1


Board -2023 -Mtg -04-Doc 00a


Gavi Alliance Board Meeting
6-7 December 2023
Kempinski Hotel, Accra, Ghana
Wednes day 6 December : 08. 00-18. 30 (Board meeting Day One)
T hur sday 7 December : 08.00 -17 .00 (Board meeting Day Two)
Quorum: 14

Document List

No. Document
00a Document list
00b Agenda
01a Declarations of interest
01b Minutes from 26-27 June 2023
01c Minutes from 11 September 2023
01d No Objection Consent Decisions
01e Consent Agenda
01f Workplan
02 Country Presentation – Ghana – No paper
0 3 CEO’s Report – To follow
04 Strategy, Programmes and Partnerships: Progress, Risks and Challenges
0 5 Country Programmes Delivery Presentation – No paper
06 Committee Chair and IFFIm Board reports – To follow
0 7 Financial Update, including forecast
08 Update from Ethics, Risk and Compliance Office
0 9 Road to Replenishment – To follow
10a Gavi’s Role in Pandemic Prevention, Preparedness and Response: Pandemic
Prevention, Preparedness and Response Approach
10b Gavi’s role in Pandemic
Prevention, Preparedness and Response: African
Vaccine Manufacturing Accelerator (AVMA)
11 Vaccine Investment Strategy 2024: Proposed Shortlist
1 2 COVAX Update

Board -202 3-Mtg -04-Doc 00b 1

Gavi Alliance Board Meeting
6-7 December 2023
Kempinski Hotel, Accra, Ghana

Sunday 3, Monday 4 and Tuesday 5 December: Pre -Board meetings &
Field Visits
Tuesday 5 December: 09.00 -17.00 Board Retreat
Wednesday 6 December : 08. 00 -18. 30 Board M eeting Day One
Thursday 7 December : 0 8.00 -17.00 Board M eeting Day Two

Quorum: 14



A genda - REVISED














Next Board Meeting : 17-18 April 2024 (Board Retreat)
26 -27 June 2024
4-5 December 2024
---
Brenda Killen , Director, Governance and Secretary to the Board, +41 22 909 6680, bkillen@gavi.org
Joanne Goetz , Head, Governance, +41 22 909 6544, jgoetz@gavi.org
Please note that the Board meeting will be recorded. This recording will be used as an aid to minute the
meeting. A transcription of the full proceedings will not normally be made. Should a transcription be made it
will be used only as an aid to minute the meeting.

1

Board -2023 -Mtg -04-Doc 01a

Gavi Alliance Board Meeting
6-7 December 2023
Kempinski Hotel, Accra, Ghana
Quorum: 14
Declarations of Interest
Declarations
Section 5.5 of the Conflicts of Interest Policy for Governance Bodies states “Members involved
in decision- making processes on behalf of Gavi must take appropriate action to ensure
disclosure of Interests and Conflicts of Interest, and take the necessary action in respect
thereof.”

Section 6.2 of the Conflicts of Interest Policy for Governance Bodies further states, “The duty
to disclose [in 6.1 above] is a continuing obligation. This means that Members are obliged to
disclose any Interests and/or Conflict of Interest, whenever the Member comes to know the
relevant matter.”

The following declarations were made by members of the Board on their most recent annual
statements .

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













José Manuel Barroso,
Chair
























None












Hult – EF (Education First) (Visiting
Professor and Chair of Advisory
Council) ; Goldman Sachs (Chair of
International Advisors from 1 April
2023) ; Princeton University Princeton
School of Public Policy, LISD (Member
of the Advisory Council from 01 April
2023) ; CAPRI, Center for Asia Pacific
Resilience and Innovation (Member of
the International Advisory Council from
1 April 2023); Catholic University of
Portugal (Visiting Professor at the
Institute of Political Studies and Director
of the Centre for European Studies) ;
The EUROPEAUM (Board Member) ;
WPL Women Political Leaders
(Advisory Board Member) ; Jean Monnet
Foundation for Europe (Honorary
Committee Member); European Centre
for Culture, (Honorary Co-P resident);
Portuguese Diaspora Council
(Chairman of the General Assembly
and Chairman of the EurAfrican
Forum); Bilderberg Meetings (Steering
Committee Member); Concordia
(Member of the Leadership Council) ;

Board -202 3-Mtg -02 1
Minutes

Gavi Alliance Board Meeting
26 -27 June 2023
Global Health Campus, Geneva, Switzerland

1. Chair’s report

1.1 Noting that the meeting had been duly convened and finding a quorum of
members present, the meeting commenced at 14 .05 Geneva time on
26 June 202 3. Prof Jos é Manuel Barroso, Board Chair, chaired the meeting.

1.2 The Chair welcomed new Board members and Alternate members attending
for the first time, namely: Eduardo Retes of Honduras , Greg Widmyer of the Bill
& Melinda Gates Foundation and Me llissa Hisko of Canada .

1.3 The Chair welcomed a number of high -level observers from Brazil, Saudi
Arabia , South Africa and Spain . He also welcomed Kenneth Lay, International
Finance Facility for Immunisation (IFFIm ) Board Chair , and other directors of
the IFFIm Board , as well as representatives from Nestor Advisors , the external
firm which is undertaking the ongoing Board and Board Committee evaluation.

1.4 He provided a brief summary on a number of preparatory meetings that took
place on the eve of the Board meeting , including the meeting of the
Implementing Country Caucus and the All Chairs Group (ACG) .

1.5 The Chair highlighted the Gavi Mid -Term Review (MTR) event that had taken
place on 13 -15 June 2023 in Madrid at the invitation of the Government of
Spain , whom he thanked for their commitment to global health. He underlined
the importance of the MTR in reviewing the progress of Gavi ’s objectives and
commended the Alliance for reaching the milestone of 1 billion children
vaccinated since Gavi’s inception in 2000.

1.6 The Chair noted that during the closed session earlier that day he had informed
the Board of a critical development related to the CEO position. Dr Muhamm ad
Pate , who was expected to assume his role as the new Gavi CEO on
3 August 2023 had informed Prof Barroso on the eve of the Board meeting that
he will not be able to join Gavi as he has accepted a request to return and
contribute to his home country , Nigeria . The Chair explained that in view of this
the Board had agreed to appoint the Chief Operating Officer (COO) David
Marlow, as interim CEO (and therefore a non -voting Board member) until a new
CEO has been recruited . He noted that the Board had also received an update
from Mr Marlow on the Operational Excellence initiative during the closed
session .

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

Board -202 3-Mtg -03 1
Minute s
Gavi Alliance Board Meeting
11 September 2023
Virtual

1. Chair’s report

1.1 Noting that the meeting had been duly convened and finding a quorum of
members present, the meeting commenced at 14 .01 Geneva time on
11 September 2 02 3. Prof José Manuel Barroso, Board Chair, chaired the
meeting .

1.2 The Chair welcomed Sai Prasad as a new Board Member . He noted that
Alexandra Rudolph -Seeman was exceptionally attending this closed session as
an observer for Germany, the anchor donor for their donor constituency cluster.

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

1.4 The Chair informed Board Members of his intention to extend the deadline for
expressions of interest in the position of Board Vice Chair to
29 September 2023, noting that the process had been launched during a period
when many may ha ve been on leave and may not have been able to give the
process due consideration.

1.5 He also updated the Board on a recent trip he had made to China for Gavi
during which he had had a number of impor tant high -level meetings at which
he had been able to highlight Gavi’s role as a key partner for China. He noted
the support received in preparing for this visit from Gavi Board Member, Yibing
Wu.

--- ---

2. Update on CEO Search Process

2.1 The Chair introduced this item recalling that the Board, in June 2023 had agreed
to re -start the ongoing CEO search and recruitment process and confirmed
member ship of the CEO Search Committee.

2. 2 He noted that, as requested by the Governance Committee, Gavi’s Chief
People and Experience Officer, Laura McKeaveney, led the task of identifying
a search firm, negotiating the contract, and ensuring the chosen firm meet s the
highest industry standards in this recruitment and that she will continue to be
available as needed by the Committee and the Board going forward.

2.3 The Chair then reported that the Search Committee had met three times during
July and August 2023 and referred to the email that he had sent to the Board

1


Board -2023 -Mtg -04 -Doc 01d

Report to the Board
6-7 December 2023

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


Since the June 2023 B oard meeting, three decisions have been circulated
electronically for approval by no -objection consent in line with Section 11 of the Board
and Board Committee Operating Procedures.
1) On 20 July 2023 , Board Members were invited to consider approv al of the
appointment of a Programme and Policy Committee Member .

No objections were received prior to the end of 2 August 2023 and the following
decision was therefore entered into the record:

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

Appointed P. Ashok Babu (Committee Delegate) to the Programme and Policy
Committee, effective immediately and until 31 December 2023
2) On 20 September 2023 , Board Members were invited to consider approv al of the
appointment of Alternate Board Members and Programme and Policy
Committee Members .

No objections were received prior to the end of 2 October 2023 and the following
decision was therefore entered into the record:

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

a) Appointed Soleh Ayubi as Alternate Board Member to Sai Prasad
re presenting the vaccine industry developing countries in the seat which is
currently vacant, effective 1 October 2023 and until 30 September 2025

b) Appointed Karin Berlin as Alternate Board Member to John -Arne Røttingen
representing Sweden on the donor constituency cluster anchored by Norway in
the seat which is currently vacant, effective immediately and until 30 June 2024

c) Appointed the following to the Programme and Policy Committee effective
immediately:
• Hannah Haaij (Committee Delegate) until 31 December 2023

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Board -2023 -Mtg -04-Doc 01e

Report to the Board
6-7 December 2023

Subject Consent Agen da – as at 5 December 2023
Agenda item 01 e
Category For Decision

Section A : Introduction
Nine recommendations are being presented to the Board under the Consent Agenda
for consideration. Detailed information on the items can be found in the relevant
Committee papers in a dedicated folder on BoardEffect at:
https://gavi.boardeffect.co.uk/workrooms/6459/resources/245825
Section B : Actions Requested of the Board
The Gavi Alliance Board is requested to consider the following recommendations from
the Gavi Alliance Governance Committee and the Gavi Alliance Programme and
Policy Committee .
Decision One – Board Vice Chair Nomination
The Gavi Alliance Governance Committee recommends to the Gavi Alliance Board
that it:
Appoint Omar Abdi as Vice Chair of the Board with individual signatory authority,
effective 1 January 2024 and until 31 December 2025.
Decision Two – Board and Committee Appointments
The Gavi Alliance Governance Committee recommends to the Gavi Alliance Board
that it:
a) Appoint the following Board Members:

• Jérémie Forrat -Jaime as Board Member representing France on the donor
constituency anchored by Germany in the seat currently held by Gabriella
Fésüs of the European Commission , effective 1 January 2024 and until
31 December 2024 .
• Karin Berlin as Board Member representing Sweden on the donor
constituency anchored by Norway in the seat currently held by John Arne
Røttingen of Norway , effective 1 January 2024 and until
31 December 2025 .

Classified as Internal #
Gavi Alliance Board Workplan
Gavi Board Paper Type Jan-MarAprMay JuneJuly-Nov DecMar/Apr JuneNov/Dec Mar/Apr JuneNov/Dec Mar/Apr JuneNov/Dec
A.Strategy/Performance/Risk/MEL CEO's Report CEO's Report Discussion
DiscussionDiscussionDiscussionDiscussion DiscussionDiscussion DiscussionDiscussion 2021-2025 Strategy Strategy, Programmes and Partnerships: Progress, Risks and ChallengesDiscussion Discussion DiscussionDiscussionDiscussion Discussion Innovation TBDInformation Information
Private Sector Engagement TBDInformation InformationInformation
Civil Society and Community Engagement Approach TBDInformation
Partners' Engagement Framework Strategy, Programmes and Partnerships: Progress, Risks and ChallengesDiscussion
Discussion DiscussionDiscussionDiscussion DiscussionDiscussion DiscussionDiscussion Disease Surveillance and Diagnostics in Gavi 5.0 TBDDiscussion
Risk and Asurance Report Risk and Assurance ReportDecision DecisionDecisionDecisionDecision
2026-2030 Strategy TBDDecisionDecision
Discussion DiscussionDiscussionDiscussion Funding Policy Review TBDDecisionGuidanceDecision
Health Systems strategy TBDDecisionGuidanceDecision
Measurement Framework (Targets & Indicators) TBD DecisionGuidanceDecision Decision B.Vaccines & Sustainablity Typhoid TBD Information Pneumococcal AMC (Advance Market Commitment) TBDInformation Vaccine Investment Strategy Vaccine Investment StrategyDecisionDecision COVID-19 Vaccine Programme Update TBD InformationInformation Gavi's role in Pandemic Prevention, Preparedness and Response TBD TBDTBD Gavi's role in support to Regional and African manufacturing TBD TBDTBD C.
Policy Transparency and Accountability Policy Decision D.Country Programmes
Nigeria TBD
InformationInformationInformation
PNG TBD
Information Information
Strategic Partnership with India Strategic Partnerships with India
Information
Fiduciary risk assurance and financial management capacity building Fiduciary risk assurance and financial management capacity building
Information
Middle-Income Countries approach TBDInformation E.Finance/Audit & Investigations Annual Accounts Annual Financial Report DecisionDecisionDecisionDecisionDecision Financial Forecast Financial Update, including forecastDecisionDecisionDecisionDecisionDecision DecisionDecision DecisionDecision
Budget Financial Update, including forecastDecision DecisionDecisionDecisionDecision
Programme Funding Policy Consent AgendaDecision
Treasury Governance Policy Consent AgendaDecision
Treasury Risk Management Policy Consent AgendaDecision
Independent Auditor Selection and Evaluation Policy Consent AgendaDecision
Audit & Investigations Report Audit & Investigations ReportInformation InformationInformationInformationInformation F.Governance
Board Chair Appointment Consent AgendaDecision Decision
Board Vice Chair Appointment Consent AgendaDecision DecisionDecision
Committee Chair Appointments Consent AgendaDecisionDecision Decision Decision
Board and Committee Appointments Consent AgendaDecision DecisionDecision
IRC Appointments Consent AgendaDecision
CEO Appointment Consent AgendaDecision Decision
Secretary Appointment Consent AgendaDecision
Treasurer Appointment Consent AgendaDecision
Appointment of MD A&I Consent AgendaDecision
Amendments to Governance Documents (Statutes, By-Laws, Committee Charters) Consent AgendaDecision
IRC Terms of Reference Consent AgendaDecisionDecision
Audit & Investigations Terms of Reference Consent AgendaDecision
G. Reporting
Committee Chair Reports Committee Chair and IFFIm Board reports InformationInformationInformationInformationInformation InformationInformation InformationInformation IFFIm Chair Reports Committee Chair and IFFIm Board reports InformationInformationInformationInformationInformation InformationInformation InformationInformation Replenishment/Resource Mobilisaton Resource Mobilisation Update Discussion
DiscussionDiscussion
Discussion HR Report Closed Session InformationInformationInformationInformationInformation InformationInformation InformationInformation Annual Report on Implementation of the Gender Policy Annex to Strategy paper Information InformationInformationInformationInformation Board and Committee minutes Annex to Board pack/On BE as additional materials Information
InformationInformationInformationInformation InformationInformation InformationInformation H.Technical Briefing Sessions/Deep Dives
Malaria - Joint session with the Global Fund Discussion
Gavi 6.0 Deep Dive (TBD) Discussion
Gavi Forecasting/Resource Allocation Discussion
Complexity of Vaccine Manufacturing - presented by IFPMA/DCVMN Discussion
Country Performance - High Impact Countries Discussion
Country Performance - Fragile Countries Discussion
Mid-Term Evaluation Discussion
Discussion
2026 2027
Last updated - 22 November 2023
Next Board Meetings: 17-18 April 2024, Retreat
26-27 June 2024
4-5 December 2024
2024
2025
Board-2023-Mtg-04-Doc 01f

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Board-2023-Mtg- 04-Doc 02

Report to the Board
6-7 December 202 3

Subject Country Presentation - Ghana
Agenda item 02
No paper

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Board -2023 -Mtg -04-Doc 03 _FR

Rapport au Conseil d’administration
6-7 décembre 2023

Rapport du Directeur exécutif
Le 29 novembre 2023
Chers membre s du Conseil d’administration,
À l'approche de notre réunion du Conseil d'administration de décembre qui va avoir
lieu au Ghana, je souhaite partager avec vous quelques réflexions personnelles sur
l'année écoulée et poser le cadre de nos discussions à venir.
Mais tout d'abord, quelques informations pratiques . Pour la présentation de ce premier
rapport au Conseil d'administration en tant que Directeur exécutif par intérim, j’ai voulu
m’écarter quelque peu du format précédent. Conscient des nombreuses contraintes
de temps auxquelles vous êtes soumis , j’ai choisi de vous présenter un bref rapport
de synthèse accompagné de diapositives (sous format PDF) qui serviront à guider nos
discussions, sans pour autant reproduire ou anticiper les exposés détaillés et les
délibérations qui nous attendent.
La confiance que vous m'avez accordée m'emplit d'humilité. Je suis également
convaincu que nous sommes globalement en bonne voie pour atteindre nos objectifs
prioritaires (accomplissement de Gavi 5.1 et mise en œuvre des mesure s d’excellence
opérationnelle, élaboration d'une stratégie ambitieuse pour Gavi 6.0 et préparation de
la reconstitution des ressources) et que ce sont là les objectifs les plus pertinents dans
ce contexte mondial en pleine évolution.
La résilience de Gavi face à l'incertitude
La réunion de notre Conseil d'administration va se dérouler dans un contexte régional
et mondial de fortes tensions géopolitiques, de turbulences dans l'économie mondiale
et d'une multitude de facteurs de risque et de vulnérabilité interdépendants ,
susceptibles d'affecter lourdement la couverture vaccinale et l'incidence des maladies
évitables par la vaccination dans de nombreux pays bénéficiant de l'aide de Gavi.
L'année dernière a été marquée par la réémergence continue de maladies évitables
par la vaccination telles que le choléra et la rougeole dans des régions où elles étaient
jusqu’alors bien contrôlées, tandis que le nombre total d'épidémies de maladies
évitables par la vaccination a continué à augmenter . Parmi les facteurs sous -jacents
et souvent interdépendants de cette augmentation figurent les conflits armés et
l'insécurité, la fragilité des systèmes de santé, les lacunes dans la couverture
vaccinale de routine, les dérèglements climatiques, l'urbanisation et les déplacements
de population.
Parallèlement, beaucoup de nos donateurs et de s pays soutenus par Gavi ressentent
les effets de l'incertitude économique mondiale et de l'inquiétude croissante face aux

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Board-2023- Mtg-04-Doc 03

Report to the Board
6-7 December 2023

Report of the Chief Executive Officer
29 November 2023
Dear Board M embers
As we approach our December Board meeting in Ghana, I want to take the opportunity
to share my personal reflections on the past year and set the scene for our coming
discussions.
But first some minor housekeeping. For this first report to the Board as interim CEO, I
want to depart slightly from the previous format. Cognisant of the many demands on
your time, it is my hope that you will find this short narrative report and the
accom panying presentation ( PDF) an easily digestible guide for our discussions,
without recapitulating or pre- empting the detailed briefings and deliberations that lie
ahead.
I remain humbled by the trust that you all placed in me. And I am equally confident
that our core priorities ? delivering on Gavi 5.1 and the Operational Excellence
enablers; developing an ambitious Gavi 6.0 strategy; and preparing for a successful
repleni shment ? are broadly on track and the most prudent focus of our collective
endeavours in the evolving global context.
Gavi’s resilience in the face of uncertainty
Our Board meeting will take place against a backdrop of high global and regional
geopolitical tensions, turbulence in the global economy, and a host of interacting risk
factors and vulnerabilities that have the potential to materially affect immunisation
coverage and the incidence of vaccine- preventable diseases in many Gavi-supported
countries.
The past year has seen the continued re- emergence of vaccine-preventable diseases
such as cholera and measles in areas where they had previously been well controlled,
while the total number of outbreaks of vaccine- preventable diseases also continued
on an upward trend. The underlying, and often interrelated, drivers of this trend include
conflict and insecurity, health system fragility, gaps in routine immunisation coverage,
climate disorder, urbanisation and displacement.
At the same time, many Gavi -supported countries and our donors are feeling the
effects of global economic uncertainty and growing disquiet over geopolitical conflict,
which may have unpredictable knock -on effects for domestic political economies.
Our Alliance is more than 22 years old. In that time, it has weathered global storms
from the financial crash to the COVID -19 pandemic, helping to vaccinate more than

Board -2023 -Mtg -04-Doc 04 -Annex A 1
Report to the Board
6-7 December 202 3
Annex A: Technical report on Gavi 5.0/5.1 indicators
This is a technical report providing definitions of and progress against Mission and
Strategy Goal indicators in the Gavi 5.0/5.1 measurement framework. The technical
report is populated based on available data and updated bi -annually. The newly
available data for 2022 included in this report relates to Mission Goals M2, M3, M4,
M5, and M6, and Strategy Goals 1, 2, and 3.2.
Note on target trajectories:
In the below graphs, the dotted lines represent the projected annual trajectory that was
forecast when we set 2025 targets with the PPC/Board in May/June 2021; our
assumption was that coverage would return to 2019 coverage levels in 2021, with the
exceptio n of India which would take until 2022. This was noted in a footnote in the
PPC paper on the 5.0 Measurement Framework at the time (PPC -2021 -Mtg -2-Doc
04):
• To account for COVID -19 -related disruptions and recovery, it is assumed that
vaccine coverage returns to 2019 levels by 2021, with the exception of India,
which we assume returns to 2019 levels in 2022 and sub -national three doses
of pneumococcal conjugate vaccine (PCV3) scale up takes an additional year.

Gavi 5.0 Mission Indicators
M.1: Under -five mortality rate – Updated
April 2023


By increasing access to immunisation
and enabling equal access to new
and underused vaccines, Gavi
support is contributing to the
reduction in under -five deaths from
vaccine -preventable diseases.
Gavi countries saw an under -five
mortality rate of 55.7 deaths per
1,000 live births in 2021. At the
portfolio level we are on track to
reach the 10% reduction target by
2025 – in 2021, Gavi countries have
achieved a 6% reduction from
baseline.
This indicator will be updated in April
2024.

Board -2023 -Mtg -04-Doc 04 -Annex B 1
Report to the Board
6-7 December 202 3
Annex B: PNG no cost extension
Section A: Summary
This paper requests the Gavi Board support for a no -cost extension (NCE) of
Gavi’s tailored strategy for Papua New Guinea (PNG) until 31 December 2027,
which includes financing for new vaccine support, and recommends an external
evaluation of the tailored strategy in 202 6. The latter would make
recommendations about possible further Gavi support to PNG beyond 2027.
Larger questions about transition will be addressed as part of the Gavi 6.0
Strategy and the associated Funding Policy Review.
PNG is part of the Fragile and Conflict (F&C) Segment and has been in Accelerated
Transition since 2016. Despite its status as a lower middle -income country, Penta1
and Penta3 coverage in PNG is lower than the median of other F&C countries and is
far below the mean of countries in Accelerated Transition. Both coverage rates are
one third lower than what PNG achieved in 2013 and one half of what PNG achieved
in 2005, suggesting that improvements should be attainable.
In June 2019 the Board approved a specially tailored strategy that extended PNG’s
Accelerated Transition Phase until December 2025. The 2020 -2025 financial envelope
is US$ 60 million, accompanied by sustained amounts of targeted country assistance
(TCA). A ll support was contingent upon fulfilment of key commitments in a PNG
Accountability Framework.
COVID -19 was declared a Public Health Emergency of International Concern (PHEIC)
in January 2020 and this delayed implementation of the Gavi PNG Strategy. The Gavi
Accountability Framework was agreed in March 2023 as part of the PNG’s Full
Portfolio Planni ng (FPP) proposal. The key actions agreed to were to: (i) increase
vaccine financing; (ii) improve coverage rates; (iii) improve EPI staffing, (iv) strengthen
coordination and oversight; and (v) increase the use of data for decision making. The
country is progressing against vaccine financing and coverage rate targets but it is too
early to assess progress on other indicators. The first formal progress review will occur
in Q1 2024. Gavi’s Accountability Framework fits into the more comprehensive Health
Acco untability Framework that donors, partners and National Department of Health
(NDOH) are working on together to strengthen NDOH’s overall lead role for the health
sector.
To improve coverage rates and reduce the number of zero dose children, the
Government, as part of its 2022 National Health Strategy, and NIS plans to:
(i) introduce at least 2,000 village health assistants that would help increase coverage;
(ii) expand outreach and fixed site immunisation delivery in zero dose targeted areas
through the join tly financed DFAT, MFAT and Gavi, AIHSS program (which targets
provinces , mostly through direct CSO support, that have relatively strong Primary
Health Care delivery systems while supporting other provinces with weaker
structures); (iii) strengthen data reporting and utilization by training provincial data
focal points on eNHIS data validation and introduction and (iii) address key human
resource issues such as optimizing the provincial and district health structures and
increasing the number of village health assistants to a tot al of approximately 6,000 in

Board -2023 -Mtg -04-Doc 04 -Annex C 1
Report to the Board
6-7 December 202 3
Annex C : Timor Leste No Cost Extension
Section A: Summary
Timor -Leste transitioned from Gavi support on 1 January 2018. In 2019, an
exceptional, Board -approved strategy provided US$ 8.3 million of post -transition
support covering 2018 to 2023 in recognition of the weak capacity of the EPI
programme and the limited support (particularly HSS) that the country had received
over its brief period of Gavi eligibility.
2021 -2022 saw significant disruptions, border closures and delays across EPI due to
the COVID -19 pandemic. The shift of focus from routine immunisation to Covid -19
vaccination efforts impacted progress in implementation of this post -transition grant,
limiting planned activity to address weak system capacity, including weak financial
management . The no -cost extension will provide the opportunity to focus on critical
activities to address systemic weaknesses, with renewed government commitment to
the revised post transition plan (end 2025) developed in conjunction with partners.
On April 18, 2023, Timor -Leste submitted to the Gavi Board Chair a request for (i) a
2-year no -cost extension of the Gavi post -transition grant and (ii) reconsidering its
eligibility for Gavi full support due to its challenging economic context.
The Secretariat recommends that the PPC supports Timor Leste’s request for a
no -cost extension of Gavi’s post -transition support for Timor -Leste until 31 of
December 2025 . Based on Timor -Leste’s latest GNI per capita, which is 9% above
the projected 2024 eligibility threshold, the Secretariat is not seeking an exception
from the Board for Timor -Leste’s eligibility to Gavi support at this stage.
Section B: Review of Post Transition Grant to Timor -Leste
1. Economic context
Emerging from decades of conflict, Timor -Leste became a new sovereign state
in May 2002. Despite significant progress in poverty reduction, Timor -Leste
continues to face challenges, with economic growth reliant on government
spending and revenues from natu ral resources. Timor Leste’s economic
slowdown since 2016 has been recently exacerbated by the COVID -19 pandemic
and Cyclone Seroja entailing significant rebuilding efforts, consuming nearly one -
third of the government’s expenditure in 2021. Government spe nding has yet to
rebound to pre -pandemic levels. Ongoing concerns include the persistent low
domestic revenue, with an anticipated cessation of petroleum revenue. In
July 2023, the World Bank indicated that Timor -Leste’s GNI per capita was
US$ 1,970, 9% above the projected Gavi eligibility threshold of US$ 1,810 for
year 2024.

Board -2023 -Mtg -04-Doc 04 -Annex D 1
Report to the Board
6-7 December 202 3
Annex D : Summary of proposed support for vaccine doses for the ‘Big catch -up’
The PPC considered three potential options on how to finance additional doses
required for the Big Catch -Up: Option 0. Permissive approach to allow countries to
request additional doses as part of their routine programmes (which would need to be
co -financed); or Option 1. Fully fund additional doses required to catch -up up to ~30% 1
of children missed (at an aggregated portfolio level) during the pandemic; or Option 2.
Fully fund all additional doses that countries request for catch -up. The Secretariat
recommended Option 1 to the PPC. This was designed to balance alleviating the
potential barrier to catch -up posed by co -financing with limiting the risk from providing
fully funded doses to the Gavi co -financing model.
Given the one -off nature of this effort that is a direct result of the pandemic, and the
urgency to close critical immunity gaps, the PPC emphasised the need to be as
permissive as possible within bounds of financial feasibility . The PPC therefore
recommends to the Board to approve flexibility to provide fully funded catch -up
doses for children missed during the pandemic for an initial amount of
US$ 290 million subject to countries developing robust plans. It should be noted
that this amount is an initial estimate and is likely to evolve as countries finalise their
plans.
The primary risk with this approach is that it may incentivise countries to request large
number of fully paid catch up doses via unrealistic plans. These doses, which are
fungible in nature across catch up and routine programmes, could subsequently be
use d in routine programmes (thereby circumventing the need to pay co -financing) or
wasted if not deployed rapidly enough. This ultimately could erode the sustainability
of the Gavi co -financing model and country efforts to build sufficient fiscal space for
th eir vaccination programmes. There is also a risk that these doses may be used to
re -immunise already vaccinated children if countries feel there is no financial cost to
re -immunisation. Risk mitigation measures to protect core co -financing requirements
and prevent wastage would need to be put in place operationally, including:
1. Provision of fully funded doses for big catch -up to be time -limited to the 2024 -
2025 period.
2. Ensuring the robustness of the country catch -up plans and the implementation
support to countries by augmenting the capacity of Alliance at global, regional and
country level, including through the provision of project management support.
3. Assessment of in -country stock and scheduled deliveries to determine dose
requirements for catch -up.
4. Phased supply of additional fully funded catch -up doses with countries needing to
demonstrate the first round of catch -up activities occur as planned before additional
doses are provided. Phased supply also mitigates potential inequities across
1 This level of fully funded doses would enable countries to reach all children who were missed due to pandemic -
related backsliding as well as a portion of the children who would have been zero dose even without the
pandemic. NOTE: This threshold is at an a ggregate portfolio level

1


Board -2023 -Mtg -04-Doc 04
Report to the Board
6-7 December 202 3

Subject Strategy, Programmes and Partnerships: Progress, Risks and
Challenges
Agenda item 04
Category For Decision
Section A: Executive Summary
Context
This report provides a progress update on the implementation of Gavi 5.0/5.1 and
associated risks 1 WHO -UNICEF estimates of national immunisation coverage
(WUENIC) for 2022 confirmed that Gavi -supported countries are, in aggregate, on the
road to recovery from the COVID -19 pandemic, with a three -percentage point (pp)
increase in the coverage of the third dose of diphtheria, pertussis and tetanus -
containing vaccine (DTP3). In 2022, Gavi -supported countries have reached roughly
the same number of children as they did pre -pandemic. In addition, the total number
of zero -dose children in Gavi -supported countries reduced by 2.2 million to
10.2 million in 2022, however, the number of zero dose remains above the 2019
baseline due to growing birth cohorts.
Questions this paper addresses :
• How is the Alliance performing against its strategic goals and indicators for
Gavi 5.0/5.1? What progress has been made against priorities?
• What are the key risks and challenges across the Alliance’s strategic performance,
programmes and partnerships, and what actions are being taken to address these?
• How should vaccine doses be funded under the big catch -up ?
• Should there be a no cost extension of Gavi support for Papua New Guinea (PNG)
and Timor -Leste to avoid the risk of backsliding?
Conclusions
The Alliance remains on -track to reach most mission indicator targets by the
end of the Gavi 5.0/5.1 period. However, whilst WUENIC data also confirms signs of
recovery in routine immunisation across Gavi -supported countries, the impact of
pandemic -related disruptions continues to be felt. This is particularly evident in the
continued high number of vaccine -preve ntable disease (VPD) outbreaks, for example
of measles . The Alliance continues to work towards delivering its Gavi 5.0/5.1 ‘must -
wins’ as part of d elivering on its 5.0/5.1 goals and objectives. The 2023 must -wins are
reaching zero dose -children; revitalising HPV; launching the malaria vaccine; and the
COVID -19 programme for 2024 -20 25 . The Alliance has also launched the ‘Big Catch -
Up’ to help restore immunisation coverage, catch -up children missed during the
1 Associated risks refer to the top risks in the Draft Risk & Assurance Report 2023 captured in Annex B.

1


Board-2023-Mtg- 04-Doc 05

Report to the Board
6-7 December 202 3

Subject Country Programmes Delivery Presentation
Agenda item 05
No paper

1


Board-2023-Mtg-04-Audit and Finance Committee Chair Report
Report to the Board
6-7 December 2023

Subject Audit & Finance Committee Chair Report
Category For Information
Section A: Introduction
• This report provides the Board with an overview of the activities of the Audit
and Finance Committee (AFC) since the Committee Chair last reported to the
Board in June 2023 .
• Since the last Board meeting, the AFC met two times (17 October in London
and 4 December virtually ) to consider Gavi recurring matters in accordance with
the standard workplan for Gavi 5. 1 and the Office of the COVAX Facility. As
part of the programme of the October meeting the AFC participated in a joint
t echnical briefing session on Gavi 6.0 design with the IFFIm Board .
• Subjects reviewed are noted under Section B and matters to be reviewed in
upcoming meetings are presented under Section C.
• AFC recommendations to the Board are attached as Annex A.
Section B: Subjects reviewed
1. Financial Update
Management Reporting • The Secretariat presented an update on financial performance as of September
2023 under the CEO, Programmatic and Quarterly Management Report
Updates section. Reporting was significantly expanded and enhanced to
respond to AFC members’ requests and feedback to provide more analysis of
underlying programmatic spend, funds with Alliance partners and a country
breakdown of HSS spending.
Financial Forecast (Gavi Core and COVAX)
Gavi 5.1 forecast
• The AFC reviewed the updated forecast which reflect s an increase in
US$ 157 million in Qualifying Resources and an increase in programmatic
expenditures of US$ 21 million before new investment approval s.
• The Secretariat commented on the key drivers : US$ 115 million investment
income returns , US$ 171 million of accelerated programmatic activity
supporting Gavi 5.1 must wins and US$ 150 million release of working capital
agreed with UNICEF S upply Division (SD) .

1


Board-2023-Mtg- 04-Doc 06

Report to the Board
6-7 December 202 3

Subject Committee Chair and IFFIm Board reports
Agenda item 06
To follow

1


Board-2023- Mtg-04-EAC Committee Chair Report
Report to the Board
6-7 December 2023

Subject Evaluation Advisory Committee Chair Report
Category For Information
Section A: Introduction
• This report provides the Board with an overview of the activities of , and
guidance provided by , the Evaluation Advisory C ommittee (EAC) since the
Committee Chair last reported to the Board in June 2023.
• At the in -person EAC meeting on 4-5 October 2023, the EAC provided guidance
on: i) progress of the commissioned Gavi 5. 1 centralised evaluations including
the Zero- Dose Evaluation; ii) the Strategy Operationalisation Evaluation; iii ) the
Mid -Term Evaluation (MTE) of Gavi’s 2021 -2025 Strategy; iv) the COVAX
Facility Phase 2 Evaluation ; v) the current relevance of the centralised
evaluation on sustainability/post transition; vi) the operationali sation of the
changes to the Gavi Evaluation Policy; and vi i) EAC engagement in Gavi 5. 1
evaluations.
Overarching issues and guidance

• The EAC continues to consider its r emit, voice and practice in supporting a Gavi
evaluation portfolio of optimal independence, credibility and u tility.

• As discussions about Gavi 6.0 gather pace, the EAC welcomes opportunities
to engage with the Secretariat - both at leadership level and through the
Monitoring, Evaluation & Learning ( MEL) Department – and, with the G avi
Board and its C ommittees, to foster reflection on how to optimally shape and
plan evaluation activities going forward. The EAC sees strengths in current
practice underpinning credibility, utility and independence; has begun to
discuss areas where further reflection is warranted, including on the EAC’s
remit, voice and practice; and has begun the process of considering potential
future shifts. The MOPAN assessment and a forthcoming E valuation Function
review offer useful inputs into this process.

• There was broad agreement by the EAC on the proposed timeline and process
for the Evaluation Function review through 2024. However, the EAC also
requested additional visibility showing the alignment with the development of
the Gavi 6.0 evaluation workplan – specifically, the EAC is keen to ensure that
any changes to remit, voice or practice of the EAC that are agreed following
upcoming reviews are in place such that they can be operationalised during the
development of the Gavi 6.0 evaluation workplan, and aligned with other
aspects of Gavi 6.0 planning.

• On the supplier review , EAC members welcomed the progress to date on this
topic and requested that work continue on this topic with EAC focal points and

1 Board-2023-Mtg-04-Investment Committee Chair Report
Report to the Board
6-7 December 2023
Subject Investment Committee Chair Report
Category For Information
S ection A : Introduction
• This report provides an overview of the activities of the Investment Committee
(“Committee ”) since the Chair last reported to the Board in June 2023.
• All values are reported as of 30 September 2023. The long-term portfolio value
is US$ 1.2 billion. Another US$ 25 million advance contributions are en route
for investment and US$ 2 million resides with Gavi’s Swiss custodian available
for immediate investment.
• The financial markets faced a battery of geopolitical and macroeconomic risks
leading to periods of volatility but not at the levels experienced in 2022. T he US
Fed eral Reserve’s higher -for -longer interest rate policy triggered market
volatility while other events such as Fitch’s downgrade of US debt in August
and Moody’s subsequent ratings outlook notice in November passed with
limited reaction. Fitch’s call to attention of the US government’ s fiscal and debt
management may not be heeded now but it will have real impact on government
spending in the future. Higher interest rates mean higher debt service
(mandatory government spending) , and a potential for crowding out
d iscretionary spending allocations .
•T

he COVID -19 pandemic and Russia- Ukraine war revealed less than resilient
global supply chains , leading to a demand- supply imbalance with inflation as
its manifestation. Large government stimulus programmes exacerbated the
demand side of the imbalance. Major central banks unleashed a rapid increase
in interest rates to dampen demand and reduce inflation, and they have been
successful in their trajector ies but still short of their preferred target s for
inflation . In the US, the annual inflation peaked at 9.1% in June 2022 and
subsequently dropped to 3.2% in October 2023, but it is still short of the
preferred 2% inflation target .
•O

n the fixed income front, major markets’ interest rates continued to rise in
2023 as a result of central bank actions and market expectation though at a
much less rapid pace than what occurred in 2022. Global bonds had significant
negative retur ns in 2022 as a consequence for the rapid pace of interest rate
hikes (e.g., bond prices and interest rates move in opposite directions) but also
from a starting point of very low yields. In 2023, the higher current yields helped
temper the decline in bond prices. The broad fixed income market, as
represented by Bloomberg Multiverse index, had a negative year -to -date retur n
of -1.9% at the end of September and clawed back into positive territory with
strong performance during the months of October and November . Interest rates

1


Board -2023- Mtg-04-IFFIm Chair Report
Report to the Gavi Board
6-7 December 2023

Subject IFFIm Chair Report
Category For Information
Overview
• This report provides the Board with an overview of the activities of IFFIm’s
support to date for Gavi’s 2021 - 2025 strategic period and expected future
capacity.
• The IFFIm Board, in consultation with Gavi and the World Bank (IFFIm’s
Treasury Manager), are developing a strategy to support Gavi through the
5.0/5.1 strategic period and beyond.
• As part of continued efforts to maximise IFFIm's strategic value for Gavi, the
Gavi Secretariat , World Bank, donors and the IFFIm Board are coordinating to
establish a Contingent Financing Mechanism to support Gavi’s Pandemic
Preparedness and Response ( PPPR) work.
• IFFIm has reviewed administrative aspects of i ts operations including the
United Kingdom’s annual rating of IFFIm as A+, Moody’s revised credit rating
outlook to stable and a joint session with the Gavi A udit and Finance
Committee. Additionally, recruitment for the IFFIm Board is underway .
• Annexed hereto, is the IFFIm Chair Report to be presented and discussed
during the forthcoming Gavi Board meeting.
Annex es
Annex A : IFFIm Chair Report

1


Board-2023- Mtg-04-PPC Committee Chair Report
Report to the Board
6-7 December 2023

Subject Programme and Policy Committee Chair Report
Category For Information
Section A: Introduction
• This report provides the Board with an overview of the activities of the
Programme and Policy Committee (PPC ) since the Committee Chair last
reported to the Board in June 2023 .
• On 24- 26 October 2023, the PPC held an in -person meeting. During the
meeting, the Committee discussed a number of important topics for the Alliance
and agreed on recommendations which are being put forward to the Board at
its 6 -7 December 2023 meeting for consideration.
• 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

gavi.orgPROGRAMME AND POLICY COMMITTEE CHAIR REPORT
BOARD MEETING
Anne Schuchat
6 - 7 December 2023, Accra, Ghana
Annex A

1


Board -2023 -Mtg -04-Doc 07

Report to the Board
6-7 December 202 3
Subject Financial Update, including forecast
Agenda item 07
Category For Decision
Section A: Executive Summary
Context
This paper presents the updated Financial Forecasts for Gavi 5.1 (2021 -2025) and
COVAX A dvance Market Commitment ( AMC ) (2020 -2023 and 2024 -2025 for the
COVID -19 immunisation programme) to the Board for approval based on
recommendation from the Audit and Finance Committee (AFC).
The Gavi 5.1 forecast confirms US$ 103 million available for future investments . T he
Secretariat continues to actively monitor risks and opportunities not yet crystallised
(including programmatic choices at the discretion of the Alliance) , noting that as we
near the end of the strategic period, with resources approaching full utilisation, there
is limited financial flexibility and any significant additional commitments would need to
come with new funding or a reprioritisation of programm atic expenditure . The forecast
reflects an increase of US$ 157 million in resources and an increase in programmatic
expenditures of US$ 21 million - before decision s submitted for approval .
• Changes to forecast: the increase in Qualifying Resources of US $157 million is
driven by actual investment income returns and favourable impact of foreign
exchange rates. Forecast Expenditure is increasing by US$ 21 million, driven
primarily by acceleration of programmatic activity supporting Gavi 5.1 must wins
(US$ 171 million) largely offset by more efficient use of vaccine working capital
(US$ 150 million) with the Alliance procurement partner, UNICEF S upply Division
(UNICEF SD) .
• Items for decision: the Board is asked to approve US$ 136 million funding for the
launch of the Multivalent Meningococcal Conjugate vaccine (MMCV) programme
(noting this represent s US$ 34 million incremental funding as US$ 102 million of
the US$ 136 million presented for decision was included in the prior forecast). The
impact on Gavi 6.0 is forecast between US$ 326 to US$ 577 million noting that all
Gavi 6.0 requests are contingent on financial resources being made available. The
Board is also asked to exceptionally approve the extension of post -transition
support for Timor -Leste , resulting in US$ 4 million of undisbursed funds being
included in the updated forecast .
The COVAX Facility closes at the end of 2023 however the COVID -19 programme
(Vaccine and C ovid -19 Delivery Support ( CDS )) will continue until the end of the Gavi
5.1 forecast period via the Board approved COVID -19 immunisation programme
(2024 -2025) . The 2024 -25 COVID -19 programme expectation (US$ 813 million)
remains aligned with the prior Board -approved forecast.

1


Board -2023 -Mtg -04-Doc 08
Report to the Board
6-7 December 202 3

Subject Update from Ethics, Risk and Compliance Office
Agenda item 08
Category For Decision
Section A : Executive Summary
Context
The Gavi Alliance Board is responsible for overseeing implementation of Gavi’s
enterprise risk management, including effective mitigation of top risks. To exercise its
oversight responsibilities, it receives the Annual Risk and Assurance Report ( See
Annex A).
The Board is also the owner of the Gavi Alliance Risk Appetite Statement for which
changes are also being proposed ( See Annex B).
Questions this paper addresses
• The Risk & Assurance Report discusses the most critical risks that could impact
the ability of the Alliance to deliver on its mission and achieve its strategic goals.
The report has been reviewed and recommended for approval by the Audit &
Finance Committee (AFC). Guidance was also sought from the Programme and
Policy Committee (PPC) on the programmatic risks. The Gavi Alliance Board is
requested to approve the report attached as Annex A.
• Moreover, the 202 1 Board -approved Risk Appetite Statement describes the
amount of risk that the Alliance is willing to take, accept or tolerate to achieve its
strategic goals. T he Gavi Alliance Board is requested to approve proposed
changes in th e Risk Appetite Statement as a result of the increasing trend in the
overall number of Vaccine -Preventable Diseases (VPD) outbreaks, driven primarily
by Cholera, Measles and to a lesser extent, Yellow Fever and other VPD outbreaks
(See Annex B) . These proposed chang es have also bee n reviewed by both the
PPC and the AFC.
• To note that th e introduction of an Ethics, Risk and Compliance (ERC) Charter ,
that describes the goals, mandates, services, structures, and resources which Gavi
has allocated for the establishment of an independent ERC Office led by Gavi’s
Chief Ethics, Risk and Compliance Officer is being proposed . The risk aspects of
the ERC charter ha ve been reviewed by the AFC. The final draft of the ERC Charter
will be reviewed by the Governance Com mittee at its meeting on 3 December
2023, and pending the endorsement of the Governance Committee, will be
submitted to the Board for approval on the Consent Agenda for the 6 -7 December
2023 Board meeting .
Conclusions
This year’s Risk and Assurance Report details 10 top risks, i.e. risks that could impact
the ability of the Alliance to deliver on its mission and achieve its strategic goals. Gavi’s

gavi.org
Road to Replenishment
BOARD MEETING
Marie-Ange Saraka- Ya o
6 -7 December 2023, Accra, Ghana
Gavi 5.1 resources are planned to be utilised
(US$ millions)
Opex
Partner support
Cash -based support
Vaccines
Gavi 4.0 Gavi 5.0
(Dec. 2020) Gavi 5.1
(Dec. 2023 v21) Gavi 5.1
(2021– 23) Gavi 5.1
(2024– 25)
Gavi 5.0 / 5.1 evolution Gavi 5.1 v21 to date /remaining
* Does not sum due to rounding
*
Strategic
Investments
Board Meeting, 6- 7 December 2023

Board -2023 -Mtg -04-Doc 10a -Annex A
Report to the Board
6-7 December 2023
Annex A : Investment Proposals

As requested by the Board in June 2023 , t he Secretariat is propos ing investment s to
advance the approach to pandemic prevention, preparedness, and response (PPPR),
building on the Alliance’s expertise and historic contribution to PPPR. These
investments cover a spectrum of public health events (PHEs) to strengthen the Gavi
Alliance’s approach to outbreaks, epidemics, and pandemics and demonstrate the
Alliance’s critical role in preventing, preparing for, and responding to PHEs . These
proposals align with the PPPR priority areas for the Gavi 5.1 strategy and support the
ambition of ‘Country Ready’, ‘Vaccines Ready’ and ‘Coalition Ready’, as illustrated in
Figure 1 below .

Six proposals were presented to the COVAX AMC Investors Group for funding
consideration using COVAX AMC PVP funding. They consider current grant
agreements and possibilities for reprogramming, relate to preparing and responding
to COVID -19 and future health emergencies, and were developed in full consideration
of enhanced collaboration with other pandemic recovery and pandemic prevention,
preparedness, and response initiatives.
Figure 1 : Proposals in support of the Countries Ready, Vaccines Ready, Coalition Ready ambition
Of the six proposals presented , three proposals align ed with funding terms for the
COVAX AMC PVP and were subsequently considered by the PPC . At its meeting in
October 2023, t he PPC considered proposals B and G (Figure 1 ) for Board
recommendation and proposal H for guidance. It recommended one (G) for Board
approval . The other proposals which do not meet funding criteria for COVAX AMC
PVP funds and/or the PPC chose not to recommend at this time, are presented for
Board awareness and transparency and may be considered for Gavi 6.0 . PPPR is a
critical area under consideration for Gavi 6.0 , and t hese proposals do not constitute
the full extent of the future ambition .

1



Board -2023 -Mtg -04-Doc 10a
Report to the Board
6-7 December 2023
Subject Pandemic Prevention , Preparedness and Response Approach
Agenda item 10 a
Category For Decision
Section A : Executive Summary
Gavi, the Vaccine Alliance (the Alliance) is a critical contributor to pandemic
prevention, preparedness, and response (PPPR) through its support of routine
immunisation and outbreak response. In the aftermath of the COVID -19 pandemic,
multiple global and regional initiatives are on -going to address gaps in the global
response. The Secretariat is collaborating with Alliance members , the Coalition for
Epidemic Preparedness Innovations ( CEPI ) and additional regional and global
partners on PPPR to build upon the lessons from COVID -19 and contribute to the
evolving PPPR architecture. These contributions build on the four areas for targeted
additional roles in PPPR presented to the Board, as part of the approval of the Gavi
5.1 Strategy : i) retain and enhance required capabilities for the next pandemic;
ii) financial innovation; iii) resilient routine immunisation program me s; and
iv) diversification of regional manufacturing.
This paper provides an update on the Alliance’s approach to PPPR and proposes
investments for the remainder of Gavi 5.1 aligned with the approach . In June 2023,
the Board requested the Secretariat to present options for the use of remaining
COVAX Advance Market Commitment (AMC) Pandemic Vaccine Pool (PVP) funding,
that include but are not limited to preparing for and responding to COVID -19 and future
health emergencies. The Programme and Policy Committee considered three PPPR
proposals during its October 20 23 meeting: the proposal on support for a coalition of
vaccine partners is being recommended for Board approval; the proposal on the Day
Zero Financing Facility for Pandemics received guidance from the PPC and elements
of this facility are being taken t o the December meeting of the Audit and Finance
Committee ( AFC ) ahead of the Board meeting for its recommendation as is the
practice with financial instruments; and a third proposal on a healthcare worker
immunisation platform will be discussed in the context of Gavi 6.0. The Board will have
an opportunity to consider the level of ambition for Gavi ’s approach for PPPR more
broadly as part of the process of developing the 6.0 Strategy. The PPPR approach
and associated investment proposals have been developed in consultation with
Alliance and additional partners.
Questions this paper addresses
• What is the vision and theory of change for Gavi’s PPPR approach?
• What are the recommended investment options for use of COVAX AMC PVP
funding to support the PPPR approach?

gavi.org
African Vaccine
Manufacturing Accelerator
BOARD MEETING
Marie-Ange Saraka- Ya o
6 -7 December 2023, Accra, Ghana
African Vaccine Manufacturing Accelerator (AVMA)
supports a resilient, secure, competitive African
Vaccine Manufacturing industry
Board Meeting, 6-7 December 2023
AVMA is a key part of
Gavi’s support to the
African Union’s vision:
•African
manufacturers
participate
competitively
• Global market health
is protected
• AVMA is one
component within an
African Union -led
ecosystem
- 60 -80 -100 -110 -120 -120 -110 -110 -110 -100
Year 1 2345 678910
However, there are significant challenges
+20%
operating costs
+50%
capital expenditures
+ 40%
labor costs
Higher initial costs compared with incumbent
manufacturers …
… resulting in unviable businesses. Example of
Measles
-Rubella cashflows (Cumulative, US$ million)
​
Strong momentum: Substantial policy and financial commitments
>30
Announced
projects
2

Board -2023 -Mtg -04 -Doc 10b -Annex A 1
Report to the Board
6-7 December 202 3
Annex A : AVMA Base Proposal – key terms
This Annex serves as an overview of the key terms of the base proposal for the design
of the AVMA, to be approved by the Gavi Board, as set out in Doc 10 b.
Design element Proposal
Size Funding requirement of US$ 750 -1,000 million – with the
upper end of the range set to accommodate an ambitious
outcome for African products in terms of number of
incentivised manufacturers and their commercial volumes
Scope All Gavi Alliance supported vaccines (with differences in
payments, see “Incentives”), fill & finish -only (i.e. drug
product) , and “end -to -end” drug substance + drug product .
Duration To be launch ed in 2024 with a proposed duration of 10 years
(payments can continue for a period beyond the 10 -year
mark, depending on tender length s)
Eligibility Vaccines manufactured (drug substance and/or drug product)
on the African continent *
Procurement
pathway
Via successful Gavi -UNICEF tenders (a potential AU pooled
procurement mechanism may be accommodated in future)
Incentives Structure Two incentive types:
• Milestone payment at WHO Prequalification
• Per -dose accelerator payment , paid upon delivery of
vaccines purchased
Priorities Although all Gavi -supported vaccines are included in scope,
the following vaccines and drug substance platforms of
specific relevance to pandemic preparedness receive
additional incentives ( as below in values):
“Priority Vaccines” : Oral Cholera, Malaria, Measles -Rubella,
Hexavalent (wP) , Yellow Fever ; Ebola ( required profile:
indication against at least 2 Ebola species and
thermostability a s from – 20C); Rotavirus ( required profile:
single -dose blow -fill -seal presentation ); Pneumococcal
(required profile: m inimum 13 valent)
Priority pandemic preparedness drug substance platforms:
mRNA, Viral Vector

Board -2023 -Mtg -04-Doc 10b -Annex B 1
Report to the Board
6-7 December 202 3
Annex B: Details of key terms amended in follow up to PPC discussions
Introduction
At its meeting in October 2023, the Programme and Policy Committee (PPC),
considering feedback received from stakeholders on the original base proposal for the
African Vaccine Manufacturing Accelerator (AVMA), asked for further analysis and
consultation to be carried out ahead of the December 2023 Board meeting on three
specific elements of the AVMA’s design. This process has resulted in three changes
being proposed for the new base proposal that is now before the Board for approval:
1. Extending the list of “Priority Vaccines”
2. Increasing the value of the incentive for fill -finish -only vaccines
3. Excluding vaccines whose DP or DS steps rely on arrangements with a CMO
(Contract Manufacturing Organisation)
Rationale
1. Extending the list of priority antigens to include Yellow Fever and ‘B+’
competitive product profiles
AVMA is designed to provide support to all Gavi -financed vaccines – including COVID -
19 and any that join the portfolio as a result of a positive Vaccine Innovation Strategy
(VIS) outcome – an important feature allowing African Manufacturers choice to
develop the routine vaccines that make sense for them and the continent. However,
AVMA also prioritises vaccines against certain pathogens and produced with certain
technology platforms, by offering higher value incentives where appropriate to send
clear signals to encourage new entrants likely to benefit market health. This allows for
an instrument offering support to a broad set of vaccine categories, but with tailored
incentives that help direct investment towards markets where new entrants are
contributory to global market health – including markets with reasonable likelihood of
commercial success.
As part of Pillar 1 of Gavi’s Regional Manufacturing Strategy, Gavi has, together with
partners, assessed vaccine markets, categorising them as follows:
A. Markets where one or more additional suppliers are expected to be contributory to
global market health.
B. Markets presenting opportunities for additional suppliers whose product profile is
at least as competitive as the current product with the most attractive profile.
C. Markets expected to present very limited opportunity for additional suppliers
(already highly competitive and/or limited scope for product profile enhancements).
The result of the categorisation conducted under Pillar 1 of Gavi’s African
Manufacturing Strategy has been a selection of vaccines assessed as suitable for

Board -2023 -Mtg -04 -Doc 11a -Annex A 1
Report to the Board
6-7 Decem ber 2023
Annex A : Implications/Anticipated impact

The Vaccine Investment Strategy ( VIS ) facilitates strategic decision -making and is a
fundamental tool in fulfilling Gavi’s equity objectives . The rigorous process estimate s
health and economic impact of the vaccines under consideration in Gavi -eligible
countries from 2026 -2040 and compares them to the expected impact of vaccines in
the current portfolio , thus providing a quantitative measure of comparable anticipated
impact .
In October 2023, the Programme and Policy Committee (PPC) recommended a
shortlist of vaccines . With Board approval, investment options will be developed for
final consideration in May/June 2024. The quantitative and qualitative analyses,
guidance from the VIS Steering Committee and consultations with other stakeholders
that inform the shortlist of vaccines are meant to guide decisions and shortlist vaccines
for potential investment that could have the highest public health impact in Gavi
countries.
To provide quantitative and other qualitative measures, the V IS depends on collecting
up -to -dat e dat a and making informed assumptions to arrive at accurate ass essments .
The Secretariat carries out a rigorous and consultative process to ensure that the
latest evidence is gathered and that any assumptions are informed and aligned with
disease experts and public health practitioners .
Shortlisted vaccines will include vaccines against endemic and epidemic diseases. As
the data to evaluate the risk of epidemic diseases and outbreaks has a higher level of
uncertainty, the Secretariat monitors these potential risks though living -assessment s
of pathogens prioriti sed by WHO’s R&D Blueprint team that have a pipeline vaccine
with preliminary data at Ph ase 2 or where there has been a public health event. Living
assessments monitor emerging data, highlight data gaps and are updated regularly to
facilitate timely decision -making upon epidemic and/or market triggers in between VIS
cycles if needed.
Adding vaccines to the Gavi portfolio through the VIS poses risks to countries and the
Alliance :
Impact on countries:
• The vaccines under consideration as part of VIS 2024 are expected to have an
important public health impact and avert deaths , morbidity and disability in Gavi -
eligible countries. The Secretariat has sought to quantify this impact for vaccines
against endemic diseases (shigella, TB, dengue and group B streptococcus).
Whilst further details are available in Annex B, it has been estimated that these
vaccines have the potential to avert in total, between 239 -1,237 future deaths per
100K vaccinated over the period 2026 -2040. Not shortlisting for further
co nsideration means that disease related deaths and disability will not be averted.
• As part of the in -depth consultations with countries and feedback received from
NITAG 1 members at the Global NITAG Network meeting in June 2023, in -country
1 National Immunisation Technical Advisory Group

gavi.org
V a c c i n e I n v e s t m e n t S t r a t e g y 2 0 2 4
Annex B: Vaccines for endemic
diseases – Summary of analyses
Board Meeting , 6-7 December 2023
Summary of methodology: evaluation of vaccines for
endemic diseases
• A vaccination strategy (or multiple strategies) was defined for each candidate based on disease epidemiology,
vaccine product profiles, product pipeline, delivery strategy, consultations with disease experts and WHO
recommendations.
• These strategies were used to forecast demand and price in current Gavi -supported countries and project health and
economic impact of future potential Gavi investments for the period 2026 -2040.
• Demand and health impact were also modelled for the original 45 countries eligible under Gavi’s Middle -Income
Country (MICs) Approach to contribute evidence and inform any future strategic approach.
• Qualitative analyses built on the criteria and indicators used in VIS 2018. Improvements to note include:
• Mixed methods approach to assess the impact of vaccination on anti -microbial resistance (AMR) including estimating the
deaths, morbidity and antibiotic use avoided due to resistant pathogens that have been averted by immunisation.
• Climate change risks, which were evaluated based on an expert survey, and diagnostics availability and need.
• An evaluation framework with criteria and indicators guided the quantitative and qualitative analyses and outcome
were rated (see next slides).
• Details of the methodology and vaccine specific analyses can be found in:
• Appendix 1 (in PPC Library – Additional materials for October 2018 PPC meeting): Appendix 1 to Doc 7 Evaluation
methodologies and consultation approach for vaccines
• Appendix 2 (in PPC Library – Additional materials for October 2018 PPC meeting): Appendix 3a -3h to Doc 7 Vaccine -
specific analyses
2

gavi.org
COVAX UPDATE
BOARD MEETING
Derrick Sim
6-7 December 2023, Accra, Ghana
Health care workers
COVAX has made considerable achievements to date
2 Board Meeting, 6-7 December 2023
Source: WHO COVID -19 vaccine information hub as of 23 Sept 2023; Imperial College estimates of the impact of COVID- 19 vaccination in COVAX AMC countries, 27 Feb 2024
•57% coverage with complete primary series among
AMC participants • 17% coverage with booster dose
• Only 6 countries remain under 10% coverage
COVID -19 coverage
• 84% vaccinated with the complete primary series
• 57% reached with a booster dose
Older adults
•72% vaccinated with the complete primary series
• 24% reached with a booster dose
As of end 2022, estimated 2.7 million deaths averted due
to COVAX -supported doses among AMC participants
COVID -19 impact

1


Board-2023-Mtg- 04-Doc 14

Report to the Board
6-7 December 202 3

Subject Review of decisions
Agenda item 14
No paper

1


Board-2023-Mtg- 04-Doc 15

Report to the Board
6-7 December 202 3

Subject Closing remarks
Agenda item 15
No paper

Classified as Internal
gavi.org
REPORT FROM AUDIT AND INVESTIGATIONS
BOARD MEETING
Lucy Elliott
6-7 December 2023, Accra, Ghana
How has A&I fulfilled its To Rin 2023?
Overseen, reviewed and monitored by the Audit and Finance Committee (AFC)
2 Board Meeting, 6- 7 December 2023: Report from Audit and Investigations
•Recommendations for improvement in governance,
risk management and control in the Secretariat and
Gavi implementing countries
• Reinforced country accountability
• US$ 45.2 million identified since 2009
• US$ 39.3 million repaid as at the last report to the AFC
• Objective is 100% recovery
• Fraud risk assessment methodology piloted
• Review of Gavi’s policies around ethics etc
• Appropriate treatment of reports
•Accountability
A&I’s Terms of Reference continue to be adequate to enable A&I to accomplish its objectives
AFC -approved work plan of country -
and secretariat -focused audits
Identification of misuse
Preventive counter -fraud work
Confidential whistle- blower reporting
Investigative activity

gavi.org
REVIEW OF DECISIONS
BOARD MEETING
6 -7 December 2023 , Accra, Ghana
Decision 1 : Consent Agenda: Board Vice Chair Nomination
The Gavi Alliance Governance Board:
Appointed Omar Abdi as Vice Chair of the Board with individual signatory authority, effective
1 January 2024 and until 31 December 2025 .
2 Board Meeting, 6-7 December 2023

Click to edit Master title style
Click to edit Master subtitle style

gavi.org
D A V I D M A R L O W
CEO Board Update
B O A R D M E E T I N G
6–7 D E C E M B E R 2 0 2 3 , A C C R A , G H A N A
Contents
Board Meeting, 6 –7 December 2023
Executive summary 01
Global context & external environment 02
Gavi 5.1 delivery 03
Looking ahead; Gavi 6.0 & replenishment 04
Reflections and focus for Ghana Board meeting 05
Reaching zero -dose children ,
including with malaria vaccine,
Oti region, Ghana
Gavi/2023/Nipah Dennis
2

gavi.org
Strategy, Programmes &
Partnerships:
Progress, R isks and C hallenges
BOARD MEETING
Aurélia Nguyen
6 -7 December 2023, Accra, Ghana
Update photo
To be completed
To be completed
Balanced scorecard | Programmatic strategic goals
Beta version Q3 2023
1.Children immunised covers only routine immunisation, not campaigns 2. Disability Adjusted Life Years 3.Baseline for timely outbreak detection is average of 2018 –2020 ; 4.30% of countries, 65% in dollar value, best performance over last 5 years 6. Baseline for preventing backsliding set for 2021 as ofJuly 2022
Baseline
(2019) H1 2023
Breadth of protection 48% 56% (2022)
New vaccine introductions** n/a (2020) 7 (Sep 2023)
• HPV applications approved** n/a 2 (Sep 23)
• Malaria applications approved** n/a 16 (Sep 23)
Timely outbreak detection 25% 3 18% (2022)
Measles campaign reach 25% 70.2% (2022)
Strategic goal 1 Introduce and scale up vaccines
Baseline
(2019) 2022
DTP3 coverage 83% 81%
Geographic equity of DTP3 67% 62%
DTP dropout 6% 6%
MCV1 coverage 81% 79%
Strategic goal 2 Strengthen health systems
Baseline
(2021) H1 2023
Co -financing fulfilment 100% (2020) 30% 4
Preventing backsliding in
Gavi -transitioned countries 8 countries 6 8 countries
(2022)
Vaccine intro in transitioned &
never -eligible countries n/a (2022) 3 (Sep 2023)
Strategic goal 3 Improve sustainability
Baseline 2022
Healthy market dynamics n/a 10
Incentivise innovations n/a 9
Scale -up innovations n/a 2
Strategic goal 4 Ensure healthy markets
Gavi 5.0
mission indicators
Baseline
(2020) 2022
Unique children immunised 1 0 >133m (2021 -22)
Future deaths averted 0 >2.4m (2021 -22)
Reduction in zero -dose children 9m (2019) 10.2m
Future DALYs 2averted 0 >121m (2021 -22)
Economic benefits unlocked 0 >$35.8bn (2021 -22)
SG2
SG4
SG1
SG3
** Updated bi -annually or more (else updated annually)
On track Delays/challenges Significant delays/challenges No target / TBD
Board Meeting, 6 -7 December 2023

gavi.org
COUNTRY PROGRAMMES
DELIVERY
BOARD MEETING
Thabani Maphosa
Andrew Owain Jones
Kate O’Brien
6 -7 December 2023, Accra, Ghana
Priorities and
programme
performance
COUNTRY PROGRAMMES DELIVERY

gavi.org
FINANCIAL UPDATE, INCLUDING FINANCIAL FORECAST
BOARD MEETING
Assietou Diouf
6 -7 December 2023, Accra, Ghana
Assumptions driving financial
update
• Resources US$ +157 m
o Driven by investment income
and foreign exchange
movements
• Expenditure US$ (21) m
o Advancement of
programmatic demand
o offset by increased working
capital efficiencies
For decision : US$ 140 m
o MMCV investment proposal
(U$ 136 m)
o Post -transition support,
Timor -Leste (U$ 4 m)
Sufficient resources available
• Forecasts confirm sufficient
resources to support Board
decisions submitted
• Limited additional flexibility remains
Change drivers 6.0 COVAX Core
2
Gavi Core (2021 - 2025)
US$ 103 million remains available for future investments
June 2023
Board
Higher
programmatic
expenditure
For decision:
MMCV & post -
transition
support
Dec 2023
Board
Higher
resources

US$ 6 million
Available for future
investment
US$ 109 m
US$ 157 m
US$ (21) m
US$ (140) m
Available for future
investment
US$ 103 m
Board Meeting, 6 -7 December 2023

gavi.org
Road to Replenishment
BOARD MEETING
Marie-Ange Saraka- Ya o
6 -7 December 2023, Accra, Ghana
Gavi 5.1 resources are planned to be utilised
(US$ millions)
Opex
Partner support
Cash -based support
Vaccines
Gavi 4.0 Gavi 5.0
(Dec. 2020) Gavi 5.1
(Dec. 2023 v21) Gavi 5.1
(2021– 23) Gavi 5.1
(2024– 25)
Gavi 5.0 / 5.1 evolution Gavi 5.1 v21 to date /remaining
* Does not sum due to rounding
*
Strategic
Investments
Board Meeting, 6- 7 December 2023

gavi.org
PANDEMIC PREVENTION,
PREPAREDNESS AND
RESPONSE APPROACH
BOARD MEETING
Derrick Sim
6-7 December 2023, Accra, Ghana
The Pandemic Preparedness, Prevention and Response (PPPR) approach
brings together Gavi’s historic contribution to PPPR and its evolution as
part of Gavi 5.1
2
PPPR is core to the Alliance’s mission and an integral part of its four strategic goals
 Gavi’s PPPR role evolved in response to the COVID- 19 pandemic, resulting in the Gavi 5.1
strategy and summarised in the proposed PPPR approach
 With climate change and other factors increasing risk of outbreaks and pandemics, Gavi proposes
a set of investments for Gavi 5.1, learning from COVAX and other recent outbreaks
 Several global and regional level efforts are underway to strengthen and shape the future global
health and PPPR architecture
 The aim is to integrate into any future medical counter -measures network
 The work would be driven by an expanded coalition of vaccine partners including, and building
on, the group that came together to fight COVID- 19
 The nature and level of ambition for PPPR will be considered through the Gavi 6.0 strategy
process
Board Meeting, 6- 7 December 2023

gavi.org
African Vaccine
Manufacturing Accelerator
BOARD MEETING
Marie-Ange Saraka- Ya o
6 -7 December 2023, Accra, Ghana
African Vaccine Manufacturing Accelerator (AVMA)
supports a resilient, secure, competitive African
Vaccine Manufacturing industry
Board Meeting, 6-7 December 2023
AVMA is a key part of
Gavi’s support to the
African Union’s vision:
•African
manufacturers
participate
competitively
• Global market health
is protected
• AVMA is one
component within an
African Union -led
ecosystem
- 60 -80 -100 -110 -120 -120 -110 -110 -110 -100
Year 1 2345 678910
However, there are significant challenges
+20%
operating costs
+50%
capital expenditures
+ 40%
labor costs
Higher initial costs compared with incumbent
manufacturers …
… resulting in unviable businesses. Example of
Measles
-Rubella cashflows (Cumulative, US$ million)
​
Strong momentum: Substantial policy and financial commitments
>30
Announced
projects
2

gavi.org
COVAX UPDATE
BOARD MEETING
Derrick Sim
6-7 December 2023, Accra, Ghana
Health care workers
COVAX has made considerable achievements to date
2 Board Meeting, 6-7 December 2023
Source: WHO COVID -19 vaccine information hub as of 23 Sept 2023; Imperial College estimates of the impact of COVID- 19 vaccination in COVAX AMC countries, 27 Feb 2024
•57% coverage with complete primary series among
AMC participants • 17% coverage with booster dose
• Only 6 countries remain under 10% coverage
COVID -19 coverage
• 84% vaccinated with the complete primary series
• 57% reached with a booster dose
Older adults
•72% vaccinated with the complete primary series
• 24% reached with a booster dose
As of end 2022, estimated 2.7 million deaths averted due
to COVAX -supported doses among AMC participants
COVID -19 impact

Classified as Internal
gavi.org
REPORT FROM AUDIT AND INVESTIGATIONS
BOARD MEETING
Lucy Elliott
6-7 December 2023, Accra, Ghana
How has A&I fulfilled its To Rin 2023?
Overseen, reviewed and monitored by the Audit and Finance Committee (AFC)
2 Board Meeting, 6- 7 December 2023: Report from Audit and Investigations
•Recommendations for improvement in governance,
risk management and control in the Secretariat and
Gavi implementing countries
• Reinforced country accountability
• US$ 45.2 million identified since 2009
• US$ 39.3 million repaid as at the last report to the AFC
• Objective is 100% recovery
• Fraud risk assessment methodology piloted
• Review of Gavi’s policies around ethics etc
• Appropriate treatment of reports
•Accountability
A&I’s Terms of Reference continue to be adequate to enable A&I to accomplish its objectives
AFC -approved work plan of country -
and secretariat -focused audits
Identification of misuse
Preventive counter -fraud work
Confidential whistle- blower reporting
Investigative activity