1


Board -2022 -Mtg -03 -Doc 00a


Gavi Alliance Board Meeting
7-8 December 2022
Hilton Geneva Hotel and Conference Centre, Geneva, Switzerland
Monday 5 and Tuesday 6 December: Pre -Board meetings
Wednesday 7 December: 09.00 -18.00 (Board meeting Day One)
Thursday 8 December: 09.00 -17.00 (Board meeting Day Two)
Quorum: 14
Document List

No. Document
00a Document list
00b Agenda
01a Declarations of interest
01b Minutes
01c No Objection Consent Decisions
01d Consent Agenda
01e Workplan
02 a CEO?s Report ? To follow
02b Strategy, Programmes and Partnerships: Progress, Risks and Challenges
03 Country Programmes ? No paper
04 a Financial Update, including forecast
04b Partners? Engagement Framework and Secretariat Budget (2023 -2024)
05 Risk and Assurance Report
06 Gavi 5.1 (including Pandemic Preparedness and Response)
07 Human papillomavirus (HPV) Vaccine Programme relaunch
08 Gavi?s role in support to Regional and African Vaccine Manufacturing
09 COVAX: Key Strategic Issues
10 Gavi?s role in a future COVID -19 Vaccine Programme
11 a Funding Policy Review : Context and Health System Immunisation Strengthening
(HSIS) Policy
11b Funding Policy Review: Eligibility and Transition Policy and Co -Financing Policy

Board -2022 -Mtg -03-Doc 00b 1

Gavi Alliance Board Meeting
7-8 December 2022
Hilton Geneva Hotel and Conference Centre, Geneva, Switzerland
Monday 5 and Tuesday 6 December: Pre -Board meetings
Wednesday 7 December: 09.00 -18.00 (Board meeting Day One)
Thursday 8 December: 09.00 -17. 00 (Boa rd meeting Day Two)
Quorum: 14



Agenda




















Next Board Meeting : 30 -31 March 2023 (Board Retreat)
28 -29 June 2023
6-7 December 2023
---
Brenda Killen , Director, Govern ance 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 a id to minute the meeting.

1

Board -2022 -Mtg -03 -Doc 01a

Gavi Alliance Board Meeting
7-8 December 202 2
Hilton Geneva Hotel and Conference Centre, Geneva, Switzerland
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 a ction 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













Jos? Manuel Barroso,
Chair
























None












Goldman Sachs International
(Chairman and Non -Executive Director -
Advisor); Princeton University -
Princeton School of Public Policy, LISD,
(Non Resident Fellow); Catholic
University of Portugal (Visiting
Professor); Centre for European
Studies (Director); Graduate Institute of
International and Development Stud ies -
Geneva, (Visiting Professor); 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 -President);
Portuguese Diaspora Co uncil
(Chairman General Assembly);
Bilderberg Meetings (Steering
Committee Member); Concordia
(Leadership Member Council); World
Leadership Alliance ? Club de Madrid
(Member); Teatro Real Madrid
(International Council member); Royal
Institute of Internat ional Affairs
(Chattam House) (Senior Advisor);

Board -202 2-Mtg -02 1
Minutes

For no -objection consent

Gavi Alliance Board Meeting
22 -23 June 2022
G lobal Health Campus , Geneva, Switzerland


1. Chair?s Report

1.1 Noting that the meeting had been duly convened and f inding a quorum of members
present, the meeting commenced at 09.07 Geneva time on 22 June 2022 .
Prof Jos? Manuel Barroso, Board Chair, chaired the meeting.

1.2 The Chair welcomed new Board members either attending for the first time or in a
new role - Takes hi Akahori , Board Member (Japan /Italy /Spain /New Zealand ),
Minister Robert Lucien Kargougou , Board Member (Burkina Faso, AFRO
Francophone/Lusophone constituency) , Aamer Ikram , Board Member (Pakistan,
EMRO constituency ) and Won Do -yeon , Alternate Board Member (United States
of America/Australia/Korea (Rep. of)) .

1.3 The Chair welcomed Ken neth Lay, IFFIm Board Chair, and other directors of the
IFFIm Board . He also welcomed David Sidwell , in his capacity as a member of the
CEO Recruitment Search Committee , as well as other observers attending from
the Gulf region .

1.4 The Chair presented a short summary of the All Chairs Group (ACG) meeting
held on 17 June 2022 , during which the ACG had discussed the Board agenda ,
and recent discussions of agenda items in the Gavi Board Committees . The ACG
emphasised the importance of fluid communication between the Chairs and Gavi
leadership in preparing the Board. He noted that the ACG had agreed the
importance of Board members taking time to understand their role and Committee
roles within Gavi governance.

1.5 He reflected on some of the important global developments affecting Gavi?s
mission. He noted the Russia -Ukraine crisis and its impact on the risk
environment, including potentially on immunisation programmes in (former) Gavi -
eligible countries due to refugee flows and possible resulting disease outbreaks.

1.6 The Chair also noted that despite the continuing risks around the COVID -19
pandemic, COVAX continues to deliver on the objectives set by the Board, recently
surpassing 1.5 billion doses delivered. He outlined the evolving Gavi 5.1 concept
as an evolution of Gavi 5.0 and as a bridge to Gavi 6.0. Gavi 5.1 is building on th e
lessons from the COVID -19 pandemic and COVAX for a stronger Alliance that is
better able to serve countries , advance the core equity agenda and promote health
security .

1.7 In relation to Gavi?s leadership transition and succession planning, Prof Barroso
noted that an executive search firm had been engaged to support the recruitment

1


Board -2022 -Mtg -03 -Doc 01c

Report to the Board
7-8 December 2022

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

Since the June 2022 Board meeting, four 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 26 August 2022 , Board members were invited to consider approv al of the
appoint ment of an Alternate Board Member and Committee Members .

No objections were received prior to the end of 7 Se ptember 2022 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 Joshua Tabah as Alternate Board Member representing C anada
on the donor constituency anchored by the United Kingdom in the seat currently
held by Megan Cain of Canada, effective immediately and until 31 December
2024 ;

b) Appointed Joshua Tabah (Alternate Board Member) to the Audit and Finance
Committee, effect ive immediately and until 31 December 2022; and

c) Appointed Roli Singh (Committee Delegate) to the Programme and Policy
Committee, effective immediately and until 31 December 2023.

2) On 7 Se ptember 2022 , Board members were invited to consider approv al of the
appoint ment of a Programme and Policy Committee Member .

No objections were received prior to the end of 20 September 2022 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 Karin Westerberg (Committee Delegate) to the Programme and
Policy Committee, effective immediately and unti l 31 December 2023.

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Board -2022 -Mtg -03 -Doc 01d

Report to the Board
7-8 December 2022

Subject Consent Agen da ? Updated as at 5 December 2022 DRAFT
Agenda item 01d
Category For Decision

Section A : Introduction
Ten 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/211597
Section B : Actions Requested of the Board
The Gavi Alliance Board is requested to consider the following recommendations from
the Gavi Alliance Governance Committee, Audit and Finance Committee and
Programme and Policy Committee.
Decision One ? Board Chair Rea ppointment
The Gavi Alliance Governance Committee recommends to the Gavi Alliance Board
that it:
a) Reappoint Jos? Manuel Barroso as an Unaffiliated Board member through to
31 December 2025; and
b) Reappoint Jos? Manuel Barroso as Board Chair, with individual signatory
authority on behalf of the Gavi Alliance, for a seco nd term through to 31 December
2025.
Decision Two ? Board Committee Chair Appointment
The Gavi Alliance Governance Committee recommends to the Gavi Alliance Board
that it:
Appoint Yibing Wu as Chair of the Investment Committee effective 1 January 2023
and until 31 December 2023.

 

Board -2022 -Mtg -03 -Doc 01d -Annex A 1

Report to the Board
7-8 December 2022

Annex A : Table of new IRC members proposed for appointment

First Name Last Name Current position EN FR Nationality Gender Category
1 Zenaw Adam Technical Director and Chief of Party, JSI
(Ethiopia) X Canadian M NVS, Meas les , Polio, Surveillance
2 Alvaro Alonso Garbayo Independent Consultant X X Spanish M Conflict & fragile settings, pro -equity
programming, HSS
3 Andrew Azman Associate Scientist, Johns Hopkins
Bloomberg School of Public Health X X American M NVS, Cholera/diarrheal disease control,
Typhoid
4 Rochika Chaudhry Independent consultant X American F NVS, Malaria
5 Ogijo Emmanuel Financial controller, Organization of Africa,
Caribbean and Pacific States (OACPS) X Nigerian M Finance & budgeting
6 Emmanuelle Espi? Employee at CEPI X X French F Pro -equity programming, HSS, NVS
7 Eleonora Genovese Independent Consultant X X Italian F Conflict & fragile settings, pro -equity
programming, HSS
8 Eus?be Hounsokou Independent Consultant X X Beninese M Conflict & fragile settings, pro -equity
programming, HSS
9 Yilchini Ishaku Independent Consultant X Nigerian M Cold Chain & Logistics, HSS
10 Philippe Jaillard Leader, Health Systems and Supply chain
strengthening at EpiLinks X X French M Cold Chain & Logistics, HSS
11 Henry Katamba Global Fund National Facilitator at the
Ministry of Health, Uganda X Ugandan M NVS, Malaria
12 Dominique Legros Independent Consultant X X French M NVS, Cholera/diarrheal disease control,
conflict & fragile settings
13 Rose Leke* Emeritus Professor of Immunology and
Parasitology, University of Yaound? X X Cameroonian F NVS, Malaria, HSS
14 Jean -Pierre Matwanga Independent Consultant X X Burundian M Finance & budgeting, audit
15 Abdul -Aziz Mohammed CEO Yobe State Drugs and Medical
Consumables Management Agency X X Nigerian M Cold Chain & Logistics

Doc 01d ? Annex B






December 2022
COVAX AMC ENGAGEMENT GROUP
TERMS OF REFERENCE
1. Purpose
The COVAX Facility Advance Market Commitment (?AMC?) Engagement Group (?the AMC
Group ?) is established by the Board (?Board?) of the Gavi Alliance (?Gavi?) to convene
representatives from implementing countries, donors and other parties engaged in the
financing and operation of the AMC portion of the Facility , with the aim of providing st rategic
guidance and advice to the Office of the COVAX Facility (?the Office?) on the operational
aspects of the COVAX Facility .
The AMC Group i s not deemed to be a committee of the Board in that its primary role is
essentially an advisory function as cont emplated under Article 20 of the Statues. It is
empowered by the Board to undertake the responsibilities outlined in these terms of
reference.
2. Membership
A. Composition and size
Membership of the AMC Group will be open to representatives of implementing countries,
donors and other parties engaged in the financing and operation of the AMC portion of the
Facility.
Additionally, a representative each from UNICEF, WHO, PAHO, the World Bank , Civil So ciety ,
and former members of the COVAX Facility Shareholders Council shall have a permanent
observer seat on the Engagement Group .
All members are treated equally in terms of membership, rights and privileges .
B. Competencies and skills
All members are expected to act in a manner consistent with the Facility?s goals.
The criteria for AMC Group membership shall be consistent with Gavi?s guiding principles on
gender for Board and Board Committee nominations and Gavi?s Conflicts of Interest Policy for
Gover nance Bodies.

JANUARY 2023
MARKET - SENSITIVE DECISIONS COMMITTEE CHARTER
1. P U RP O S E
The Market - Sensitive Decisions Committee (?Committee? or ? the MSDC ?) is
established by the Board (?Board?) of the Gavi Alliance (?Gavi ?) to support the Board
in fulfilling its oversight responsibilities .
The Committee will make decisions which are market and/or commercially sensitive,
subject to powers reserved specifically to the Board in Article 13 of the Statutes.
Words and expressions used in this Charter shall, unless the context requires
otherwise, have the meaning attributed to them in the Gavi Board and Committee
Operating Procedures (?Operating Procedures?) .
2. M E M B E RS H I P
The membership , resources, responsibilities and authorities of the Committee to
perform its role effectively are stipulated in this Charter, which may be amended by
the Board as and when required or deemed necessary and are specifically governed
by Article 18 of the Statutes and Sec tion 18 of the Operating Procedures .
A. Composition and size
The composition of the MSDC shall allow it to function efficiently and effectively in
fulfilling its functions and responsibilities .
The MSDC shall comprise up to 1 4 members (?Members?) according to the following
representational composition and shall be chaired by the Board Chair:
? One seat for the Board Chair;
? One seat for the Board Vice Chair;
? Two seat s for representati ve s of the multilaterals ( World Health Organization ,
UNICEF, World Bank ) ;
? One seat for a representati ve of the Bill & Melinda Gates Foundation;
? Two seats for representatives of implementing country governments;
? Three seats for representatives of donor country governments;
? One seat for a representative of the civil society organisations;
? One seat for the Chair of the Audit and Finance Committee;

Doc 01d - Annex C

DOCUMENT ADMINISTRATION
VERSION
NUMBER APPROVAL PROCESS DATE
1.0
Approved by: Gavi Alliance Board 2 - 3 December 2015VERSION
NUMBER APPROVAL PROCESS DATE
1.0 Prepared by: Internal Audit
Approved by: Gavi Audit and Finance
Committee 11 April 2012
2.0 Review ed and recommended by: Gavi
Audit and Finance Committee 22 April 2013
Approved by: Gavi Alliance Board 11 June 2013
3.0 Revised by: Audit and Investigations
Reviewed and recommended by: Gavi
Audit and Finance Committee 6 November 2015
Approved by: Gavi Alliance Board 2 December 2015
4.0 Revised by: Audit and Investigations
Reviewed and recommended by: Gavi
Audit and Finance Committee 25 April 2019
Approved by: Gavi Alliance Board 26 June 2019
5.0 Revised by: Audit and Investigations
Reviewed and recommended by: Gavi
Audit and Finance Committee 22 June 2020
Approved by: Gavi Alliance Board 24 June 2020
6.0 Revised by: Audit and Investigations
Reviewed and recommended by: Gavi
Audit and Finance Committee 30 November 2022
Approved by: Gavi Alliance Board 7 December 2022 Gavi Alliance
Audit and Investigations:
Terms of Reference
Version 6 .0

Doc 01d - Annex D

Classified as Internal #
Gavi Alliance Board Workplan 2023 Gavi Board Paper Type Jan/Feb Mar/Apr June Nov/Dec Mar/Apr June Nov/Dec Mar/Apr June Nov/Dec Mar/Apr June Nov/Dec Mar/Apr June Nov/Dec
A.Strategy/Performance/Risk/MEL CEO's Report CEO's Report Discussion Discussion Discussion Discussion Discussion Discussion Discussion Discussion Discussion Discussion Discussion 2021-2025 Strategy Strategy, Programmes and Partnerships: Progress, Risks and ChallengesDiscussion Discussion Discussion Discussion Discussion Discussion Discussion Discussion 2021-2025 Strategy Gavi 5.0Decision
Measurement Framework (Targets & Indicators) Strategy, Programmes and Partnerships: Progress, Risks and ChallengesDecision
Innovation TBDInformationInformation Information
Private Sector Engagement TBDInformationInformationInformationInformation
Civil Society and Community Engagement Approach TBDInformationInformation
Gavi role in Pandemic Preparedness and Response TBDDecision
Partners' Engagement Framework Strategy, Programmes and Partnerships: Progress, Risks and ChallengesDiscussion
Discussion Discussion Discussion Discussion Discussion Discussion Discussion Discussion Discussion Discussion Disease Surveillance and Diagnostics in Gavi 5.0 TBDDecision Discussion Risk and Asurance Report Risk and Assurance ReportDecisionDecisionDecisionDecisionDecisionDecision
2026-2030 Strategy TBDDecision Guidance Decision Discussion Discussion Discussion Discussion Funding Policy Review DecisionGuidanceDecisionMeasurement Framework (Targets & Indicators) TBD Decision Guidance Decision B.Vaccines & Sustainablity Typhoid TBD Information Pneumococcal AMC (Advance Market Commitment) TBD Information Hexavalent Investment Case TBD Decision Decision Malaria Co-financing TBD Decision Decision Vaccine Investment Strategy TBD Decision Decision Decision Decision COVAX - Key Strategic Issues COVAX/COVID-19 Vaccine Programme Decision Information Information Gavi's role in future COVID-19 Vaccine Programme COVAX/COVID-19 Vaccine Programme TBD Decision Information Gavi's role in support to Regional and African manufacturing Gavi's role in support to Regional and African manufacturing TBD Decision C.Policy Transparency and Accountability Policy Decision Decision D.Country Programmes
Nigeria TBD
InformationInformationInformationInformation
PNG TBD
InformationInformation
Strategic Partnership with India Strategic Partnerships with India
Information
Post-Transition Support (e.g. Angola, Timor-Leste) TBD
Information
Fiduciary risk assurance and financial management capacity building Fiduciary risk assurance and financial management capacity building
DecisionInformation
Middle-Income Countries approach TBD Information Information E.Finance/Audit & Investigations Annual Accounts Annual Financial Report Decision Decision Decision Decision Decision Decision Financial ForecastFinancial Update, including forecastDecisionDecisionDecisionDecisionDecisionDecision
Budget Financial Update, including forecastDecisionDecisionDecisionDecisionDecisionDecision
Programme Funding Policy Consent AgendaDecisionDecision
Treasury Governance Policy Consent AgendaDecisionDecision
Treasury Risk Management Policy Consent AgendaDecisionDecision
Independent Auditor Selection and Evaluation Policy Consent AgendaDecisionDecision
Audit & Investigations Report Audit & Investigations Report Information Information Information Information Information Information F.Governance
Board Chair Appointment Consent AgendaDecision Decision
Board Vice Chair Appointment Consent AgendaDecisionDecision DecisionDecision
Committee Chair Appointments Consent AgendaDecisionDecision DecisionDecision
Board and Committee Appointments Consent AgendaDecisionDecision DecisionDecision
IRC Appointments Consent AgendaDecision
CEO Appointment Consent AgendaDecisionDecision
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 AgendaDecision
Audit & Investigations Terms of Reference Consent Agenda Decision G.Reporting Committee Chair Reports Committee Chair and IFFIm Board reports 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 Replenishment/Resource Mobilisaton TBD Discussion Discussion Discussion HR Report Closed Session Information Information Information Information Information Information Information Information Information Information Information Annual Report on Implementation of the Gender Policy Annex to Strategy paper Information Information Information Information Information Information CEPI Progress Report Annex to Board pack/On BE as additional materials Information Information Information Information 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 H. Technical Briefing Sessions
Vaccine Investment Strategy Discussion Discussion Health Systems & Immunisation StrengtheningEvaluation Discussion Discussion Discussion Discussion Discussion
20262027 Last updated - 23 November 2022
Next Board Meetings: 30-31 March 2023, Retreat
28-29 June 2023
6-7 December 2023
20242025

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Board -2022 -Mtg -03 -Doc 02a FR

Rapport pour le Conseil d?administration
7-8 d?cembre 2022

Rapport du Directeur ex?cutif

30 novembre 2022
Chers memb re s du Conseil d?administration ,
Comme toujours, je suis tr?s impatient de vous voir ? Gen?ve dans quelques
semaines . Cette r?union du Conseil d'administration a lieu au moment crucial o?
l'Alliance s'engage dans ce qui correspond certainement pour certains ? une "nouvelle
normalit?" - tr?s diff?rente du contexte dans lequel nous op?rions avant la pand?mie.
L'ordre du jour de notre prochaine r?union refl?te bien la complexit? et le climat
d'incertitude dans lesquels nous poursuivons notre travail. La pand?mie continue
d'occuper le devant de la sc?ne, ce qui donne lieu ? un certain nombre d?hypoth?ses
qua nt ? l??volution mondiale de la situation sanitaire et des risques de perturbations ,
notamment au niveau de la vaccination . Parall?lement , nous assistons ? une
recrudescence des tensions g?o politiques, des probl?mes macro?conomiques et des
?pid?mies, ce qui ?videmment, a des r?percussions sur notre travail.
C?est ainsi que , lors de notre prochaine r?union, nous allons devoir, pour la premi?re
fois dans l'histoire de Gavi, modifier ? mi -parcours la strat?gie (Gavi 5.0) qui d?finit
nos priorit?s et nos programmes , pour passer ? ce que nous appelons Gavi 5.1. En
raison ?galement de l'?volution tr?s rapide de tout ce qui nous entou re , nous vous
demanderons de donner votre accord "de principe" ? un programme , celui qui
concerne la vaccination contre la COVID -19. De fait, nous reconnaissons ainsi que,
m?me si nous savons que beaucoup de choses vont encore changer au cours de
l'ann?e ? venir, y compris la demande des pays pour les vaccins contre la COVID -19 ,
nous savons aussi qu?il nous faut commencer ? nous projeter d?s main tenant si nous
voulons pouvoir soutenir les pays, de quelque mani?re que ce soit, au -del? de 2023.
Alors que nous cherchons ? avancer sur un certain nombre de fronts, nous devons
tenir compte des capacit? s des pays, aussi bien que de celles des partenaires de
l?Alliance et du Secr?tariat de Gavi , ainsi que de leurs limites . La p?riode actuelle
d'instabilit? mondiale va probablement se prolonger , et c'est pourquoi, en tant
qu'Alliance, nous devons continuer ? accorder la priorit? ? la vaccination syst?matiqu e
pour lui ?viter tout nouveau recul, au rattrapage des enfants qui ont ?t? laiss?s de
c?t?, et plus particuli?rement des enfants z?ro dose et des communaut?s oubli?es .
Par ailleurs, nous devons continuer ? faire preuve d'agilit? pour pouvoir nous adapter
aux nouvelles incertitudes et tirer parti des ?valuations et des enseignements tir?s de
la riposte ? la COVID -19 et de COVAX, afin de mieux r?pondre aux besoins des pays,
notamment en ce qui concerne les ?pid?mies ?mergentes ou en cours.
Il s'agit d'un v?ritable exercice d'?quilibriste, mais je suis convaincu que l'Alliance du

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Board -2022 -Mtg -03 -Doc 02a

Report to the Board
7?8 December 2022

Report of the Chief Executive Officer

30 November 2022
Dear Board Members,
As ever, I am very much looking forward to seeing you in Geneva in a week ?s time.
This Board meeting is taking place at a critical moment, when as an Alliance we are
embracing what must certainly be described as a ?new normal? for some ? quite
different from our pre -pandemic operating context.
We need look no further for evidence of the complexity and uncertainty in which we
continue to work than the agenda of our upcoming meeting. The pandemic continues
to loom large, presenting a number of possible trajectories and disruptions to global
health and immunisation. At the same time, we are witnessing increased geopolitical
tensions, macroeconomic troubles and disease outbreaks, all of which are impacting
our work.
As a result, at our upcoming meeting, for the first time in the history of Gavi we will be
evolving our programme strate gy mid -cycle into what we call Gavi 5.1. Also as a result
of the very fast -moving environment, we will be requesting you to approve an
?in principle? programme, that of COVID -19 vaccination. This is in acknowledgement
of the fact that, while we know much will evolve over the year ahead, including country
demand for COVID -19 vaccines , we also know we must start planning now if we wish
to support countries in any capacity beyond 2023.
As we look to move forward across a number of fronts, we must take into account the
capacity limitations among countries, Alliance partners and the Gavi Secretariat alike.
The current period of global instability is likely to continue, and therefore as an Alliance
we need to continue to prioritise avoiding further backslidi ng of routine immunisation,
catching up missed children , and reaching more zero -dose children and missed
communities. At the same time, we must continue to retain our agility in adapting to
new uncertainties, and leverage evaluations and learnings from COV AX and COVID -
19 response, so we can better respond to country needs ? especially with regards to
ongoing and emerging outbreaks.
This is quite the balancing act, however I strongly believe the Vaccine Alliance remains
well positioned to deliver. In many wa ys, the pandemic and COVAX have brought the
Alliance closer than ever before. Indeed, this experience has shined a light on how
impactful our Alliance can be when we work in lockstep. But not every member of the
Alliance was working on COVAX , and therefore we need to make sure that all Alliance
partners feel connected.

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Board -2022 -Mtg -03-Doc 02b

Report to the Board
7-8 December 2022

Subject Strategy, Programmes and Partnerships: Progress, Risks and
Challenges
Agenda item 02b
Category For Information
Section A : Executive Summary
Context
This report provides a progress update on the implementation of Gavi 5.0 and
associated risks 1. WHO -UNICEF coverage estimates (WUENIC) for 2021 confirm ed
the Al liance?s expectations that 2021 would continue to see ongoing disruption of
routine immunisation (RI) , largely related to th e COVID -19 pandemic . The number
of zero -dose children in Gavi -supported countries has increased by 5% to 12.5 million ,
and routine immunisation coverage (diphtheria , tetanus , and pertussis third dose -
DTP3 ) decre ased by another percentage point (pp) in 2021 compared with 2020 . At
the same time, there are signs of resilience and recovery. Gavi -supported countries
delivered ~3.5 time s more vaccines in 2021 alone, than in 2020. The rate of DTP3
coverage decline slowed when compared to 2020. Further, one third of Gavi -supported
coun tries saw a DTP3 increase in 2021 . Positive trends in administrative data from a
subset of countries from the first half of 2022 suggest s more children are being reached
with DTP3 than in the same period in 2019 (pre -pandemic) . In addition, countries
managed to expand breadth of protection 2 whilst also delivering 1.65 billion COVID -19
vaccine doses. This is a testament to the hard work of countries and the Alliance , and
the critical role of the Alliance?s long -standing investments in strengthening health and
immunisation systems , especially so, in the wider context of the pandemic .
Questions this paper addresses
How is the Alliance perform ing against its mission , strategic goals and indicators ,
and h ow has the context of the COVID -19 pandemic impacted progress ?
What are the key risks and challenges being seen across the Alliance ?s strategic
performance, programmes and partnerships, and what actions are being taken to
address these?



1 Associated risks refer to the top risks in the Risk & Assurance Report 2022 (see Doc 5). 2 This measures the extent to which countries have introduced and scaled up Gavi -supported vaccine .
For further information see Annex A

Board -2022 -Mtg -03-Doc 02b -Annex A 1
Report to the Board
7-8 December 2022
Annex A: Gavi 5.0 Mission and Strategy indicator dashboard and Strategy
Implementation Indicators update
This is a technical report summari sing progress against Mission and Strategy Goal
indicators in the new Gavi 5.0 measurement framework. It is populated based on
available data and updated bi -annually. The newly available data for 2021 included in
this repo rt relates to Mission Goals M2, M3, M4, M5, and M6, as well as Strategy
Goals 1, 2, and 3.2.
This Annex also includes an update on the Gavi 5.0 Strategy Implementation
Indicators, which are more operational in nature. These indicators have been reviewed
by the Gavi 5.0 Measurement Framework Alliance Technical Working group but have
not yet been finalized. They will be finalized following the October /December 2022
governance cycle after addressing any comments raised by the PPC.
Note on target trajectories:
In the below graphs, the dotted lines represent the projected annual trajectory that was
forecasted when Gavi set 2025 targets with the PPC/Board in May 2021. As
communicated to the PPC and Board, t he assumption was that coverage would return
to 2019 cove rage levels in 2021, with the exception of India which would take until
2022. This assumption has proven not to be correct. Based upon 2022 trajectories,
the Secretariat may come back to the Board to review and adjust the targets.

Gavi 5.0 Mission Indicators
M.1: Under -five mortality rate

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.
Indicator will be updated for 2021 in
April 2023.
58 56
Target: decrease by 10%
0
10
20
30
40
50
2019(Baseline) 2020 2021 2022 2023 2024 2025

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Board -2022 -Mtg -03 -Doc 03

Report to the Board
7-8 December 2022

Subject Country Programmes
Agenda item 03
No paper

1


Board -2022 -Mtg -03-Doc 04a

Report to the Board
7-8 December 2022

Subject Financial update, including forecast
Agenda item 04a
Category For Decision
Section A: Executive Summary
Context
This paper presents the updated Financial Forecasts for Gavi 5.0 (2021 -2025), COVAX
AMC (2020 -2023) and Gavi 6.0 (illustrative) (2026 -2030) to the Board for approval
based on a recommendation from the Audit and Finance Committee (AFC).
The Gavi 5.0 forecast confirms sufficient financial flexibility given the uncertain context
with US$ 183 million available for future investments.
? The updated forecast includes the impact of the HPV relaunch (US$ 167 million) and
proposed revision to the Eligibility & Transition and Co -Financing policies
(US$ 80 million), both of which are being presented for decision at this meeting.
? The underlying forecast reflects a decrease of US$ 301 million in resources due to
the impact of macro -economic factors (noting no chang e to underlying pledges), and
a decrease in programmatic expenditures of US$ 317 million reflecting continued
disruption of routine immunisation due to the pandemic as well as greater visibility
on country needs and absorptive capacity (based on existing r esources in -country) .
? Key elements of Gavi 5.1 are still under development and therefore this updated
forecast does not include programmatic estimates related to regional manufacturing
diversification, a potential ongoing routine COVID -19 immunisation pro gramme, or
Gavi?s future role in pandemic preparedness and response, noting these elements
are pending further Board approval.
The COVAX AMC forecast reflects the status of ne gotiations with COVID -19 vaccine
manufacturers and includes a n estimate of US$ 1 .9 billion reduction in vaccine liability .
Included in the forecast is US$ 2.7 billion under the Pandemic Vaccine Pool, with
US$ 0.8 billion anticipated to be used in 2023, subject to AMC Investors Group
approval. Therefore, US$ 1.8 billion is anticipated to be available to respond to potential
future escalations in the pandemic.
Questions this paper addresses
Is there sufficient funding available to deliver on Board -approved priorities for Gavi 5.0
and COVAX AMC, with adequate financial flexibility remaining to respond to the
uncertain operating context?
What elements of Gavi 5.1 are included in the financial forecast, and which items still
require financial implications to be determined and reflected?

1


Board -2022 -Mtg -03-Doc 04b

Report to the Board
7-8 December 2022

Subject Partners? Engagement Framework and Secretariat Budget
(2023 ?2024)
Agenda item 04b
Category For Decision
Section A : Executive Summary
Context
This paper presents the operating budget s for the Gavi Secretariat , COVAX AMC
(COVAX) and Partners? Engagement Framework (PEF) for the fiscal years 202 3 and
202 4 to the Board for approval based on a recommendation from the Audit and
Finance Committee (AFC) .
The proposed Secretariat budget for 2023 and 2024 is in line with the total Gavi 5.0
envelope included in the Board approved Financial Forecast , including the additional
budgets approved for the special initiatives (Malaria, Diagnostics and Middle -Income
Country strategy (MICs) ), with the US$ 45 million underspend from 2021 and 2022
rephased across the strategic period . This rephasing reflects the anticipated
acceleration of activities delayed due to the pandemic and higher inflation, as well as
provid ing a level of flexibility to enable the Secretariat to respond to uncertainties and
evolving needs given that we are still operating in the context of the pandemic as well
as enhanced global economic uncertainty. This flexibility will also enable certain
ope rating costs associated with Gavi 5.1 to be absorbed , specifically the human
papillomavirus (HPV ) vaccine relaunch and some of the potential costs relating to
regional manufacturing diversification (noting these are still to be determined) .
The Secretariat budget does not yet reflect the efficiency gains and synergies to be
realised through the new Operational Excellence approach . The Operational
Excellence framework is structured around 5I?s: Innovate (e.g. EVOLVE), Integrate
(e.g. COVAX Integration), Improve (e.g. simplify the way we work ), Invigorate (Gavi?s
culture and employee engagement ) and Inform (change management and
communication ). The full financial impact of the Operational Excellence initiatives and
related needed capabilities still need to be qualified and quantified . This will include a
holistic view of implementation costs (funded under the existing budget) , financial
benefits, impact on the organisation design and workforce, and a multi -year timeline
for execution.
The proposed COVAX budget is in line with the 2020 -2023 budget envelope approved
by the Board , with the US$ 10 million underspend from 2022 rephased to 2023 . The
Board has approved the COVAX mandate until the end of 2023 .
A potential COVID -19 vaccine programme from 2024 onwards as well as Gavi?s role
in pandemic preparedness and response (PPR) is being considered as part of Gavi
5.1. An in -principle decision on these Gavi 5.1 priorities is being requested by the

1


Board -2022 -Mtg -03-Doc 05
Report to the Board
7-8 December 2022

Subject Risk and Assurance Report
Agenda item 05
Category For Decision
Section A : Executive Summary
Context
The Gavi Board has ultimate responsibility for overseeing the most significant risks of
the Alliance and related mitigation , and for agreeing on overall risk appetite. It
therefore receives an annual comprehensive Risk & Assurance Report (see Annex A).
Questions this paper addresses
The Risk & Assurance Report 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 has been reviewed and recommended for approval by the Audit & Finance
Committee (AFC). The Gavi Alliance Board is requested to approve the report
attached as Annex A and to provide guidance on the questions outlined below .
Conclusions
This year?s report prioritises 18 top risks, and shows that Gavi?s overall risk profile has
changed, with seven top risks increasing and three top risks decreasing. One risk
exposure is deemed to be outside of Gavi?s risk appetite with intensive mitigation still
ongoing .
Section B : Risk and Assurance Report 202 2
1. Portfolio discussion on top risks to the Alliance
1.1 This is the 7th 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. its willingness to accept being exposed to certain risks) as per
Gavi?s Risk Appetite St atement 1 approved by the Board. Detailed information
including analysis of each top risk and corresponding mitigation is included in
the annexes. Where applicable, links are made with findings from audits,

1 See https://www.gavi.org/news/document -library/risk -appetite -statement or in French:
https://www.gavi.org/fr/actualites/librarie -de -documents/declaration -de -gavi -alliance -sur -lappetit -pour -le-risque

Gavi

1


Board -2022 -Mtg -03-Doc 06


Report to the Board
7-8 December 2022
Subject Gavi 5.1 (including Pandemic Preparedness and Response )
Agenda item 06
Category For Decision
Section A: Executive Summary
In light of the impact of the COVID -19 pandemic on global health and immunisation, the
Board , at its April 2022 retreat , asked for a renewed focus on Gavi?s 5.0 priorities and to
lay out how COVID -19 vaccination , COVAX and its learnings will come together with
Gavi?s core strategy. This is being articulated as Gavi 5.1.
Gavi 5.1 is not a new strategy but rather a natural ev olution of 5.0 ; serving as a
bridge to 6.0 and reflecting the changing context in recent years. Building on the
lessons from the pandemic, Gavi 5.1 recognises the profound societal, geopolitical,
economic and technological shifts that have transformed the environment the Alliance
operates in. It also acknowledges the new challenges to global health security posed by
the increasing number of outbreaks of vaccine preventable diseases. Gavi 5.1 was
developed through a consultative process between June and Nove mber 2022,
involving Board and Programme and Policy Committee ( PPC ) members, country
stakeholders and the Alliance.
Gavi 5.1 will continue the 5.0 focus on preventing further backsliding of routine
immunisation (RI) , catching -up missed children, and reach ing zero -dose children
and missed communities . The introduction of key Gavi -supported vaccines not yet
included in countries? national schedules will continue at pace and remain central. The
Alliance will accelerate its support to help countries optim ise their vaccine portfolio and
prioritise the most critical vaccines in an evidence -based, country -driven way. Gavi 5.1
continues to highlight the importance of improving the sustainability of immunisation
programmes and ensuring healthy markets . It will entail an evolution of the Alliance?s
role in Pandemic Preparedness and Response (PPR) , including increased support
to regional manufacturing diversification . Gavi 5.1 would also see a relaunch of the
Human Papilloma virus (HPV ) vaccine programme, a nd include a COVID -19 vaccine
programme for 2024 and 2025 depending on the evolving epidemiology of the disease .
Docs 0 8, 07, and 10 respectively describe these three latter areas in detail.
This document provides an overview of the updated Gavi 5.0 strateg ic framework
(strategy ?one pager? ) for Gavi 5.1 . The Alliance?s future contribution to PPR , cutting
across all four strategic goals is summarised in Annex B of this document . The approach
to operationalising the 5.1 strategy, and the financial implications are included in
Annex C. The Board is requested to approve the targeted updates to the strategy
?one -pager? and provide guidance on the Alliance?s future role in PPR. Of note, i t is
proposed that the 5.0 strategy indicators and targets will remain unchanged . Gavi will
monitor on an ongoing basis whether updates are needed. The Secretariat will revert to
the PPC and Board on progress in implementing Gavi 5.1 on a bi-annual basis as part
of regular progress updates on the Alliance?s strategy .

Board -2022 -Mtg -03 -Doc 06 -Annex A

1

Report to the Board
7-8 December 2022

Board -2022 -Mtg -03-Doc 06 -Annex B 1
Report to the Board
7-8 December 2022
Annex B: Gavi ?s future role in Pandemic Preparedness and Response (PPR)

This annex outlines the evolving global health architecture related to pandemic
preparedness and response (PPR) , including Gavi?s historical involvement and
engagement through COVAX , and most recently Ebola Sudan, and provides an
overview of three areas for a potential targeted additional role for Gavi in PPR :
1) R equired capabilit ies for the next pandemic ; 2) Financial innovations ; and 3)
Resilient Routine Immuni sation programmes , with a fourth area ? supporting
African vaccine manufacturing ? presented in separate document . Th ese build
on PPC and Board guidance on Gavi?s potential role in PPR as first presented in June
2022, and refined at the July 2022 Gavi 5.1 mini -workshop, September 2022 Gavi 5.1
deep -dive consultation, and October 2022 PPC meeting. The Board is invited to
provide gui dance on Gavi?s additional future role in PPR as part of the discussion on
Gavi 5.1 .

1. Pandemic Preparedness and Response immunisation landscape

1.1 Over the past two and a half years, a range of profound societal,
geopolitical, economic and technological shifts have occurred, many as
a consequence of the COVID -19 pandemic . The pandemic has disrupted
essential health services, including routine immunis ation , and exacerbated
existing inequities in access to health and immunisation between and within
countries. At the same time, the global community has responded to the
pandemic with unprecedented investments, political attention, and engagement
that allowed new he alth interventions such as COVID -19 vaccines to be
developed and scaled in record time.

1.2 Consequently, the global health architecture has been evolving . The
pandemic required o rganisation s to leverage their comparative advantage s, but
also new structures and actors as illustrated in Figure 1. For example, the
Access to COVID -19 Tools Accelerator (ACT -A) was launched to coordinate
across vaccines, therapeutics and diagnostics. As part of ACT -A, COVAX
brought together CEPI, Gavi, UNICEF and WHO to ensure fair and equitable
access to COVID -19 vaccines. Financial and economic bodies traditionally less
focused on health such as the World Bank, IMF, G7 and G20 also increased
their engagement on the global health security agenda. New regional
collaborat ion mechanisms have been launched, such as the African Vaccine
Acquisition Trust, which aims to secure vaccine doses for African countries.
Bilateral funding and vaccine donations played an important role in the delivery
of COVID -19 vaccines. At the same t ime, the global health landscape has
become more crowded and fragmented. For example, a multitude of players
including the World Bank and multilateral development banks, Gavi, WHO,
UNICEF, AU -AVAT and bilateral donors now fund COVID -19 vaccine delivery,
wh ile other vaccines are almost exclusively supported through Gavi.

Board -2022 -Mtg -03-Doc 06 -Annex C 1
Report to the Board
7-8 December 2022
Annex C: Gavi 5.1 operationalisation and financial considerations
Th is Annex gives a high -level overview of the approach to operationalising the key
shifts in Gavi 5.1. It also includes an overview of the financial implications , in line with
financial forecast v20 (see Doc 04). More details on the operationalisation and
financial implications of the HPV programme relaunch, the COVID -19 programm e for
2024 -2025 and regional manufacturing diversification can be found in Docs 0 7, 08 and
10 .
Operationalising Gavi 5.1
? Implementing the Gavi 5.1 priorities will require acceleration and some
adjustments to Gavi?s funding levers . The Alliance will continue to
reprogramme ongoing funding to countries, accelerate the Full Portfolio
Planning (FPP) and Equity Accelerator Funding (EAF) applications to prevent
further backsliding of routine immunisation, catch up missed children and
accelerate the zero -do se agenda ( see Doc 02). If approved by the Board, p lans
for the relaunch of HPV will be included when appropriate as a priority . To
enable the timely relaunch of the HPV programme , the Secretariat will work
with countries to reallocate funding within ongoing HSS grants or approve new
funding where required (see Doc 07). This approach , coupled with concerted
efforts across the Alliance in support to countries , represents the most rapid
opportunity for countries to incorporate support to HPV into their HSS grants .
The Secretariat will closely monitor the additional investments in the HPV
relaunch and if needed go back to the PPC and the Board to ensure the
progr amme is appropriately funded. The Secretariat will continue to monitor the
use of the COVID -19 vaccine Delivery Support (CDS) and explore how CDS
could further support routine immunisation, building on the pivot initiated with
the focus of the recently launched CDS3 1 (see Doc 09). P ending the final Board
decision in June 2023, Gavi will operationalise the HSIS support for the
COVID -19 programme and implement the scale up of information systems in
WKH FRQWHxW RI *DvL?V HxSDQGHG UROH LQ 335 (see Annex B) .
? The modalities of PEF support will be adjusted to allow effective
operationalisation of Technical Assistance (TA) required in Gavi 5.1 .
Pending Board approval of the HPV relaunch , the PEF funding will be rapidly
allocated through Targeted Country Assistance (TCA) , Foundational Support
(FS) , and Strategic Focus Areas (SFAs ). These resources will be pivota l to
deliver on strategic shift 3 of the HPV relaunch programme (i.e . ?(QKDQFLQJ
technical assistance through PEF, TCA , and )6? ), and complement the current
TA support at global, country, and sub -national levels . Additional PEF funding
will be made available for the COVID -19 immunisation programme in 2024 and
2025 pending final Board approval of the programme in June 2023. The

1 CDS is increasingly being focused on integrating COVID -19 vaccination into RI, the new CDS3 envelope
launched in July (total USD 748 million) prioritises such investments into COVID -19 integration (see doc 7)

1


Board -2022 -Mtg -03-Doc 07

Report to the Board
7-8 December 2022

Subject Human papillomavirus (HPV) Vaccine Programme relaunch
Agenda item 07
Category For Decision
Section A : Executive Summary
Cervical cancer is 70 -90% preventable through Human Papillomavirus (HPV)
vaccination, yet 342,000 deaths were recorded in 2020, with ~90% of th ese occurring
in low - and middle -income countries (LMICs) . HPV vaccine has amongst the highest
impact 1 and is the key intervention towards the ambitious WHO 2030 targets to
achieve cervical cancer elimination 2.
In 2021, global HPV coverage stood at 12%, whil e 9% in Gavi 73 and 4% in eligible
Middle -Income Countries (MICs) 3. Severe supply constraints have been the major
driver behind low coverage in LMICs and imped ed progress durin g Gavi 4.0 (2016 -
2020 )4. Other drivers includ e vaccine/operational costs; competing priorities; the
unique challenges of vaccinating adolescent girls (such as service delivery, gender -
related barriers, demand and trust, lack of existing touchpoints within the health
system); and COVID -19 pandemic disruptions including school closures .
HPV vaccination is critical to reduce cervical cancer , especially in lower -income
countries with high disease burden and weak secondary prevention programmes. It is
also a bridge to women and girls? health and an opportunity to positively impact gender
equity. The new WHO SAGE (Strategic Advisory Gro up of Exper ts on Immunization)
recommendation permitting countries to opt for a single -dose schedule and an
increased global supply provides a critical opportunity to inject renewed
momentum . To accelerate the number of girls reached with HPV, from 9.8 million
(2021) to the ambitious target of ?86 million by 2025, the fo llowing objectives have
been set: 1) accelerate quality introductions; 2) rapidly improve global and national
coverage; and 3) generate long term programmatic sustainability through building and
integrating HPV vaccination within routine delivery mechanism s and into Primary
Health Care (PHC).



1 Vaccine Impact Modelling Consortium (VIMC), 2022 2 To achieve this, 90% of girls should be fully vaccinated with HPV vaccine by 15 years of age ; 70% of
women should be screened using a high -performance test by age 35, and again by age 45; 90% of
those identified with cervical disease should receive appropriate treatment. 3 MICs -eligible countries refer to the 45 countries and economies that are eligible under the MICs
Approach : all former -Gavi, never -Gavi lower middle -income countries (LMICs) and never -Gavi -
International Development Association (IDA) - eligible economies). Uzbekistan/Nicaragua, whilst now
eligibl e for the MICs Approach, are reported as Gavi 57. 4 Original 2020 target was 40 million girls, only reached 7.1 million girls by end of 2020 ( Gavi APR 2020 )

Board -2022 -Mtg -03-Doc 07 -Annex A 1
Report to the Board
7-8 December 2022
Annex A : HPV programme relaunch risks and implications
Secretariat risks/implications:
? HR: anticipated workload for the HPV programme relaunch will substantially
increase per the proposed ambition and necessary shifts, therefore budget
include s support for Secretariat and Alliance partners (for breakdown of budget
please see Annex F).
? Operation al: to facilitate iterative and adaptive implementation, grant processes
will need to be reviewed and adapted with lens of simplicity, flexibility, and agility
to allow for rapid disbursement, timely course correction and iterative
implementation , and ther efore accompanied by real -time monitoring and clear
indicators, including lessons learned, to measure and evaluate impact and inform
future investments in Gavi 6.0.
? Reputational: if there is slow HPV uptake including due to operational
complexities and fund availability , the Alliance will not reach its proposed ambition
of 86 million girls . To mitigate this, there will be close financial tracking and review
of existing processes to identify, escalate and resolve bottlenecks that may aris e.
Country risks/implications:
? Country bandwidth: countries have an increasing workload beyond their routine
programmes, including COVID -19, new vaccine introductions such as malaria,
outbreak response , and zero -dose agenda that could compromise focus on HPV
vaccination. To mitigate this risk the proposal includes consultations with countries
and HPV TCA funding to country, including support to EPI for dedicated country
coordinators ( e.g., per experience for Sierra Leone?s introduction) and allocation
fra mework which will account for programmatic readiness and competing priorities
before moving countries forwards. In the case of former Gavi -eligible countries,
dedicated support for new vaccine introductions ? including country -specific
technical assistance ? is available through the MICs Approach.
? Decision -making: Lack of a regulatory pathway to achieve licensure for 1-dose
may create inconsistency between PQ status and country decision for 1-dose
therefore challenges may occur on the decision -making pathway for 1 -dose
(e.g. National Regularity Authorities, National Immunisation Technical Advisory
Groups). This will be addressed through PEF including TCA (e.g. development of
normative guidance, simu lation models on the long -term benefit / risk and costs
implications of adopting single -dose , facilitation of NITAGs), leveraging existing
funded HPV technical bodies (e.g. HPV Vaccine Acceleration Program Partners
Initiative (HAPPI) Consortium Single -Dose HPV Vaccine Evaluation Consortium,
the Coalition to Strengthen the HPV Immunization Community (CHIC), Choice
Optimization for Immunization: Country Exercises in Sustainability (CHOICES)
projects ) and WHO /UNICEF to advise manufacturers and countries to nav igate the
regulatory implications that could arise due to the inconsistency in labelling (e.g.
leverage lessons learned from off -label IPV fractional doses recommendation).

Gavi

Board -2022 -Mtg -03-Doc 07 -Annex C 1
Report to the Board
7-8 December 2022
Annex C: Initial estimated cost of HPV programme relaunch 2023 -2025
HPV Expenditure Forecast Evolution
In addition to providing detail on the initial estimated cost of the HPV programme
relaunch 2023 ?2025, this annex sets out the changes to, and drivers of, the total
expendit ure forecast of the HPV vaccine program me included in the financial forecast
for the strategic period 2021 -2025. Total forecast expenditure (excluding COVAX
AMC) totals US$ 10.2 billion ( reducing from US$ 10.4 billion in the prior forecast) ?
see Doc 04a ? Financial Update, including forecast for details .
Figure 1: HPV expenditure forecast
Health systems strengthening: US $ 40 million forecast remains an estim ate of direct -HPV support - current HSS grants will be utilised to strengthen HPV programmes , but activities are often embedded in broader routine immunisation strengthening efforts
US$ 509 million ex penditure directly related to HPV Vaccine Programmes was
included in the prior financial forecast (v19.1) approved by the Board in June 2022.
The current financial forecast (v20) presented to the December 2022 Board for
approval includ es a US$ 102 m illion net increase in the HPV Vaccine Programmes
envelope resulting from two offsetting variances :
? US$ 65 million reduction in vaccine programme costs, principally driven by the
forecasted impact of permissive dose -schedule change from 2 dose to
permissive 1 dose regimen , in line with WHO SAGE recommendation .
? US $ 167 million vaccine programme costs, related to the HPV re -launch as
detaile d below funded from earmarked Canada funding ~$ US 60 million (CAD
75 million ) and allocation of existing resource s.

1



Board -2022 -Mtg -03-Doc 08
Report to the Board
7-8 December 2022

Subject Gavi ?s Role in Regional and African Vaccine Manufacturing
Agenda item 08
Category For Decision
Section A : Executive Summary
Context
The COVID -19 pandemic demonstrated that vaccine supply security varies by region
and impacts vaccine equity. Limited regional manufacturing capacity, particularly in
Africa, may have contributed to delays in progressing towards equitable access of
COVID -19 va ccines. This renewed commitment at the highest levels of government s
to establish industrial capacities on the continent for both pandemic response and
routine immunisation. The African Union (AU) set out a bold agenda to develop
sustainable local vaccine manufacturing , supported by the European Union (EU), G7,
G20 and international partners. 20 years ? experience in vaccine market shaping,
pooled procurement and design of innovative financial instruments position Gavi w ell
to support the down stream elements of this vision (e.g. via strategically curated
product portfolios ), whilst preserving and, wherever possible, enhancing global market
health for vaccine markets . In June 2022, Gavi?s Board requested that the Alliance
align behind African manufacturing as supportive of pandemic preparedness and
response (PP R) in the context of the Gavi 5.1 strategy. Over the past six months, Gavi
has led ex tensive consultations, including with AU counterparts and the Board , to
develop the four -Pillar strategy described in this paper.
Questions this paper addresses
As interventions are required across the value chain, where should Gavi focus? How
can Gavi help new African market entrants find a pathway to sustainability, whilst
preserving market health? How can Gavi?s processes be adapted to make it easier for
African/regional products to be selected? H ow can Gavi anticipate & manage expected
high initial costs from new entrants, and the risk of price increases (or mar ket exits) by
incumbent supplier s? How can Gavi work with other partners to provide indications of
future demand to manufacturers, whilst respecting its country -led mode l? How could
a new financial instrument best incentivise new manufacturers & investors in Africa ?
Conclusions
Gavi should use its comparative advantage to focus on a downstream approach that
offers clear incentives and a path to commercial viability to partners and investors
operating upstream. This approach has four Pillars: 1) advisory support for antigen &
plat form selection; 2) evolution of Gavi?s market shaping principles; 3) seeking
demand assurances; 4) a new financi al instrument for Africa . The Pillars are designed
to work in synergy as a coherent ?bundle? of interventions, with Pillar 4 lending
significant ly more leverage to Pillars 1 -3 than if Gavi were to deploy 1 -3 only.

Board -2022 -Mtg -03-Doc 08 -Annex A 1
Report to the Board
7-8 December 2022
Annex A: Incumbent supplier and market dynamics analysis
Accommodation of new suppliers into existing (global) markets which are already well
supplied and competitive, and in which demand is no longer growing, will likely have
an impact on the commercial outcome (and hence behaviour) of the incumbent
suppliers. As a general rule, when commercial volumes of a supplier decline, unit
COGS will tend to go up, and required pricing also. In some hitherto ?stable? markets
(e.g., PCV, Rota), we have an indication from incumbent suppliers of the yearly volume
below which they would reconsider their participation in the market. In other markets,
we have an idea of the price increases to be expected as volumes decrease, thanks
to some historical tender bidding behaviour where price -volume ladders were
submitted. As these sou rce data are sensitive, scenarios driven by them will not be
shared, but the Market Shaping team and UNICEF -SD have relative confidence in
predicting how any given market would likely play out given such insights. Another
scenario is where an incumbent man ufacturer simply raises prices after observing that
Gavi is willing to pay more to others, even if their existing price is still profitable.
The markets where undesirable incumbent behaviour can more likely be avoided are
the ones which are currently under supplied or predicted to be heading for undersupply
due to imminent demand expansion or potential supplier exit (e.g. OCV, Malaria,
multivalent Ebola). Markets where new suppliers are sought out for the purpose of
stimulating more competition should have the opposite effect on incumbents (e.g. MR,
or any market where new supplier has a profile advantage).
An example of a market where product profiles are relatively generic, competition is
intense, and prices have no further room for reduction, is Pentaval ent. The healthy
market equilibrium for Gavi supply turns out to be ~4 suppliers globally (optimi sing
across production economics & price of each supplier and overall supply security and
buffer). Given that we have historical price -volume ladder and other bidding data,
some scenarios have been generated, driven by varying levels of volume shift to a
new supplier. In examples such as IPV, not only would exits be inevitable, but we are
already in a situation where new aspiring entrants never managed to secure a Long -
Term Agreement (LTA) with UNICEF in the first place, such is the oversupply already
(even before a notional African IPV comes to the table). HPV is another market that is
predicted to be in overcapacity by the time a viable African HPV source could
materialize.
This is not to say, however, that incumbent suppliers cannot strategi se to maintain
some economic interest in a market in anticipation of their own -branded product facing
reduced demand. In the near term , new African suppliers will not , by and large , ?invent?
vaccines for existing categories but seek to in -license and tech -transfer appropriate
assets from incumbent manufacturers (who will receive royalties in most cases) 1. In
this way, volumes of procured finished goods can shift between ge ographic source but
exiting incumbents could consider partially compensat ing for this if they move fast to


1 In the medium -long term, of course, African R&D will start delivering innovations across improved
product profiles and unaddressed diseases

Board -2022 -Mtg -03-Doc 08 -Annex B 1
Report to the Board
7-8 December 2022
Annex B: Rationale for initial illustrative vaccine product prioriti sation







See also table in Annex A giving qualitative market dynamics analysis of categories B and C .

1





Board -2022 -Mtg -03-Doc 08 -Annex C


Report to the Board
7-8 December 202 2
Annex C: A new financial instrument to incentivise African vaccine
manufacturers & investors in Africa

Summary:

The paper outlines the results of the analysis conducted to dat e on a
potential financial instrument , ?Phase I?.
On this basis, approval is sought for Secretari at to develop full proposals
(?Phase II?) for an AMC to accelerate the expansi on of end -to -end African
vaccine Manufacturing ? with the detail ed design return ing to the Board for
consideration and approval in 2023.
Analysis to date indicates the role for a time -limited , Africa -focused Advance
Market Commitment with the following objectives :
? Supporting healthy global markets ? minimise market distortions and help to
sustain low global prices and resilient supply for priority vaccines
? Driving efficient market outcomes ? provide a signal to guide and align new
manufacturers and investors behind resilient , sustainable business propositions
? Reducing barriers to investment ? carefully structuring the level of incentive to
help offset initial costs of market entry whilst aligning support with other providers
of capital for greater overall impact
- guided by the following initial design considerations :
(i) minimising market distortions through a post -tender inventive payment (ii) time -
limited (iii) independent of Gavi?s core funding and (iv) Gavi designed, with an
option for an external partner to host all or part of the instrument.
Background
This Annex summarises work conducted to date in Phase I of the scoping of a
proposed instrument to incentivise African vaccine manufacturers & investors in Africa .
It addresses the strategic objectives of the instrument, its potential scope, and
proposes a process for its further development. The Gavi Board is recommended to
approve embarking on Phase II; the development of a detailed proposal for the design
and oper ationalisation of the AMC .
To reach this stage, t he Secretariat conducted detailed review s of existing work on
African vaccine market dynamics undertaken by the Clinton Health Access Initiative ,
Mc Kinsey and Company, Africa CDC Partnership for African Vaccine Manufacturing
(PAVM) together with reviews carried out into the Pneumococcal AMC . In addition,
detailed consultations were held with the AU, Multilateral and Bilateral Development

1


Board -2022 -Mtg -03-Doc 09
Report to the Board
7-8 December 2022

Section A: Executive Summary
Context
Emerging variants and evolution of the COVID -19 pandemic, new vaccine products,
and evolving policy guidance exemplify the continued volatility and uncertainty
surrounding the pandemic. In June 2022, the Board agreed that Gavi continue
admini strating the COVAX Facility in 2023, delegated authority to the CEO to adapt
programmes based on updated World Health Organization (WHO) Strategic Advisory
Group of Experts on Immunization (SAGE) recommendations and approved limited
provision of donated pa ediatrics doses. In line with these decisions and as participants
work toward their own coverage ambitions, COVAX will continue to support AMC
participants? vaccine demand with an increased emphasis on higher -risk groups,
including as new appropriate and r ecommended products enter the market, such as
variant -containing vaccines.
COVAX?s 2023 strategy will bridge to the Gavi 5.1 COVID -19 vaccine investment
approach that would begin in 2024 and is focused on ongoing protection of higher
priority population groups, pending Board approval in December 2022 (D oc 10 ) and
Board approval o f the financial envelope in June 2023. COVAX will also use 2023 to
transition its operating model from one of leading an emergency response to a
programme utilising existing Alliance processes. Some established elements of the
COVAX model will continue in 2023 including retaining the capacity to respond to the
WHO worst -case scenario through the Pandemic Vaccine Pool, while some
components will evolve, such as COVID -19 vaccine delivery support and the
sunsetting of the Humanitarian Buffer, with humanitarian access continuing to be
provided via other means.
Questions this paper addresses
? What progress has COVAX made in 2022 in supporting AMC participants achieve
their COVID -19 vaccination goals?
? What is the state of supply and demand and what are the projections for 2023?
? How does COVAX plan to keep its vaccine portfolio ?fit for purpose ? in 2023,
especially in light of variant -containing vaccines?
? How will COVAX adjust specific initiatives in preparation for the shift from
emergency response to a programme that uses existing Alliance processes?

Subject COVAX : Key Strategic Issues
Agenda item 09
Category For Information

Board - 2022 - Mtg - 03 - Doc 09 - Annex A Report to the Board
7 - 8 December 2022
Annex A : COVAX Reporting Framework
Section A: Update on Gavi?s COVAX Facility and COVAX AMC Monitoring,
Evaluation and Learning (MEL) strategy
The table below provides some of the key highlights and updates on progress against
the core elements of Gavi?s COVAX Facility and COVAX AMC MEL Strategy since the
June 2022 Gavi Board.
MEL
strategy
component Key activity Highlights / update ( October 2022 )
Cross -
cutting COVAX Theory
of Change Modest updates to vision and objectives for
2022 made mid - year, in alignment to broader
COVAX Pillar updates. Discussions on updates
for 2023 ongoing.
Monitoring COVAX
Reporting
Framework Reporting against COVAX Reporting
Framework made available for PPC and Board.
Some modest refinements made to 2022
COVAX Reporting Framework (see below)
since June 2022 Board meeting .
Complementar
y monitoring to
COVAX
Reporting
Framework COVAX Facility, Gavi Secretariat teams and
core COVAX partners continue to monitor
aspects of the Facility and AMC to a much
greater extent beyond the metrics currently
captured in the topline Reporting Framework.
Examples include:
? COVID19 Vaccine Deliver y Partnership
outputs focusing on absorption rates , delivery
financing and other key delivery metrics;
? Monitoring of progress across subgrants
funded through COVID19 Delivery Support;
? Other operational metrics and analyses
across supply, allocation, deliveries and in -
country implementation gathered internally.
Core country
monitoring and
reporting on
COVID - 19 /
COVAX COVAX continues to utilise the WHO - UNICEF
electronic Joint Reporting Form COVID - 19
module (monthly reporting) launched in March
2021 to gather core reporting from COVAX
participants. Despite improvements over time,
reporting completeness continues to be an
issue. Concerted efforts are underway with
Pillar partners to improve reporting on priority
population groups in particular.
Recipients of COVID - 19 Delivery Support
grants are expected to report back on a six -
monthly basis to Gavi.

1



Board -2022 -Mtg -03-Doc 10
Report to the Board
7-8 December 2022
Section A: Executive Summary
Context
COVAX, the Alliance?s emergency vaccine response to COVID -19 is set to sunset
in 2023. This paper considers Gavi?s potential role in providing countries with
access to COVID -19 vaccines starting in 2024. The Gavi COVID -19 Vaccine
Investment Approach, part of Gavi 5.1, considers how a future Gavi -supported
COVID -19 vaccine pr ogramme could be designed and implemented considering
target populations and scope of country support . The investment approach tak es
into account modelling on the estimated impact of future COVID -19 programmes
and potential implications for the broader immunisation landscape while building
on key learnings to date .
The Secretariat is proposing an up -to -investment figure of US$ 1.8 billion for the
first phase of the programme (2 024 -2025) . This would ensure timely ongoing
procurement of vaccines for higher risk groups in AMC countries , with
differentiated support for the Gavi54 - those countries eligible for Gavi support -
and the AMC37 - the never - and former -Gavi eligible countries which received
COVAX support.
The approval requested of the Board at this meeting is ?in principle? reflecting the
inherit uncertainty in underlying assumptions , and yet the need to start planning .
The Secretariat will return to the Board by June 2023 for approval of the financial
envelope , with updated country demand estimates to inform supply volumes , and
an updated delivery approach based on continued learning s from COVID -19
vaccine Delivery Support (CDS) deployment . The Secretariat w ill also return to the
Board and relevant committees should WHO SAGE (Strategic Advisory Group of
Experts on Immunization) guidance and/or the assumptions on which this
investment approach is based deviate significantly from current status . Finally , the
Secretariat will return to the Board in June 2024 as part of the Gavi 6.0 strategy
development process to assess the case for the continuation of the programme
informed by the experience of the first phase, trade -offs with other Gavi 6.0
priorities , and up to date epidemiological considerations for a longer -term
COVID -19 vaccine programme as part of the 2024 Vaccine Investment Strategy
(VIS) .
Key inputs were collected from across the Secretariat and partners (including
WHO, UNICEF, CEPI ( Coalition for Epidemic Preparedness Innovations) ) and
through country consultations. Additionally, the investment approach reflects the
steer provided by Board and Programme and Policy Committee ( PPC ) members
Subject Gavi?s role in a future COVID -19 V accine Programme
Agenda item 10
Category For Decision

1

Board -2022 -Mtg -03 -Doc 10 -Annex A
Report to the Board
7-8 December 2022
Annex A: Impact Modelling
In order to inform Gavi governance deliberations on potential future support for
COVID -19 vaccination in 2024 -2025, the Gavi Secretariat commissioned Imperial
College, London , to generate estimates of the potential impact of COVID -19
vaccination over 2024 -2025 based on several different epidemiological and
programmatic scenarios. As such, this annex leads with their analyses and initial
estimates. We were subsequently able to bring in outputs generated by t he Institute
for Disease Modelling (IDM) from the Bill & Melin da Gates Foundation as a partial
comparator in part to address model uncertainty (noting that their work is based on a
set of similar scenarios and assumptions to Imperial?s, but not an exact match) .
The primary outputs sought from these modelling efforts included cases,
hospitalisations, deaths, years of life lost (YLL) averted as well as cost -effectiveness.
Given th at much of the disease burden is in the elderly, it would be beneficial to
compare DALYs for C OVID -19 vaccines versus other vaccines. Unfortunately , this
was unable to be done given the uncertainties. Instead, YLL was used, which
constitutes the largest po rtion of the DALY s los t. For more details on the specific
scenarios, assumptions and limitations across both Imperial and IDM?s work, technical
summaries have been made available as appendices on Board Effect.
Topline summary based on modelled outputs from Imperial and IDM
Initia l results from both Imperial and IDM suggest the following:
? Modelled estimates from both Imperial and IDM broadly support the proposed
COVID -19 programme in 2024 -2025 being brought for discussion to the Gavi PPC
and Board (yearly boosting of high/highest p riority groups) as laid out in Doc 10 .
Continuing COVID -19 vaccination in 2024 -2025 has benefits, but the overall
expected health impact is lower than that seen earlier in the pandemic.

? Initial projections for the proposed 2024 -2025 programme show deaths averted
ranges comparable to the current Gavi core routine immuni sation portfolio (albeit
on the lower end). However, after incorporating costs , the proposed programme
appears to compare relatively less favourabl y from a value -for -money perspective
than Gavi core supported vaccine programmes.

? While expanding the vaccination programme to include broader population groups
such as all adults, adolescents and children results in greater total health impacts,
it is less efficient in tha t the expected cases and deaths averted per fully vaccinated
person declines when including younger age groups in the program.

? Results are highly sensitiv e across several key uncertainties including:
- Epidemiological evolution
- Assumptions around waning i mmunity and affinity maturation
- Vaccine efficacy assumptions across different vaccine products
- Coverage levels assumed at end of 2023 and for 2024 and 2025
- Cost (both procurement and delivery)

Board -2022 -Mtg -03 -Doc 10 -Annex B 1
Report to the Board
7-8 December 2022

Annex B: Looking Ahead and Uncertainties
There are several uncertainties against which we are planning for a future COVID -19
programme and which will influence how the programme will evolve, including:
? Demand: Our ability to predict future demand for the proposed programme is
limited, with several factors impacting countries? abilities to plan, develop, and
execute long -term immunisation plans. The Secretariat is consulting countries to
better understand their appetite for a future COVID -19 vaccine programme. While
there are indications that some countries are eager to begin a COVID -19
programme - and some have already begun integrating COVID -19 vaccines into
their health systems - global demand has waned over 2022 as the world has shifted
out of the acute phase of the pandemic. The Secretariat has used primary vaccine
coverage projections to estimate demand for a future COVID -19 programme
starting in 2024. However, a better understanding of the demand for a COVID -19
programme will emerge from the det ailed Alliance wide demand planning process
in 2023, and the Secretariat will share updated demand projections at the June
2023 Board meetin g.
? Vaccine Products : Depending on the evolution of the virus, it is unclear whether
the current vaccine products wi ll continue to be effective or that manufacturers will
continue to manufacture them. Further evolution of products and implications on
efficacy (including against transmission), durability, required frequency of
boosters, and programmatic feasibility are a lso uncertain.
? Epidemiology of the virus : Although this programme is designed for the WHO?s
current base -case scenario, there is potential for new variants to emerge that could
be more severe or more immune -escaping against current vaccines. Variants
cou ld affect population groups differently, which could impact which demographics
and population cohorts are prioritised for vaccination by SAGE, including the
potential inclusion of different VCVs. Historically, surges have not followed
predictable patterns or seasonality, making planning difficult.
? Impact : Estimating public health impacts for potential future support is challenging
given the number of variables, assumptions and uncertainties involved. Modelled
estimates are highly sensitive and as such, shou ld be considered with appropriate
caution in view of key evidence gaps that exist. As more evidence is generated in
the coming months, for example on vaccine efficacy, these estimates are likely to
change. The Secretariat will continue to engage impact mod elling groups to
generate updates as needed.
? Non -vaccine tools : As COVID -19 becomes endemic, the potential market for new
therapeutics to treat or prevent the symptoms is expected to grow and with it,
industry investment in innovative therapies. If effort s are taken to make these
accessible and affordable, it is possible that the opportunity cost for a country to

1

Board -2022 -Mtg -03 -Doc 10 -Annex C
Report to the Board
7-8 December 2022
Annex C: Modelling Assumptions
Number of doses per year: The Secretariat is basing calculations for the COVID -19
vaccine programme on one booster dose per year based on the assumption that future
vaccines will give more durable protection , limiting the need for more frequent
vaccination. It is also possible that by 2024 most people globally will have either been
infected with COVID -19 at some point and/ or been vaccinated, and this hybrid
immunity will result in one dose per year being sufficient.
Coverage and demand : The programme should aim to support countries to reach
ambitious targets yet be based on realistic assumptions of coverage. We consid ered
comparable rates of coverage to use as proxies for what we may expect for the
COVID -19 context. Alliance demand planning groups project overall primary coverage
in the AMC 91 to be between 40 and 65 percent by end -2023. A drop off from primary
to boos ter coverage has been assumed using HIC data (~18 percent drop off). The
model, therefore, assumes we can expect countries? additional dose coverage rates
to be somewhere between 35 and 55 percent for the proposed programme.
Procurement cost per dose : Sev eral factors will determine the procurement cost per
dose. For the cost factored into this model, we assume that manufacturing will
continue on an ongoing basis, and therefore there will be predictable supply from a
diverse range of suppliers. Current vacc ine technologies will continue to be used, and
fit-for -purpose vaccines, such as variant containing vaccines, will be well -matched
against circulating variant strains. As we integrate into established Alliance processes ,
we will revert to regular tendering processes through UNICEF. Actual future vaccine
prices may be influenced by volumes contracted/procured, level of competition, new
technologies, product preferences, geographic base of manufacturing networks, and
other factors.
Delivery costing : Delivery costing has been calculated with the support of the Delivery
Costing Working Group (DCWG) in September 2022. The DCWG has members from
CoVDP, UNICEF, BMGF, Harvard School of Public Health, MSH, WHO and Gavi. The
costing encompasses several compo nents, including PPE, hand hygiene, per diem for
service delivery, transportation for outreach, training, planning & coordination, social
mobilization, cold chain maintenance, waste m anagement , vax certificates,
pharmacovigilance. Costing excludes ancilla ries (syringes and safety boxes), TA and
cost of vial.

1


Board -2022 -Mtg -03-Doc 11a

Report to the Board
7-8 December 2022

Subject Funding Policy Review : Context and Health System
Immunisation Strengthening (HSIS) Policy
Agenda item 11a
Category For Decision

Section A: Executive Summary
Context
The aim of the Funding Policy Review is to simplify, streamline and align Gavi?s three
key funding policies: 1) Eligibility and Transition Policy; 2) Co -financing Policy; and 3)
Health System and Immunisation Strengthening (HSIS) Support Framework 1. The
review began in 2019 as part of the op erationalisation of Gavi 5.0. It was paused in
2020 due to the pandemic and restarted in late 2021 with touchpoints at the October
2021 and May and October 2022 meetings of the Programme and Policy Committee
(PPC). An independent evaluation and subsequent consultation and policy analysis
found the policies to have been fundamental to Gavi?s success but recognised that
more nuance and flexibility could improve their implementation.
Questions this paper addresses
Whilst the initial scope of the review sought to comprehensively update the policies,
the scope has since been modified in consultation with Board members and Alliance
partners in recogni tion of the current political and economic environment. As a result ,
the Secretariat has focused on addressing key, urgent issues for the current strategic
period, with a view to address longer -term aspects as part of the operationalisation of
Gavi 6.0. The updat ed focus of the review is on : i) addressing the risk of unsuccessful
transition of countries from Gavi support; ii) ensuring co -financing is not a barrier to
uptake of the malaria vaccine; and iii) ensuring prior Board -approved HSIS Framework
shifts are reflected in a new HSIS Policy.
This paper provides the scope and context of the overarching review and the process
and consultations that have led to the proposed revisions , as well as a reminder of
what shifts have already been approved and implemented to HSIS support. This paper
sho uld be read and discussed in conjunction with Doc 11b, which proposes specific
shifts to the co-financing , and eligibility and transition polices , as well as an approach
to co -financing for malaria vaccine . Additionally, this paper presents the updated
Framework for Gavi Funding to Countries , which outlines the key principles and
interactions between the three policies .


1 The HSIS support framework operates in a similar manner as a Gavi policy, but with a greater level of
detail. The Policy review seeks to resolve this inconsistency with other Board -approved policies.

Board -2022 -Mtg -03-Doc 11a -Annex A 1
Annex A: Framework for Gavi Funding to Countries


Gavi Alliance
Framework for Gavi
Funding to Countries
Version 1.0

DOCUMENT ADMINISTRATION
VERSION NUMBER OWNER DATE
1.0 Policy Team 8 December 2022

1. Purpose and Scope of Document
1.1 This document serves as an overarching framework for Gavi?s three
programmatic funding policies for Gavi -eligible countries: a) The Eligibility &
Transition Policy; b) The Co -financing Policy; and c) The Health Systems and
Immunisation Strengthening (HSIS) Policy. The purpose of this document is to
set out the objectives, principles and approach for Gavi funding to eligible
countries.
1.2 Gavi supports lower -income countries, to increase the equitable and
sustainable use of vaccines in routine immunisation programmes. This
document describes the policies that outline the scope of Gavi funding available
to Gavi -eligible countries. This funding is intended to support countries as they
increase the equitable and sustainable use of vaccines in routine programmes
and facilitate their successful transition out of Gavi support. It includes the
procurement of vaccines and support to strengthen health systems to extend
routine immunisation services to reach zero dose and missed communi ties, as
well as introduce new vaccines, conduct planned campaigns and other
supplemental delivery strategies, and implement outbreak response
vaccination.
1.3 This document does not cover other Gavi funding through the Partners?
Engagement Framework, the Middle -Income Country?s Approach (the ?MICs
Approach?) for former and select never Gavi -eligible countries, nor other special
initiatives which Gavi might fund from time to time.
2. Principles of Gavi Funding to Eligible Countries
2.1 Country -driven, predi ctable and sustainable: Gavi support is country -driven,
meaning that it bolsters country leadership to sustainably deliver and finance
immunisation. Support is planned and predictable over time. It is directly linked

Board -2022 -Mtg -03-Doc 11a -Annex B 1
Report to the Board
7-8 December 2022
Gavi Alliance
Health Systems and Immunisation
Strengthening Policy
Version 1.0
Annex B: Health System and Immunisation Strengthening Policy






DOCUMENT ADMINISTRATION





VERSION
NUMBER APPROVAL PROCESS DATE
1.0
Prepared by: Marta Tufet, Head,
Policy
Reviewed by: PPC 1 November 2022
Approved by: Board [Full date]
Effective from: 1 January 2023
Next review: At the request of the Board


Board -2022 -Mtg -03-Doc 11a -Annex B 2
Report to the Board
7-8 December 2022
1. Scope & Objective
1.1 The objective of this policy is to ensure that HSIS funding is allocated and
programmed to enable countries to build strong, equitable, sustainable, and
high - quality immunisation programmes. Funding is available for countries to
strengthen and extend immunisation serv ices to regularly reach zero -dose
children and communities using tailored and differentiated strategies to build a
stronger primary health care platform.
1.2 The policy applies to all Gavi -eligible countries; however, in the
implementation of the policy, s pecific considerations for the use of funds, and
the depth of the Alliance?s engagement will vary depending on the country
need, fragility status and other country and local contexts.
1.3 The scope of this policy is Gavi?s Health System and Immunisation
Strengthening support including Health System Strengthening (HSS), the Cold
Chain Equipment Optimization Platform (CCEOP) and support to vaccine
implementation. While this scope does not cover time -limited funding such as
the Equity Accelerato r Funding (EAF) 1, COVID -19 Delivery Support (CDS), or
support through the Partners? Engagement Framework (PEF) Targeted Country
Assistance (TCA) 2, countries are expected to align planning of support through
EAF, PEF/TCA and HSIS funding. The Framework fo r Gavi Funding to
Countries provides an overview of the support and the objectives, principles
and approach for Gavi funding to eligible countries.
2. Principles
2.1 The following principles should be used to prioritise HSIS investment objectives
and lead grant design:
? Country -driven, predictable and sustainable beyond Gavi support:
grants should be designed to focus on system strengthening. Gavi
strongly encourages countries to increasingly take over operational
costs necessary for recurrent activities as they approach exit from Gavi
support.
? Equity: missed communities, first priority: investments should
prioritise reaching zero -dose and under -immunised children and missed
communities as well as mitigate risk of disruption of ongoing routine
immunisation.
? Tailored to context, adaptable and flexible: Proposed interventions
should be aligned with national plans and priorities and adapted to the
local context. Interventions should be tailored to address the specific
1 The Equity Accelerator Fund (EAF) is not covered by the policy as this support is time -limited to Gavi?s 5.0
Strategy Period (2021 -2025). 2 Gavi provides technical assistance to countries through the Partners? Engagement Framework (PEF) to support
countries in introducing vaccines and strengthening routine immunisation programmes through its core partners
[WHO, UNICEF, Centers for Disease Control and Prevention (CDC), and the World Bank] and expanded partners
(including local institutions) via Targete d Country Assistance (TCA).

1


Board -2022 -Mtg -03-Doc 11b

Report to the Board
7-8 December 2022

Subject Funding Policy Review: Eligibility and Transition Policy and
Co -Financing Policy
Agenda item 11b
Category For Decision

Section A: Executive Summary
Context
The Eligibility & Transition Policy and Co -financing Polic y are being reviewed as part
of the Funding Policy Review . An independent evaluation and subsequent analysis
and consultation concluded that these policies have been fundamental to the success
of Gavi?s sustainability model, but that some shifts could facilitate their implementation.
Given the current political, economic environment and timepoint in Gavi?s strategic
cycle, the review has shifted to address two urgent issues: 1) countries in accelerated
transition phase (ATP) face financial sustainability challenges that could impede their
successful transition from Gavi support; and 2) the initial high cost of the malaria
vaccine is a barrier to u ptake and public health impact . These issues are exacerbated
by slow economic growth and rising inflation, while the impacts of the pandemic,
ongoing war in Ukraine, and increasing debt burden have created an uncertain and
challenging fiscal and economic environment.
Questions this pap er addresses
This paper proposes to address these two issues via i) updates to the Eligibility &
Transition and Co -financing policies: extending the duration of ATP from five to eight
years and instituting a minimum 35% co -financing thr eshold for countries to move from
preparatory transition to ATP ; and ii) providing an exceptional time -limited approach
for malaria co -financing.
Additionally, the paper proposes two provisions in the co -financing policy: i) following
up from the discussion on the Fragility, Emergencies and Displaced populations policy
approved by the Board, for there to be no co -financing required for refugee
populations; and ii) formalising previous Board decisions which state that no co -
financing is required for outbreak response campaigns.
Conclusions
The Programme and Policy Committee ( PPC ) recommends to the Alliance Board to
approv e the updated Eligibility and Transition policy, the Co -financing policy , as well
as the exceptional time -limited approach for malaria co -financing.
 

Board -2022 -Mtg -03-Doc 11b -Annex A 1
Report to the Board
7-8 December 2022
Annex A : Eligibility and Transition Policy


Gavi Alliance
Eligibility and Transition
Policy
Version 4.0



DOCUMENT ADMINISTRATION
VERSION
NUMBER APPROVAL PROCESS DATE
4.0
Prepared by: Marta Tufet, Head,
Policy
Reviewed by: PPC 1 November 2022
Approved by: Board [Full date]
Effective from: 1 January 2023
Next review: At the request of the Board
3.0
Reviewed by: Gavi Programme
and Policy Committee 3 May 2018
Approved by: Gavi Alliance Board 7 June 2018
Effective from: 7 June 2018
2.0
Prepared by: Robert Newman,
Policy and Performance
Reviewed by: Gavi Programme
and Policy Committee 4 and 21 May 2015
Approved by: Gavi Alliance Board June 2015
Effective from: 1 July 2015






Board -2022 -Mtg -03-Doc 11b -Annex A 2
Report to the Board
7-8 December 2022
1. Purpose & Objective
1.1 The purpose of this policy is to set out the criteria and procedures that
determine which countries are eligible for Gavi support and to define the
transition pathway through which this support is phased out, ensuring that Gavi
funding is aligned with its mission to focus support on lower -income countries.
1.2 Further information about the levels of Gavi funding for Gavi -eligible countries
is found in the co -financing policy and Health Systems and Immunisation
Strengthening (HSIS) policy. A dditionally, the Framework for Gavi Funding
to Countries outlines the overall structure of Gavi?s support to countries.
2. Definitions
2.1 Gross National Income per capita (GNI p.c.): GNI is the sum of value added
by all resident producers plus any product taxes (less subsidies) not included
in the valuation of output plus net receipts of primary income (compensation of
employees and property income) from abroad. GNI p.c. is GNI divided by mid -
year population. GNI p.c. in US dollars is converted using the W orld Bank Atlas
Method which smooths exchange rate fluctuations using a three -year rolling
average, price -adjusted conversion factor, calculated by the World Bank.
2.2 Gavi -eligible country: a country which is in one of the three phases of Gavi
support defined by GNI p.c. thresholds. These phases and thresholds are
detailed in section 4 of this policy.
2.3 Penta3 coverage: percentage of infants in a given country that received three
doses of pentavalent (or equivalent) vaccine based on WHO/UNICEF WUENIC
source.
3. Principles
3.1 The following principles guide the application of the Gavi -eligibility and
transition policy:
Country -led, predictable and sustainable: Gavi support is country -driven,
meaning that it bolsters country leadership to sustainably deliver and
finance immunisation. It is predictable over time and directly linked to a
country?s ability to pay and is intended to be catalytic and time -limited and
to incentivise domestic investm ents in health.
Tailored to context, adaptable and flexible: The use of Gavi support is
differentiated to meet the needs of countries as they change over time.
4. Procedures and Thresholds
4.1 Gavi uses GNI p.c. to determine eligibility for Gavi support. T he threshold for
eligibility for Gavi support is US$ 1730 GNI p.c. in 2023. The threshold for
eligibility is updated annually using the inflation adjustments the World Bank
makes annually to its income categories.

Board -2022 -Mtg -03-Doc 11b -Annex B 1
Report to the Board
7-8 December 2022
Annex B: Co -financing Policy


Gavi Alliance
Co -financing Policy
Version 3.0



DOCUMENT ADMINISTRATION
VERSION
NUMBER APPROVAL PROCESS DATE
3.0
Prepared by: Marta Tufet, Head,
Policy
Reviewed by: PPC 1 November 2022
Approved by: Board [Full date]
Effective from: 1 January 2023
Next review: At the request of the Board
Updated
Section 6 and
7.3
Reviewed by: Gavi Programme
and Policy Committee 12 May 2016
Approved by: Gavi Alliance Board 23 June 2016
2.0
Prepared by: Robert Newman,
Policy and Performance
Reviewed by: Gavi Programme
and Policy Committee 4 May 2015
Approved by: Gavi Alliance Board June 2015
Effective from: 1 January 2016







Board -2022 -Mtg -03-Doc 11b -Annex B 2
Report to the Board
7-8 December 2022
1. Purpose & Objective
1.1 The purpose of this policy is to set out the requirements and procedures for
country co -financing of vaccines introduced with Gavi support for use in routine
programmes. Further information on the vaccines for which co -financing
applies can be found in the application guidelines.
1.2 This policy covers vaccine co -financing levels at different phases of the
transition pathway, compliance requirements and exceptions.
1.3 This policy only covers co -financing for vaccine procurement. The Framework
for Gavi Funding to Countries outlines the overall structure of Gavi?s support
to countries and other Gavi funding support is covered in the Health Systems
and Immunisation Strengthening (HSIS) policy.
1.4 The objective of this policy is to facilitate the mobilisation and sustaining of
domestic fin ancing for vaccines introduced with Gavi support.
2. Definitions
2.1 Co -financing share: The co -financing share represents the share of total costs
of co -financed vaccines borne by countries. It may differ from the price fraction
as the price fraction is applied to vaccines costs only, excluding devices and
freight.
2.2 Grace year: first year of preparatory or accelerated transition phase, during
which co -financing rules of the previous transition phase apply.
2.3 Starting fraction: the starting fraction is calculated by dividing a country?s total
co -financing for all co -financed vaccines by t he total cost of all co -financed
vaccines based on the weighted average prices of the presentations used by
the country. The starting fraction shall be calculated in year 1 of preparatory
transition to apply from year 2. The starting fraction will not incl ude the costs of
the malaria vaccine or other specific vaccines for which co -financing follows an
exceptional approach.
2.4 Price fraction: the price fraction applies to countries in preparatory transition
and first year of accelerated transition. It is ca lculated annually by increasing
the previous year?s fraction by 15% (i.e., a factor of 1.15). The price fraction is
applied to the price of a co -financed vaccine to determine the amount that a
country co - finances for that vaccine. Price fraction is also u sed for setting the
co -financing level of vaccines introduced by countries in accelerated transition,
in line with rules set out in section 4.
3. Principles
3.1 The following principles guide the application of the co -financing policy:
? Country -driven, pred ictable and sustainable beyond Gavi support:
Gavi support is country -driven, meaning that it bolsters country

1


Board -2022 -Mtg -03 -Doc 13

Report to the Board
7-8 December 2022

Subject Committee Chair and IFFIm Board reports
Agenda item 13
To follow

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Board -2022 -Mtg -03 -Doc 14

Report to the Board
7-8 December 2022

Subject Review of decisions
Agenda item 14
No paper

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Board -2022 -Mtg -03 -Doc 15

Report to the Board
7-8 December 2022

Subject Cl osing remarks
Agenda item 15
No paper

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Board -2022 -Mtg -03-Doc 12
Report to the Board
7-8 December 2022

Subject Report from Audit and Investigations
Agenda item 12
Category For Information
Section A : Executive Summary
Context
The Managing Director, Audit and Investigations (A&I) is required, under A&I?s Terms
of Reference approved by the Board, to report to the Board at least annually and to
confirm to the Board at least annually the organisational independence of A&I.
Questions this paper addresses
How has A&I fulfilled its Terms of Reference in 2022 , to provide an evaluation, through
a risk -based approach, on the effectiveness of governance, risk management, and
internal control to the organisation?s governing body and senior management ?
How does A&I plan to undertake its 2023 activity?
Does A&I report to a level within the organi sation that allows the activity to fulfil its
responsibilities ? Can A&I confirm the necessary organi sational independence ?
Conclusions
A&I has provided risk -based and objective assurance, advice and insight to the
governing body and senior management and has assessed probity in 2022. A&I has
facilitate d the Audit and Finance Committee in executing its responsibility to oversee,
review and monitor the operation of the A&I function, in support of the Board?s
oversight responsibilities .
A&I has prepared, and the Audit and Finance Committee has approved, a work plan
for 202 3. The plan continues the trend for executing more audits which began i n 2022
in response to elevated and continuing risks and starts to gear up to provide the
accountability and counter -fraud services which would be reasonably expected in the
context of Gavi 5.1 and moving towards Gavi 6.0.
A&I reports to the Board, effectin g this through routine reporting to the Audit and
Finance Committee, and to the CEO, and this reporting arrangement allows the activity
to fulfil its responsibilities. A&I confirms the necessary organisational independence.

gavi.org
CONSENT AGENDA
BOARD MEETING
7 -8 December 2022, Geneva, Switzerland
Recommendation 1: Consent Agenda: Board Chair
Reappointment
The Gavi Alliance Governance Committee recommends to the Gavi Alliance Board that it:
a) Reappoint Jos? Manuel Barroso as an Unaffiliated Board member through to
31 December 2025 ; and
b) Reappoint Jos? Manuel Barroso as Board Chair, with individual signatory authority on behalf
of the Gavi Alliance, for a second term through to 31 December 2025 .
2 Board Meeting, 7 -8 December 2022

gavi.org
CEO BOARD
UPDATE
D R S E T H B E R K L E Y
In Baluchistan Province, Pakistan, a boat made
with plastic barrels carries a team to vaccinate
children with typhoid conjugate vaccine (TCV).
Credit: Gavi/2022/ Asad Zaidi
Council of Europe?s
2021 North - South Prize to COVAX
2 CEO Board Update
? Cited COVAX as ?a major actor
of global solidarity? in COVID -19
pandemic , contributing to
protecting public health and
building a more equitable world
? Prof Jos? Manuel Barroso, Chair of
the Gavi Board, attended award
ceremony in October 2022 on
behalf of Gavi Secretariat

gavi.org
COUNTRY PROGRAMMES
UPDATE
BOARD MEETING
Thabani Maphosa
7 -8 December 2022, Geneva, Switzerland
Segment distinctives and % of zero -dose children
2 Board Meeting, 7 -8 December 2022
? Large and federated
countries
? Extremely large birth
cohorts, zero -dose
children
? De -centralisation of health
to sub -national areas
? Higher programmatic
and fiduciary risks
? Intensive Alliance and
partner engagement
? 19 former Gavi -eligible
countries
? 26 never Gavi -eligible
lower middle income &
IDA -eligible economies
? Support differentiated
based on needs
? Includes
supporting fragile MICs
Middle -Income
45 countries
High Impact
5 countries
? Different country maturity:
priority; standard
? Priority: large birth
cohorts, weak system &
performance
? Standard: smaller birth
cohorts, strong
performance
? High numbers of countries
in accelerated transition
Core
40 countries
? Significant disruption to
immunisation services
? Limited health
infrastructure
? Limited pool of qualified
healthcare workers
? Sometimes inaccessible
to externals
? Low national coverage
(80%)
Fragile & Conflict
12 countries
~51% ~14% ~25% ~10%

gavi.org
Finance
BOARD MEETING
David Marlow, Assietou Diouf
7 -8 December 2022, Geneva, Switzerland
Key Forecast and Budget Highlights
US$ 183 m
Gavi 5.0: available for future
investments (after new investments)
? Decrease in resources due to market condition offset by lower forecast expenditure.
Flexibility remains to respond to uncertain context .
? Funding for HPV relaunch & updated Co -Financing, Eligibility & Transition policies reflected
No increase
Gavi 5.0: Secretariat budget
US$ 1.9 bn
COVAX: resources released
through negotiations
Secretariat capacity
Increasing risk for the Alliance
? Total budget remains within Board approved envelope ; with underspend rephased
? Average operating expense ratio for Gavi 5.0 remains 7.5%; increases for 2023 -2024
? Renegotiations to return ~ US$ 1.9 bn to the AMC
? C ombined exit costs and expiration forecast to date reduced to ~US$ 1.8 bn, with additional
risk of expiries based on 2023 demand (figures exclude in -country wastage)
? Efficiency and simplification with launch of Operational Excellence framework
? Holistic workforce plan to meet Secretariat resource capability needs and drive end to end
process effectiveness across all functions
2 Board Meeting, 7 -8 December 2022

gavi.org
RISK AND ASSURANCE
REPORT
BOARD MEETING
Jacob van der Blij
7 -8 December 2022, Geneva, Switzerland
The world continues to be uncertain and faces
unexpected shock after shock
? Immediate COVAX risks decreasing , but uncertainties persist with the pandemic not yet over;
? Lower sense of urgency with Omicron variant affects demand (and risk of vaccine expiries );
? Health systems and country capacity remain strained, posing risks to routine immunisation;
? The external world continues to be uncertain, requiring a shift from efficiency and ?just in time?
to resilience and ?just in case?
? The Russia -Ukraine conflict posing economic, geopolitical, supply, donor support and cyber risks.
Geopolitical tensions and rivalry have increased substantially, even involving nuclear threats;
? Increasing inflation and rising interest rates may lead to a global recession, cost -of -living crisis
and volatile financial markets, impacting Gavi finances, country fiscal space and debt crises;
? Increasingly visible impacts of climate change and food insecurity may disrupt routine
immunisation and raises the risk of disease outbreaks and future pandemics.
Gavi continues to operate with a high risk appetite, while relying on robust risk management
2 Board Meeting, 7 -8 December 2022

gavi.org
Gavi 5.1 (including Pandemic
Preparedness & Response)
BOARD MEETING
Aur?lia Nguyen
Johannes Ahrendts
7 -8 December 2022, Geneva, Switzerland
2022
April July July -
Sept
December
Board retreat:
take stock of
the impact of
the pandemic
on routine
immunisation
Gavi 5.1 mini -
workshop: reconfirm
5.0 priorities and
integrate C19
learnings
2 deep -dives
on
targeted
additions for
Gavi 5.1
Board
decision
on 5.1
Recap: Gavi 5.1 journey started in April ?22 led by the Board with
close PPC involvement
?Bringing it all
together?
consultation
November
Today
Gavi 5.1 is not a new strategy. A natural evolution of 5.0 serving as bridge to 6.0
Oct -
Nov
PPC
meeting:
guidance
on 5.1
Board Meeting, 7 -8 December 2022

gavi.org
HUMAN
PAPILLOMAVIRUS
(HPV) VACCINE
PROGRAMME
RELAUNCH
BOARD MEETING
Jalaa? Abdelwahab
7 -8 December 2022, Geneva, Switzerland
Board Meeting, 7 -8 December 2022
Gavi 4.0
2
2011 2012 2015 2019 2021 -22
1M GIRLS
REACHED
(Demos)
Start of HPV
NATIONAL
SCALE -UPs
SEVERE SUPPLY
CONSTRAINT
SUPPLY
CONSTRAINTS/
COVID -19
2016 2017 -18 2020
HPV 1 st
TENDER
DEMONSTRATIONS
PROGRAMME
? Girls reached: 9.8M
SUPPLY
CONSTRAINTS
FURTHER COVID -
19 DISRUPTIONS
HPV vaccination ? a high impact programme - has gone
through several setbacks requiring a relaunch for Gavi 5.1
Historical background
Gavi 5.0
? Introductions: 28 R outine & 9 MACs ? Gavi 73 coverage: 11% HPV1, 9% HPV2
? Large countries yet to introduce
? Mixed country -level performance
Reach to date

gavi.org
GAVI?S ROLE IN SUPPORT TO REGIONAL AND AFRICAN
VACCINE MANUFACTURING
BOARD MEETING
Dominic Hein, David Kinder
7 -8 December 2022, Geneva, Switzerland
The African region, while having significant demand for vaccines,
currently has limited regional manufacturing
2 Board Meeting, 7 -8 December 2022
Figure: Supply of WHO pre -qualified vaccines in 2021
Source: WHO, Linksbridge
? Limited regional manufacturing, particularly in
Africa, may have contributed to delays in
equitable vaccine access during C -19 pandemic
? This highlighted that supply security is not
always guaranteed
? Desire from many African countries to increase
local capacity ? for both pandemic response and
routine / interpandemic vaccines
? Broad support from international community
? Gavi has opportunity to support given market
shaping experience & large volumes procured
? Gavi?s contribution will have a downstream focus
that synergises with actors upstream

gavi.org
COVAX: KEY STRATEGIC ISSUES
BOARD MEETING
Thabani Maphosa, Derrick Sim
7 -8 December 2022, Geneva, Switzerland
Population
Focus
Progression from COVAX in 2022 -2023 to Gavi -supported COVID -19
programme from 2024
Today: COVAX in transition 2024 onwards: Potential Gavi supported C19 Programme
Increasing focus on higher
priority user groups, incl.
additional boosters
Continued support across all
user groups for primary + 1,
esp. for low coverage countries
Transition to support higher priority user groups
Additional doses/ newer products via
PVP for worst case scenario
Reactive strategy for worst case scenario
ILLUSTRATIVE
Board Meeting, 7 ?8 December 2022

Classified as Internal
gavi.org
GAVI?S ROLE IN A FUTURE
COVID -19 VACCINE PROGRAMME
BOARD MEETING
Derrick Sim, Richard Mihigo
7 -8 December 2022, Geneva, Switzerland
Classified as Internal
Why should Gavi support a future COVID - 19 programme ?
2
Shift from an
emergency
response focused
on global health
security to
protection of the
most vulnerable ,
while retaining ability
to quickly mobilise in
a worst -case
scenario
Strategic
Objective
Board Meeting, 7 ?8 December 2022
Impact to date...
Recent modelling estimates that COVAX -supported COVID -19 doses have
averted over 1.7 million deaths across AMC participants
AMCs look to COVAX to supply a large proportion of their COVID -19 doses
? with LICs relying on COVAX for ~75% of their supply ? providing
continued access critical for global fight against COVID -19
Current epidemiology...
Initial impact projections show deaths averted per fully vaccinated person ,
especially for higher -risk populations, are in the same range as those of other
Gavi -supported vaccine programmes
Looking ahead...
A COVID -19 programme can support and strengthen platforms for life -course
vaccination and contribute to learnings on integration of immunisation into
primary health care in view of Gavi 6.0
Many regions are experiencing a surge as several variants continue to co -
circulate . Some countries are experiencing their highest ever incidence,
although vaccination has helped reduce severe disease and death .

gavi.org
FUNDING POLICY REVIEW
BOARD MEETING
Marta Tufet, Emmanuel Bor
7 -8 December, Geneva, Switzerland
The Framework on Gavi Funding to Countries offers a
narrative of the three policies' principles and interactions
Co -financing Policy
Vaccine procurement:
rules, safeguards and exceptions
Eligibility and Transition Policy
Sustainable progress:
readiness, criteria and phases
HSIS Policy
Sustainable and equitable immunisation,
system -wide support
Funding Policy
Framework
Overarching narrative
document that outlines
the key principles and
interactions between
the three policies
Board Meeting, 7 -8 December 2022

gavi.org
REPORT FROM AUDIT AND INVESTIGATIONS
BOARD MEETING
Lucy Elliott
7 -8 December 2022, Geneva, Switzerland
Audit and Finance Committee -approved work
plan of country - and secretariat -focused audits
Identification of misuse
Preventive counter -fraud work
Confidential whistle -blower reporting
Investigative activity
How has A&I fulfilled its Terms of Reference in 2022?
Overseen, reviewed and monitored by the Audit and Finance Committee
2 Board Meeting, 7 -8 December 2022
? Recommendations for improvement in
governance, risk management and control
? Enhanced accountability
? US$ 44.5 million identified since 2009
? US$ 38.1 million repaid as at the last report to
the Audit and Finance Committee
? Objective is 100% recovery
? Fraud risk assessment
? Appropriate treatment of reports
? Accountability

gavi.org
AUDIT AND FINANCE COMMITTEE CHAIR REPORT
ANNEX A: REVIEW OF DECISIONS
BOARD MEETING
Naguib Kheraj
7-8 December 2022 , Geneva, Switzerland
Decision 1: Risk Management update (incl. Risk and
Assurance Report)
The Gavi Alliance Audit and Finance Committee recommended to the Gavi Alliance Board that it:
? Approve the Draft Risk & Assurance Report 2022 as set out in Annex A of Doc 04 , as amended by
revisions as requested by the AFC .
2 Audit and Finance Committee Meeting, 19 October 2022

gavi.org
EVALUATION ADVISORY
COMMITTEE CHAIR REPORT
BOARD MEETING
James Hargreaves
7 -8 December 2022, Geneva,
Switzerland
Overview: Gavi 5.0 multi - year evaluation workplan
2 Board Meeting, 7 -8 December 2022

gavi.org
GOVERNANCE COMMITTEE CHAIR REPORT
BOARD MEETING
Sarah Goulding
7 -8 December 2022, Geneva, Switzerland
Routine (Recurring) Work
? Board and Committee nominations, including Committee Leadership
? Recruitment of Unaffiliated Board Members (GC Subcommittee)
? Monitoring of application of Guiding Principles on Gender for Board and Committee
nominations
? Monitoring of Governance Risk Matrix
2 Board Meeting, 7 -8 December 2022

gavi.org
INVESTMENT COMMITTEE
CHAIR REPORT
BOARD MEETING
Afsaneh Beschloss
7 -8 December 2022, Geneva, Switzerland
Easy Monetary Policy Inflated Asset Prices
2 Board Meeting, 7 -8 December 2022
1Q
2022
2Q
2022
3Q
2022
4Q
2022
1Q
2023
Bloomberg Data Monthly as of 09 Nov 2022
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
0
5
10
15
20
25
30
35
40
Balance Sheet (USD Trillions)
Central Bank Balance Sheet Versus S&P 500
Fed ECB China Japan S&P 500

gavi.org
IFFIM CHAIR REPORT
BOARD MEETING
Kenneth Lay
7 -8 December 2022, Geneva, Switzerland
IFFIm contribution to Gavi?s funding requirements
? In the period 2016 -2020 (Gavi 4.0), IFFIm contributed US$ 872 million to Gavi
? In the 2021 -2025 period (Gavi 5.0), IFFIm has the capacity to provide US$ 3.4 billion
? US$ 2.5 billion for core funding
? US$ 975 million for COVAX AMC
? Disbursements for Gavi 5.0 as of end August 2022 are US$ 1.2 billion
? US$ 957 million for core funding
? US$ 209 million for COVAX AMC
? IFFIm has provided 17 % of Gavi resources to countries since 2006
2 Board Meeting, 7 -8 December 2022

PPC Meeting, 31 October - 1 November 2022
Discussion, Information and Guidance Items
? CEO Report
? COVAX ? Key Strategic Issues
2 Board Meeting, 7 -8 December 2022
PPC Meeting, 31 October - 1 November 2022
Recommendations to the Board
? Human papillomavirus (HPV) Vaccine Programme ( Agenda Item 7 )
? Gavi?s role in support to Regional and African Vaccine Manufacturing ( Agenda Item 8 )
? Gavi?s role in a future COVID -19 Vaccine Programme ( Agenda Item 10 )
? Funding Policy Review ( Agenda Item 11 )
? Gavi Support for Inactivated Poliovirus Vaccine ( Consent Agenda )
3 Board Meeting, 7 -8 December 2022