10 Approach to Fragile and Humanitarian Settings pdf
1
Board- 2025-Mtg-01-Doc 10
Report to the Board
24- 25 July 2025
Subject Approach to Fragile and Humanitarian Settings
Agenda item 10
Category For Decision
Executive Summary
The purpose of this paper is to request approval of the approach to Fragile
and Humanitarian (F&H) settings for Gavi 6.0.
F&H settings represent a growing share of Gavi - supported countries, with
persistently low coverage levels and high numbers of zero- dose children. In
response to the Board’s guidance, a dedicated approach has been developed to
address these challenges.
This paper outlines the context, Board- endorsed challenges and seven strategic
shifts embedded in a theory of change. It is informed by lessons from Gavi 5.0/5.1
and closely aligned with the direction of the Gavi Leap and the Gavi 6.0 Health
Systems Strategy. The shifts include:
1. Focus on context -appropriate vaccines including traditional vaccines ;
2. Drive new programmatic approaches to reach missed communities and zero-
dose children including catch- up immunisation ;
3. Institute new ways to direct immunisation resources to missed communities and
zero-dose children;
4. Support sub- national fragile settings in non- fragile countries and fragile &
humanitarian settings in countries in the catalytic phase;
5. Establish immunisation as humanitarian health practice;
6. Create a dedicated ‘Gavi Resilience Mechanism ’ (GRM) 1; and
7. Ensure a better equipped Gavi Secretariat
The F&H approach is projected to save over ~ 2. 8-3.2 2 million lives over the Gavi 6.0
strategic cycle , with an estimated cost of US$ 3. 7-3. 8 billion , of which
US$ 48 5 - 575 million reflects the additional cost to fully deliver on the new ambition
vs. previous ways of working 3. It has been developed with a recognition of the very
1 Proposed scope of the Gavi Resilience Mechanism includes i) Newly arising needs in chronically fragile countries
and sub- national pockets; ii) Emergencies including disease outbreak support not covered through existing
mechanisms ; iii) Settings requiring humanitarian programming; and iv) Catalytic phase countries facing fragility or
emergencies (see shift 4).
2 Of the ~ 2.8–3.2 million lives saved, an estimated ~0.4 -0.8 million would be achieved through the new ambition
captured in the F&H theory of change.
3 Of the US$ 485-575 million, US$ 195 million was already included in the June 2024 Gavi 6.0 strategic cost estimate
– of which US$135 million for FED and ZIP like investments and US$ 60 million for Diphtheria and Typhoid outbreak
responses. The additional US$ 290- 380 million are included in the updated Gavi 6.0 financial forecast, taking the
mid -point of the ranges in this paper, for discussion by the Audit and Finance Committee at its meeting on 17 July
2025. These updated costs will also be used as the basis of the Board recalibration exercise.
