Board -201 9-Mtg -3-Doc 00a



G avi Alliance Board Meeting
4-5 December 2019
H yatt Regency Hotel , Delhi , India

Monday 2 and Tuesday 3 December : Pre -Board meetings & Field Visits
Wednesday 4 December : 0 8. 30 -18. 30 (Board meeting Day One)
Thursday 5 December : 0 8.30-18.00 (Board meet ing Day Two )
Quor um: 14

Document list

No. Document
00a Document list
00b Agenda
01a Declarations of interest
01b Minutes from 26-27 June 201 9
01c Minutes from 19 July 2019
01 d No Objection Consent D ecisions
01e Consent Agenda
01 f Action Sheet
01 g Workplan
02 Country Presen tation - In dia (No paper )
03 CEO ?s Report (To follow)
04 2016 -2020 Strategy: Progress, Challenges and Risks
05 Replenishment 2020
06 a Financial Update, including forecast
06b Partners ? Engagement Framework & Secretariat Budget 2020
07 Malaria Vaccine Pilots and Long -term Supply
08 Gavi ?s engagement in Ebola va cci ne
09 Gavi 5.0: Funding Policy Review
10 Update on development of strategy for Middle -Income Countries (MICs)
11 Risk Manag ement Update
12 Committee Chair and IFFIm Board reports (To fol low)
13 Review of decisions (No paper)
14 Closing remarks and review of Board workplan (No paper)

Boa rd-201 9-Mtg -3-Doc 0 0b





G avi Alliance Board Meeting
4-5 December 2019
Hyatt Regency Hotel, Delhi, India


Monday 2 and Tuesday 3 December : Pre -Board meetings & Field Visits
Wednesday 4 December : 08.30 -18. 30 (Board meeting Day One)
Thursday 5 December : 08.30 -18.00 (Board mee ting Day Two)
Quorum: 14


Agenda REVISED












Next Board Meeting s: 19 March 2020 , 13.30 -15.30 GVA, Teleconference
11 May 2020, 14.30 -16.30 GVA, Teleconference
24 -25 June 2020, Geneva
16 -17 December 2020, TBD

---
Philip Armstrong , Director, Governance and Secretary to the Board, +41 22 9 09 6504, parmstrong@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 transcr iption of the full proceedings will not normall y be made. Should a transcription be made it will be used
only as an aid to minute the meeting .

Board -2019-Mt g-3-Doc 01a




Gavi Alliance Board Meeting
4-5 December 201 9
Hyatt Regency Hotel, Delhi, India
Quorum: 1 4
Declarations of Interest

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

Financial/Personal/Advisor Int /
Others
Ngozi Okonjo -Iweala , Chair None Gavi -appointed special adviser
William Roedy , Vice Chair None
US State Department, Foreign
Aff airs Policy Board (Member)
with no engagement with USAID
Margaret ( Peggy ) Hamburg
Joint Coordinating Group ,
Co alition for Epidemic
Preparedness Initiative (CEPI)
CEPI Board (Observer) ; Sabin -
Aspen Vaccine Sc ience and
Policy Group ; Vaccine advisory
grou p of the Wellcome Trust ;
Scienti fic Advisory Board on
Global H ealth of the Bill & Melinda
Gates Foundation








Hele n Rees









Chair, South African Health
Products Regulatory Authority
(SAHPRA) ; Board Chair, WHO
AFRO Regional Immunization
Technical Advisory Group ;
Chair, WHO International
Health Regulations (IHR)
Committee o n Polio ; Co -Chai r,
WHO SAGE Working Group
on Ebola Vaccines ; Member,
WHO SAGE Working Group
on the Decade of Vaccines
and Global Va ccine Action
Plan ; Member, WHO SAGE
Working Group on HPV
vaccines ; Member, WHO HSV
Vaccine Advi sory Group ;
Chair, WHO STI Vac cine
None

Board -201 9-Mtg -01 1
Minutes




Gavi Alliance Board Meeting
26-27 June 2019
Global Health Campus , Geneva, Switzerland


1. Chair?s Report

1.1 Finding a quorum of members present, the meeting commenced at 08. 53 local
time on 2 6 June 2019 . Dr Ngozi Okonjo -Iweala, Board Chair, chaired the meeting.

1.2 The Chair welcomed new Board members and Alternate Board members, as well
as Rob Moodie, Chair of the Evaluation Advisory Committee, Cyrus Ardalan, Chair
of the International Finance Facility for Immunisati on (IFFIm) and other directors
of the IFFIm Board. She noted that departing members would be recognised for
their service at the dinner that evening.

1.3 The Board met in closed session during the afternoon of 2 5 June to discuss a
number of items including th e CEO?s 201 9 mid -year performance review, vaccine
supply related challenges, some country audit issues, as well as an initial
discussion on what Gavi support to Middle Income Countries (MICs) might look
like in the 2021 -202 5 strategic period.

1.4 Standing dec larations of interest were tabled to the Board (Doc 01a in the Board
pack). The Chair noted that in the context of the items for decision on the agenda,
there were some Board members who would have conflicts of interest and that
these would be raised at the appropriate time and recorded in the applicable
section of the minutes.

1.5 The Board noted its minutes from 28 -29 November 2018 (Doc 01b) which were
approved by no obj ection on 27 February 2019 . The Board also noted decisions
approved by them by no -objection consent since the last meeting (Doc 01c),
namely , appointments to the Board and Board Committees .

1.6 The Chair refer red to the consent agenda (Doc 01d) where 11 recom mendations
were being presented to the Board for consideration . No requests had been
received to place any of the consent agenda items on the main agenda . The
decisions would be presented at the end of the meeting during the Review of
Decisions.

1.7 The Board also noted its action sheet (Doc 01 e) and workplan (Doc 01 f) and the
Chair encouraged Board members to contribute to the forward plan by raising
issues which they may wish to add either with her directly or with the Board
Secretary. She noted that the style of presentation of the workplan is more detailed
and that it extends out to 2025 which should enable the Board to have a longer -
term view of work going forward.

Board -201 9-Mtg -02 1
Minutes




Gavi Alliance Board Meeting
19 July 2019
Teleconference


1. Chair?s Report

1.1 Finding a quorum of members present, the meeting commenced at 15.00 Geneva
time on 19 July 2019. Dr Ngozi Okonjo -Iweala, Board Chair, chaired the meeting.

1.2 The Chair highlighted that this teleconference had been convened as an
extraordinary meeting of the Board as she felt that the Board, as a whole, should
be engaged in the issues that arose with the donor group in recent consultations
relating to the investment case for the Gavi 2021 -202 5 Strategy (Gavi 5.0).

1.3 She noted that while the Gavi Statutes and By -laws are silent on the convening of
a Board meeting by short notice, meaning that it is held within a period of less than
the required 14 days? notice, Article 2.7.4.1 of the By -laws permits that a meeting
of this nature can proceed provided there is no o bjection (protest) raised at the
commencement of this meeting. As no objections were expressed by Board , the
meeting was duly constituted as a formal meeting of the Board of the Gavi Alliance.

1.4 Standing declarations of interest were included with the materials shared with the
Board in advance of this meeting.

------

2. Gavi Strategy 2021 -2025 ? Investment Case Ask

2.1 The Chair recalled that the purpose of this meeting is to have a clear and agreed
view of what is to be presented as the investment case ask at the Yokohama
Replenishment Launch on 30 August 2019 , including an agreed level of strategic
investments funding .

2.2 She highlighted that this constitutes a high -level projection of the investment need
for the next strategic period to deliver on the strategy and that it will require a
number of specific budget approvals for the respective programmes over that
period . She re called that an ?ask? is a notional fundraising target , and not a budget,
and highlighted that the starting point of the replenishment ask is grounded in the
projections of Board -approved programmes and expenditures as laid out in the
financial forecast for 2021 -2025 .

2. 3 Seth Berkley, CEO, presented an overview of the breakdown of the US$ 8.9 bil lion
for estimated future expenditure highlighting that every component of expenditure

1



Board -2019 -Mtg -3-Doc 01d
Report to the Board
4-5 December 2019



Since the June 201 9 Board meeting, two decision s have been circulated to the
Board electronically for approval by no -objection consent in line with Article s
2.7.3. 2 and 2.7.3.4 of the By -Laws.

1) On 30 July 2019 , Board members were invited to consider approval of the 201 8
Annual Financial Report .

No objections were received prior to the end of 1 2 August 201 9 and the following
decision was therefore entered into the record:

?In accordance with article 2.7.3.2 of the By -Laws, on a no -objection basis the Gavi
Alliance Board:

? Approved the Gavi Alliance 201 8 Annual Financial Report?

2) On 1 October 201 9, Board members were invited to consider approval of the
appointment of Board and Board Committee members.

No objections were received prior to the end of 11 October 2019 and the following
decision was therefore entered into the record:

?In accordance with article 2.7.3.4 of the By -Laws, on a no -objection basis, the
Gavi Alliance Board:

a) Appointed the following Board Members:
? Yibing Wu as an Unaffiliated Board Member in the seat formerly held by
Richard Sezibera, effective 1 November 2019 and until 31 October 2022.
? Mah amoud Youssouf Khayal of Chad as Board member representing the
developing country constituency in the seat currently held by Mahamat
Saleh Aziz of Chad, effective immediately and until 31 December 2021.

b) Appointed the following to the Market -Sensitive Decisions Committee
effective immediately:
? Muhammad Pate (Board Member) until 31 Dece mber 2019.

c) Appointed the following to the Governance Committee effective immediately:
? Omar Abdi (Board Member) until 31 December 2019.

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

1



Board -2019 -Mtg -3-Doc 01e
Report to the Board
4-5 December 2019

Section A: Introduction
Five recommendations are being presented to the Board under the Consent
Agenda for consideration. Detailed information on each of the items can be found
in the relevant Committee paper in a dedicated folder on BoardEffect at :
https://gavi.boardeffect.co.uk/workrooms/6459/resources/24636
Section B: Actions requested of the Board
The Gavi Alliance Board is requested to consider the following recommendatio ns
from the Gavi Alliance Governance Committee and Programme and Policy
Committee.
Decision One ? Sudan ?s eligibility for Gavi support in 2020
The Gavi Alliance Programme and Policy Committee recommended to the Gavi
Alliance Board that it:
Approve , exceptionally, that the determination of Sudan?s eligibility for 2020 will
be based on the latest GNI data point instead of the average GNI per capita over
the past three years.
Decision Two ? Board Vice Chai r appointment
Governance Committee recommendation to be shared with the Board after
Governance Committee meeting of 2 5 November 2019 and/or 3 December 2019 .
Decision Three ? Board Committee Chair appointments
Governance Committee recommendation to be shared with the Board after
Governance Committee meeting of 2 5 November 2019 and/or 3 December 2019.
Decision Four ? Board and Board Committee member appointments
Governance Committee recommendation to be shared with the Board after
Go vernance Committee meeting of 2 5 November 2019 and/or 3 December 2019 .


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

1



Board -2019 -Mtg -3-Doc 01e
Report to the Board
4-5 December 2019

Section A: Introduction
Five recommendations are being presented to the Board under the Consent
Agenda for consideration. Detailed information on each of the items can be found
in the relevant Committee paper in a dedicated folder on BoardEffect at :
https://gavi.boardeffect.co.uk/workrooms/6459/resources/24636
Section B: Actions requested of the Board
The Gavi Alliance Board is requested to consider the following recommendations
from the Gavi Alliance Governa nce Committee and Programme and Policy
Committee.
Decision One ? Sudan ?s eligibility for Gavi support in 2020
The Gavi Alliance Programme and Policy Committee recommended to the Gavi
Alliance Board that it:
Approve , exceptionally, that the determination of Sudan?s eligibility for 2020 will
be based on the latest GNI data point instead of the average GNI per capita over
the past three years.
Decision Two ? Board Vice Chair appointment
Governance Committee recommenda tion to be shared with the Board after
Governance Committee meeting of 3 December 2019 .
Decision Three ? Board Committee Chair appointments

The Gavi Alliance Governance Committee recommended to the Gavi Alliance
Board that it:

a) Reappoint the following as Chair of the Investment Committee:
? Stephen Zinser until 30 June 2020

b) Reappoint the following as Chair of the Audit and Finance Committee:
? David Sidwell until 31 December 2020

SUBJECT: CONSENT AGENDA REVISED AT 25 NOVEM BER 2019
Agenda item: 01 e
Category: For Decision

Board -2019 -Mtg -3-Doc 01 f




G avi Alliance Board

Action sheet as of 20 November 2019


Request Matter Responsible Action taken



28 -29
Nov 2018
? 6b
Approaches to Fiduciary Risk
Management in Gavi ?s Cash Grants :
? Board to receive a table of the
proportion of funds tha t go through
government and partner systems
over time to clearly see change.



Secretariat
(Bijleveld )



See Agenda Item
4, December
2019 Board
meeting


26-27
June
2019 ? 3
2016 -2020 Strategy : Pro gress,
Challenges and Risks
? Alliance partners to provide input and
rec ommendations on routine
immunisation , campaigns and
outbreak response
? Board to receive information on
proposed way forward to address
issue of HPV vaccin e supply
const raints for Gavi coun tries



UNICEF ( Abdi )/
W HO (Salama)


IFPMA
(Silb ermann )/
WHO ( Salam a)



Presented to
PPC at October
2019 meeting

TBD


26-27
June
2019 ? 6
Committee Chair and IFFIm Board
report s:
? Board to receive f urther information
on IFFIm investments ca ses , a
simplified narrative on how IFFIm
work s an d more analysis on relative
return on investment histo rically



Secretariat
(Saraka -Yao/
Sison)



See IFFIm Chair
report , December
2019 Board
meeting

Classified as Internal #
Gavi Alliance Board Workplan
Gavi Board Paper Type Mar May June No Obj Oct Dec Mar/Apr June No Obj Nov/Dec Mar/Apr June No Obj Nov/Dec Mar/Apr June No Obj Nov/Dec Mar/Apr June No Obj Nov/Dec Mar/Apr June No Obj Nov/Dec
A.Strategy/Performance/RiskCEO's Report CEO's Report Discussion 2016-2020 Strategy 2016-2020 Strategy: Progress, Risks and Challenges Discussion 2021-2025 Strategy Gavi 5.0 Decision Measurement Framework (Targets & Indicators) Gavi 5.0: Operationalisation Decision Decision Decision Funding Policies* Gavi 5.0: Operationalisation Decision Decision Programmatic Approaches TBD TBD Portfolio Management Processes TBD TBD Review of Partner Engagement Model Gavi 5.0: Operationalisation Decision Decision Innovation (including private sector partnerships) TBD TBD Middle Income Countries (MICs) TBD Decision Decision Risk and Asurance Report Risk and Assurance Report Decision Decision Decision Decision Decision Decision Decision B.Vaccines & SustainablityTyphoid TBD Information Information Pneumococcal AMC (Advance Market Commitment) TBD Information C.PolicyGender Policy Review of the Gavi Gender Policy Decision Decision Co-Financing Policy Gavi 5.0: Operationalisation Decision Decision Eligiblity & Transition Policy Gavi 5.0: Operationalisation Decision Decision Fragility, Emergencies, Refugees Policy TBD TBD Supply & Procurement Strategy Review of Gavi's Supply and Procurement Strategy Decision Decision Transparency and Accountability Policy Decision D.Country ProgrammesNigeria TBD Information Information Information Information Information Information Information PNG TBD Information Information Post-Transition Support (e.g. Angola, Timor-Leste) TBD Information HSIS Support Framework Gavi 5.0: Operationalisation Decision Decision CCEOP Gavi 5.0: Operationalisation Decision Decision E.Finance/Audit & Investigations Annual Accounts Annual Financial Report Decision Decision Decision Decision Decision Decision Decision Financial Forecast Financial Update, including forecast Decision Decision Decision Decision Decision Decision Decision Budget Financial Update, including forecast Decision Decision Decision Decision Decision Audit & Investigations Report Audit & Investigations Report Information Information Information Information Information Information Information F.GovernanceBoard Chair Appointment Board Chair Appointment Decision Decision Board Vice Chair Appointment Consent Agenda Decision Decision Decision Decision Committee Chair Appointments Consent Agenda Decision Decision Decision Decision Decision Decision Board and Committee Appointments Consent Agenda Decision Decision Decision Decision Decision Decision IRC Appointments Consent Agenda Decision CEO Appointment Consent Agenda Decision Decision Secretary Appointment Consent Agenda Decision Decision Treasurer Appointment Consent Agenda Decision Amendments to Governance Documents (Statutes, By-Laws, Committee Charters) Consent Agenda Decision IRC Terms of Reference TBD Decision Audit & Investigations Terms of Reference TBD Decision G.ReportingCommittee Chair Reports Committee Chair and IFFIm Board reports Information Information Information Information Information Information Information Information Information Information Information Information Information IFFIm Chair Reports Committee Chair and IFFIm Board reports Information Information Information Information Information Information Information Information Information Information Information Information Information Replenishment TBD Discussion Discussion Discussion HR Report Closed Session Information Information Information Information Information Information Information Annual Report on Implementation of the Gender Policy Annex to Board pack/On BE as additional materials Information Information CEPI Annual Progress Report Annex to Board pack/On BE as additional materials Information Information Information Information Information Information Information Board and Committee minutes Annex to Board pack/On BE as additional materials Information Information Information Information Information Information Information Information Information Information Information Information Information H. Pre-Board Technical Briefing SessionsTBCTBC
*Includes Eligiblity & Transition Policy, Co-Financing Policy, HSIS Support Framework
Last updated - 20 November 2019
Next Board Meetings : 19 March 2020, Teleconference 11 May 2020, Teleconference 24-25 June 2020, Geneva 16-17 December 2020, TBD
2020 2021 2022 2023 2024 2025
Board Meetings/Retreats Gavi 4.0 Gavi 5.0
Board-2019-Mtg-3-Doc 01g

1



Board -2019 -Mtg -3-Doc 02
Report to the Board
4-5 Dec ember 201 9

















SUBJECT: COUNTRY PRESENTATION ? INDIA
Agenda item: 02
No paper

1



Board -2019 -Mtg -3-Doc 03

Report to the Board
4-5 December 201 9


27 November 201 9

Dear Board members ,
I look forward to seeing you all in Delhi next week . Our meeting has a very full
agenda, com ing at a busy time for the Alliance and the global health community .
On the one hand. w e are focus ed on delivering Gavi 4.0 . The latest WHO -
UNICEF Estimates of Immunisation Coverage (WUENIC) show that the Alliance
is on track to achieve , and in some cases exceed , all of our Mission Indicators as
well as our targets for breadth of protection and coverage with a first dose of
measles vaccine. However, pentavalent coverage is off track , despite 2.5 million
more children being reached in 2018 than in 2015 . This is due in part to
exceptional events in one large country in 2018 (which will likely be reversed in
2019 ) as explained further in the paper on 2016 -2020 Strategy: Progress,
Challenges and Risks . W e are simultaneously preparing to implement Gavi 5.0 ,
including rethinking many of the Alliance?s approaches , policies, processes and
engagement model , planning for our upcoming Replenishment in London on
4 June 2020 , and getting ready to celebrate the 20th anniversary of Gavi?s
creation at the World Economic Forum in Davos.
It is also a busy time for the broader community . As discussed further below, w e
are actively engaged in the process to develop the Immunisation Agenda 2030
and are working with other agencies to begin implementing the Global Action
Plan for Healthy Lives and Wellbeing for All (GAP) . Meanwhile, the health world
is facing reversals in efforts to eradicate polio, control measles and bring the
ongoing Ebola outbr eak in DR Congo to an end . We will therefore have a lot to
discuss and reflect on at our meeting.
Key developments in our global landscape
Accelerating progress on primary healthcare and universal health coverage
At this year?s United Nations General Assembly , world leaders met for their first
ever High -Level meeting on Universal Health Coverage (UHC) . This was an
opportunity to take stock of global progress towards UHC four years after the
launch of the Sustainable Development Goals (SDGs) , and to recommit to
Report of the Chief Executive Officer

1



Board -2019 -Mtg -3-Doc 04


Section A: Executive Summary
Context
Gavi?s current m ission for the 2016 -2020 period is to save children?s lives and
protect people?s health by increasing equitable use of vaccines in lower -income
countries . It is guided by four strategic goals: accelerating vaccine coverage and
uptake, strengthening health and imm unisation systems, improving sustainability
of national immunisation programmes and shaping markets. In June 2019, the
Board approved the Gavi 2021 -20 25 (?Gavi 5.0?) strategy, with the vision of ?leaving
no one behind with immunisation?.
Questions this pap er addresses
This report presents a holistic view of Alliance -wide progress, challenges and
potential risks 1 in implementing Gavi?s 2016 -2020 strategy , and a short update on
the ongoing operationalisation of Gavi?s 2021 -2025 strategy (?Gavi 5.0?) .
Conclusions
The Alliance is fully on track on all of its five Mission indicator s. We are also
seeing good progress on a number of key indicators across the four strategic
goals , including breadth of protection, MCV1 (first dose of measles vaccine)
coverage, strengthening supply chains, c ountry fulfilment of co -financing
commitments and reductions in vaccine prices. However, challenges also
persist , such as less than targeted improvement in Penta3 coverage and
difficulties with measuring progress on our equity indicators .
The six Gavi 5.0 operationalisation workstreams are in various stages of
development and generally on track , with the policy workstream discussed in Doc
09 and a separate update on the measurement framework as Annex B to the pack
for this Board meeting .


1 Associated risks refer to the top risks described in more detail in the Risk & Assurance Report
2019 (see Doc 11 ).
SUBJECT : 2016 -2020 STRATEGY: PROGRESS, CHALLENGES AND
RISKS
Agenda item: 04
Category: For Information
Report to the Board
4-5 December 2019

04 ? Annex A

Re port to the Report to the Board
Board -201 9-Mtg -3-Doc 0 4 ? Annex A

Annex A : Updated Alliance KPI dashboard








BOARD & COM M ITTEE ATTENDANCE
GENDER BALANCE
Partners3
1
2
3
4
5
6
7
SFA/PEF ACHIEVEM ENTS
CSO ENGAGEM ENT
PLEDGE CONVERSION
DONOR ENGAGEM ENT IN COUNTRY
END 2018TARGET: N/A EVALUATION ALIGNM ENT
END 2018TARGET: N/A COUNTRY REPORTING
END 2018TARGET: 85%
59%
END 2019TARGET: 50%
END 2019TARGET: 100%
END 2018TARGET: N/A
END 2018TARGET: 95%
Governance4
1
Secretariat & partners1
2
4
5
6
VACCINE INTRODUCTIONS
END 2019TARGET: 56 NEW VACCINE COVERAGE
END 2019TARGET: 90%
END 2019TARGET: 90% HSS PROPOSAL QUALITY
END 2019TARGET: 75% HSS FUND UTILISATION
END 2019TARGET: 75% HSS GRANT TARGETS
END 2018TARGET: 50% 50%
Secretariat
OPERATIONAL DEM AND FORECAST
PROGRAM M E FINANCE FORECAST
SPEED OF CASH GRANT DISBURSEM ENTS
END 2019 TARGET: 9 months AUDITS ON TRACK
END 2019TARGET: 80% RISK M ANAGEM ENT PLAN PROGRESS
END 2019TARGET: 60% OPERATING EFFICIENCY
TARGET: N/A?
END 2018 TARGET: +/-10%
18%
END 2018TARGET: +/-10%
1
2
2016 ?2020 INDICATORS ALLIANCE PROGRESS
4
Gavi BoardUPDATED: 25 October 2019
PARTNER GROUP PEF
PEF
CSO
DONORS
DONORS
COUNTRIES
TCA ACTIVITIES ON TRACK
5 EVALUATIONS
Health system strengtheningTargeted country assistanceStrategic focus areaPartners' engagement frameworkCivil society organisation
HSSTCASFAPEFCSO
END 2019TARGET: 90% 87%
END 2019TARGET: 40%
50%
82%
2018BASELINE: 46
2018BASELINE: 95%
2018BASELINE : 13%
2018BASELINE: 100%
2018BASELINE: 61%
2017BASELINE : 27%
2018BASELINE: 17.5 months
2018BASELINE :80 %
2018BASELINE : 60%
2017BASELINE $283k:
2016BASELINE : -3%
2016BASELINE : -16%
2018BASELINE: 80 %
2018BASELINE : 76%
2017BASELINE : 53%
2017BASELINE : 89%
2017BASELINE : 45%
2017BASELINE : 8
2017BASELINE : 92%
2018BASELINE : 90%
2018BASELINE : 44%
25
ON TRACKMODERATE DELAYS / CHALLENGESSIGNIFICANT DELAYS / CHALLENGES
6
TRACKING TREND ONLY
45%
89%
510
94% 58%
87%
95%
96%
-19%
-10%
10%
278K
NO UPDATE AT THIS REPORTING PERIOD
3M EASLES CAM PAIGN COVERAGE
No update
11.5months
4
5
6
3
2
1
2
No update No update
42%

04 ? Annex B

Report to the Board
Board -201 9-Mtg -3-Doc 0 4 ? Annex B

Annex B: 2016 -2020 Strategy progress dashboard with original indicator definitions

Classified as Internal
2
3
Improve sustainability3 Market shaping4 Accelerate vaccines1 Strengthen capacity2
2016 ?2020 INDICATORS STRATEGY PROGRESS
5
Gavi BoardUPDATED: 18 September 2019
1
EQUITY: GEOGRAPHIC DISTRIBUTION
ROUTINE IM M UNISATION COVERAGE 1
2
3
4
5
EFFECTIVE VACCINE M ANAGEM ENT
DATA QUALITY
PENTA1 COVERAGE & DROP -OUT
INTEGRATED HEALTH SERVICE DELIVERY
CIVIL SOCIETY ENGAGEM ENT
2
3
4
1
COUNTRY INVESTM ENT IN VACCINES
COUNTRIES ON TRACK TO TRANSITION
INSTITUTIONAL CAPACITY
CO-FINANCING COM M ITMENTS
2
3
4
1
VACCINE PRICE REDUCTION
VACCINE INNOVATION
HEALTHY M ARKET DYNAM ICS
SUPPLY SECURITY
Measles -containing vaccine 1 stdose Percentage pointPentavalent 1 stdose Pentavalent 3 rddose
MCV1
PPPenta1Penta3
CURRENT: + 1PP 2020 TARGETPENTA3 85%MCV1:83% 2015 BASELINEPENTA3: 80% MCV1:78%
CURRENT: + 1PP 2020 TARGET 26% 2015 BASELINE16%
2020 TARGET43%** 2015 BASELINE16%
2020 TARGET 38% 2015 BASELINE28%
2020 TARGETPENTA1: 90% DROP-OUT: 4% 2015 BASELINEPENTA1: 86% DROP-OUT: 7%
2020 TARGET100% 2015 BASELINEN/A 2020 TARGET55%
100%2020 TARGET100% 2020 TARGET11/11
$15.90 2020 TARGET N/A1
2020 TARGET 10
2020 TARGET 6/11
59%2020 TARGET43%**
2020 TARGET **
2015 BASELINE45%
2020 TARGET 75% 2015 BASELINE63%
2015 BASELINEN/A
2015 BASELINEN/A
2015 BASELINE85% 2015 BASELINE7/11
2015 BASELINE$20
2015 BASELINE0
2015 BASELINE1/11
BREADTH OF PROTECTION
PENTA381%
CURRENT: + 1PP 2020 TARGET 63% 2015 BASELINE31%
52%
22% MCV181%
87%
45%
22%
8/11
7
3/11 4EQUITY: WEALTH
CURRENT: + 1PP 2020 TARGET 45% 2015 BASELINE35%5EQUITY: M ATERNAL EDUCATION
CURRENT: + 1PP 2020 TARGET 40% 2015 BASELINE30%
ON TRACKMODERATE DELAYS / CHALLENGESSIGNIFICANT DELAYS / CHALLENGES
8
NO UPDATE AT THIS REPORTING PERIOD
18
35%
32%
54%
7PP
35%
56%
1Not published due to commercial sensitivity** Revised baselines and targets Approved by the Board in November 2018
Indicators reported as originally defined
16%
TRACKING TREND ONLY/ DATA INCONCLUSIVE2
No update

1

04 ? Annex C
Board -2019 -Mtg -3-Doc 04-Annex C
Annex C: Annual Report on the Implementation of the Gender Policy
Section A: Executive Summary
Context
This report provides an update on progress made in 2019 on implementing Gavi?s
Gender Policy. It covers the programmatic, corporate, governance and advocacy
dimensions of Gavi?s gender -focused work.

The goal of Gavi?s Gender Policy is to 1) increase immunisation coverage by
supporting countries to overcome gender -related barriers to accessing
immunisation services and 2) promote equal access and utilisation for all girls and
boys, women and men to immunisation and related health services that respond
to their different health needs.
In 2019, Gavi made progress in implementing recommendations from an external
evaluation of Gavi?s Gender Policy , including articulating a clear case for
addressing gender issu es as part of Gavi?s Strategy for 2021 -20 25 and creating a
new sub -team f ocused on gender, communities and demand within the
Secretariat?s Health System and Immunisation Strengt hening team. The
Secretariat is in the process of reviewing and updating its Gender Policy, which
will be brought to the Gavi Board in June 2020 for review .
Section B: Facts and Data
Gender Policy at a glance
1.1 ITAD completed an external evaluation of Gavi?s Gender Policy in April
2019. The recommendations included i) articulating a clear case for
addressing gender as part of Gavi?s 2021 ?2025 Strategy; ii) enhancing
internal Secretariat systems and processes to understand and address
gender barrier s, iii) ensuring participation of national partners and core
partners in the update, monitoring and implementation of the Gender Policy,
and iv) elaborating a strategic level implementation plan to guide
implementation with a robust monitoring and evaluati on framework. These
findings and recommendations were the starting point for the Secretariat?s
work with Alliance partners and other stakeholders to update the policy.
1.2 A consultative approach has been taken over the course of the year to
strengthen Gavi?s Gender Policy. This includes consultations with donors,
country stakeholders and CSOs; ongoing dialogue with peer and partner
organisations; and discussions with country -facing teams in the Secretariat.
In addition, a n expert consultative workshop was held in July 2019 with 17
gender and immunisation experts . The m ain themes emerging from these
consultations echo feedback received from the evaluation , includ ing the
need to a) m ake a clear case for how addressing gender barriers contribute s
to achieving Gavi?s mission ; b) e nsure a country tailored approach is taken
Report to the Board

05 ? Annex A

Re port to the Report to the Board
Board -201 9-Mtg -3-Doc 0 5 ? Annex A

Annex A: Implications/Anticipated impact
Risk implications
Due to fiscal pressures in donors markets alongside competing replenishments, there
is a risk of decreased support from existing donors or inability to increase new donor
contributions to Gavi. Hence, a successful Replenishment that engages all
stakeholders and donors will be crucial for ensuring continuity of Gavi programmes at
country level, as well as maintaining industry and manufacturer confidence.
In addition, the rec ent Global Fund replenishment has underlined the need to
anticipate exchange rate fluctuations. As an illustration, if all donors contributions to
Gavi, pledged in their national currencies, remained at a flat -line level compared to the
Berlin replenishmen t, at today?s exchange rates Gavi would not be able to secure the
minimum required in the new Investment Opportunity.
If there are insufficient resources to deploy in 2021 ?2025, the Alliance would be faced
with hard choices, and would undertake a rigorous prioritisation exercise. Gavi would
need to resize its ambitions around supporting particular vaccines, enabling grants in
health systems, protecting the world with vaccine stockpiles, and/or strategic
investments to secure immunisation returns, among oth er priority areas. Gavi would
also likely have to pull back from some of the work of collaborating with other
institutions.
As a result, country demand would not be met, risking backsliding on the tremendous
progress made to date. This has implications n ot only for the poorest people?s ability
to live healthy lives, but also their ability to thrive and lift themselves out of poverty. In
addition, in a world without vaccines, disease outbreaks would cause significant
economic loss, not only to families and communities from unnecessary suffering and
loss of earnings, but this would be multiplied many times over by loss of trade, lost
productivity, and decimated health services. Many of the hard -fought gains made
could be reversed but with far greater global implications in a hyper -connected world.
It can be a major threat to global prosperity and security if we do not take steps to stop
disease at source.
With respect to assuring contributions from new donors, it should be noted that a
number of them are as king for a seat and/or greater voice at the Board in consideration
of their contributions. Another challenge emerging from discussions with some new
and emerging donors is that some of them may not make donations directly to Gavi
because the Alliance?s sta tus does not meet their definition of an International
Organisation. Finally, the use of innovative finance mechanisms may require legal
issues and tax deductibility limitations to be addressed, especially when considering
contributions from the private se ctor.

1


Board -2019 -Mtg -3-Doc 05

Section A: Executive Summary
Context
This report describes Gavi?s campaign in the lead up to its third pledging
conference, to be hosted by the United Kingdom on 3-4 June 2020 in London . It
presents an overview of the Replenishment launch that was held on 30 August
2019 in Japan as part of the 7 th edition of the Tokyo International Conference on
African Development (TICAD 7) , a summary of the key points of Gavi?s Investment
Opportunity and financia l ask and insights on the campaign approach .
Conclusions
Following a successful Replenishment launch in August 2019 and the unveiling of
the 2021 -2025 Investment Opportunity , the Replenishment process was set in
motion to secure at least US $ 7.4 billion in donor contributions by June 2020 . If the
financial ask is met , Gavi will be able to reach another 300 million people with life -
saving vaccines , preventing 7 -8 million future deaths , and deliver more than
US$ 80 -100 billion in economic benefits to countries .
There is significant potential to further accelerate impact if funding were to exceed
the ask. Gavi?s Replenishment strategy will therefore seek to increase pledges
from core donors, bring in new donors closely aligned with Gavi priorities,
incentivis e private sector pledges , and leverag e innovative financial instruments to
generate flexible fund s. The strategy will also need to mitigate the volatilit y in
exchange rates since the Berlin replenishment .
While the ask is global in nature , Gavi?s campaign will be focused on tailored
approaches , aligned with donor countries? aid priorities. The approach will combine
high -level strategic donor engagement by Gavi?s Leadership and Secretariat, UK -
led government -wide efforts , peer donor outreach, and coordinated civil society
actions in key markets . Global moments will also be leveraged , including Gavi?s
upcoming 20th anniversary , to be celebrated at the World Economic Forum (WEF)
in Davos in January .

SUBJECT : REPLENISHMENT 20 20
Agenda item: 05
Category: For Information
Report to the Board
4-5 December 2019

1

06a - Annex A
Report to the Board


Board -2019 -Mtg -3-Doc 06a -Annex A

Annex A : Implications/Anticipated impact

1. Impact on countries
1.1 Approval of the Financial Forecast will enable funding to be allotted to
programmes throughout 20 20 , in accordance wit h the Programme Funding
Policy.

2. Risk implication and mitigation, including information on the risks of
inaction
2.1 Determination of Gavi?s financial capacity to approve the recommended
decisions relies on the current Financial Forecast. Risks that may impact the
reliability of financia l forecast are described below, as well as the mitigation
strategies in place to address these ris ks.
2.2 One of those risks arises from exposure to foreign currency exchange rate
fluctuations. In the forecast, non -USD pledges are valued at their USD
equivalents using the current Bloomberg forecast exchange rates when
compiling the forecast (consistent with th e approach agreed with donors at
the Berlin Replenishment Meeting) or, where hedged, at the hedge rate.
Pledges are hedged progressively, and pledges representing 6% of
2016 - 2020 Assured Resources are not yet hedged, pending clarification of
timing.
2.3 Gavi?s eight -month Cash and Investments Reserve provides a cushion for
adverse fluctuations in resources and expenditures. Gavi can also decline or
defer funding requests based on resource availability.
3. Risks associated with the financial forecast and mitigations
Factors that may impact the expenditure forecast include:
3.1 Demand volumes can vary significantly based on small changes in country
introduction assumptions. While the introduction assumptio ns made in the
current forecasts leverage the information readily available, there remains an
inherent high degree of uncertainty on these assumptions. In addition, the
assumptions on introduction timing are often dependent on projections of
when a country will no longer be eligible for new Gavi support. This forecast
represents the application of the current Board approved Eligibility and
Transition Policy. Changes or exceptions to this policy could vary demand
significantly.
3.2 Price forecasts reflect expected market dynamics specific to each vaccine.
The point forecast represents a moderate most likely scenario estimate
among a range of possible estimates and reflects information available at the
time of preparation.
3.3 The forecast includes assumpt ions for supply availability for Rotavirus, HPV ,
IPV , Yellow Fever and Typhoid as currently anticipated.

1
06a ? Annex B

Report to the Board


Board -2019 -Mtg -3-Doc 06a -Annex B
Annex B : Terminology and rounding
Terms used in this paper have the meanings described below, and are relevant to
Gavi?s Board Approved Programme Funding Policy:
a) Assured Resources comprise:
? Cash and investments of Gavi, in the amount that exceeds the Cash and
Investments Reserve (see (g) below)
? Expected proceeds from IFFIm, based on existing donor pledges
? Expected AMC and any other contributions that are contingent on
programmatic expenditu re included in the expenditure forecast
? Confirmed direct contributions to GAVI Alliance that are pledged under
already -signed agreements or otherwise confirmed in writing.
? Projected investment income
b) Allowance for Further Direct Contributions (for th e purpose of approving
funding decisions): An allowance for further expected direct contributions
from existing donors who have not confirmed their pledges for each year,
based on current overall contribution levels. The allowance is mandated by
the Progra mme Funding Policy and is important towards enabling
programme funding decisions to be made while pledges have yet to be
completed for particular years. The allowance assumes that in years where
currently confirmed direct contributions total less than the current level,
further contributions will bring the total to that level. This is currently US$ 1.4 9
billion for the year, which equates to the annual average of confirmed pledges
for 201 7-201 9.
c) Qualifying Resources : The sum of Assured Resources and the Allowance for
Further Direct Contributions (i.e. (a) plus (b) above) .
d) Existing Programmes : Country programmes (for vaccine and cash -based
programmes and investment cases) that have already been approved for
support by Gavi, the Partners? Engagement Fr amework and the Secretariat
budget.
e) New Requests : Projected demand from country applications that are
currently being recommended by the Independent Review Committee for
approval.
f) Expected Future Requests: Projected demand from countries expected t o
request Gavi support in the future for the currently approved portfolio of
vaccines and cash -based programmes. It does not include any additional
vaccines that Gavi may consider for support in the future.
g) Cash and Investments Reserve : The reserve required by the Programme
Funding Policy to be maintained at a minimum equalling eight months of
expected annual expenditures.

1



Board -2019 -Mtg -3-Doc 06a


Section A: Executive Summary
Context
This report asks the Board to approve the updated projections of resources and
expenditure for 2016 -2020 and indicative financial projections for 2021 -2025.
The Audit and Finance Committee (AFC) has reviewed the 2016 -2020 and
2021 - 2025 forecast , includi ng the financial implications of the decisions that the
Board will consider at this meeting. The AFC concluded that these decisions could
be approved by the Board , in accordance with the Programme Funding Policy .
? For 2016 -2020 , the overall expenditure forecast has decreased by
US$ 0.1 billion (1%) whereas resources have remained consistent at the level
that was presented in the forecast on the 19 July 2019 Board call.
? For 2021 -2025 , the indicative financial projections for expenditures and
resources remain materially aligned to figures presented in the ?Investment
Opportunity? launched at TICAD, in Yokohama on 30 August 2019.
In addition to the forecast, th is report also provides an update on the evolution of
the estimates of resources and expenditure in 2019, an overview of expenditures
that are subject to Board -approved programme funding limits and of in-country
cash balances of Gavi support , and finally an update on foreign currency exposure .
Conclusion
The updated financial projecti ons show that sufficient resources are available such
that the programmes presented at this Board can be approved in accordance with
the provisions of the Programme Funding Policy.
Section B: Facts and Data
Financial Forecast
1.1 The Gavi financial forecast is updated annually for approval by the Board,
in order to enable the CEO to allot funding to programmes in the following
year , in accordance with the Programme Fundi ng Policy .
1.2 Figure 1 below summarises the forecasted resources and expenditures
(including the proposed decisions to be considered at this meeting ) for the
current period (2016 -2020 ) and subsequent one (2021 -2025 ) and indicates
SUBJECT : FINANCIAL UPDATE, INCLUDING FORECAST
Agenda item: 06a
Category: For Decision
Report to the Board
4-5 December 2019

06b ? Annex A

Re port to the Report to the Board
Board -201 9-Mtg -3-Doc 0 6b ? Annex A

Annex A: Implications/Anticipated impact
Risk implication and mitigation, including information on the risks of inaction
? PEF: the 2020 PEF budget is dependent on countries? demand for technical
assistance as well as partners? capacity to provide the required technical support
to sustainably address coverage and equity challenges and support well
function ing immunisation programmes. As highlighted in the Risk and Assurance
Report (Doc 11 ), partner capacity is recognised as a top risk for th e Alliance and
is being actively monitored.
? Secretariat: the 2020 Secretariat budget includes the cost of the preparation for the
replenishment and the event itself. Current assumptions for these costs are based
on the overall spend during the last mid -term review and replenishment period.
Impact on countries
? Overall, the Ministry of Health in Gavi countries have the primary responsibility for
delivering on Gavi programmes. Gavi?s deliverables and associated activities are
intended to support this implemen tation and delivery on the goals.
? Through the Joint Appraisal process, countries identify their technical assistance
needs, which form the basis of the partner proposals for activities to be funded
through the PEF. This creates more country ownership and v isibility for countries
on the work -streams being implemented, allowing better coordination of activities
and better alignment with Gavi funded programmes .
Impact on Alliance
? WHO and UNICEF will remain core partners of the Alliance, continue to provide
mos t of the assistance funded by Gavi and engage with Gavi as true partners.
However, as the PEF TCA intends to leverage the capacity of a broader set of
partner institutions, the Alliance model which at Gavi?s inception relied solely on
WHO and UNICEF as imp lementing partners is de facto evolving towards a
broader diversity of partners providing assistance to countries.

1



Board -2019 -Mtg -3-Doc 06b

Section A: Executive Summary
Context
This paper pr esent s the detailed component s of t he Partners ? Engagement
Framework (PEF) and Secretariat budget for 2020 and seeks the Board ?s approval
of the se budget s.
In compiling its budget request for 2020 (the last year of the current strategic
period ), the Secretariat continued to focus on efficiency gains and a high level of
fiscal responsibility while preparing for Replenishment and Gavi 5.0
operationali sation.
Conclusion
No increase is proposed in relation to the 2020 PEF and Secretariat budget
compared to the 2019 budget , excluding the financial impact of the one -off cost of
the replenishment :
? The proposed 2020 PEF budget of US$ 253 million is at the same level as the
Board -approved 2019 budget, with minor changes between the respective
components. Specifically, t he PEF budget reflects a higher allocation for
targeted country assistance (TCA) in line with the growing emphasis on
subnational level technical support and enhanced focus on fragile countries.
? Secretariat budget needs are estimated at US$ 110 million for 2020, compared
to US$ 108 million for 2019. The increase is primarily due to the inclusion of a
one -off cost of US$ 2 .1 million for replenishment .
The Gavi updated financial forecast for the strategic period 2016 -2020 presented
in Doc 0 6a makes a provision for the proposed budget amounts and indicates that
enough resources are available .
Section B: 2020 Proposed PEF and Secretariat Budget
Overview of expenditure
1.1 The table below provides a summary of programmatic, Secretariat and PEF
expenditures for 2019 along with the projections for 2020 .
SUBJECT : PARTNERS? ENGAGEMENT FRAMEWORK &
SECRETARIAT BUDGET 2020
Agenda item: 06b
Category: For Decision
Report to the Board
4-5 December 2019

07 ? Annex A

Report to the Board
Board -2019 -Mtg -3-Doc 07-Annex A
Annex A: Implications / Anticipated Impact

Risk implications and mitigation for both funding of the malaria vaccine implementation
programme and longer -term supply are included in the paper. The impact on countries
and the Alliance and gender implications are described below .

1. Impact on countries and on the Alliance

a) The decision to continue funding the pilots will directly affect the MVIP
countries, given their investment in the routine use of vaccine. However even
countries that are n ot currently included in the pilots are likely to have an interest
in understanding how RTS,S could add to current malaria interventions , and a
lack of funding to complete the pilots would jeopardise the ability to make policy
and investment decisions .

b) A number of countries have communicated their strong interest in considering
introduction of RTS,S . The decision regar ding whether to risk -share continued
manufacturing will impact countries in terms of the supply available for their
introduction and scale -up of RTS,S in the case of positive policy and investment
decisions .

c) This decision is relevant to the Alliance in several ways :

i. Given the global burden of malaria and the public health impact, the
availability of a new intervention could have significant impact in terms of
contributing to the prevention of malaria -related morbidity and mortality in
the longer term .

ii. At this stage, there is an opportunity to signal the need to understand the
role of RTS,S as part of a broader disease control strategy and the
implications of using a partially efficacious vaccine.

iii. The experience with RTS,S provides a learning opportuni ty which could
enable us to plan for pilot s introductions and for the future supply of
vaccines without dual markets.

2. Gender implications of this decision

Full analysis of the gender implications of a malaria vaccine programme would be
included in a fu ll investment case for broader roll -out .

Looking forward to a potential malaria vaccine programme there is greater gender
equity with childhood vaccines in Africa than for care -seeking behaviour, which is
poorer for girls than boys. Moreover, girls are m ore likely to be tasked with caring for
their younger sick siblings, with knock -on effects for girls? school attendance and
achievement.

20, AVENUE A PPIA ? CH - 1211 G ENEVA 27 ? S WITZERLAND ? T EL CENTRAL +41 22 791 2111 ? F AX CENTRAL +41 22 791 3111 ? WWW . WHO . INT





Annex B
Background on the RTS,S/AS01 malaria vaccine



P r ep ar ed f o r
G av i B o ar d an d Co m m i ttee Mem b er s

1 9 N o v em b er 2 019




Prepared by the World Health Organization and PATH













FOR LIMITED CIRCULATION ? FOR USE BY GAVI BOARD & COMMITTEE MEMBERS
This document is being provided as background information ; it is not an official WHO publication.
This document draws on a background brief
prepared in advance of a stakeholder meeting
convened by WHO in October 2019 to discuss the
RTS,S/AS01 malaria vaccine.
07 - Annex B
Board-2019-Mtg-3-Doc 07-Annex B
ii
FOR LIMITED CIRCULATION Contents
Annex B: Background on the RTS,S/AS01 malaria vaccine ................................ ................................ ..... 1
Overview ................................ ................................ ................................ ................................ ............. 1
The disease ................................ ................................ ................................ ................................ .......... 2
The impact of imperfec t tools, used imperfectly ................................ ................................ ............ 2
The need for new tools ................................ ................................ ................................ ................... 2
The vaccine ................................ ................................ ................................ ................................ ......... 3
Current status of the RTS,S/AS01 malaria vaccine ................................ ................................ ......... 4
Efficacy and safety ................................ ................................ ................................ .......................... 4
A vaccine designed to reduce malaria illness and death ................................ ................................ 7
Potential public health impact ................................ ................................ ................................ ........ 7
Increased coverage and reach, including to the poorest children ................................ ................. 8
Cost - effectiveness/economic evaluation ................................ ................................ ........................ 9
Potential demand for the vaccine ................................ ................................ ................................ . 10
Pathway to access and related challenges ................................ ................................ ....................... 11
Regulatory status and 2016 WHO recommendation for pilots ................................ .................... 11
Future WHO policy recommendation ................................ ................................ ........................... 12
Country adoption decisions ................................ ................................ ................................ .......... 13
Global financing decisions ................................ ................................ ................................ ............. 13
Vaccin e supply ................................ ................................ ................................ .............................. 13
Key challenges to access ................................ ................................ ................................ ............... 14
The malaria vaccine as a potential, complementary tool for added protection against malaria ..... 15
Appendix 1. The RTS,S/AS01 malaria vaccine and its potential contributions to achievement of the
Sustainable Development Goals and other internationally agreed goals ................................ ............ 16
Appendix 2. Statement by the Malaria Policy Advisory Committee (MPAC) on the RTS,S/AS01 malaria
vaccine ................................ ................................ ................................ ................................ .................. 18
Appendix 3. Additional information on the Malaria Vaccine Implementation Programme ................ 19
Progre ss to date ................................ ................................ ................................ ............................ 20
Endnotes ................................ ................................ ................................ ................................ ............... 22


07 - Annex B
Board-2019-Mtg-3-Doc 07-Annex B

07 - Annex C
Board-2019-Mtg-3-Doc 07-Annex C

1



Board -2019 -Mtg -3-Doc 07

Section A : Executive Summary
Context
Despite progress since 2000, the global burden of malaria is increasing. The first
licensed malaria vaccine, RTS,S /AS01 , is a potential tool to complement existing
interventions. In 2016, Gavi, in partnership with others , committed to fund the
Malaria Vaccine Implementation Programme (MVIP) for 2017 -2020 .1 The MVIP is
a pilot of routine programm atic use of RTS,S which will generate evidence to inform
future WHO policy recommendations and investment decisions on broader roll -out
of RTS,S. Funding for 2021 -2023 is now required to complete the MVIP , which
was anticipated at the time of the original MVIP funding decision .
W hile RTS,S policy and investment decision s are on the horizon , a critical decision
regarding continuation or otherwise of vaccine production by the manufacturer
needs to be made soon (preferably before end 2019) and in advance of th e broader
policy and investment decisions . There are v arious options regarding production ,
each of which has different programmatic and financial trade -offs . Th is paper
seeks Board decisions on both topics (MVIP and vaccine production) based on the
recommendations of the Programme and Policy Committee (PPC) .
Questions this paper addresses
1) What does the latest evidence , including data emerging following the
recommendation for pilots, tell us about the safety and impact of RTS,S ?
2) What is the value of the MVIP and what resources are required to complete
it?
3) What options are available for Gavi engagement in vaccine production
pending policy/investment decisions and what are the implications , trade -
offs and risks ?
Conclusions
The MVIP will provide critical evidence to inform broader policy and inves tment
decisions. The PPC recommended that the Board approve funding of

1 https://www.gavi.org/about/governance/gavi -board/minutes/2016/22 -june/minutes/09 --- malaria -
vaccine -pilots --- appendices/
SUBJECT : MALARIA VACCINE PILOTS AND LONG -TERM SUPPLY
Agenda item: 07
Category: For Decision
Report to the Board
4-5 December 2019

08 ? Annex A

Report to the Board
Board -2019 -Mtg -3-Doc 08-Annex A
Annex A: Implications / Anticipated Impact
Risk implications and mitigation are included in the paper. The impact on countries
and the Alliance and gender implications are described below.

1. Impact on countries and Alliance

a) Gavi -supported countries face the greatest risk of an Ebola outbreak and a re
disproportionately affected by outbreaks when they occur. Access to vaccines
would enable affected countries to plan for the use of vaccines as part of their
preparedness and risk mitigation activities, thereby limiting the broader impact
on health syst ems and services (including routine immunisation).

b) It is important that countries have strong capacities in prevention, detection and
response, as these will be important also for outbreaks beyond Ebola. This will
require countries and partners to commit resources for new/ strengthened
surveillance and detection activities.

c) This report describes the high degree of uncertainty and need for new
knowledge and evidence ? across all aspects (duration of protection,
vaccin ation strategy, products, etc.). Countries will need to share experiences
and knowledge with counterparts , as they have been doing for recent Ebola
outbreaks, for example through the work of the Guinea n vaccination team in
the current outbreak in DRC .

d) Through engagement in Ebola, the Alliance will contribute to improved
understanding of the role of routine immunisation as part of epidemic and
pandemic response.

e) Section 4 highlights the different roles and responsibilities of Alliance
stakeholders in t he emergency stockpile mechanism and the need to ensure
that in the longer -term Ebola vaccines are considered as part of an integrated
approach to disease prevention and control.

2. Gender implications:

a) Risk: Studies report differences in exposure to EVD by gender, noting that while
men may be at risk of exposure to Ebola infection through initial spill over events
(e.g. through hunting), in protracted outbreaks women are at greatest risk of
exposure through t heir role as caregivers. In Gavi -supported countries where
the majority of HCWs are female, women are also at high risk of occupational
exposure.

b) Impact: In previous outbreaks, EVD has caused very high mortality in pregnant
women. Beyond Ebola infection, the impact of EVD on access to obstetric care
has also been documented. Finally, literature highlights the broader social and
economic impacts of the 2014 -2016 West African outbreak on girls and
women?s access to healthcare and participation in education and the labour
force.

1



Board -2019 -Mtg -3-Doc 08

Section A: Executive Summary
Context
The current time -limited Ebola funding envelope approved in 2014 will come to an
end in 202 0; furthermore, since the Programme and Policy Committee ( PPC )
discussion in October 2019 the first Ebola vaccine was licensed and pre -qualified
and licensed doses are expected to become available in mid -2020 , with other
vaccine s to follow . Following discussion by the PPC, t his paper proposes the
opening of a new funding window for a long -term licensed Ebola vaccine
programme. This would comprise support for reactive vaccination for outbreak
response through an emergency stockpile ? including vaccination in neighbouring
count ries ? and preventive vaccination of high -risk groups outside of an outbreak
(such as certain healthcare workers in countries classified as being at high risk) .

Questions this paper addresses
To consider the value of an Ebola vaccine programme this pape r adapts the
Vaccine Investment Strategy (VIS) evaluation approach for vaccines for epidemic
preparedness and response approved in June 2018. This framework presents the
four main questions :
1) Is the epidemic potential of Ebola Virus Disease sufficient to prioritise a
stockpile? (Section 2)
2) Would use of the vaccine be feasible/impactful (and in what contexts )?
(Sections 3,4 )
3) What is Gavi?s comparative advantage? (Section 5)
4) What are the financial implications? (Section 6)
Conclusions
The Board is asked to approve the opening of a funding window for an Ebola
vaccine programme with estimated financial implications of US$ 9 million for 2020
and US$ 169 million for 2021 -2025 . This funding window would replace the time -
limited Ebola envelop e approved in 2014. The Board is asked to approve retaining
the health systems strengthening ( HSS )/operational cost support window from the
2014 Ebola envelope in order to provide any required operational support for the
use of investigational vaccine reco mmended by WHO , for the interim period before
licensed vaccine doses are available in sufficient volume and the stockpile is
operational including in the ongoing outbreak and other outbreaks that may occur .
SUBJECT : GAVI ?S ENGAGEMENT IN EBOLA VACCINE
Agenda item: 08
Category: For Decision
Report to the Board
4-5 December 2019

09 ? Annex A

Report to the Board
Board -2019 -Mtg -3-Doc 09-Annex A
Annex A: Implications/Anticipated impact
Risk implication
? Risk of inaction: A decision to not move forward with the proposed changes in
an updated policy could potentially result in the policies being out of alignment
with the new strategy. It would continue to foster overly complex and
burdensome approaches and misaligned incentives. There could be a risk that
Gavi would not achieve its goals if its funding policies cannot adequately
support the new strategy.
? The proposed policy shifts respond to changes identified through examination
of performance in Gavi 4.0 or to changes required to deliver on Gavi 5.0. While
the proposed changes are intended to simplify and streamline the policies and
the processes that follow, changing the policies could result in confusion for
stakeholders. This could be mitigated through clear communication to
countries, partners and governance bodies, which would begin as early as the
start of 2020. Finally, certain changes, such as increased differentiation or
potentially higher funding in certain contexts (e.g. fragile countries), great er
flexibility to waive requirements and integration of grants could reduce current
ability to scrutinise use of funding. In finalising approaches and developing an
updated set of policies in phase II, the Secretariat will examine this potential
risk and i dentify mitigation measures at policy or operational levels.
Impact on countries
? The intention in making these policy changes is to at least maintain cost
neutrality for countries. For example, the shift in calculation for co -financing will
be carefully ex amined in the next phase to minimise distortions. However, in
some cases there might be a deliberate choice to adjust the level of funding for
a country. For example, in line with the Gavi 5.0 principle of equity, some
countries might see increased or redu ced funding for HSS depending on their
number of zero -dose or underimmunised populations. The Secretariat will
communicate early and transparently on these proposed implications to
minimise disruption .
? To better manage more integrated grants, countries wil l need to have increased
programme and financial management capacity. The degree of integration
could be further differentiated, with higher capacity countries rolling out
integrated grants, and increased investment in capacity building to prepare
countrie s with lower capacity.
? A stronger focus on differentiation and tailoring to country context will ideally
result in a more streamlined and responsive approach to addressing country
needs. For example, principles for differentiation in HSS grants, integrati ng
CCEOP, and removal of the universal PBF scheme will allow countries to better
design their proposals and use more suitable mechanisms to achieve their
goals. Finally, correcting policy rigidity (for example, co -financing waivers in
exceptional circumst ances) will allow the Secretariat to better respond to rapidly
changing contexts, enabling countries to access the appropriate support in a
timely manner.

09 ? Annex B

Report to the Board
Board -2019 -Mtg -3-Doc 09-Annex B

Annex B: Paragraphs referenced in decision points for Eligibility & Transition and
Co -financing Policies
Paragraphs 1.8 to 1.1 3 of Doc 04 to the PPC ? Part A ? as amended by
discussions at the PPC
1.8 Support: As indicated by the Board at the Ottawa retreat, the main policy
flexibility envisaged is the tailoring of the accelerated transition phase
through a time -limited extension . This process would be guided by three key
principles: successful transition depen ds, first and foremost, on strong national
ownership and political will, with Gavi playing only a supporting role; any
extension should not create perverse incentives that could lead to repeated
underperformance, and any additional support should be strict ly limited to the
identified needs (e.g. if main bottlenecks are found to be programmatic, and not
financial, only HSS and/or Targeted Country Assistance (TCA) support would
be extended, and not vaccine financing support) ? this question will be
addressed in Phase II.
1.9 Definition: The identification of countries at risk of failing to transition
successfully would use a combination of outcome -level measures (e.g.
coverage and equity), complemented by health system component -level
analytics (e.g. data, supply chain, demand, human resources). This evaluation
would take into account both the absolute levels as well as the directionality of
recent change (i.e. not only if a country?s coverage is high or low, but also
whether it has been increas ing or decreasing). From the experience of other
partners and per Steering Committee (SC) guidance, it is unlikely that precise
metrics and thresholds could be predetermined that would be automatically
valid across all countries. Thus, the evaluation would need to be informed by
dialogue with national stakeholders and partners with relevant technical
expertise, to ensure it appropriately reflects country -specific contextual
considerations.
1.10 Any metrics and analytics used would be aligned with Gavi 5.0 strat egic
indicators and targets and would therefore rely on currently available
information and data sources. Importantly, these are also expected to help
guide Gavi?s engagement with countries early on , ensuring that
investments are adequately tailored and ta rgeted to strengthen programmatic
sustainability well before countries reach the accelerated transition phase. A
major benefit of this approach is that it allows for early dialogue within and early
visibility by the Alliance and the PPC/Board to emerging p rogrammatic
sustainability trends and risks.
1.11 Another key benefit of this approach is that it aligns decision -making and
accountability with the end -goals that Gavi support seeks to achieve ,
including a renewed emphasis on equity in the context of Gavi 5.0. Moreover,
it also explicitly recognises that a detailed analysis of different health system
components is key not only to provide a more nuanced understanding of the
main drivers of programmatic underperformance, but also to inform the design
of investme nts. Additional details can be found in Appendix 3 .

1



Board -2019 -Mtg -3-Doc 09


Section A: Executive Summary
As part of operationalising Gavi 5.0, the Secretariat is undertaking a two -phase
review of Gavi?s existing funding policies: Eligibility & Transition Policy, Co -
Financing Policy and the Health System & Immunisation Strengthening
(HSIS) Support Framework 1. The purpose of this paper is to seek Board approval
on select policy changes as identified in th e first phase of the review and
recommended by the Programme and Policy Committee (PPC) . The se changes
reflect key strategic shifts in Gavi 5.0 and lessons learned from Gavi 4.0 .
Implementation experience , evaluations , consultations and analyses have
demonstrated that for the most part these Gavi policies function well . For example,
eligibility based on gross national income ( GNI ) per capita , requirements for
countries to co -finance a portion of vaccine procurement and the objectives for
health systems strengthening (HSS) and other non -vaccine funding continue to
support Gavi?s mission and strategic goals.
However, new directions for Gavi 5.0 and lessons learned from Gavi 4.0 drive a
proposed evolution of Gavi?s funding policies , particularly in view of the following :
? An increased focus on equity
? A stronger emphasis on programmatic sustainability
? Greater differentiation to target and tailor support to countries , particularly
fragile contexts
? Simplification and country ownership .
While the scope of this paper is focused on the proposed policy revisions , how
these policies are implemented will also be a key driver of success in the next
strategic period . The proposed policy changes are part of a much broader effort to
operationalise Gavi 5.0 (see Strategy Progress Update at Doc 04 for other
workstreams) .



1 The HSIS support framework operates in a similar manner as a Gavi policy, but with a greater
level of detail . Th e funding policy review would seek to resolve this inconsistency with other Board -
approved policies .
SUBJECT : GAVI 5.0: FUNDING POLICY REVIEW
Agenda item: 09
Category: For Decision
Report to the Board
4-5 December 2019

End of Gavi
financingLow - income
country threshold Eligibility
threshold100%
Variable duration 5 years yearsFormer Gavi - eligible
Fully self - financing
% of Gavi
vaccine
cost Preparatory transitionInitial self - financing
$0.20
per dose LMICS
Fully self - financing
Variable duration
End of price freeze for
former Gavi - eligibleAccess to LMIC tiered
price
UMIC threshold
Gavi MIC support threshold
Fully self - financingAnnex A: Diagram of MICs approach and the country journey
Access to price freeze for x
years TBCAccelerated transition
x years TBCCo - financed vaccine support
Technical Country Assistance
Health systems immunisation strengthening Advocacy and political will building
Innovative financing - backed pooled procurementAreas of Gavi support
Preventing Backsliding
Vaccine Introduction Support
Vaccine Introduction Support Vaccine Introduction SupportDRAFT ? For discussion only. Not for distribution
Vaccine catalytic financing
10 - Annex A

1



Board -2019 -Mtg -3-Doc 10


Section A: Executive Summary
Context
In June 2019, the Board requested the Secretariat to develop an institu tionalised
approac h for post -transition support to former Gavi -eligible countries and , in
response to inter -country equity concerns, to also explore extending this approach
to select neve r Gavi -eligible middle -income countries (MICs )1. This paper presents
an update to the Board on progress and the current th inking .
Questions this paper addresses
1. From the country perspective, what are the main barriers to immunisatio n
programme sustainability and new vaccine introductions (NVIs)?
2. Based on these findings , what could Gavi?s MICs approach include and how
will it leverage the Alliance and wider partner efforts?
Conclusions
Barriers to NVIs and sustaining immunisation programmes are complex and
interwoven. Countries perceive the sustainable f inancing of vaccines and
operations and vaccine price as key issues alongside a lack of political will,
restrictive procurement poli cies, inadequate data , and regulatory issues . Other
challenges include limitations in decision -making , insufficient supply chain capacity
and maintenance, and growing vaccine hesitancy. Manufacturers consider low
political will and regulatory barriers to be the main bottlenecks to N VIs and
emphasise the importance of addressing these alongside procurement support.
An MICs approach would be designed to prevent backsliding in former Gavi -
eligible countries and to stimulate the sustainable introduction of key missing
vaccines in former a nd never -Gavi eligible countries. Crucially, the approach would
also be designed to both mobilise and maximise the efficiency of countries ?
domestic resourcing for immunisation. It could include three inter -linked and
mutually reinforcing components to address these challenges: advocacy and
political will bui lding, targeted technical assistance, and an innovative financing
facility to support procurement . Each component could be tailored to the different
groups of countrie s. It would levera ge the Alliance and wider partner initiatives
including UNICEF Supply Division (SD ), the WHO MICs Strategy, and existing

1 Specifically , countries with a GNI p.c. under US $ 4,000 and possibly countries up to US $ 6,000
GNI p.c.
SUBJECT : UPDATE ON DEVELOPMENT OF STRATEGY FOR
MIDDLE -INCOME COUNTRIES (MICs)
Agenda item: 10
Category: For Information
Report to the Board
4-5 December 2019

Gavi

1



Board -2019 -Mtg -3-Doc 11

Section A: Executive Summary
Context
The Gavi Board has ultimate responsibility for risk oversight in the Alliance and is
responsible for agreeing on overall risk appetite and understanding and agreeing
the most significant risks and related mitigation. It therefore receives an annual
comprehensive Risk & Assurance Report .
Questions this paper addresses
The Risk & Assuranc e Report 2019 has been reviewed and recommended for
approval by the Audit & Finance Committee (AFC) and guidance has been
incorporated in the final version annexed to this paper. The Gavi Alliance Board is
requested to approve the report attached as Annex A and to provide guidance on
the questions outlined below.
This year?s report includes an additional section sharing some preliminary thoughts
on how Gavi?s risk profile may shift under Gavi 5.0. Board members are invited to
discuss these and share prelimi nary views.
Conclusions
This year?s report shows that Gavi?s overall risk profile has remained relatively
stable with 16 top risks from last year still included and one having decreased to
become a medium risk.
Section B: Risk and Assurance Report
Portfolio discussion on top risks to the Alliance
1.1 This is the fourth annual Risk & Assurance Report which discusses the most
critical risks that could potentially have an impact on the ability of the
Alliance to achieve its mission and strategic goals. The report provides an
update on risk management across the Alliance, an analysis of macro -
trends affecting Gavi?s risk profile, an overview of key changes in top risks
compared to last year, and an overview of how current levels of risk
compare to Gavi?s risk appetite (i.e. the willingness to accept being
exposed). Detailed information including analysis of each top risk and
corresponding mitigation is included in the annexes of the report . Where
SUBJECT : RISK MANAGEMENT UPDATE
Agenda item: 11
Category: For Decision
Report to the Board
4-5 December 2019

1



Board -2019 -Mtg -3-Doc 12
Report to the Board
4-5 December 201 9

















SUBJECT: COMMITTEE CHAIR AND I FFIM BOARD REPORT S
Agenda item: 12
To follow

1



Board -2019 -Mtg -3-Doc 13
Report to the Board
4-5 December 201 9

















SUBJECT: REVIEW OF DECISIONS
Agenda item: 13
No paper

1



Board -2019 -Mtg -3-Doc 14
Report to the Board
4-5 December 201 9

















SUBJECT: CLOSING REMARKS AND REVIEW OF BOARD
WORKPLAN
Agenda item: 14
No paper

Board -2019-Mtg -3-A





G avi Alliance Board Meeting
4-5 December 2019
Hyatt Regency Hotel, Delhi, India

Board and Committee minutes




No te
Minutes of Board and C ommittee meetings held since the Board meeting in Geneva in June 2019 are
included in this document for ease of reference. Decision slides are i ncluded when meeting mi nutes
have not been approved . The agenda of a meeting is pr ovided when no decision wa s made or when
discussions/ decisions were commercially sensitiv e or confidential .

Pages MINUTES
1-28 Board ? 26 -27 June 2019
29 -32 Board ? 19 July 2019
33 Board ? 12 August 201 9 (No -objection consent)
34 Boar d ? 11 Octobe r 201 9 (No -objection consent)
35 -42 Audit and Finan ce Committee ? 25 July 2019
43 -49 Audit and Finance Committee ? 10 October 2019 (Decision slides)
50 -51 Audit and Finance Committee ? 26 Nove mber 2019 (Agenda)
52 -63 Programme and Policy C ttee ? 23 -24 October 2019 (Decision slides)
64 -72 Gove rnance Co mmittee ? 1 October 2019
73 -78 Investment Committee ? 10 September 2019
79 -81 Investment Committee ? 14 N ovember 2019 (Decision slides)
82 -84 Evaluation Advisory C ommi ttee ? 2-3 October 201 9 (Decision slides)

1



Board -2019 -Mtg -3-Audit and Finance Committee Chair Report

Section A: Introduction
? This report provides the Board with an overview of the activities of the Audit
and Finance Committee ( AFC ) since the Board last met in June 201 9.
? The AFC met three times (2 5 July , 10 October and 26 November ).
Subjects reviewed are noted below under Section B.
? AFC recommendations to the Board are attached as Annex A.

Section B: Subject matters reviewed
1) Audit & financial reporting
? External audits were completed on time, with no significant audit issues
identified by Deloitte .
? The 201 8 Annual Financial Report (AFR), was completed and published
on -time, with no significant issues identified by Deloitte .
? Gavi's annual tax return (For m 990) was filed in November ahead of the
deadline . The AFC reviewed the compensation section included in the
return. Unlike previous years there was no significant changes to the 2018
990 compared with 2018 in terms of compensation for CEO and others
beca use the exchange rate of Swiss francs and dollars remained largely
unmoved over the year.
? Quarterly abridged consolidated and standalone financial statements we
discussed with no issues raised .
? Th e transition was completed successfully between KPMG and Deloitte as
Gavi?s external auditor .
? Standalone Swiss audit and internal control requirements : The Committee
was updated with additional reporting requirements for the year end
31 December 2019 and the actions required to comply with these
requirements.
2) Financial Update
? The financial update covering 2019 actuals and the forecast for 2016 -2025
was received.
SUBJECT : AUDIT & FINANCE COMMITTEE CHAIR REPORT
Category: For Information
Report to the Board
4-5 December 201 9

1



Board -2019 -Mtg -3-Doc B


Section A: Executive Summary
Context
Key shifts in the Gavi 5.0 strategy objectives and goals necessitate new ways of
approaching monitoring and evaluation (M&E) that build up on the lessons learned
from Gavi 4.0.
Improvements in the Gavi 5.0 M&E system will include 1) developing a theory of
change underpinning the Gavi 5.0 strategy goals and objectives with well -
articulated causal pathways and key assumptions ; then using this to outline the
measurement and learning objectives from the outset of the strategy period,
establish indicators interlinked across the results chain (i.e. the measurement
framework) and risks that are routinely monitored and used for timely performance
management and shared accountability for delivering results.
In October 2020, t he PPC was requested to provide g uidance on the approach to
development of the 2021 -2025 M&E system, and more narrowly, the principles and
process for development of the Gavi 5.0 strategy performance measurement
framework , as described in this paper . More recently, the Gavi 5.0 Measurement
Framework Technical Working Group (TWG) discussed indicator options for
measuring ?zero -dose? children.
Questions this paper addresses
1) What approaches , principles and processes does the Gavi Alliance intend to
develop and use for manag ing performance , monitor ing progress ,
demonstrat ing accountability and generat ing learning for achieving the
2021 - 2025 strategy objectives ?
2) How will the Gavi Alliance measure ?zero -dose? children in the 2021 -2025
strateg y?
Conclusions
The Programme and Policy Committee (PPC) expressed strong support for the
proposed structur e, principles and process for developing the 2021 -2025 M&E
system and approach to evaluations , which will rely on theory of change to
underpin the the measurement framework and evaluation workplan. I n a recent
meeting of the Gavi 5.0 Measurement Framework TWG, it was agreed that lack of
SUBJECT : 2021 -2025 MEASUREMENT FRAMEWORK
Agenda item: B
Category: For Information
Report to the Board
4-5 December 2019

1



Board -2019 -Mtg -3-Doc B


Section A: Executive Summary
Context
Key shifts in the Gavi 5.0 strategy objectives and goals necessitate new ways of
approaching monitoring and evaluation (M&E) that build up on the lessons learned
from Gavi 4.0.
Improvements in the Gavi 5.0 M&E system will include 1) developing a theory of
change underpinning the Gavi 5.0 strategy goals and objectives with well -
articulated causal pathways and key assumptions ; then using this to outline the
measurement and learning objectives from the outset of the strategy period,
establish indicators interlinked across the results chain (i.e. the measurement
framework) and risks that are routinely monitored and used for timely performance
management and shared accountability for delivering results.
In October 2020, t he PPC was requested to provide g uidance on the approach to
development of the 2021 -2025 M&E system, and more narrowly, the principles and
process for development of the Gavi 5.0 strategy performance measurement
framework , as described in this paper . More recently, the Gavi 5.0 Measurement
Framework Technical Working Group (TWG) discussed indicator options for
measuring ?zero -dose? children.
Questions this paper addresses
1) What approaches , principles and processes does the Gavi Alliance intend to
develop and use for manag ing performance , monitor ing progress ,
demonstrat ing accountability and generat ing learning for achieving the
2021 - 2025 strategy objectives ?
2) How will the Gavi Alliance measure ?zero -dose? children in the 2021 -2025
strateg y?
Conclusions
The Programme and Policy Committee (PPC) expressed strong support for the
proposed structur e, principles and process for developing the 2021 -2025 M&E
system and approach to evaluations , which will rely on theory of change to
underpin the the measurement framework and evaluation workplan. I n a recent
meeting of the Gavi 5.0 Measurement Framework TWG, it was agreed that lack of
SUBJECT : 2021 -2025 MEASUREMENT FRAMEWORK
Agenda item: B
Category: For Information
Report to the Board
4-5 December 2019

1



Board - 2017 - Mtg - 1 - Doc CHOOSE DOC NUMBER
Section A: Introduction

? This report provides the Board with an overview of the activities of th e
Evaluation Advisory Committee ( EAC ) since the Board last met in June
2019.

? The EAC met in Geneva on 2 - 3 October 2019 under a new Chair, Nina
Schwalbe. The EAC also welcomed 4 new members to the Committee ;
Marta Nune s, Maty Dia , Juan Pablo Guti?rrez and Ez zedine Mohsni .

? At this meeting, the EAC revi e wed the draft Terms of Reference ( ToRs ) for
the evaluation of Gavi?s Engagement with the Private Sector and the
evaluation of Gavi?s Supply and Procurement Strategy . These will be issued
for competitive external tende r in December 2019 and the reports will be
available to the Board by Q3 2020 .

? The EAC assessed the quality and usefulness of the draft final report of the
Eligibility, Transition and Co - financing Policies evaluation . The committee
had a number of recommendations and requested to review the next draft
before issuing its report.

? The EAC discussed the Gavi evaluation workplan for 202 0 and which
evaluations would come under its review (centrali s ed).

? The EAC Chair informed the Committee that she and the Gavi Secretariat
had met with the Global Fund Technical Evaluation Reference Group C hair
(TERG) and the Global Fund Secretariat and agreed to shar e the findings
of selected evaluations and to invite each other ? s members to be part of
relevant evaluation steering committee s.

? R egard ing Gavi 5.0 , t he EAC suggested areas that should be considered
in the evaluation workplan for Gavi , which will be further discussed with the
Board in spring 2020.

Annexes
Annex A : Current E valuation W orkplan

Annex B : Evaluation Advisory Committee Chair reportSUBJECT : EVALUATION ADVISORY COMMITTEE CHAIR REPORT
Category: For Information Report to the Board
4 - 5 December 2019

1



Board -2019 -Mtg -3-Governance Committee Chair Report

Section A: Introduction
? This report provides the Board with an overview of the activities of the
Governance Committee (GC) since the Board last met in June 2019 .
? The GC met by teleconference on 1 October 2019 and 25 November 2019 .
? In addition to some routine business such as B oar d and Committee
nominations and the recruitment of Unaffiliated Board members, Committee
discussions focussed on work in relation to the Board Chair and Board Vice
Chair recruitment processes , the annual HR report and discussions on the
need for a potentia l governance review .
? A number of Board and Committee nominations submitted to the
Governance Committee at its meeting on 1 October 2019 have already
been circulated to the Board for no objection consent .
? The GC will meet on 3 December 2019 , preceding the Board meeting, and
it is expected that further recommendations will be put forward to the Board
on the consent agenda at its December meeting.
? The GC Chair report is attached in the form of a presentation as Annex A .
Annexes
Annex A : Governan ce Committee Chair report





SUBJECT : GOVERNANCE COMMITTEE CHAIR REPORT
Category: For Information
Report to the Board
4-5 December 2019

1



Board -2019 -Mtg -3-Investment Committee Chair Report


Section A: Introduction
? This report provides the Board with an overview of the activities of the
Investment Committee along with an update on market trends since the
Board last met in June 2019 . The Committee met four times in 2019.
? All performance results presented in Annex A are shown as of 31 October.
The long -term portfolio return is +9.4%. The short -term portfolio over which
the Investments team has control delivered a return of +3.0%. The total
portfolio as at October 2019 is US$ 1.6 billion of which US$ 902 million is
invested in the long -term portfolio. The remaining US$ 669 in the million
short -term portfolio includes US$ 190 million of cash proceeds that will be
invested back into the long -term portfolio. As a reminder, these figures do
not include the UNICEF Proc urement Account or IFFIm assets.
? Overall 2019 returns are positive across all asset classes despite periodic
market fragility related to stalled trade negotiations between the US and
China, the two larges t economies of the world. In addition, an agreemen t
between the European Union and the UK on how Brexit will be implemented
remains unresolved and dependent on the UK December General Election,
leaving trade, border and labour questions unanswered. Also looming in the
background is the US 2020 election, and whether there will be a re -profiling
of national priorities .
? In Q3 the US economy expanded at an annualized rate of 1.9%, solid but
not s pectactular. While the US labour market and consumer spe nding are
strong , weakening business inve stment and trade data , and inflation falling
short of its longer -run goal of 2% led the US Federal Reserve (?Fed?) to pre -
emptively cut rates in July, September and October in order to sustain the
current economic e xpansion , the longest since World War II . For now the
Fed will likely keep it s benchmark short -term interest rate at current levels
until data pointing to a materal weakness of the US economy emerges.
? Since the Great Financial Crisis in 2008 , inflation levels have remained
muted . However , the effect of tariffs will begin to appear in prices of raw
materials such as steel and aluminium as well as finished goods, and raise
inflation levels . Less er known and tracked factors that will also impac t
inflation include climate change measures meant to limit emissions. For
example, in 202 0 the International Maritime Organization (?IMO?) imposes
rules aimed at limiting air pollutant emissions by requiring ships to use more
expensive low -sulfur fue ls su ch as marine gasoil and ultr a-low -sulfer fuel
oil. From an investment perspective, rising inflation levels requiring
SUBJECT : INVESTMENT COMMITTEE CHAIR REPORT
Category: For Information
Report to the Board
4-5 December 2019

1



Board -2019 -Mtg -3-IFFIm Chair Report

Section A: Introduction
? This report provides an overview o f IFFIm ?s contribution to Gavi and its role
in the 2021 -2025 replenishment.
? IFFIm is an innovative financing mechanism with strong donor support and
recognised as a pioneer in socially responsible investing
? IFFIm is expected to provide US $ 1.475 billion in assured resources for
2021 -2025 period with add ed value through its financial flexibility .
? IFFIm?s existing resources will be nearly exhausted by the end of the
2021 -2025 period and its financial strength compromised from 2024 .
? A replenishment of US$ 500 - US$ 1 billion will enable Gavi to fully meet its
flexible funding needs and retain IFFIm?s effectiveness as a financing
mechanism for the next strategic period .
Annexe s
Annex A : IFFIm Chair report

SUBJECT : IFFIM CHAIR REPORT
Category: For Information
Report to the Gavi Board
4-5 December 2019

1



Board -2019 -Mtg -3-Programme and Policy Committee Chair Report


Section A: Introduction
? This report provides the Board with an overview of the activities of the
Programme and Policy Committee ( PPC ) since the Board last met in June
2019 .
? The PPC met in Geneva on 23 -24 October 2019. During the two -day PPC
meeting, the Committee discussed a numb er of important topics for the
Alliance and agreed on recommendations which are being put forward to
the Board at its December meeting for consideration.
? In the context of the light touch Board Effectiveness Review, which included
a survey by PPC members o f the PPC, the PPC met in closed session on
24 October 2019 to review the results of the survey and to provide any
further comments.
? The PPC Chair report is attached in the form of a presentation as Annex A
and the PPC recommendations to the Board are attached as Annex B.
Annexes
Annex A : PPC Chair report
Annex B : PPC recommendations to Gavi Alliance Board
SUBJECT : PROGRAMME AND POLICY COMMITTEE CHAIR REPORT
Category: For Information
Report to the Board
4-5 December 2019

www.gavi.org
CEO BOARD UPDATE
Seth Berkley, CEO
4 December 2019 , New Delhi
Gavi - India partnership: catalysing transformation of
world?s largest immunisation programme
Penta
HSS1
(2014 -17)
HepB
Injection safety support
(2005 -07)
Gavi -India partnership approved
Rota
MR (C)
PCV
IPV Td
HSS2
(2017 -21)
Mission Indradhanush
Number of underimmunised children (based on DTP 3 coverage) India DTP3 coverage
Number of
underimmunised
children (million)
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
2
4
6
8
10

Gavi

Gavi

Gavi

Gavi

Malaria Vaccine Pilot Implementation and Long - term Supply
Lusitana
Vaccinated in Malawi on 23 April 2019
Abigail Blessing
Vaccinated in Ghana on 30 April 2019
Elian
Vaccinated in Kenya on 13 Sept 2019
Dr Kate O?Brien, Director, Immunization, Vaccines & Biologicals, WHO
Gavi Alliance Board Meeting, 4 -5 December 2019
2
Progress has stalled, new tools are needed
(millions)
Cases
Current prevention tools 1
?45% reduction in uncomplicated malaria
?50% population sleeping under an ITN
?14% reduction in uncomplicated malaria
?6.6% population at risk protected
?12 countries implemented with 53% of
eligible children treated
?74% reduction in uncomplicated malaria
Insecticide -treated mosquito nets ( ITNs )
Indoor residual spraying
Intermittent preventive treatment (IPT) 2
222
230
233
241
248 248
241
238
235
239 239
229
226
221
217
214 217 219
190
200
210
220
230
240
250
260
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Number of malaria cases worldwide
1 Coverage numbers for Africa in 2017; 2 Numbers shown for Seasonal Malaria Chemoprevention , previously referred to as IPTc . Source: World Health Organization . World Malaria Report , 2018; Cochrane Database Syst Rev . 2018; (11)CD000363; Cochrane Database Syst Rev . 2010; (4)CD006657; Cochrane Database Syst Rev . 2012; (2)CD003756; The Lancet 374.9700 (2009): 1533 -1542
Progress has stalled

Gavi

Gavi

www.gavi.org
UPDATE ON DEVELOPMENT
OF STRATEGY FOR MIDDLE -
INCOME COUNTRIES (MICs)
BOARD MEETING
Santiago Cornejo
4 -5 December 2019, Delhi, India
Reach every child
Outline of the Board decision
2
Resource allocation: No more than 3.0% of Gavi 5.0 planned expenditure
Former
Gavi -
eligible
countries
Never
Gavi -
eligible
countries
GNI per capita
? Many of these countries face similar
challenges as former Gavi -eligible countries.
? To explore options to engage with these
countries on the same set of modalities
? To also explore options to engage with these
countries.
? However based on needs, t he modalities of
engagement may be different
Board Meeting
4-5 December 2019
Post -transition support to former Gavi -eligible countries to be institutionalised
Approach focusing on:
Political advocacy, technical assistance, innovation, access to pricing, and catalytic
financial support to jumpstart vaccine introductions

Gavi

Gavi

Gavi

Gavi

Gavi