 80% 17 M
Shift C 147 M
PT Cap 139 M
PT Cap for PT countries 80% 43 M
PT Cap for countries with downwards adjustment 80% 95 M
NVI - Introductory price fraction c ap for PT 35% 9 M
Shift D 5 M
NVI - Introductory price fraction c ap for AT 35% 5 M
SIDS 22 M
Vaccine downwards adjustment and Cap 80% 7 M
HSS support 15 M
Shift E 35 M
Additional Prog. Support 35 M
Shift F 0 M
TOTAL ELTRACO COST in Gavi 6.0 348 M

2. NVI support in 2025
The estimated additional cost of implementing the decisions on new vaccine
introductions from 2025 (under shifts C and D) would be US$ 9.5 million (of
which up to US$ 0.5 million in 2025) and is anticipated to support the following
country introductions: Bangladesh (HepB, JEV, TCV), Cameroun (MenA), Côte
d'Ivoire (DTP Booster 1st), Ethiopia (DTP Booster 1st, HepB) and Pakistan
(HPV). The cost during 2025 will depend on the timelines for these vaccine
introductions and will be funded from the overall vaccine envelope .

3. Costings for the Catalytic Phase are included in annex D
Assumptions
Shift A
• The policy changes are anticipated to incur no additional costs for Gavi.
• Both Gavi and relevant countries are expected to experience cost
reductions in the mid to long term.

1


Board -2024 -Mtg -03-Doc 06b ii-Annex D
Report to the Board
4-5 December 2024
Annex D: Catalytic Phase – Technical Annex and costing breakdown
Overview of the Catalytic Phase

Objective 1: New Vaccine Introduction
The levers for NVI support are consistent with those deployed in 5.0/5.1, including
technical assistance (TA) and peer -to -peer learning initiatives at the global and
regional level ; a t country -level , TA, vaccine catalytic financing – equivalent to 50% of
a first target cohort - and one -off costs.
Vaccines eligible for introduction support in the Catalytic Phase
HPV, PCV and rotavirus vaccine introduction has been supported through the Gavi
MICs Approach in Gavi 5.0/5.1, and these will remain the priority focus of NVI support
in the Catalytic Phase , with over 80% of Catalytic Phase NVI funding envelope being
directed to the introduction of these vaccines .
It is proposed to also include support for dengue vaccine introduction and for TA to
prepare for future tuberculosis vaccines .
The rationale for the inclusion of these two additional vaccines includes the high
burden of disease and anticipated health impact in MICs , with 96% and 62% of
potential deaths that could be averted through dengue vaccine and TB vaccine,
respectively (see Figure s below) . While global morbidity and mortality attributable to
dengue is not as great as other diseases (though noting the paucity of data from some
regions, thus a potential underestimate of overall burden), it is a disease with high
outbreak potential, which weakens and stresses health systems, and as such is an
important disease , as evidenced by its inclusion in VIS 2024.

Board -2024 -Mtg -03-Doc 0 6c 1
Report to the Board
4-5 December 2024

Subject Gavi 6.0 Measurement Framework
Agenda item 06c
Category For Guidance

Executive Summary
The purpose of this paper is to request that the Board provides guidance on:
i) potential key shifts to Gavi’s approach to measurement, evaluation and learning
(MEL) in Gavi 6.0, to be developed through the Gavi 6.0 Learning System Strategy ;
ii) the proposed design features of the 6.0 Measurement Framework, and iii) priority
topics for evaluations in Gavi 6.0.
The potential key shifts for MEL in 6.0 include coordinated MEL across the Gavi
results chain, strengthened MEL at country level, and use of adaptive learning
approaches. The design of the 6.0 Measurement Framework includes anchoring on
the Gavi 6.0 theory of change (TOC) and a proposed focus on indicators mapped
directly to the 6.0 strategic objectives. It will be supported by comprehensive
monitoring through a delivery cascade. Potential priority evaluation topics will be
further developed through on -goin g consultations including with the Evaluation
Advisory Committee (EAC).
The PPC agreed with the potential key shifts in Gavi’s MEL approach for Gavi 6.0
and the design features of the Gavi 6.0 measurement framework, including a more
focused measurement framework that leverages existing country data sources
without imposing new reporting requirements , with a n emphasis on supporting
countries to meet their measurement needs for effectively managing their
immunisation programme s in line with the Lusaka agenda . The PPC also provided
guidance on potential evaluation topics for the next strategy period.

Action Requested of the Board
The Gavi Alliance Board is requested to provide guidance on:
a) Key shifts to Gavi measurement, evaluation and learning for Gavi 6.0;
b) Design features of the Gavi 6.0 Measurement Framework; and
c) P otential evaluation topics for Gavi’s 2026 -2030 strategy.

Board -2024 -Mtg -03 -Doc 06c -Annex A 1
Report to the Board
4-5 December 202 4
Annex A: Implications/Anticipated impact
Risk
The strategy performance indicators and associated targets will be developed to help
the Gavi Board assess the extent to which the 2026 -2030 strategy is on track. The
indicators will provide annual information on strategy performance , with one indicator
linked to each strategic objective in the Gavi 6.0 one -pager . These performance
indicators , with accompanying targets, will provide the Board with a high -level
understanding of stra tegy progress for shared Alliance accountability, however they
will not provide a complete picture of strategy implementation and performance. We
will seek to address this by monitoring Alliance -wide process and output indicators as
part of the broader monitoring system , including the Delivery Cascade, and to provide
intelligence about progress on the causal pathway towards the strategic objectives.
Evaluations , learning activities, and other assessments will also supplement and
contextualise the strategy performance indicators.
Recognising the different stages of development of the Gavi 6.0 strategy elements ,
the importance of Alliance and country ownership, and availability of the latest data for
target setting (e.g. immunisation coverage) , the development of the measurement
framework will require a staged approach , with indicators brought to the Board for
approval in June 2025 and targets in December 2025 , assuming no significant delays
in other aspects of Gavi 6.0 operationalisation .
Impact on countries
The design of the measurement framework and associated indicators is not expected
to have a large impact in terms of imposing additional burden on countries to facilitate
Gavi strategy monitoring . It is anticipated that the Gavi 6.0 Measurement Framework
will largely use indicators that leverage country data systems , and that it will be aligned
with indicators in the IA2030 Framework for Action. One of the proposed selection
criteria for indicators is that they are useful at country level, and as in Gavi 5.0 , the
expectation is that the same indicators would be used for strategy and country level
outcome monitoring , thus ensuring alignment of measurement at country and portfolio
level.
The targets set in the 6.0 Measurement Framework for the 2026 -2030 period will have
an impact on countries in the sense that they focus Alliance -wide efforts on specific
measurable outcomes. However, this is appropriate given the indicators and targets
will be tied to the expected activities and strategy objectives of the 2026 -2030 Gavi
strategy .
Impact on Alliance
The Gavi 2026 -2030 strategy performance indicators and their associated targets will
be the main measures used for Alliance -wide accountability. Developing a shared
understanding of ambition, setting targets at an appropriate level of ambition, and
ongoing review by the Board will be crucial for incentivising progress towards the
2026 -2030 strategy objectives. Review against the targets could also lead to course

Board -2024 -Mtg -03 -Doc 06c -Annex B 1
Report to the Programme and Policy Committee

Report to the Board
4-5 December 2024
Annex B: Gavi 6.0 Theory of Change
1.1 Introduction
Based on the strategy one -pager and narrative for Gavi 6.0 approved by the
Board in June , the first instance of the 6.0 Strategy Theory of Change (TOC)
has been developed as part of 6.0 strategy operationali sation efforts to describe
how Gavi levers, activities, and interventions will lead to achieving Alliance
objectives for Gavi 6.0 . The TOC (see section 2.1) describes the change
process of how Gavi can reach its Gavi 6.0 Strategic Goals. It is organised
around the 4 Strategic Goals (SGs) and 12 Strategic Objectives (SOs) in the
6.0 strategy one -pager, and it is not intended to modify the Gavi 6.0 strateg ic
objectives approved by the Board.
The TOC is a tool to support the design and operationalisation of the Gavi
6.0 strategy. The T OC will be used as an input into the design of Gavi
programmes and their TOCs ; to underpin routine performance m onitoring ,
facilitat ing the selection of indicators that sit along the casual pathway ; and to
support the selection of learning and evaluation activities during Gavi 6.0.
Updates the TOC may be required as operationalization of Gavi 6.0 strategy
progress , therefore it should be considered a living document. As
operationalisation activities progress and documentation on Gavi 6.0 shifts is
finali sed, a written narrative to support the TOC diagram will be developed
including referencing of source documents , e.g. Board documents describing
sub -strategies.
1.2 Design
In the TOC diagram, a ctivities and outputs are split out into the most relevant
SG (best fit), while recogni sing that many activities contribute to multiple
outputs and outcomes . The TOC provides a high -level overview of both the key
shifts and continuing activities at global and country -level to enable delivery of
the strategy. Approaches to operationali se the Gavi 6.0 strategy have been
embedded either as principles , inputs, levers or interventions . Key assumptions
(see Section 3.1 for details on assumptions) DERXW *DYi’V RSHUDWiQg FRQWHxW DQG
risks to achieve its objectives are included within the T OC, along with the Gavi
6.0 one -pager Principles. By organi sing the T OC by SG , it does not always
capture a logical flow of cause and effect between the 12 SOs and 4 SGs. For
example, reaching Zero -Dose children (a strategic objective) does not lead to
a strengthened health system (SG2), but rather a stronger health system leads
to reaching Zero -Dose children. Given this, the design uses the SGs to
categori se/orient the reader on the 12 SOs .

Board -2024 -Mtg -03 -Doc 06c -Annex C 1
Report to the Board
4-5 December 202 4
Annex C: Proposed c omposition of the Alliance Technical Working Group
A technical working group (TWG) to support the development of the Gavi 2026 -2030
strategy (“Gavi 6.0”) measurement framework will enable the Alliance to identify key
performance indicators and targets that the Gavi Board will use for monitoring Alliance
progress over strategy period.
The TWG is an advisory body to provide guidance to the Gavi Secretariat on technical
issues related to development of the measurement framework. Final decision on
indicators and targets to be included in the Gavi 6.0 strategic framework will be made
by the Gavi Board.
The TWG shall consist of technical representation from relevant Alliance partners, with
the Gavi Secretariat leading and coordinating these efforts. Proposed representation
is as follows:

No. Institution
1 Bill & Melinda Gates Foundation
2 Country representative – High impact segment
3 Country representative – Fragile & Conflict segment
4 Country representative – Core segment
5 Country representative – Middle Income Country segment
6 Foreign, Commonwealth, and Development Office
7 Gavi Civil Society Organisations constituency
8 Gavi Research & Technical Health Institutes constituency
9 UNICEF
10 WHO
11 World Bank (represented by Global Financing Facility per World Bank request)

Board -2024 -Mtg -03 -Doc 06c -Annex D 1
Report to the Board
4-5 December 202 4
Annex D: Draft c riteria for defining and selecting indicators for the Gavi 6.0
Measurement Framework
As an initial step in determining how to improve strategy performance monitoring for
Gavi 6.0, a list of draft criteria for quality indicators was established. Criteria were
based on internationally recognised criteria used by international development
organisations including OECD, Global Affairs Canada, the United States Agency for
International Development, and the UK Foreign, Commonwealth, and Development
Office.
Criterion Definition Meaning in Gavi context
Accuracy The degree to which the
indicator can be correctly
estimated to describe the
quantities or characteristics that
it is designed to measure
Indicator results are direct measure of the
outcome of interest
Comparability The indicator is defined and
measured in a way that allows
for valid comparisons across key
dimensions of interest (e.g.
across countries or time)
Trends over time reflect the same country
mix (e.g. for Gavi 6.0, Gavi54 countries ),
indicator definition remains the same
throughout strategic period, and ideally
across countries
Timeliness Data is available at a useful
frequency, is current and timely
enough to inform management
decision making
Data are available on an annual basis, for
reporting in annual cycles during 5 -year
strategic period. Historic revisions to data ,
e.g. WUENIC , can update time series and
change view of performance over time
Completeness The degree to which all required
occurrences of the data are
populated
Countries routinely collect and report on
required data elements
Interpretability

Reflects the ease with which
users may understand, use and
analyse the data
Indicator reflects results from implementation
in period under review, measures attributes
that are within Gavi’s scope of investment
and programming, allow s for assessment of
progres s
Country u tility Degree to which metrics are
meaningful and useful at country
level
Indicator reflects country -level results that
are in scope for Gavi -supported
interventions, indicator is useful for countries
to understand performance, and where
possible, indicator is aligned with metrics
used by countries and other partners

1


Board -2024 -Mtg -03 -Doc 07
Report to the Board
4-5 December 2024

Subject Gavi ’s Response to Mpox
Agenda item 07
Category For Information

Executive Summary
The purpose of this report is to provide an update on Gavi’s response to the ongoing
mpox outbreak. It provides highlights of mpox response coordination and activities
from across key partners and donors linked to Phase I of the mpox response (which
is projected to span September 2024 -February 2025). Phase I activities are being
driven by complementary and aligned approaches articulated in the WHO Global
Strategic Preparedness and Response Plan and the Africa C enters for Disease
Control (C DC )-WHO African Continental Preparedness and Response Plan .
Recognising both the outbreak and coordinated response efforts continue to evolve,
the report provides a summary of engagements across key partners and the Gavi
Secretariat as of early November . The Programme and Policy Committee discussed
this update in October 2024 and Alliance partners were consulted on the paper.
Action Requested of the Board
This report is for information only.
Next steps/timeline
The Gavi Secretariat will consider Board perspectives in the evolving response to
the m pox outbreak.
Previous PPC or Board deliberations related to this topic
In October 2024 Programme and Policy Committee Meeting: Doc 05 - Gavi’s
response to mpox
Gavi Board Technical Briefing on m pox – September 2024
In June 2024 Board meeting book : Doc 11 a - Day Zero Financing Facility – First
Response Fund & Doc 11b African Vaccine Manufacturing Accelerator & Doc 10
Vaccine Investment Strategy 2024 – Investment cases
In December 2023 Board meeting : Doc 10a - Pandemic Prevention, Preparedness
and Response Approach – UPDATED
In October 202 3 Programme and Policy Committee Meeting : Doc 5a - Pandemic
Prevention, Preparedness and Response Approach

Board -2024 -Mtg -03-Doc 07 -Annex A 1
Report to the Board
4-5 December 202 4
Annex A: Summary of available supply

Supply source Vaccine Volume (doses, thousands)
Already delivered 380
HERA -BN
MVA -BN
305
USG 60
BN -Gavi 15
Immediately available 804
USG
MVA -BN
305
HERA 164
Canada 200
Gavi 125
BN -HERA 10
Available by Dec 2024 1,670
Gavi
MVA -BN
375
UNICEF tender 500
USG 695
HERA 100
Timing of supply unknown 3,050
Japan LC16 3,000
Emergent ACAM -2000 50
Total 5,904

Board -2024 -Mtg -03-Doc 07 -Annex B 1
Report to the Board
4-5 December 202 4
Annex B: Key risks and mitigations associated with mpox and Gavi’s response

Key risks and challenges Proposed mitigations
Delivery support: Lack of clarity on
delivery supporting funding, scope /
scale and timeliness of this going
countries
Comprehensive mpox response
financing tracker launched by the G20
Health Financing Taskforce to track
funding commitments, pledges and
disbursements. O ngoing discussions to
share intelligence across partners (e.g.:
Continental IMST)
Mpox vaccination in children under
12: Use of with MVA -BN for under 12s
would be off -label, with clinical
effectiveness data for use in infants not
expected in the near term; LC16
presents programmatic challenges

Countries can follow WHO policy
position and opt to use MVA -BN off -label
for under 12 year olds (noting this
generates indemnification & liability
challenges) . WHO has offered to
implement a protocol for expanded
access using WHO’s insurance, in the
short term, if no alternative is available.
WHO PQ granted for MVA -BN in 12 -17
year olds (noting countries’ national
regulatory authorities have yet to apply
this recommendation to facilitate the
inclusion of this population).
Technical assistance can be provided to
countries to assist in LC16 specific
training and programmatic needs
Partner coordination: Broad and
inclusive with many partners, where
roles and decision making need to be
clear - for timely and coordinated
response
Coordination structures are in place
across key partners, with several critical
mechanisms and high -level roles and
responsibilities being refined
Supply & Demand forecasts: Need for
timely supply and clear demand from
across affected countries
Supply and Demand are dedicated
cross -partner workstreams to support
alignment

Uncertainties: Uncertainties linked to
financing landscape, epidemiological
evolution of mpox outbreak, country
demand and timelines associated with
the integrated response strategy all
generate challenges in planning and
implementation
Cross -partner structures in place offer
appropriate avenues to share critical
intelligence, to strategize together and to
mitigate key risks and challenges as they
arise

1


Board -2024 -Mtg -03 -Doc 09 UPDATED
Report to the Board
4-5 December 2024
Subject Financial update, including f orecast and Partners’ Engagement
Framework and Secretariat Budget 2025 - UPDATED
Agenda item 09
Category For Decision

Executive Summary
This paper presents (i) the updated Financial Forecasts for Gavi 5.1 (2021 -2025)
and COVAX AMC (including ongoing approved funded programmes and subject to
donor repurposing ) and (ii) the 2025 annual budgets for the Secretariat and for those
Partners’ Engagement Framework (PEF) categories not covered by the Programme
Funding Policy for Gavi Board approval based on the recommendation from the
Audit and Finance Committee (AFC) .
Financial Forecast s
Country demand for Gavi support has significantly increased over the course of the
Gavi 5.1 strategic period (Annex A ). This is a testament to countries’ strong
commitment to immunisation , their ability to bounce back after the COVID -19
pandemic and the important role of the Alliance in supporting countries over the
course of 5.1 , specifically a refocus on routine immunisation, renewed momentum
on established vaccine programmes (e .g. HPV) , new vaccine launches (e .g.
Malaria , some of which could have been expected in 6.0 ) and a n increase in
outbreaks and campaigns after the pandemic.
Within this context, t he Secretariat has reflected the following in the forecast
(i) repurpose d US$ 732 million of COVAX AMC funds , now forecast as available for
Gavi 5.1 Programmes , (ii) updated the programme forecast by US$ 860 million
based on the latest insights from country applications for Gavi support , detailed
review of all programme envelopes and anticipated disbursement s and utilisation ,
and (iii) put additional focus on recovering /repurposing ageing in -country cash
balances with a targeted reduction of US$ 60 million by the end of 2025 . Based on
these actions to explore all available sources of funding to cover demand , the
Secretariat has assessed that there are currently sufficient resources to cover
forecast disbursements based on country demand , s upply considerations and
considering likely execution risks.
In parallel, the Secretariat has taken a prudent and proactive approach and prepared
an updated Prioritisation Mechanism for Gavi’s Support to Countries for Gavi 5.1 ,
which has been recommended for Board approval at the Programme and Policy
Committee ’s (PPC) November 2024 meeting 1. The PPC confirmed that t his
mechanism should only be applied as a last resort, in cases where projected country
demand exceed s available funding during the remaining Gavi 5.1 period and the

1 This mechanism provides a pathway for the Secretariat to make prioritisation decisions for country support
based on a Board -agreed approach. It ensures that the most impactful country applications are prioritised .

Board -2024 -Mtg -03-Doc 09 -Annex A 1
Report to the Board
4-5 December 202 4
Classified as Internal
Annex A

Financial Forecast Additional Info (Gavi 5.1 2021 – 2025)
1. Consolidated Financial Forecast (2021 -2025)
The o verview below of Gavi 5.1 and COVAX AMC (including ongoing approved
programmes), provided for illustrative purposes and sets out the total resources
and expenditure of Gavi during the strategic period (2021 -2025) . Unless
otherwise stated, commentary and analysis are provided at the Gavi 5.1 and COVAX
“sources of funds” basis .
Fig ure 1: Consolidated Financial Forecast (2021 – 2025)

Excludes i n-kind resources (Dose Sharing) US $ 6,668 million
US$ million, cash-flow basis GAVI 5.1
(v22)
COVAX 2020-
2025 (v22)
Consolidated
GAVI 5.1 &
COVAX AMC
Assured resources 2021-2025 10,511 13,175 23,686
Allowance for Further Direct
Contributions (not yet pledged) 300 300
Qualifying Resources 10,811 13,175 23,986
$10.8 bn $13.2 bn $24.0 bn
Forecast Expenditure 10,651 11,529 22,180
$10.7 bn $11.5 bn $22.2 bn
COVAX AMC balance 1,646 1,646
Available for future investments 160 0 160
$0.2 bn $0.0 bn $0.2 bn

1


Board -2024 -Mtg -03 -Doc 10

Report to the Board
4-5 December 2024
Subject Prioritisation Mechanism - UPD ATED
Agenda item 10
Category For Decision

Executive Summary
This paper proposes to the Board that i t approve an update to the
Prioritisation Mechanism for Gavi’s Support to Countries (approved as
‘Prioritisation Mechanism for New Vaccine Support Policy ’ in 2013 ) for the remainder
of the 5.1 strategic period . The proposed update to the dated mechanism follows a n
interim review , conducted as a good practice to align it with Gavi 5.1 strategic
priorities , and has been recommended for approval by the Programme and Policy
Committee (PPC) . The updat ed mechanism is intended to prioritise Gavi’s funding
decisions for support to countries in case of a situation in the course of a strategic
period where country demand for Gavi programmes exceeds available resourcing ,
entailing a projected mismatch of demand and resources .
Country demand for Gavi support has significantly increased since the
COVID -19 pandemic and as the Alliance nears the final year of the Gavi 5.1
strategic period. This is a testament to countries’ strong commitment to
immunisation, and the important role of the Alliance in supporting countries over the
course of 5.1 . As a result, should projected programmatic demand exceed available
funding during the remaining Gavi 5.1 period , the Secretariat would either need to
confirm availability of new resources or apply the updated prioritisation m echanism
to ensure that the most impactful applications are funded in Gavi 5.1 and resources
are managed sustainably .
The updated mechanism retains the principles of objectivity, transparency
and feasibility, with additions of honouring continuity and predictability of
support. These principles inform the updated scope of the mechanism . New
vaccine support and associated cash support stays within scope, with the innovation
top -up added . Of these, a ll applications that have not yet been committed via
Decision Letter s are in scope, including those forecast ed over the remainder of the
5.1 strategic period. The existing objectives of minimising loss of health impac t,
maximising value for money , improving financial sustainability of immunisation
programmes and maintain ing equitable access to vaccines are retained, with
adjustments to some indicators . Two new objectives are added : Upholding health y
markets for vaccines and related products , and m inimis ing risk of disruptive future
outbreak s and impact on global health security. The mechanism would be applied
following rounds of the Independent Review Committee (IRC) when there is a
projected mismatch of demand and resources until such a time passes.
The PPC reviewed the updated mechanism during its meeting on 20 November
2024 . The Committee broadly agreed with the proposed updates and asked t he
Secretariat to consider integrat ing country pr iorities in the mechanism . A proposed

Board -2024 -Mtg -03 -Doc 10 -Annex A 1





DOCUMENT ADMINISTRATION


VERSION
NUMBER APPROVAL PROCESS DATE
1.0
Prepared by: Gian Gandhi, Policy and
Performance
Reviewed by: Gavi Programme and Policy
Committee 16 April 2010
Approved by: Gavi Alliance Board 17 June 2010
2.0
Prepared by: Nina Schwalbe, Policy and
Performance
Reviewed by: Gavi Programme and Policy
Committee 30 April 2013
Approved by: Gavi Alliance Board 12 June 2013
3.0
Prepared by: Gavi Policy and Strategy,
Funding & Performance teams
Reviewed by: Gavi Programme and Policy
Committee 20 November 2024
Approv ed by: Gavi Alliance Board 5 December 2024 TBD
Next review: 2025
Gavi Alliance
P rioritisation M echanism for
Gavi ’s S upport to C ountries
Version 3.0
Board -2024 -Mtg -03 -Doc 10 -Annex A 2
1. Purpose & Objectives
1.1. The purpose of the policy is to inform Gavi’s funding decisions for support to countries
in the case of a mismatch of expen ditures demand and resources in the course of a
strategic period . The policy enables the ranking of country applications recommended
for approval by the Independent Review Committee (IRC) or equivalent body 1 in the
event that available resources are not sufficient to fund all country applications
recommended for approval in an application round.
1.2. Specifically, the prioritisation mechanism is directed by s ix objectives to: (i) M inimise
loss of health impact; (ii) Maximise value for money; (iii) Maintain equitable access to
vaccines ; (iv) Safeguard financial sustainability of programmes ; (v) Minimise risks of
disruptive outbreaks and impact on global health security; and (vi) Minimise risks to
market health .
2. Principles
2.1. The following principles guide the development and scope of the policy :
• Objectivity: rely on evidence -based criteria and published data .
• Transparency: ensure clear and accessible criteria (objectives and indicators) and
rely on broadly available data whose validity is accepted by Gavi -eligible countries
and Alliance partners , a s well as clarity in communication about decisions .
• Feasibility & Simplicity : ensure ease of implementation of the policy and ensure
data are available and comparable across Gavi -eligible countries and updated on
a regular basis .
• Continuity of Support for ongoing programmes : seek to minimise disruptions
to on -going programmes and activities by honouring support which has been firmly
committed to countries via decision letter s after recommendation by the
Independent Review Committee (IRC) or equivalent body .
• Predictability of Support for planned programmes : seek to uphold country
access to support for which country -specific funding envelopes that can be
accessed through an application process have been communicated 2). The
principle highlights that support countries have been planning for should be
honoured.
3. Scope
3.1. The policy appl ies to Gavi support for which countries apply and which are reviewed
by the IRC or equivalent bodies .
Types of country support
3.2. New vaccine support: Funding decisions for new vaccine support (NVS) are subject
to the prioritisation mechanism . This includes routine introductions , preventive, follow -
up and catch -up campaigns, and vaccine switches that are not mandatory and come
at a higher incremental cost to Gavi, along with their respective cash support 3, as well
as vaccine catalytic support for Middle Income Countries (MICs ). NVS applications for
1 For example, s ome application types are reviewed by the S ecretariat instead of the IRC 2 This usually takes place at the beginning of a strategic period. 3 Vaccine Introduction Grants (VIGs) for routine immunisation and operational cost grants (Ops) for campaigns

1
Board -2024 -Mtg -03-Doc 10 -Annex B
Report to the Board
4-5 December 2024
Annex B: Additional detail on updates to the mechanism and s imulated ranking of country
applications
Contents
1. Summary of key changes to the prioritisation mechanis m
2. Overview of the scope of the updated prioritisation mechanism for Gavi 5.1
3. Implications of the operationalisation of the priority mechanism
4. Proposed changes to indicators and application of indicators
5. Rationale for proposed changes to weighting
6. Detailed flow of country applications through Gavi’s funding cycle over IRC rounds
7. Inclusion of inclusion of country priority parameter s
1. Summary of key changes to the prioritisation mechanism
Existing mechanism Proposed mechanism
Principles Objectivity, transparency,
feasibility
Existing principes + simplicity, continuity of support and
predictability of support
Scope

Category of
application
Applications from countries
recommended for approval by
the IRC on a round -by-round
basis
Informed by ‘continuity of support’ principle: protect
ongoing country programmes focusing prioritisation on
country applications not yet binding inc luding:
i. Applications forecasted (for 2025)
ii. Applications recommended for approval in an IRC
round
iii. Applications previously IRC recommended and with no
decision letter issued yet
Types of
support
Restricted to New Vaccine
Support applications from
countries
Informed by ‘predictability of support’ principle : protect cash
grants with communicated ceilings (incl. HSS, EAF, TCA)
and focus prioritisation on:
i. New Vaccine Support applications 1
ii. Cash grants with no communicated ceilings (Innovation
Top Up)
Objectives
• Maximise health impact (30%)
• Maximise value for money
(30%)
• Reinforce financial
sustainability of immunisation
programmes (25%)
• Support countries with the
greatest needs (15%)
• Promote equitable distribution
of Gavi’s resources among
countries (each country can
only prioritise one application)
Changes to objective names to better reflect intention
No change:
• Maximise value for money (30%)
Refined indicators:
• Minimise loss of health impact (30%)
• Safeguard financial sustainability of programmes (30%)
• Support countries with greatest needs indicator moved
under ‘financial sustainability’ objective
• Maintain equitable access to vaccine (10%)
New:
• Minimise risk of disruptive future outbreaks and impact
on global health security (qualitative assessment)
• Minimise risks to market health (qualitative assessment)
1. Includes preventive, follow up, catch up campaigns, MICs vaccines) and related cash grants (VIGs & Ops). Exclude outbreak response, switch grants; incl. Applications linked for epidemiological reasons to be assessed together

Board -2024 -Mtg -03-Doc 11 1
Report to the Board
4-5 December 2024

Subject Update from Ethics, Risk and Compliance Office
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 9th Annual Risk & Assurance Report 2024 attached as Annex A and (ii) the
updated Risk Policy attached as Annex B. Both the Annual Risk & Assurance Report
2024 and the updated Risk Policy have been reviewed and recommended for
approval by the Audit & Finance Committee (AFC) . The Annual Risk & Assurance
Report 2024 has also been reviewed by the Programme & Policy Committee (PPC).
The report discusses the most critical risks that could have an impact on the ability
of the Alliance to deliver on its mission and achieve its strat egic goals. As a key
component of Gavi’s Enterprise Risk Management (ERM) strategy, the updated Risk
policy is intended to guide the Alliance’s strategic and operational decision making
on risk management to achieve optimal outcomes .
Action Requested of the Board
The Gavi Alliance Audit and Finance Committee recommends to the Gavi Alliance
Board that it :
a) Approv e the Annual Risk & Assurance Report 2024 attached as Annex A to Doc
10 ; and
b) Approve the updated Risk Policy attached as Annex B to Doc 10.
Next steps/timeline
Following the Board’s approval :
• The Annual Risk & Assurance Report 2024 will be published on Gavi’s intranet
and website; and
• The updated Risk Policy will be effective as of 1 January 2025 .

September 2024
gavi.org
Annual Risk and
Assurance Report
2024
Doc 11 - Annex A
Contents
1 The Report 3
Foreword from Gavi’s CEO 4
1.1
In

troduction 5
1.2
Executiv

e summary 6
1.3
General con

text 9 4 Annexes 32
4.1
Methodol

ogy 33
4.2
Gavi’

s risk appetite statement 36
4.3
Last y

ear’s top risk profile 37
4.4
180-Day pl

an interventions 39
4.4
A

cronyms 42 2
Gavi’s Risk
Landscape in 2024
10
2.1
The Alliance top risks 11
2.2
Spo

tlight on other relevant risks 26 3
The Future of Ethics,
Risk and C
ompliance
29
3.1
Risk management 30
3.2
Ethics and compliance 31
2
Cover image: Gavi/2024/Mulugeta Ayene
Photo credits: Gavi/2024/Running Reel; Gavi/2024;
UNICEF/2023/Mapalo Mwenya; UNICEF/Togo/2023/Combetey
2024 Annual Risk and Assurance Report
Doc 11 - Annex A

Board -2024 -Mtg -03 -Doc 11 - Annex B 1

Gavi Alliance
Risk Policy
Version 2.0




DOCUMENT ADMINISTRATION



VERSION
NUMBER APPROVAL PROCESS DATE
1.0
Reviewed and recommended by:
Gavi Programme & Policy Committee
10 November 2014

Reviewed and approved by: Gavi,
the Vaccine Alliance Board

11 December 2014
Effective from: 1 January 2015
2.0 Reviewed by: Audit and Finance
Committee [8 October ] 2024

Approv ed by: Gavi Alliance Board


[4-5 December] 2024
Effective from : [1 January] 2025
Next review: As and when requested





Board -2024 -Mtg -03 -Doc 11 - Annex B 2

Gavi Alliance
Risk Policy

1. Purpose
1.1. Gavi, the Vaccine Alliance (henceforth refer red to as ‘Gavi ’), recognises that its
ambitious mission, its focus on lower -income countries, its operating principles and
its business model come with inherent risks. The Alliance’s mandate requires
working in settings and with an urgency that could expose decision makers and
implementers to dilemma of managing programmes within acceptable levels of risk
exposure. Therefore, there is the necessity for the Alliance to identi fy the risks and
opportunities that could arise in the pursuit of its objectives.
1.2. Gavi recogni ses that objectives can only be achieved by taking calculated and
carefully managed risks. Some high -impact opportunities may require taking
greater risks.
1.3. Gavi aims to make risk management integral to its culture, strategic planning,
decision making and resource allocation. A coordinated and structured approach
allows the Alliance to proactively manage risk.
1.4. This policy is intended to guide the Alliance’s strategic and operational risk
management activities to achieve optimal outcomes, by:
1.4.1. creating a consistent risk language and a shared understanding of risk
concepts.
1.4.2. promoting a culture of risk awareness, which encourages careful
assessment of risks and benefits involved with Gavi operations and decision -
making.
1.4.3. providing high level guidance on risk management.
2. Scope
2.1. Gavi Risk Policy forms the overarching framework for Gavi’s risk management
approach, which is embedded across the Alliance in various structures and
processes for risk monitoring, reporting and mitigation.
2.2. This Risk Policy applies to the following stakeholders:
• Gavi’s Alliance Board;
• Audit and Finance Committee (AFC);
• Senior Leadership Team (SLT);
• Ethics, Risk and Compliance Office (ERCO); and
• Gavi Secretariat Staff .
3. Definitions
3.1. A Risk in the context of this policy is an event that may or may not occur and that
could have a detrimental impact upon the achievement of the Alliance's mission
and objectives if it were to occur. A risk can be inherent or residual.
3.1.1. Inherent risk (or gross risk) refers to the level of risk that exists in an
activity, process, or organization without considering any internal controls or risk
mitigation efforts .

Board -2024 -Mtg -03-Doc 12 1
Report to the Board
4-5 December 2024

Subject Road to Replenishment
Agenda item 12
Category For Information

Executive Summary
On 20 June 2024, Gavi launched its Investment Opportunity (IO) for the 2026 -2030
period (Gavi 6.0), as well as the groundbreaking African Vaccine Manufacturing
Accelerator (AVMA), convening seven Heads of State, 25 Ministers, and over 200
senior representatives from key Gavi stakeholders. France, Spain, and the United
States (US) provided a strong start to Gavi’s public replenishment campaig n by
announcing a total of US$ 2.4 billion in pledges. AVMA resonated strongly at a
political and practical level, demonstrating Gavi’s strengths of partnership,
innovation, and sustainability. Notwithstanding the political and financial success of
the lau nch event, the global geopolitical situation has grown more challenging with
continued budgetary pressures and elections in many countries, ongoing conflicts,
as well as other replenishment processes within the global health and development
space. The Secr etariat continues to adjust via a dynamic and agile approach,
adapting our replenishment campaign to respond to such challenges. Under the
strategic vision provided by the IO, specific and targeted market strategies have
been developed. These have helped t o maximise donor engagement, empower
advocates from civil society, and mobilise Gavi’s influential champions from both
donor and implementing countries. Following the launch event in Paris, the
European Commission (EC) made a high -visibility pledge to Gavi during the United
Nations General Assembly (UNGA) and stated that Europe will do its fair share. To
fund its 6.0 activities costing at least US$ 11.9 billion, Gavi is working to finalise the
level of assured resources to US$ 2.9 billion and to bring in ne w pledges for at least
US$ 9 billion (of which US$ 2.8 billion has been secured to date) both in direct
contributions and through innovative financing sources. Focused replenishment
activities will continue into 2025 to continue to build the momentum towar ds a final
Replenishment Summit.
Th e priorities for the Secretariat in the coming months are to:
• Finali se discussions with donors on funds for 5.0/5.1, confirm assured
resources for 6.0 and obtain new pledges for 6.0, including early pledges
• Double -down on an agile and flexible public replenishment campaign,
building on key global events notably at the World Economic Forum annual
meeting in Davos which will include Gavi’s 25 th anniversary leading to Gavi’s
Replenishment Summit in the first half of 2025

Board -2024 -Mtg -03-Doc 13 1
Report to the Board
4-5 December 2024

Subject Update on Collaboration with Other Organi sations
Agenda item 13
Category For Information

Executive Summary
The purpose of this paper is to provide an update on Gavi’s collaboration and recent
engagement with other global and regional health institutions. This includes: i) an
update on Gavi’s engagement with the Lusaka Agenda with a focus on Gavi’s
collaboration with GPEI ; ii) an update on Gavi’s enhanced collaboration across four
workstreams (malaria, health systems strengthening (HSS), country engagement,
enabling functions and operations) with a fifth under development (tuberculosis) with
the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and the
Global Financing Facility (GFF); iii) the formation and readout from the first meeting
of the ‘Joint Committee Working Group’; and iv) a summary of engagement with the
African Union (AU) and Africa Centres for Disease Control and Prevention (Africa
CDC), including the finalisation of the Africa CDC Grant A greement and the launch
of its programme of work. This paper builds on recent discussions including the
October 2024 meeting of the Programme and Policy Committee ( PPC ), and the
previous June 2024 governance cycle. Other related topics at the December 2024
Board meeting include CEO Update, including Strategy, Programmes and
Partnerships; Health Systems Strategy; and Gavi 6.0 Operationalisation (evolution
of the partnership approach , 6.0 measurement framework ).

Action Requested of the Board
This report is for discussion only.
Next steps/timeline
Gavi will continue to collaborate with the Global Fund and the GFF to drive progress
across the four priority workstreams with close sponsorship from the Gavi CEO,
Global Fund Executive Director and GFF Director and regular updates to the Joint
Committee Working Group, Board and Committees as relevant. Gavi will also
continue to collaborate with Africa CDC on implementation of the Grant Agreement
as well as African Vaccine Manufacturing Accelerator (AVMA) and the mpox
response, and these collaborations will inform the evolution of Gavi’s operating and
partnership model in Gavi 6.0.

Board -2024 -Mtg -03-Doc 13 -Annex A 1
Report to the Board
4-5 December 202 4
Annex A: Gavi -Global Fund -Global Financing Facility Enhanced Collaboration –
Workstream Updates

As noted in the main paper, the Enhanced Collaboration effort is organised into four
key workstreams including: i) country engagement; ii) Health Systems Strengthening
(HSS); iii) malaria; and iv) back office and enabling functions, noting that there are
many interdependencies across these workstreams and the GHIs’ engagement at
country level must be tailored and unique to each country context. There is also a fifth
and emerging workstream on tuberculosis which will build on early lessons from the
malaria collaboration workstream.

i) Enhancing country engagement through “wave 1” countries

To operationalise this increased ambition around our collaboration, this work is moving
forward with an enhanced approach to country engagement in a small group of
“wave 1” countries . This is based on country requests to model and drive enhanced
collaboration in their context. Several countries have already confirmed including
Ethiopia, Mozambique, Guinea, Chad and Malawi. Several additional countries are
also in discussions with the three GHIs to determine if they would also want to be part
of this initial phase. In these wave 1 lead c ollaboration countries, the three GHIs will
leverage existing work in -country and further focus our efforts to unpack, align to
country plans and, where applicable, reform the processes, relationships,
mechanisms and funding levers to establish greater coh esion in support of country
leadership across our respective programmes, leveraging one another’s comparative
advantages. The intention is that this wave 1 will quickly be followed by a wave 2 with
another set of countries already indicating interest for future increased involvement.

This enhanced approach to country engagement has so far included the
establishment of regular cross agency country team meetings, mapping of
existing collaboration efforts, and identification of opportunities for synergies,
complementarity of funding and alignment with country plans . In taking a
pragmatic, tailored and often opportunistic approach, not all enhanced collaboration
activities in each country will include all three GHIs. Under the leadership and
guidance of the countries, priorities and agreed actions will be identified per the
countries’ plans and steer, with the GHI country teams working though the Ministry of
Health and other sectoral Ministries as appropriate, as well as Country Coordinating
Mechanisms (CCMs) and Interagency Coordination Committees (ICCs ) or other in -
country coordinating mechanisms .

ii) Leveraging HSS investments across GHIs

In anticipation of increased engagement through wave 1, the HSS workstream
undertook mapping of existing collaborations and held two workshops to identify
opportunities for global alignment , both scaling up existing efforts and exploring newer
areas, drawing in relevant expertise across the GHIs . The initial mapping indicated a
number of technical areas where collaboration is already advanced, including data,
supply chain, and public financial management . Described further below, these

Countr y Engagement
Workstream
1Confirmed Wave 1 Countries
Doc 13 - Annex B
There are currently 5 confirmed lead collaboration
countries with others expected in the future
2Confirmed lead
collaboration countries that
will begin more formal
country dialogue to identify
gaps and opportunities in
GHI alignment within their
countries Confir med Wave 1
Has signaled a strong
interest in participating as
a lead collaboration
country; in the process of
obtaining official
confirmation Pending Wave 1
Progress as collaboration
country is on hold for now
due to political uncertainty. Paused Wave 1
Countries where Gavi, GFF,
and Global Fund will begin
internal mapping to determine
viability to participate as a
lead collaboration country Potential Wave 2
Ethiopia
Malawi
Mozambique Chad
Guinea Nigeria
Bangladesh
Ghana
Laos
Senegal
South Sudan
Doc 13 - Annex B

Malaria Vaccine
Guidelines on Gavi and Global Fund support
for complementary interventions to facilitate
the deployment of malaria vaccines
12 November 2024
Doc 13 - Annex C
2
1. Introduction
2.
Joint Gavi-Global Fund guidance on co-financing
3.
Gavi support
4.
Global Fund support
5.
Contact points for further information
Annex 1: Illustrative activities for Gavi vaccine introduction grants
Annex 2:

Illustrative activities to support malaria vaccination
within Gavi’s health systems strengthening grants
Annex 3: Global Fund RSSH-PPR modules and interventions that include
activities relevant to systems support for the roll-out of the malaria vaccines
Annex 4: Mapping of Global Fund GC7 Modules and Gavi Investment Areas
Endnotes
Contents
Gavi, the Vaccine Alliance, and the Global Fund to Fight AIDS,
Tuberculosis and Malaria are working together to strengthen the
impact of their collective investments. As part of their collaboration
on malaria, the organisations have put together this joint guidance
document that sets out the programme areas that each organisation
can support in relation to the deployment of the malaria vaccines,
including on co-financing requirements of each organisation.
Cover credit: The Global Fund/2023/Nana Kofi Acquah
3
3
4 5
5
6 7
9
11
13

Doc 13 - Annex C

Clas s if ied as Inter nal
gavi.org
REPORT FROM AUDIT & INVESTIGATIONS
BOARD MEETING
Lucy Elliott
4 -5 December 2024, Bali, Indonesia
How has A&I fulfilled its ToR in 2024?
Overseen, reviewed and monitored by the Audit and Finance Committee
2 Board Meeting, 4 -5 December 2024
• Recommendations for improvement in governance,
risk management and control in the Secretariat and
Gavi implementing countries
• Reinforced country accountability
• Audit quality
• US$ 46.9 million identified since 2009
• US$ 43.8 million repaid as at the last report to the AFC
• Objective is 100% recovery
• Fraud risk assessment methodology piloted
• Advice to management on Gavi’s policies around ethics etc
• Appropriate treatment of reports
• Accountability
A&I’s Terms of Reference will need updating in 2025
AFC -approved work plan of country -
and secretariat -focused audits
Identification of misuse
Preventive counter -fraud work
Confidential whistle -blower reporting
Investigative activity

1


Board-2024-Mtg- 03-Doc 15

Report to the Board
4-5 December 202 4

Subject Review of decisions
Agenda item 15
No paper

1


Board-2024-Mtg- 03-Doc 16

Report to the Board
4-5 December 202 4

Subject Any other business and Closing remarks
Agenda item 16
No paper

Board-2024-Mtg -03-Doc A

1

Gavi Alliance Board Meeting
4-5 December 2024
Hilton Bali Resort, Bali, Indonesia


Board and Committee minutes
Pages MINUTES
1 - 31 Board – 6-7 June 202 4
32 Board – 19 Jul y 202 4 (No -objection consent)
33 Board – 1 5 August 202 4 (No -objection consent)
34 Board – 15 August 202 4 (No -objection consent)
35 Board – 16 September 202 4 (No -objection consent)
36 Board – 2 October 202 4 (No -objection consent)
37 Board – 29 October 2024 (No -objection consent)
38 Board – 8 November 2024 (No -objection consent)
- Market -Sensitive Decisions Committee – 16 September 2024 *
39 Audit and Finance Committee – 20 August ( Unanimous Consent )
40 - 48 Audit and Finance Committee – 8 October 202 4 (Decision slides)
49 - 50 Audit and Finance Committee – 27 November 2024 (Agenda)
51 - 61 Programme and Policy Committee – 22 -24 October 2024 (Decision
slides)
62 Programme and Policy Committee – 20 Novem ber 2024 ( Agenda )
63 Governance Committee – 8 July 202 4 (No -objection consent)
64 Governance Committee – 2 August 202 4 (No -objection consent)
65 Governance Committee – 2 August 2024 (No -objection consent)
66 Governance Committee – 2 September 2024 (No -objection consent)
67 Governance Committee – 18 September 202 4 (No -objection consent)
68 - 71 Governance Committee – 1 October 2024 (Decision slides)
72 Governance Committee – 16 October 2024 (No-objection consent)
73 Governance Committee – 2 8 October 2024 (No -objection consent)
74 Investment Committee – 18 September 2024 (Agenda)
75 - 77 Investment Committee – 14 November 2024 ( Decision slides )
78 - 80 Evaluation Advisory Committee – 2 5 -2 6 September 2024 (Decision
slides)

2023
Annual Progress Report
List of figures and tables 3
Introduction from Dr. Richard Hatchett, CEO 5
2023: CEPI’s achievements in numbers 8
Background to the 2023 Report 11
Progress Against the Strategic Objectives 16
Strategic Objective 1: PREPARE for known epidemic
and pandemic threats 17
1.1 End the acute phase of the COVID-19 pandemic 20
1.2 Accelerate the development of vaccines and other
biologic countermeasures against known high-risk pathogens
23
1.3 Reduce the risk of further coronavirus pandemics 28

Strategic Objective 2: TRANSFORM the response
to the next novel threat 31
2.1 Use vaccine prototypes and platform initiatives
to give a head-start on novel threats
31

2.2 Scale enabling sciences to further accelerate
vaccine development
35
2.3 Transform vaccine manufacturing 39

Strategic Objective 3: CONNECT to enhance and expand
global collaboration 41
3.1 Secure financing for epidemic preparedness and response 42

3.2 Coordinate among key stakeholders to enable system readiness 43
3.3 Equitable access principles as the foundation of any
effective global response
50
Funding and Finance 56
4.1 Contributions from investors 56

4.2 R&D&M Project disbursements 57
4.3 Operating expenses (Opex) and total expenditure 60
4.4 Procurement 61
Risk management 63
5.1 Risk Management 63
5.2 Compliance 64
5.3 Security and organisational resilience 66
Appendices 68
Appendix 1: Organisational update 69
Appendix 2: Monitoring, Evaluation and Learning 70
Appendix 3: Finance 74
Appendix 4: Human Resources 75
Appendix 5: CEPI Board Summary 76
Appendix 6: Summary of the Scientific Advisory Committee 78
Appendix 7: Summary of the Joint Coordination Group 78
Table of contents

gavi.org
REVIEW OF DECISIONS
BOARD MEETING
4 -5 December 2024, Bali, Indonesia
Decision 1: Consent Agenda: Board Chair Recruitment
The Gavi Alliance Board:
Endorsed the amendments to the process for the appointment of Board Chair and in line with this amended process
(Annex A to 01d), as read with Section 4.B of the Governance Committee Charter:
a) Delegated to the Governance Committee the authority to set up and oversee the process for the recruitment of a
Board Chair to succeed Professor José Manuel Barroso at the end of his term on 31 December 2025; and;
b) Delegated to the Governance Committee the authority to establish a Search Committee for this purpose.
Board Meeting, 4 -5 December 2024

gavi.org
CEO'S REPORT,
INCLUDING
STRATEGY,
PROGRAMMES AND
PARTNERSHIPS
Update photo
To be completed
To be completed
BOARD MEETING
S ania Nishtar
4 -5 December 2024, Bali, Indonesia
Gavi/2024/Jjumba Martin
CEO Board Update
2
Embracing the future Operating context:
challenges and opportunities
Strategic and programmatic
performance
• Operating context: impact on
Gavi and implementing countries
• Conflict, fragility and risk: global
risk elevated; global economic
picture mixed;
new opportunities, technology and
innovations to address challenges
• Mission indicators: strong
performance, on track (except
reaching zero -dose children); most
Gavi 5.0/5.1 targets on track
(except DTP3 & MCV1 coverage)
• Must -wins: significant progress on
revitalised HPV vaccine
programme (on track to reach 86m
girls by end 2025); 23 malaria
vaccine applications approved;
funding for ‘The Big Catch -up’ fully
committed
• 180 -day plan achievements:
launched key reforms, initiatives
• 2025 priorities: Gavi 5.1 delivery,
getting ready for Gavi 6.0,
successful replenishment, build a
stronger Secretariat
• Getting ready for Gavi 6.0: five
workstreams to operationalise
strategic and operational shifts
• Building a stronger Secretariat :
leadership structure, SLT, decision -
making, delivery architecture
Board Meeting, 4 -5 December 2024

gavi.org
JOINT ALLIANCE UPDATE
ON COUNTRY DELIVERY
BOARD MEETING
Thabani Maphosa
Kate O’Brien
Ephrem Lemango
4 -5 December 2024, Bali, Indonesia
List of acronyms
1. BCU –Big Catch -Up
2. CCE/CCEOP –Cold Chain Equipment / Optimisation Platform
3. CSO –Civil Society Organisations
4. CDS –COVID -19 Delivery Support
5. DHS –Demographic and Health Surveys
6. DRC –Democratic Republic of Congo
7. DTP3 –Third dose of diphtheria, tetanus and pertussis -
containing vaccine
8. EAF –Equity Accelerator Fund
9. ELTRACO –Gavi Alliance policies on Eligibility, Transition and
Co -financing
10. EPI –WHO Expanded Programme on Immunization
11. F&C –Fragile & Conflict Countries
12. FED –Fragility, Emergencies and Displaced Populations Policy
13. FMOH –Federal Ministry of Health
14. GMRs –Grant Management Requirements
15. HSS –Health System Strengthening support
16. HI –High Impact Countries
17. HPV – Human papillomavirus
18. IRC – Independent Review Committee
19. LMC – Gavi Alliance Leadership, Management &
Coordination workstream
20. MAC - Multi -Age Cohort
21. MCV1 – First dose of measles -containing vaccine
22. MICs – Middle -Income Countries
23. MOH – Ministry of Health
24. NITAG – National Immunization Technical Advisory Group
25. OOC – One -off costs
26. PEF – Partners’ Engagement Framework
27. PCV – Pneumococcal Conjugate Vaccine
28. PHC – Primary Health Care
29. PIRI - Periodic Intensification of Routine Immunisation
30. RI – Routine Immunisation
31. R+MAC – Routine + Multi -age cohort
32. Rota – Rotavirus
33. SIAs – Supplemental Immunisation Activities
34. TA – Technical Assistance
33. TCA – Targeted Country Assistance
34. UI – Under Immunised
35. UCC – Ultra -cold chain
36. VIGs – Vaccine Introduction Grants
37. VCF – Vaccine Catalytic Financing
38. WUENIC - WHO/UNICEF Estimates of
Immunization Coverage
39. ZD – Zero -dose
40. ZDC – Zero -dose children
41. ZIP – Zero -dose Implementation
Programme
Board Meeting, 4 -5 December 2024

gavi.org
GAVI 6.0 STRATEGY
OPERATIONALISATION:
GETTING READY TO DELIVER
ON THE NEXT STRATEGIC
PERIOD
BOARD MEETING
Johannes Ahrendts, Amy LaTrielle
4 -5 December 2024, Bali, Indonesia
High - level approach to get us ready to deliver on
Gavi 6.0 with five key workstreams
2
Recommendation for decision
For guidance Strategy / design finalisation
Gavi 6.0 theory of
change and measurement
framework
Sub -strategies , including:
• Health Systems Strategy
• Approach to Fragile
& Humanitarian settings
• Market shaping strategy
Funding Policy Review :
• Eligibility, Transition Co -financing
• Health Systems and Immunisation
Strengthening
Beyond Funding Policy Review:
• Vaccine prioritisation & optimisation
• Vaccine donation policy
Policy
Implementation
Evolution of partnership approach :
• Accelerate collaboration with GHIs in context of Lusaka agenda
• Update the Alliance partnership model, redesign PEF
Update of Secretariat operating model :
• Roll out grant management reform (EVOLVE) incl. tools for access to funding and
IRC transformation
• Operational effectiveness and efficiency initiatives
• Update of vaccine, programme funding and other operational guidelines
• Reprogramme HSS -like support in line with 6.0 objectives
• Country Delivery Initiative
2
4
5
3
Item 6A
Item 6B
Item 6C
Item 6
1
Workstreams 1 -3 inform the design and implementation of workstreams 4 and 5
Board Meeting, 4 -5 December 2024

Board-2024-Mtg-03- Doc 06a 1
Report to the Board
4-5 December 2024

Subject Health Systems Strategy
Agenda item 06a
Category For Guidance

Executive Summary
The purpose of this paper is to seek guidance from the Board on the foundational
elements of Gavi’s first -ever Health Systems (HS) Strategy. The pr oposed HS
Strategy is detailed in Annex A and introduces a new theory of change with two
goals of equity and sustainability and six pillars guiding Gavi’s HS investments as
well as five shifts needed to deliver on it:
i. A systematic approach to differentiate health systems investments, with the
ultimate goal of ensuring programmatic sustainability ;
ii. Consolidation of health systems programming and planning for routine
immunisation alongside campaigns ;
iii. Harmonised ecosystem to catalyse innovation on health systems across and
beyond the Alliance;
iv. Strengthened partnerships and collaboration in country to implement a
PHC- driven approach to immunisation; and
v. Intentional measurement, monitoring and learning.
The HS Strategy has been informed by guidance received from the P rogramme and
Policy Committee in May 2024 and Board in June 2024 and by the PPC at its
October 2024 meeting and by consultations with countries and Alliance partners. It
has been co-developed with the Health Systems Strategy Technical Advisory Group
(TAG), which includes representatives from the World Health Organization (WHO),
UNICEF, World Bank, US Centers for Disease Control (CDC), Bill & Melinda Gates
Foundation, expanded partners including civil society organisations (CSOs), and the
Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund).
Action Requested of the Board
The Gavi Alliance Board is requested to provide guidance on :
a) the foundational elements of the Health Systems Strategy, including the
Theory of Change and key shifts attached as Annex A to Doc 06a.

Board -2024 -Mtg -03-Doc 0 6b 1
Report to the Board
4-5 December 2024

Subject Funding Policy Review
Agenda item 06b
Category For Information

Executive Summary
This paper provides an introduction to the review of Gavi’s core funding polices ,
namely the : a) Eligibility and Transition Policy; b) Co -Financing Policy (both policies
together are known by the acronym ELTRACO), and the c) Health Systems and
Immunisation Strengthening (HSIS) Policy. The Funding Policy Review (FPR)
proposes changes to programmatic policies needed to deliver on the Gavi 6.0
strategy (incl. the proposed new Health Systems Strategy ), providing important
inputs into the new end -to -end grants management approach (EVOLVE) and other
changes to the Secretariat operating model in 6.0 . The policy options outlined in
Docs 06bi and 06bii have been reviewed and recommended for approval by the
Programme and Policy Committee ( PPC ); and were informed by guidance from a n
FPR Task Team with representatives from the PPC and Board, and consultations
with countries, civil society organisations (CSOs) and vaccine manufacturers.
Technical guidance from Alliance partners was provided through an Alliance
Technical Team for the ELTRAC O policies and a Technical Advisory Group for the
HSIS Policy.
Action Requested of the Board
This report is for information only.
Next steps/timeline
At its December 2024 meeting, the Board will review policy options based on
recommendations from the PPC. Approved options will be incorporated into revised
policies submitted to the PPC and Board in May and June 2025, respectively.
Previous Board Committee or Board deliberations related to this topic
See Docs 06bi and 06bii for complete lists.

gavi.org
HEALTH SYSTEMS AND IMMUNISATION
STRENGTHENING POLICY
BOARD MEETING
Marta Tufet Bayona
4 -5 December 2024, Bali, Indonesia
Gavi is seeking approval to consolidate multiple
cash funding levers into one funding envelope
*Does not include funding for emergencies, including outbreak response
One consolidated cash grant for all health
systems and immunisation strengthening support*
Multiple funding levers for cash support
Health Systems
Strengthening
Vaccine Introduction
Grants
Equity Accelerator Fund
Operational support for
campaigns (M/MR Follow
up and other preventive
campaigns)
Switch Grant
Cold chain equipment
optimisation platform
Innovation top -up
From:
Partner’s Engagement Framework Targeted Country
Assistance
To: Proposal
Potential benefits:
+ Simplified processes
+ Reduced transaction
costs
+ Programmatic
efficiencies
Potential risks:
- Lower ability to target funding to
Gavi’s priorities
- Weak country planning capacity
- High level of effort for change
management
Portion of TCA (and potentially SFA) funds allocated
to core partners for key long -term country functions
before defining country ceilings
2 Board Meeting, 4 -5 December 2024

gavi.org
ELIGIBILITY, TRANSITION, AND CO - FINANCING,
INCLUDING CATALYTIC PHASE
BOARD MEETING
Benjamin Loevinsohn
Adriana Jimenez Cuen
4 -5 December 2024, Bali, Indonesia
ELTRACO Shifts and Catalytic Phase
A Coherent Continuum of Support for Countries
2
Board Meeting, 4 -5 December 2024 2
ISF countries
exposed to
price for some
vaccines Shift A
Additional programmatic
support for countries at risk
Shift E
SIDS
12 years of AT plus a one -time
downward co -financing
adjustment to 80%
Accompanied by an ELTRACO
Learning Agenda
Small Island Developing States
face specific and unique
challenges
Multi -year waivers or partial
co -financing for fragile
countries Shift F
A need for greater flexibility to
provide support in fragile
contexts
Co -financing in PT capped at 80%,
plus a 35% co -financing cap for new
vaccine introductions (NVIs) Shift C
Some countries in PT and AT face high & rapidly increasing
rates of co -financing and struggle to introduce new vaccines
ISF
Countries contribution
towards vaccine procurement
100%
80%
35%
AT
Low -income
threshold
PT
Gavi’s Eligibility
threshold
0%
Former Gavi Never Gavi
Catalytic Phase
End of Gavi support
LMIC
threshold
or IDA -eligible
Programmatic challenges pose a
risk to successful transition for
some countries
8 years of support for NVIs
in AT plus a 35% co -
financing cap for NVIs Shift D
NVIs
Limited price
sensitivity may lead
to unfavourable
demand
dynamics with
market shaping
consequences
• Eligibility threshold updated to US$ 2,300
• One -time downward adjustment of co -
financing to 80% for countries regaining
eligibility Shift B
Despite macro -economic difficulties & rising costs
of expanding vaccine portfolios, Gavi’s eligibility
threshold has remained constant in real terms
challenging countries’ ability to pay
Board Meeting, 4 -5 December 2024

Board -2024 -Mtg -03-Doc 0 6c 1
Report to the Board
4-5 December 2024

Subject Gavi 6.0 Measurement Framework
Agenda item 06c
Category For Guidance

Executive Summary
The purpose of this paper is to request that the Board provides guidance on:
i) potential key shifts to Gavi’s approach to measurement, evaluation and learning
(MEL) in Gavi 6.0, to be developed through the Gavi 6.0 Learning System Strategy ;
ii) the proposed design features of the 6.0 Measurement Framework, and iii) priority
topics for evaluations in Gavi 6.0.
The potential key shifts for MEL in 6.0 include coordinated MEL across the Gavi
results chain, strengthened MEL at country level, and use of adaptive learning
approaches. The design of the 6.0 Measurement Framework includes anchoring on
the Gavi 6.0 theory of change (TOC) and a proposed focus on indicators mapped
directly to the 6.0 strategic objectives. It will be supported by comprehensive
monitoring through a delivery cascade. Potential priority evaluation topics will be
further developed through on -goin g consultations including with the Evaluation
Advisory Committee (EAC).
The PPC agreed with the potential key shifts in Gavi’s MEL approach for Gavi 6.0
and the design features of the Gavi 6.0 measurement framework, including a more
focused measurement framework that leverages existing country data sources
without imposing new reporting requirements , with a n emphasis on supporting
countries to meet their measurement needs for effectively managing their
immunisation programme s in line with the Lusaka agenda . The PPC also provided
guidance on potential evaluation topics for the next strategy period.

Action Requested of the Board
The Gavi Alliance Board is requested to provide guidance on:
a) Key shifts to Gavi measurement, evaluation and learning for Gavi 6.0;
b) Design features of the Gavi 6.0 Measurement Framework; and
c) P otential evaluation topics for Gavi’s 2026 -2030 strategy.

gavi.org
GAVI’S RESPONSE TO MPOX
BOARD MEETING
Derrick Sim
4 -5 December 2024, Bali, Indonesia
Context: Mpox outbreak
2 Board Meeting, 4 -5 December 2024
Latest epidemiology*
Strategic response
Funding landscape
Phase I : Stop outbreaks - Focuses on
interrupting transmission by vaccinating
contacts of recent cases and healthcare/
frontline workers in areas with active
outbreaks.
Phase II: Expand protection
Phase III : Protect for the future
• Global Mpox response financing tracker
• Almost US$ 577 million committed / pledged for Mpox response
efforts
• 11,148 confirmed cases (85% of these in DRC)
• 53 confirmed deaths (81% of these in DRC)
• 19 affected countries
*Data source: WHO, data as of 3 Nov 2024
Supply landscape
• 5.9 million doses available (2.9 million MVA -BN and 3 million LC16)
…of which 280k MVA -BN delivered + ~900k MVA -BN recently allocated

gavi.org
FINANCIAL UPDATE, INCLUDING FORECAST AND
PARTNERS’ ENGAGEMENT FRAMEWORK AND
SECRETARIAT BUDGET 2025
BOARD MEETING
Francois Note,
4 -5 December 2024, Bali, Indonesia
Higher Qualifying Resources
+US$ 172 million
Higher Programmatic
Expenditure + US$ 144 million
(total US$ 876 million
including US$ 732 million
repurposing from COVAX)
Core Available Funds
US $160 million
2 Board Meeting, 4 -5 December 2024
• Strong commitment to immunisation driving significant increase in country 5.1 demand
• Repurposed COVAX AMC funds available to support higher 5.1 demand (if Board approved)
• Sufficient resources to cover Gavi 5.1 disbursements based on country demand*
GAVI Core: 2021 -2025
Higher Qualifying Resources
+US$ 344 million
Lower Current Programmatic
Expenditure -US$ 465 million
Additional Programmatic
Repurposing + US $ 968 million (of
which US$ 732 million to 5.1**)
Retained AMC Funds US$ 1.6 bn
2024 Forecast under budget
Stable 2025 Budget:
US$ 199 million
Opex ratio ≤ 5.4% to support
higher programmatic spend
COVAX AMC: 2020 -2025 Secretariat OPEX
Key Forecast and Budget Highlights
* The Secretariat has assessed that there are currently sufficient resources to cover forecast disbursements based on country de mand, supply considerations and considering likely execution risks.
** And not held for 6.0. Subject to Board approval and Donor agreement.

gavi.org
Update photo
To be completed
To be completed PRIORITISATION MECHANISM
BOARD MEETING
Marta Tufet Bayona, Quentin Guillon
4 -5 December 2024, Bali, Indonesia
Principles Objectivity, transparency, feasibility Existing principles + simplicity,
continuity and predictability of support
Scope
Categories
of country
applications
Country applications recommended for
approval by the Independent Review
Committee (IRC) on a round -by -round
basis
Country applications that are:
(i) forecasted for the remainder of Gavi 5.1
(ii) recommended for approval at the IRC round
that triggers the mechanism
(iii) previously recommended for approval by the
IRC but with no decision letter issued yet
Types of
country
support
New Vaccine Support applications
New Vaccine Support applications 1 & cash grants
with no communicated ceilings
(i.e. Innovation Top Up)
Objectives
• Maximise health impact
• Maximise value for money
• Reinforce financial sustainability
• Support countries with the greatest needs
• Promote equitable distribution of Gavi’s
resources among countries
Existing objectives refined + ‘Minimise disruptive
future outbreaks’ and ‘ Minimise risks to market
health’ ; measured through a qualitative
assessment
The existing Board - approved prioritisation mechanism has
been updated to ensure it stays fit for purpose in Gavi 5.1
From existing mechanism …to Gavi 5.1 mechanism
1. Includes routine introductions, preventive, follow up, catch up campaigns, and and vaccine switches that are not mandatory and come at a higher incremental cost to Gaviand their associated cash grants (VIGs & Ops, switch grants), vaccine catalytic support for MICs. Excludes outbreak response
2 Board Meeting, 4 -5 December 2024Gavi 5.1 mechanism applied after each IRC round with projected demand -resource mismatch

gavi.org
UPDATE FROM ETHICS, RISK AND COMPLIANCE OFFICE
BOARD MEETING
Maria Thestrup
4 -5 December 2024, Bali, Indonesia
Annual Risk
and
Assurance
Report

Board -2024 -Mtg -03-Doc 12 1
Report to the Board
4-5 December 2024

Subject Road to Replenishment
Agenda item 12
Category For Information

Executive Summary
On 20 June 2024, Gavi launched its Investment Opportunity (IO) for the 2026 -2030
period (Gavi 6.0), as well as the groundbreaking African Vaccine Manufacturing
Accelerator (AVMA), convening seven Heads of State, 25 Ministers, and over 200
senior representatives from key Gavi stakeholders. France, Spain, and the United
States (US) provided a strong start to Gavi’s public replenishment campaig n by
announcing a total of US$ 2.4 billion in pledges. AVMA resonated strongly at a
political and practical level, demonstrating Gavi’s strengths of partnership,
innovation, and sustainability. Notwithstanding the political and financial success of
the lau nch event, the global geopolitical situation has grown more challenging with
continued budgetary pressures and elections in many countries, ongoing conflicts,
as well as other replenishment processes within the global health and development
space. The Secr etariat continues to adjust via a dynamic and agile approach,
adapting our replenishment campaign to respond to such challenges. Under the
strategic vision provided by the IO, specific and targeted market strategies have
been developed. These have helped t o maximise donor engagement, empower
advocates from civil society, and mobilise Gavi’s influential champions from both
donor and implementing countries. Following the launch event in Paris, the
European Commission (EC) made a high -visibility pledge to Gavi during the United
Nations General Assembly (UNGA) and stated that Europe will do its fair share. To
fund its 6.0 activities costing at least US$ 11.9 billion, Gavi is working to finalise the
level of assured resources to US$ 2.9 billion and to bring in ne w pledges for at least
US$ 9 billion (of which US$ 2.8 billion has been secured to date) both in direct
contributions and through innovative financing sources. Focused replenishment
activities will continue into 2025 to continue to build the momentum towar ds a final
Replenishment Summit.
Th e priorities for the Secretariat in the coming months are to:
• Finali se discussions with donors on funds for 5.0/5.1, confirm assured
resources for 6.0 and obtain new pledges for 6.0, including early pledges
• Double -down on an agile and flexible public replenishment campaign,
building on key global events notably at the World Economic Forum annual
meeting in Davos which will include Gavi’s 25 th anniversary leading to Gavi’s
Replenishment Summit in the first half of 2025

Board -2024 -Mtg -03-Doc 13 1
Report to the Board
4-5 December 2024

Subject Update on Collaboration with Other Organi sations
Agenda item 13
Category For Information

Executive Summary
The purpose of this paper is to provide an update on Gavi’s collaboration and recent
engagement with other global and regional health institutions. This includes: i) an
update on Gavi’s engagement with the Lusaka Agenda with a focus on Gavi’s
collaboration with GPEI ; ii) an update on Gavi’s enhanced collaboration across four
workstreams (malaria, health systems strengthening (HSS), country engagement,
enabling functions and operations) with a fifth under development (tuberculosis) with
the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and the
Global Financing Facility (GFF); iii) the formation and readout from the first meeting
of the ‘Joint Committee Working Group’; and iv) a summary of engagement with the
African Union (AU) and Africa Centres for Disease Control and Prevention (Africa
CDC), including the finalisation of the Africa CDC Grant A greement and the launch
of its programme of work. This paper builds on recent discussions including the
October 2024 meeting of the Programme and Policy Committee ( PPC ), and the
previous June 2024 governance cycle. Other related topics at the December 2024
Board meeting include CEO Update, including Strategy, Programmes and
Partnerships; Health Systems Strategy; and Gavi 6.0 Operationalisation (evolution
of the partnership approach , 6.0 measurement framework ).

Action Requested of the Board
This report is for discussion only.
Next steps/timeline
Gavi will continue to collaborate with the Global Fund and the GFF to drive progress
across the four priority workstreams with close sponsorship from the Gavi CEO,
Global Fund Executive Director and GFF Director and regular updates to the Joint
Committee Working Group, Board and Committees as relevant. Gavi will also
continue to collaborate with Africa CDC on implementation of the Grant Agreement
as well as African Vaccine Manufacturing Accelerator (AVMA) and the mpox
response, and these collaborations will inform the evolution of Gavi’s operating and
partnership model in Gavi 6.0.

Clas s if ied as Inter nal
gavi.org
REPORT FROM AUDIT & INVESTIGATIONS
BOARD MEETING
Lucy Elliott
4 -5 December 2024, Bali, Indonesia
How has A&I fulfilled its ToR in 2024?
Overseen, reviewed and monitored by the Audit and Finance Committee
2 Board Meeting, 4 -5 December 2024
• Recommendations for improvement in governance,
risk management and control in the Secretariat and
Gavi implementing countries
• Reinforced country accountability
• Audit quality
• US$ 46.9 million identified since 2009
• US$ 43.8 million repaid as at the last report to the AFC
• Objective is 100% recovery
• Fraud risk assessment methodology piloted
• Advice to management on Gavi’s policies around ethics etc
• Appropriate treatment of reports
• Accountability
A&I’s Terms of Reference will need updating in 2025
AFC -approved work plan of country -
and secretariat -focused audits
Identification of misuse
Preventive counter -fraud work
Confidential whistle -blower reporting
Investigative activity