1



Board -2018 -Mtg -2-Doc 03

Section A: Introduction
? This report present s a holistic view of Alliance -wide progress, challenges
and potential risks in implementing Gavi?s 2016 -2020 strategy.
Section B: 2016 -2020 Strategy: Implementation and Progress
Progress against Gavi?s mission aspiration s: t he Alliance is on track
to reach all Mission Progress indicator targets by 2020


SUBJECT : 2016 -2020 STRATEGY: PROGRESS, CHALLENGES AND
RISKS
Agenda item: 03
Category: For Information
Report to the Board
28 -29 November 201 8 2016 ?2020 INDICATORS MISSION PROGRESS
1
Gavi BoardUPDATED: 1 October 2018
1UNDER -5 M ORTALITY
2FUTURE DEATHS AVERTED
3FUTURE DISABILITY -ADJUSTED LIFE YEARS (DALYS) AVERTED
4CHILDREN IM M UNISED WITH GAVI SUPPORT
5VACCINES SUSTAINED AFTER GAVI SUPPORT ENDS
2020 TARGET56 per 1,000 2015 BASELINE62 per 1,000
2020 TARGET300 million 2015 BASELINE ? 0
2020 TARGET250 million 2015 BASELINE ? 0
2020 TARGET5-6 million
ON TRACKMODERATE DELAYS / CHALLENGESSIGNIFICANT DELAYS / CHALLENGES
500
100% 2020 TARGET100%
2015 BASELINE ? 0
2015 BASELINEn/a
AWAITING DATA0
127m
The Vaccine Alliance tracks five key targets to help achieve our mission: to save children's lives and protect people's health by increasing equitable use of vaccines in lower -income countries .
?Baseline value reset to ?0? at the start of the strategy period. Targets for 2020 represent anticipated cumulative achievement over the duration of the strategy period.
2.5m
105m
57 PER 1,000

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Board -2018 -Mtg -2-Doc 04
Report to the Board
28 -29 November 201 8

















SUBJECT: GAVI MID -TERM REVIEW (MTR)
Agenda item: 04
No paper

Board -2018 -Mtg -2-Doc 05
Report to the Board
27 -28 November 2018

Section A: Introduction
? This report asks the Gavi Alliance Board to approve the updated financial
forecast of resource s and expenditure for 2016 -2020 and take note of the
indicative financial projections for 2021 -2025 . Doing so will enable the CEO
to allot funding to programmes in 2019.
? The Audit and Finance Committee (AFC) has reviewed the 2016 -2020
forecast and 2021 -2025 projections , including the financial implications of
the decisions that the Board will consider at this meeting . The AFC
concluded that these decisions could be approved by the Boar d in
accordance with the Programme Funding Policy.
? This report also recommends that the Board approve a request from
UNICEF for an additional amount of US$ 0.7 million in 2019 for UNICEF
fees for procurement of cold chain equipment for delivery to countr ies.
? For information, the report provides an update on the evolution of the
estimates of resources and expenditure in 2018, reports back on
expenditures that are subject to Board -approved programme funding limits,
and provides an overview of in -country cas h balances of Gavi -support.
? For 2016 -2020, the overall expenditure forecast has remained consistent
at the level that was forecast a year ago, whereas resources have
increased. Therefore, the amount available for future investments has
increased slightly. Expected p rogrammatic expenditure for this period is
less than previously forecast , primarily due to supply constraints . This has
enabled the decisions made at the June 2018 Board, and those proposed
for the current Board meeting to be absorbed .
? For 2018, the programmatic expenditures are anticipated to be 86% of the
forecast , again due mainly to the impact of supply constraints. The
Partners? Engagement Framework ( PEF ) and Secretariat budgets are
forecast to b e nearly fully utilised by the year -end , and as a result, the
Secretariat?s operating and overhead ratios have increased slightly .
? For 2021 -2025 , an indicative projection is included , based on existing and
anticipated programmatic expenditures, and a formulaic allowance for
future contributions , in a ccordance with policy . This projection i s dependent
on the future Board approval of Gavi?s strategy for th e 2021 -2025 period,
as well as any programmatic or policy changes .
SUBJECT: FINANCIAL UPDATE , INCLUDING FORECAST
Agenda item: 05
Category: For Decision

Gavi

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Board -2018 -Mtg -2-Doc 06a

Section A: Introduction
? At the end of each year, the Board reviews and approves the Alliance?s Risk
& Assurance Report. The Risk & Assurance Report 2018 has been
reviewed and recommended for approv al by the Audit & Finance Committee
(AFC) and guidance from both the Audit and Fina nce Committee and the
Programme and Policy Committee (PPC) have been incorporated in the
final version annexed to this paper.
? The Gavi Alliance Board is requested to approve the report attached as
Annex A and to provide guidance on the questions outlined b elow.
Section B: Risk & Assurance Report
Portfolio discussion o n top risks to the Alliance
1.1 The Gavi Alliance Board has ultimate responsibility for risk oversight in the
Alliance and is responsible for agr eeing on overall risk appetite and
understanding and agreeing with the most significant risks and related
mitigation. It therefore has an annual in -depth discussion on risk, based on
a comprehensive Risk & Assurance Report.
1.2 This is the third year the Alliance prepares its annual Risk & Assurance
Report which discusses the most critical risks that could potentially impact
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 -trend s affecting Gavi?s risk profile, an overview of key
changes in top risks compared to last year, and an overview of how current
levels of risk compare to Gavi?s risk appetite (i.e. the willingness to accept
being exposed). Detailed information including ana lysis of each top risk and
corresponding mitigation plans is included in the annexes of the report .
Where applicable, links are made with findings from audits, evaluations and
other reviews where these provided assurance on the effectiveness of
current mit igation measures and/ or identified risks.
1.3 This year?s report shows that Gavi?s overall risk profile has remained
relatively stable with all 15 top risks from last year still included and two
additional top risks. One new risk (Polio transition) was previo usly unranked
pending assessment and is now included as a high risk. The other new risk
SUBJECT : RISK AND ASSURANCE REPORT
Agenda item: 06 a
Category: For Decision
Report to the Board
28 -29 November 201 8

Report to the Board
Board -2018 -Mtg -2-Doc 06b -Annex A
Annex A: Fiduciary risk mitigation models
Model Basic description When used / Other features Current case s
*) joint with Global Fund
Possible future cases
Fiduciary
agent (FA)
Usually embedded within
governmen t systems to manage
Gavi risks through
approval/validation of grant
expenditures. Typically Gavi
contract s FAs in conjunction with
another agency e.g. Global Fund. A
capacity building component would
usually be included in its scop e of
work.
Can be used in a variety of high risk situations where
a close control of procurement and spending is
needed. If remaining at central level only may be
ineffective in dealing with sub -national risks.
The FA role can be expanded to the sub -nati onal
level with a subnational presence which also may
support coverage & equity objectives.
Relatively low cost but becomes more costly as the
sub -national level is included.

? DRC
? Madagascar *
? Malawi *
? Uganda
? Guinea * (under discussion)
Monitoring
agent (MA)
Party providing external assurance
of programme implementation and
management but which can be
focussed towards financial
assurance only .
MAs are a very flexible way to attain better
assurance. Can be used in almost any situation but
add most value where systems exist but compliance
and management override is a big risk. Scope of work
is risk driven and fully tailored to Gavi needs in each
case.
May engage in capacity building.
Costs are normally lower than a Fiduciary Agent.
? Ghana
? Kenya * (CSO)
? Burundi
? Mozambique
(campaign)
? Ethiopia (campaign)
? Ghana (campaign)
? Rwanda (construction)
? Ghana 2 campaigns
? DRC (campaigns)
Management
agent (ManA)
An alternative UN partner or
external agency (not a Gavi Alliance
partner) which acts as lead
implementer taking responsibility for
delivery of results and managing
risks and overseeing the activities of
implementers. Would typically cover
both programmati c and fiduciary
responsibilities.
Could be used in any high risk situation when there is
a need for stronger oversight (inc l. fiduciary risk
management) , usually where Alliance partners would
be operating through 3 rd party implementers rather
than directly implementing the programme.
Capable of delivering effective capacity building.
Generally an expensive option.

This model has not been
used before by Gavi ? Use of a private foundation
as a ManA is under
discussion in PNG
? Use of UNDP as lead
implementer in a country
TBD

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Board -2018 -Mtg -2-Doc 06b

Section A: Summary
? This paper addresses the recent trend that an increasing amount of Gavi
funds are being channelled away from governments in Gavi supported
countries primarily as a means to manage fiduciary risks. It provides a more
holistic evaluation of the issue and tra de -offs associated with the current
way of managing fiduciary risks, and presents alternative approaches that
Gavi proposes to further explore, evaluate and scale up. It is anticipated
that th is will allow Gavi to strike a better balance between using and building
country systems and staying within acceptable levels of fiduciary risk.
? Following a discussion in the Programme and Policy Committee (PPC), t he
Board is asked for further guidance on this proposal. PPC members were
overall support ive and expressed a desire to accelerate timelines for moving
funds back to government systems. Some members clarified that their
constituencies? fiduciary risk appetite remained low while others welcomed
looking into a more differentiated risk appetite for misuse beyond d eliberate
fraud. PPC members asked to identify which tools are, and under what
circumstances, most conducive and appropriate to achieving the aims of
channelling more funds through government systems and to building
country systems, while keeping fiduciary risks at a low level. It was also
highlighted as important to pro -actively identify and address patterns of
fiduciary risk and to ensure Gavi works closely with national assurance
mechanism s where feasible, relevant and practical.
Section B: Working throu gh country systems while managing fiduciary risk
Introduction
1.1 Working through country systems and building country ownership and long -
term sustainability is at the heart of the Gavi model . However, work ing in
the world?s poorest countries, often with weak systems, comes with inherent
risks of misuse . W ith an improved understanding of country -level risks and
the Board?s low appetite for fiduciary risks, Gavi ha s found it inc reasingly
challenging to channel i ts cash grants through country systems.
1.2 While PPC and Board members, in previous discussions, agreed that the
amount of funding being channelled away from governments is concerning
SUBJECT : APPROACHES TO FIDUCIARY RISK MANAGEMENT IN
GAVI?S CASH GRANTS
Agenda item: 06 b
Category: For Guidance
Report to the Board
28 -29 November 2018

1


Re port to the Board
?
Doc 07 ? Annex A: Risk im plication and mitigation
Annex A: Risk implication and mitigation
1. Risks associated with this proposed transaction are as follows:
a) Risk of Norway failing to honour its commitment: IFFIm will issue a bond
on the back of the pledge from Norway and disburse the proceeds of the
bond to Gavi. Gavi disburses this amount to CEPI. Repayment of the bond
will be covered by IFFIm?s assets, which will now include the new Norway
pledge. If Norway fail to make a payment, IFFIm would use future pledges
that have not been drawn to repay that portion of any debt incurred on the
back of the defaulting donor?s pledge. This is an inherent risk of any IFFIm
pledge that has not materialised in over 11 years of operation. It is for this
reason that the IFFIm donors must approve any new donor and why IFFIm
pledges are legally binding. IFFIm has the capacity to seek recovery from
any donor of any unpaid pledge. Norway is Gavi?s third largest donor (and
IFFIm?s fifth largest donor) and has a longstanding strategic relationship
with Gavi, as well as being rated triple -A (the highest credit rating awarded
by rating agencies). Donors are also aware of the fact that any non -
payment could be seen as weakening of donor support to IFFIm with a
subs equent downgrading of IFFIm and loss of its financial strength in the
capital markets.

b) Risk that Gavi is perceived as acting outside of its mandate: At the PPC
discussion of Norway?s proposal in May, there were questions around
whether Gavi could support research and development under its current
mandate. Gavi?s Statutes set out its purpose as promoting health by ?(i)
providing vaccines and the means to deliver such vaccines to people in
the poorest countries; (ii) facilitating the research and development of
vaccines of primary interest to the developing world; and (iii) to provide
support in connection with achieving the foregoing purposes by helping to
strengthen health care systems and civil societies supporting such
purposes in the developing world.? T he Secretariat considers that the
support proposed in this paper would fall within the wording of sub -
paragraph (ii) above given CEPI?s focus on emerging infectious diseases
for which no commercial market exists that would typically affect low
income count ries. The Secretariat has consulted with Swiss counsel, who
have confirmed that support to CEPI would fall within the scope of Gavi?s
mandate. Furthermore, Gavi?s mission and strategic goals are not
changing for the current strategic period, and the CEPI A rrangement will
not impact upon Gavi?s current focus.

c) Risk of liability for Gavi arising from an adverse event following
immunisation: At this point the Secretariat considers this risk to be limited
given that Gavi would be funding CEPI, and CEPI would th en be funding
a vaccine developer. Gavi would be remote from any decisions made by
CEPI and/or a vaccine developer and as a consequence any third party
claims would be directed against the vaccine developer. For example, at
no point would Gavi have any con trol as to how a clinical trial would be
managed. The Secretariat has also confirmed with its insurers that any

1


Re port to the Board
?
Doc 07 ? Annex B: Overview of arrangement for Gavi support for CEPI
Annex B: Overview of arrangement for Gavi support for CEPI
Subject to approval by the Gavi Board of providing support to CEPI as a Non -
Country Specific Programme and the establishment of an ad hoc review and
evaluation group, Gavi could fund the CEPI Arrangement by way of the following
steps. The responsible party or parties are highlighted in bold below:
a) Gavi and Norway: Gavi enters into a new legally binding grant agreement with
Norway in the form agreed with IFFIm (the CEPI Pledge). The CEPI Pledge
would total NOK 600 million (ca. US$ 77 million), payable from 2022 to 2025 in
equal yearly instalments of NOK 150 million (ca. US$ 19 million);
b) Gavi: Gavi assigns the CEPI Pledge to IFFIm, as usual, thus making the CEPI
Pledge part of IFFIm?s assets pool, i.e. fungible with, and comingled with, all
other IFFIm funds;
c) CEPI: CEPI will make Non -Country Specific Application(s) to Gavi for
disbursement to CEPI in line with IFFIm?s Procedures Memorandum, which sets
out the process by which Gavi can apply for disbursements from IFFIm;
d) Gavi: An ad hoc review and evaluation gr oup is constituted in accordance with
IFFIm?s Procedures Memorandum and the Programme Funding Policy to
assess the Non -Country Specific Application for disbursement to CEPI in line
with the criteria described in IFFIm?s Procedures Memorandum, which in brie f
look at whether the proposed programme is in line with Gavi?s Strategic Goals,
the extent to which the proposed programme meets Gavi?s immunisation
objectives and needs which cannot be met through existing support or
programmes, and the extent of availab le funding contributions from other
sources;
e) Gavi: On the basis of the report of the ad hoc review and evaluation group,
Gavi?s CEO approves the application. Gavi decides to request funding from
IFFIm by submitting a funding request to the IFFIm Board sub ject to the IFFIm
treasury manager?s assessment that such proposed funding is in accordance
with IFFIm?s Gearing Ratio Limit and IFFIm?s Strategies (consistent with the
current process of Gavi requesting funding from IFFIm);
f) IFFIm and IBRD: Subject to the funding approval by the IFFIm Board, IFFIm
would seek to issue a bond to frontload the receivables from the CEPI pledge
(the CEPI Bond). The transaction will be financially neutral to IFFIm and Gavi;
g) IFFIm via Gavi: IFFIm would pay the proceeds of the CEPI Bond to Gavi for
disbursement to CEPI as a Non -Country Specific Programme under a grant
agreement between CEPI and Gavi (the CEPI Grant Agreement);
h) CEPI: CEPI uses the funds provided from Gavi in accordance with the Non -
Country Specific Application and t he CEPI Grant Agreement, and provides
agreed upon reporting on the use of Gavi/IFFIm funding to the Gavi and IFFIm
Boards for monitoring and evaluation;
i) Norway and IFFIm : Norway will make grant payments to IFFIm according to
the terms of the CEPI pledge. T hese payments will be used to repay principal

1



Board -2018 -Mtg -2-Doc 07

Section A: Introduction
? Following a request from the Kingdom of Norway (Norway) to the Gavi
Programme and Policy Committee in May 2018, the Secretariat has
explored Norway?s proposal that Gavi support the Coalition for Epidemic
Preparedness Innovations (CEPI) subject to funds being made available by
Norway and disbursed via IFFIm (the CEPI Arrangement). The CEPI
Arrangement is to be fully funded by Norway and will therefore be cost -
neutral to Gavi. The CEPI Arrangement will enable Norway?s contribution to
be frontloaded to CEPI.
? Having reviewed the proposed CEPI Arrangement, the Gavi Audit and
Finance Committee (AFC) noted, at its meeting held on 12 October 2018,
that the CEPI Arrangement would not have any material adverse impact on
Gavi?s finances or operations and provided guidance on implementing and
executing the CEPI Arrangement as outlined in Section B.
? The IFFIm Board of Directors also reviewed the financial and risk
implications of the CEPI Arrangement for IFFIm , at its meeting held on 16
October 2018. The IFFIm Board expressed support for the CEPI
Arrangement and p rovided guidance for executing the related transaction(s)
as outlined in Section B.
? The Gavi Programme and Policy Committee (PPC) was given an
informational update on the proposed CEPI Arrangement at its meeting held
on 18 -19 October 2018.
? This report req uests that the Gavi Board approv e Gavi support to CEPI
through the CEPI Arrangement , and requests the Secretariat to put in place
the necessary measures to implement the CEPI Arrangement with IFFIm,
CEPI and Norway, taking into account the guidance provide d by the AFC.
Section B: Facts and Data
Introduction
1.1 CEPI is a new international non -profit association, established under
Norwegian Law, to provide financing for late stage research and
development (R&D) into new vaccines for vaccine preventable diseases of
epidemic proportions for which no vaccines are currently available.
SUBJECT : IFFIm AND CEPI
Agenda item: 07
Category: For Decision
Report to the Board
28 -29 November 201 8

Report to the Board
Doc 08 ? Annex A : Implications/Anticipated impact
Annex A: Implications/Anticipated impact

Risk implication and mitigation

? Should the Board choose not to support the VIS vaccines, it would be a missed
opportunity to potentially avert ~0.2 -0.8 million deaths over the 2021 -2030
timeframe, to close crucial equity gaps and protect marginalised populations
and to shape markets for improved supply and price. For cholera and
meningoc oc cal vaccines, lack of support for preventive programmes would also
result in continued reliance on stockpiles for outbreak response, which carries
significant cost (in terms of mortality and disruption d ue to outbreaks, as well
as the cost of response). For rabies and cholera vaccines, there would also be
a missed opportunity to leverage vaccine to potentially incentivise development
of comprehensive disease control strategies. For RSV, lack of support fo r
demand and evidence generation activities would result in continued lack of
understanding of the true burden of RSV in contributing to paediatric morbidity
and reduced likelihood that manufacturers would account for Gavi -eligible
countries in their suppl y plans . Finally, for hepatitis B and D, T, & P-containing
boosters, Gavi could miss an opportunity to achieve the additional impact of
strengthening and establishing new immunisation platforms, in addition to
preventing morbidity and mortality.

? Given the different nature of some of these vaccines, there is a risk that Gavi?s
current policies might not be fit for purpose. This could be mitigated through a
future review of Gavi?s support model (for both the current portfolio and VIS
vaccines). Ther e is also a risk that replenishment efforts might not result in the
financing required to establish successful programmes and Gavi might need to
deprioritise some of the approved vaccines. On a vaccine specific basis, some
additional risks associated with investment include :
o For RSV and meningococcal vaccines, there is a risk that timelines are
delayed and new products come to market later than expected; there is
also a risk that they do not meet the financial parameters indicated in the
investment cases . A n ?in principle? decision for support would allow Gavi
to re -evaluate these vaccines when the products are made available and
the other conditions are met .
o For cholera and rabies vaccines, there is a risk that requiring commitment
to broader disease contr ol strategies could delay the use of the vaccine.
However, this commitment would itself mitigate the risk that programmes
are poorly planned and do not achieve impact. It would be important to
ensure that partners engaged in these broader efforts can suppo rt
countries to meet the conditions for support.
o For D, T, & P -containing boosters and hepatitis B birth dose, there is a risk
that the proposed support might not be sufficient to catalyse development
of the immunisation delivery platform. This risk can be mitigated by
ensuring that platform strengthening activities are appropriately identified

Report to the Board

Doc 08 ? Annex B: VIS 2018 candidates: cost, impact and case for investment
1
Annex B: VIS 2018 candidates: c ost, impact and case for investment

Cost and impact projections
The following tables provide a summary of the projected costs to Gavi and health
impact for each VIS candidate in Gavi?s 5.0 and 6.0 strategic periods. These
projections assume all six VIS vaccines are supported and account for projected
introductions of t he current portfolio of supported vaccines.
Table 1: Total cost to Gavi, 2021 -2025 and 2026 -2030 1, in US$ millions

Table 2: Total deaths averted, 2021 -2025 and 2026 -2030 2, in thousands

Table 3: Total cases averted, 2021 -2025 and 2026 -2030 , in thousands


1 The projected costs for D, T & P-containing boosters assume that all Gavi -supported countries would
elect to use the pentavalent vaccine for the 1 st booster dose due to programmatic benefits. The use of
the pentavalent vaccine for the 1 st booster dose would result in increased cost to Gavi due to vaccine
co -financing. 2The low and high values represent the lower and upper range of potential health impact outcomes of
each VIS candidate. The range of potential health impact reflects both uncertainty in key parameters
as advised by diseas e experts (e.g. vaccine efficacy, burden of disease) and the use of multiple disease
impact models. Deaths averted will be in future years based on vaccination in this time period. Procurement costs Operational costs Procurement costs Operational costs
Cholera 124 37 159 49
D, T, P - containing boosters 19 22 77 18
Hepatitis B birth dose 0 5 0 9
Multivalent meningococcal 82 38 81 0
Rabies PEP 10 2 26 12
RSV maternal vaccine 12 4 159 13
Total cost by cost type 248 111 504 103
TOTAL COST
VIS candidate 2021-2025 2026-2030
360 608 Low High Low High Low High
Cholera 8.1 91.0 10.8 119.8 19.0 210.8
D, T, P - containing boosters 6.9 6.9 30.6 30.6 37.6 37.6
Hepatitis B birth dose 11.3 56.0 75.1 337.9 86.5 394.0
Multivalent meningococcal 6.0 20.5 8.7 28.3 14.8 48.8
Rabies PEP 1.4 5.8 19.7 58.9 21.1 64.7
RSV maternal vaccine 0.5 5.2 7.0 56.6 7.5 61.8
Total 35 180 150 630 180 810
VIS candidate 2021-2025 2026-2030 2021-2030 Low High Low High Low High
Cholera 870 9,150 800 8,320 1,670 17,470
D, T, P - containing boosters 1,500 1,500 3,950 3,950 5,460 5,460
Hepatitis B birth dose 130 180 510 630 640 820
Multivalent meningococcal 170 560 130 440 310 1,000
Rabies PEP - - - - - -
RSV maternal vaccine 100 430 1,220 2,670 1,330 3,100
Total 2,800 11,840 6,630 16,040 9,430 27,880
VIS candidate 2021-2025 2026-2030 2021-2030

1



Board -2018 -Mtg -2-Doc 08

Section A: Introduction
? The purpose of this report is to present the final investment cases for the six
shortlisted vaccines for endemic disease prevention in the Vaccine
Investment Strategy (VIS) 2018. These six vaccines are : diphtheria,
pertussis & tetanus -containing (D,T& P cont aining) boosters ; hepatitis B
birth dose ; A, C, W -containing multivalent meningococcal conjugate
vaccines ; oral cholera vaccine (OCV) ; rabies post -exposure prophylaxis
(PEP) ; and respiratory syncytial virus (RSV) immunisation products.
? This report covers the vaccines for endemic disease prevention only;
inactivated polio vaccine (IPV )1 and pandemic influenza are addressed in
Docs 1 2 and 13, respectively.
? The Board is asked to :
o Approve an extension of Gavi support for use of the global cholera
stockpile in endemic settings for 2020; and a learning agenda for oral
cholera vaccine in 2019 -2020. The financial implications are
approximately US$ 43.5 million for 2019 -2020 .
o Approve investment in the six VIS vaccines with programmes
beginning in the next strategic period (i.e. 2021), contingent upon
sufficient funding being available for the 2021 -2025 period and subject
to the final parameter setting for Gavi 5.0 at the June 2019 Board
meeting . Learning agenda activities for the five vaccines beyond
cholera would b egin subsequent to this 5.0 alignment in the second
half of 2019. The financial implications are approximately
US$ 6.5 million for 2019 -2020 and US$ 373 million for 2021 -2025 .
Section B: Facts and Data
VIS m ethodology
Occurring every five years, the VIS i s Gavi?s prioritisation approach for new
immunisation investments to inform Gavi?s next strategic and funding cycle.
The VIS 2018 took a differentiated approach to the candidates: a) vaccines

1 The report on IPV includes consideration of support for whole -cell -pertussis -containing
hexavalent vaccine
SUBJECT : VACCINE INVESTMENT STRATEGY
Agenda item: 08
Category: For Decision
Report to the Board
28 -29 November 2018

Re port to the Report to the Board


Doc 09 ? Annex A: Proposed updates to targets for 2016 -2020 Strategic Indicators as recommended
by the PPC

Annex A: Proposed updates to targets for 2016 -2020 Strateg ic Indicators as
recommended by the PPC
Update on proposed targets for 2016 -2020 Strateg ic Indicators: S2.1 ( effective
vaccine management), S2.5 ( civil society engagement) and S3.4 ( institutional
capacity)
? In June 2018, the Gavi Alliance Board:
a) Approved the changes to the definitions and targets of the Strategy
Indicators as set out in Annex A to Doc 02h; and
b) Requested the Secretariat to also continue tracking the original definitions
and targets of these Strategic Indicators for monitoring purposes. 1
? In June 2018, targets for strateg ic indicators S2.1 ( effective vaccine
management) and S3.4 ( institutional capacity) were still under development by
the respective technical working groups.
? In addi tion, in June 2018 , the Board recommended that the Secretariat
establish a target for strateg ic indicator S2.5 ( civil society engagement).
The proposed targets for these three strategic indicators have been reviewed by the
PPC in October 2018, and are being presented to the Board for approval at their
meeting in November 2018.
This annex presents a summary of considerations that informed tar get -setting for the
three indicators (Section 1), as well as the full indicator definitions , with the proposed
2020 targets (Section 2).


1 Decision 8 of the Gavi Alliance Consent Agenda, June 2018.

Re port to the Report to the Board


Doc 09 ? Annex B : Proposed updates to targets for 2016 -2020 Strategic Indicators as recommended
by the PPC

Annex B: Proposed updates to targets for 2016 -2020 Strateg ic Indicators with
alternative CSO indicator target
Update on proposed targets for 2016 -2020 Strateg ic Indicators: S2.1 ( effective
vaccine management), S2.5 ( civil society engagement) and S3.4 ( institutional
capacity)
? In June 2018, the Gavi Alliance Board:
a) Approved the changes to the definitions and targets of the Strategy
Indicators as set out in Annex A to Doc 02h; and
b) Requested the Secretariat to also continue tracking the original definition s
and targets of these Strategic Indicators for monitoring purposes. 1
? In June 2018, targets for strateg ic indicators S2.1 ( effective vaccine
management) and S3.4 ( institutional capacity) were still under development by
the respective technical working gro ups.
? In addition, in June 2018 the Board recommended that the Secretariat establish
a target for strateg ic indicator S2.5 ( civil society engagement).
The proposed targets for these three strategic indicators have been reviewed by the
PPC in October 2018, and are being presented to the Board for approval at their
meeting in November 2018.
This annex presents a summary of considerations that informed tar get -setting for the
three indicators (Section 1), as well as the full indicator definitions , with the proposed
2020 targets (Section 2).
Section 1: Summary of considerations that informed target -setting
S2.1 ? Effective vaccine management : The proposed 2020 target for the average of
the country composite score o f the last completed Effective Vaccine Management
(EVM) assessment is 72%. The target represents an increase from the 2015
baseline ? 67%. The 2020 target was computed by creating cou ntry -level projections
to 2020 based on their historical EVM values and then averaging them, as follows:
? For countries in which the composite score increased between the last two
EVM assessments: the projected 2020 value was calculated based on the
observed annualised rate of increase.
? For countries that have had only one previous EVM assessment: the
composit e score from that assessment was held constant and carried
forward to 2020.
? For countries in which the composite score decreased between the last two
EVM assessments: the composite score on the most recent assessment is
held constant and carried forward t o 2020.
Note that countries will only undergo one EVM assessment in the 2016 -2020 strategy
period. This is due to the change in frequency of EVM assessments from once every
3 years to once every 3 to 5 years. This target assumes that Gavi and the Alliance ?s
1 Decision 8 of the Gavi Alliance Consent Agenda, June 2018.

1



Board -2018 -Mtg -2-Doc 09

Section A: Introduction
? In order to enable better monitoring of the Alliance?s performance against
its strategic goals, c hanges to specific strategic indicators and related
targets were approved at the June 2018 Board . At that time, targets for three
indicators were still to be confirmed : S2.1 effective vaccine management,
S2.5 civil society engagement and S3.4 institutional capacity.
? The proposed targets for these three strategic indicators were presented to
the PPC in October 2018. The PPC was supportive of the targ ets for the
effective vaccine management and institutional capacity indicators, and
recommended these for approval by the Board.
? At the PPC meeting, t he CSO constituency raised concerns in relation to
the civil society engagement indicator, and it was agr eed that the
methodology for the civil society engagement indicator would be updated to
include all 68 Gavi -supported countries in the denominator (rather than just
those countries for which a programme capacity assessment (PCA) has
been completed) . This m eans that for countries where no PCA will be
conducted the value to be included would be zero and, therefore, the
revised methodology would make it unlikely that a 2020 target of 63% would
be achieved. At its meeting, the PPC did not have the opportunity t o discuss
these implications in detail and for this reason the Secretariat, in
consultation with the CSO constituency, considered it important for the
Board to have an alternative option for this indicator?s 2020 target.
? This paper presents an overview of the proposed target s for the se three
strategy indicators (including two options for the CSO indicator) . Annex A to
this document provides a more detailed description of the methodology that
informed the target -setting as well as the full indicator definitions . Annex B
provides the same description of the methodology with an alternative option
for the CSO indicator?s 2020 target as described in this paper.
Section B: Proposed targets for three 2016 -2020 Strategy Indicators
1.1 S2.1 ? Effective vaccine ma nagement (EVM) : The proposed 2020 target
for th is indicator is 72%. The target represents an increase from the 2015
baseline (67% ), and has been developed based on country -level projections
informed by historical EVM assessment values . The proposed target,
SUBJECT : APPROVAL OF SELECTED TARGETS FOR 2016 -2020
STRATEGIC INDICATORS
Agenda item: 09
Category: For Decision
Report to the Board
28 -29 November 201 8

1



Board -2018 -Mtg -2-Doc 10

Section A: Introduction
? Concerns relating to developing country participation and engagement in
the governance structures of the Gavi Alliance and the level of support
provided to the developing country constituency have been raised
consistently in Board and Committee self -evaluations since 2012.
? In the context of the 2016 Board and Committee self -evaluation, concerns
were again expressed in relation to the voice of the constituency not being
sufficiently heard in critical strategic and programmatic and policy
discussions which could impact Gavi -eligi ble countries.
? Since 2017, the Governance Committee has been considering the various
aspects of these challenges.
? At its meeting on 10 October 2108, the Governance Committee considered
options relating to (i) the Terms of Reference (ToRs) for developing co untry
representation on the Board and Board Committees and the process of
nominations to Gavi?s governance structures; (ii) proposed changes to
Board Committee Charters to strengthen the voice of the constituency by
providing flexibilities in relation to t he nomination of Committee Delegates;
and (iii) proposed options to strengthen the Special Adviser model and
associated arrangements.
? This paper present s the recommendation of the Governance Committee in
relation to (ii) above, namely proposed changes to B oard Committee
Charters to strengthen the voice of the constituency by providing flexibilities
in relation to the nomination of Committee Delegates .
Section B: Strengthening Developing Country constituency
Background
1.1 In the context of the 2016 Board and Committee self -evaluation, concerns
were raised in relation to the representation of the developing country
constituency on the Board and Board Committees.
1.2 The self -evaluation did not fully elaborate with any precision on the specific
concerns that were identified in the course of the review, but it was identified
as one of the actions that the Governance Committee would further review.
SUBJECT : CONSENT AGENDA: COMMITTEE CHARTERS
Agenda item: 10
Category: For Decision
Report to the Board
28 -29 November 201 8

1



Board -2018 -Mtg -2-Doc 10a

Section A: Summary
? Dr Richard Sezibera, Programme and Policy Committee (PPC) Chair,
comes to the end of his second three -year term as an Unaffiliated Board
member on the Gavi Alliance Board on 31 December 2018. His term as
PPC Chair will therefore also come to an end.
? Professor Rob Moodie, Evaluation Advisory Committee (EAC) Chair, comes
to the end of his second term as EAC Chair, also on 31 December 2018.
Professor Moodie was appointed to serve on the EAC as a member of the
Committee in July 2011 and was appointed EAC Chair from 1 J anuary 2015
for a two -year term, which was subsequently renewed.
? This report outlines the Governance Committee recommendation to the
Board to approve the appointment of Dr Helen Rees to succeed Dr Sezibera
as PPC Chair, and to approve the exceptional exten sion of Professor Rob
Moodie as EAC Chair to 30 June 2019 .
Section B: PPC and EAC Chair
PPC Chair
1.1 Dr Richard Sezibera comes to the end of his tenure as a Gavi Board
member, and concurrently as PPC Chair, on 31 December 2018.
1.2 The PPC Chair plays an importan t role in managing the affairs of the PPC
to ensure that it is organised properly, functions effectively, and meets its
obligations and responsibilities to the Board.
1.3 At the time of her appointment to the Board in 2016, Dr Helen Rees, who is
also a PPC mem ber, had indicated her interest in potentially taking on the
role of PPC Chair, should the opportunity arise.
1.4 At its meeting on 10 October 2018, Governance Committee members noted
the interest expressed by Dr Helen Rees and agreed that Dr Rees is well
qual ified for the role.
1.5 They felt that in the interests of ensuring a transparent process, it would be
appropriate to seek expressions of interest in the role from other Board
SUBJECT : CONSENT AGENDA: COMMITTEE CHAIR APPOINTMENTS
Agenda item: 10a
Category: For Decision
Report to the Board
28 -29 November 2018

1



Board -2018 -Mtg -2-Doc 10b

Section A: Introduction
? At its meeting on 26 November 2018 , the Governance Committee
considered nominations to the Board and Board Committees which are now
being submitted to the Board for approval.
Section B: Board/Committee Member Appointments
Constituency process for Board and Committee nominations
1.1 The Secretary to the Board initiated a process for Board and Committee
nominations in August 2018 by inviting Board constituencies to submit
nominations to enable consideration by the Governance Committee at its
meeting on 10 October 2018.
1.2 A number of constituencies submitted nominations and appointments which
have in the meantime been approved by the Board through the no -objection
consent provision in the Gavi By -laws.
1.3 Some constituencies requested an extension of the deadline to November,
and further nominations submitted were considered by the Governance
Committee at its meeting on 26 November 2018.
1.4 This report therefore outlines the Governance Committee recommendation
to the Board for further appointments to the Board and Board Committees.
Gender Implications
2.1 Board -approved guidelines on the Gavi Board gender balance state that a
ratio of 60/40 male/female Board Members and Alternate Board members
should be established and maintained. This is extended to include Board
Commi ttees as required by Article 4.2 of the By -laws.
2.2 For the purposes of this calculation, the Board Members and Alternate
Board Members are assessed as separate groups. The Board currently has
14 men (5 4%) and 12 women (4 6%). 10 alternates are men (5 6%) a nd 8
are women ( 44 %).
2.3 The gender balance is deemed to be within the acceptable range if there is
no more than 60% of any one gender. These same principles are also
applied to the Board Committees. In order to arrive at an aggregate position
SUBJECT : CONSENT AGENDA: BOARD/ COMMITTEE MEMBER
APPOINTMENTS
Agenda item: 10b
Category: For Decision
Report to the Board
28 -29 November 201 8

1



Board -2018 -Mtg -2-Doc 10c

Section A: Introduction
? This report informs the Board of the Governance Committee?s
recommendations for membership of the Independent Review Committee
(IRC).
? The Governance Committee recommends that the Gavi Board appoint as
new IRC members the individuals listed in Annex A for terms effective
immediately through 31 March 2021.
Section B: Independent Review Committee Nominations
Introduction
1.1 Under the Gavi By -Laws, the IRC is an independent, impartial group of
experts that serves to guarantee the integrity and consistency of funding
decisions related to Gavi grants to countries.
1.2 The IRC consists of a group of diverse public health experts who review
funding proposals and recommend their approval to the Gavi CEO, based
on an assessment of whether countries? plans will likely achieve the
proposed results and contribute to Gavi achieving its mission and strategy.
1.3 In response to the new typhoid w indow approved by the Board in November
2017 and to deepen the measles expertise in the pool, as well as to increase
and augment the available skill set for reviewing health system and
immunisation strengthening (HSIS) support, the Secretariat set out in
January 2018 to identify additional members to be added to th e pool of
potential reviewers. The Secretariat retained the services of Russell
Reynolds Associates, an executive search firm, to undertake this search.
1.4 Upon the recommendation of the Governance C ommittee, the Gavi Alliance
Board at its June 2018 meeting approved the addition of 32 additional
candidates (from an initial group of about 350 individuals originally identified
by Russell Reynolds) to the pool of IRC members. Following the June 2018
Boar d meeting, the search continued for individuals in some specific
additional areas such as: supplementary immunisation activities, health
systems strengthening project management, finance and budgeting, and
cold chain and logistics, in particular combined w ith French language skills .
SUBJECT: CONSENT AGENDA: INDEPENDENT REVIEW COMMITTEE
APPOINTMENTS
Agenda item: 10c
Category: For Decision
Report to the Board
28 -29 November 201 8

1



Board -2018 -Mtg -2-Doc 10d

Section A: Introduction
The Gavi Alliance Governance Committee receives an annual report on the
implementation of the Gavi Alliance Board Travel Policy.
This report outlines a proposed recommendation to the policy as considered by
the Governance Committee at its meeting on 26 November 201 8.
Section B: Review of Board Travel Policy
Proposed amendment
1.1 The Board Travel Policy currently foresees reimbursement of
expenses/payment of per diem either
i) by bank transfer; or
ii) to a cash card provided by Gavi
1.2 Recent trend shows that there is an inc rease in the number of people
choosing bank transfer .
1.3 The recent review of Gavi internal control processes has highlighted that
there is an increased risk of error and delay in payments due to the use of
a variety of different methods for reimbursement of expenses/payment of
per diem under the Board Travel Policy.
1.4 This has been considered by the Governance Committee which has agreed
to recommend an amendment to the policy such that
reimbursements/payments by bank transfer be offered as the primary
proce ss and the provision of a cash card by Gavi only be offered in
exceptional circumstances (but strongly discouraged) .
1.5 The proposed amendement to the policy can be found in tracked changes
in Annex A.


SUBJECT : CONSENT AGENDA: REVIEW OF BOARD TRAVEL POLICY
Agenda item: 10d
Category: For Decision
Report to the Board
28 -29 November 201 8

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Board -2018 -Mtg -2-Doc 10e

Section A: Summary
? The IFFIm governing doc uments , namely, its Memorand um (Memorandum)
and Articles of Association (Articles) , have undergone a review with its
lawyers in the United Kingdom (UK) and have been revised and updated in
line with prevailing best practice determined by UK law and governance
standards for charitable organisations registered in the UK.
? The IFFIm Board has received a copy of the revised and updated
Memorandum and Articles for its review and these document s were
approved by the IFFIm Board at its meeting on 16 October 2018.
? The IFFIm Board is now r equired to convene a General M eeting of its sole
member, namely, the Gavi Alliance , to formally approve the revised and
updated Memorandum and Articles and which will then be submitted to th e
UK regulatory authorities in the normal course for registration.
? This requires that the Gavi Alliance appoint a duly authorised representative
to represent it, and to vote, at the General Meeting to be convened by the
IFFIm Board.
? This report invites th e Board to consider the recommendation of the
Governance Committee, at its meeting on 10 October 2018, that the CEO
of the Gavi Alliance be appropriately authorised accordingly.
Section B: IFFIm Memorandum and Articles of Association
1.1 The IFFIm Memorandum and Articles have been revised and updated to
reflect prevailing best practice determined by UK law and governance
standards for charitable organisations registered in the UK regarding certain
aspects of IFFIm?s governance arrangements and provisions.
1.2 The review was undertaken in conjunction with IFFIm?s UK lawyers,
Slaughter and May.
1.3 The changes are largely of a procedural nature.
1.4 The Memorandum was updated to remove a redundant reference to the
Gavi Fund Affiliate and to incorporate s ome minor editorial changes.
SUBJECT : CONSENT AGENDA: CEO AUTHORISATION TO
REPRESENT GAVI A T IFFIm GENERAL MEETING
Agenda item: 10e
Category: For Decision
Report to the Board
28 -29 November 2018

1



Board -2018 -Mtg -2-Doc 10f

Section A: Introduction
? Based on a recommendation from the Programme and Policy Committee
(PPC) this paper asks the Board to extend remaining 2017/2018 support for
Syria (approved by the Board in December 2016) for use in 2019, while a
new proposal for support is being developed.
? In July 201 8, the World Bank classified Syria as a low income country,
making it eligible for Gavi's portfolio of support as of 1 January 2019.
? In its discussion on this topic, the PPC asked the Secretariat to ensure that
it engages with all humanitarian and development partners and
stakeholders in developing a proposal for support and in the implementation
of support in Syria. The PPC also stressed that Gavi ensures support is
equitably accessible across the whole country. Finally, the PPC requested
regul ar updates on the progress made in Syria.
Section B: Ongoing and planned Alliance support for Syria
1.1 In its eighth year, the Syria crisis remains complex and marked by suffering,
destruction and disregard for human life. At least 5.3 million children out o f
a 13 million population are affected by the conflict, with an estimated 7
million refugees residing outside Syria and 6.2 million internally displaced.
The World Bank estimates the cost of the war for Syria between 2011 -2017
at US$ 226 billion.
1.2 Over the past few years, no recent estimates have been available for Syria?s
gross national income (GNI ) per capita 1. However, in its latest GNI release
in July 2018, the World Bank has classified Syria as a low -income country,
with a GNI per capita below US$ 995. Under Gavi?s Eligibility and
Transition Policy, this makes Syria eligible for Gavi?s portfolio of
support as of 1 January 2019 .2

1 However, for the previous three years, WHO had classified Syria as a grade 3 humanitarian
emergency and the W orld Bank classified it as a lower middle -income country. 2 This includes new vaccine support, financial support for health systems strengthening and
operational costs for campaigns/introductions, as well as access to the cold chain equipment
optimisation platform (CCEOP) and technical assistance through the Partners? Engagement
Framework. In addition, Syria is eligible for flexibilities under Gavi ?s Fragility, Emergencies,
SUBJECT : CONSENT AGENDA: ONGOING AND PLANNED SUPPORT
FOR SYRIA
Agenda item: 10f
Category: For Decision
Report to the Board
28 -29 November 201 8

1



Board -2018 -Mtg -2-Doc 10g

Section A: Introduction
? Based on a recommendation from the Programme and Policy Committee
(PPC) this paper asks the Board to approve flexibilities under Gavi's Health
System and Immunisation Strengthening (HSIS) support framework . These
flexibilities aim to support a better balance between Supplementary
Immunisation Activities (SIAs) and routine immunisation (RI) activities in the
implementation of the Gavi Alliance Board approved Measles and Rubella
Strategy.
? In its discussions , the PPC acknowledged that while SIAs remained an
important instrument to ensuring rapid increase in population immunity,
Gavi support structures should be clearly aligned to the goals of
strengthening routine immunisation, achieving high immunity, and avoiding
over -reliance on SIAs .
? The PPC voiced overall support for the decision to provide more flexibilities
to countries in undertaking SIAs . PPC members also noted that it was
important to be consistent in terms of the guidance provided to countries
and propose d that Gavi work closely with some select countries to
operationalise these flexibilities. Gavi, through the A lliance Coordination
Team (A CT ), should carefully monitor the implementation of the flexibilities
in these countries and report back on progress m ade.
? PPC members further acknowledged the need for coherence in guidance
across the Strategic Advisory Group of Experts (SAGE) on Immuni zation ,
the WHO Regional Immuni sation Technical Advisory Group s, and other
technical working groups and agreed that it was important that SAGE
provided clear guidance on the frequency and implementation of
subnational SIAs. Alliance partner regional and country offices would need
to ensure appropriate implementation at the regional and national level.
Section B: Facts a nd Data
1.1 In December 2015, the Gavi Board approved the Measles and Rubella (MR)
Strategy. Under the strategy, Gavi has disbursed from 2017 to date
SUBJECT :
GAVI SUPPORTED MEASLES AND RUBELLA
IMMUNISATION ACTIVITIES : AMENDMENT TO HSIS
SUPPORT FRAMEWORK
Agenda item: 10g
Category: For Decision
Report to the Board
28 -29 November 201 8

Report to the Board
Doc 10h ? Annex A: Table with Board Decisions on Post -Transition Support
Annex A : Table with Board Decisions on Post -Transition Support

1 The 14 countries include: Armenia, Azerbaijan, Bhutan, Bolivia, Cuba, Georgia, Guyana, Honduras, Indonesia, Kiribati, Moldova, Mongolia, Sri Lanka and
Vietnam.
Board Meeting Decision Amount Duration of Support Countries Focus of Support
Nov 2017
Post -transition engagement
and envelope
US$ 30 million 2018 ? 2020 14 countries that
transitioned by 2019 1
? Access to pricing ? Support advocacy activities ? Targeted technical to mitigate risks ? Incentives to leverage domestic resources
PNG Tailored Transition Plan US$ 6 million for HSS
and additional support
for an MR campaign

2018 ? 2020

PNG
? Increase HSS allocation ? Support for MR campaign (vaccine and operational) ? Adjust co -financing for vaccines introduced w/Gavi ? Increase TCA ? Revision in 2020 for potential continuation of support
June 2018
Post -transition support for
high -risk countries
US$ 20 million
(indicative amount of
up to US$ 30 million
approved)

2018 ? 2020

Angola, Congo Republic
and Timor -Leste
? Access to pricing ? Support advocacy activities ? Targeted investments on supply chain, capacity building and data ? Catalytic vaccine introduction support ? Strategic investments to increase coverage in targeted areas with low coverage
Nigeria Tailored Transition
Plan
US$ 1 billion (US$ 575
million additional
funding)
2018 -2028 Nigeria
? Increase HSS allocation ? Support the introduction of new vaccines (co -financing) ? Adjust co -financing for vaccines introduced w/Gavi support ? Increase TCA
Nov 2018
(proposed)
Post -transition support for
high -risk countries
Additional US$10
million (to be added to
the approved US$ 20
million)

2018 - 2023

Angola and Timor -Leste
? Access to pricing ? Advocacy support ? Targeted investments on supply chain, capacity building and data ? Catalytic vaccine introduction support ? Strategic investments to increase coverage in targeted areas with low coverage
Gavi eligibility for Congo
Republic
Additional US$ 5.5
million for HSS
support
2018 - to be determined
by eligibility updates Congo Republic
? Increase HSS allocation ? One -off increase in the HSS allocation ? Access to TCA support ? Support the introduction of new vaccines (co -financing) ? No support for vaccines introduced previously w/Gavi support

1



Board -2018 -Mtg -2-Doc 10h

Section A: Introduction
? The purpose of this paper is to respond to the request of the Gavi Alliance
Board to address transition challenges in high risk countries by requesting
the approval of post -transition support for Angola and Timor -Leste, based
on detailed country plans, as well as exceptionally approving that Congo?s
eligibility be determined on the latest GNI data .
? The implementation of the proposed country plans for Angola and Timor -
Leste would require an addition al US$ 10 million , in addition to the
US$ 20 million approved by the Board in June 2018 . The main cost driver
of the additional funding is the extension of some existing activities beyond
2020 in the next financing period (e.g. capacity building) and new ly identified
activities (e.g. polio transition in Angola or pneumococcal conjugate vaccine
(PCV ) and human papillomavirus vaccine ( HPV ) introductions in Timor -
Leste ). The PPC was supportive of this request.
? For Congo Repu blic, a costed country plan in line with the Board request
has also been developed. However, since then, critical information has
come to light regarding Congo Republic?s gross national income (GNI) per
capita. Data released in July 2018 shows that the cou ntry?s economy
continues to deteriorate and its 2017 GNI per capita decreased further to
US$ 1,360, the same as it was more than 10 years ago. While Congo?s
three -year GNI per capita average 1 remains just above Gavi?s eligibility
threshold, the latest GNI is significantly lower and represents the largest
decrease among Gavi countries. Furthermore, while the IMF projects
economic growth in Congo for 2018 , this growth would not be enough to
prevent the country from regaining Gavi eligibility in 2020. Therefor e, r ather
than approving post -transition support for 2019 and then Congo Republic
becoming Gavi -eligible in 2020, the PPC recommend s the Gavi Board to
exceptionally determine Congo Republic ?s eligib ility for 2019 on the latest
GNI data. As a result , the PPC recommended that Congo Republic become
eligible for Gavi support as of 1 January 2019 and that its health system
strengthening ( HSS ) grant ceiling be increased from US$ 4.5 million to
US$ 10 million (which is the amount the country needed as part of its post -
transition efforts ).

1 Gavi?s Eligibility and Transition Policy states countries are Gavi -eligible if their average GNI p.c.
over the past three years is equal to or below the threshold amount.
SUBJECT :
CONSENT AGENDA: POST -TRANSITION PLANS FOR
ANGOLA AND TIMOR -LESTE AND CONGO REPUBLIC ?S
ELIGIBILITY FOR GAVI SUPPORT
Agenda item: 10h
Category: For Decision
Report to the Board
28 -29 November 201 8

Report to the Board
Doc 11 ? Annex A: Methodology for income level classification

Annex A: Methodology for income level classification
The m ethodology is based on the fact -based framework put forward by Hans Rosling
in his book Factfulness 1 (data available on www. gapminder .org ). Hans Rosling
characterised people as belonging to four ?levels? rather than living in developed or
developing countries.
These levels are based on the average daily income of the population in any country/
geography. A count ry will have people living across the four income levels (people
earning different amounts) , however, their shares will differ substantially.
Hans Rosling defines the income levels as following:
? Level 1: Earning US $ 2 per day
? Level 2: Earning between US $ 2 - US $ 8 p er day
? Level 3 : Earning between US $ 8 - US $ 32 per day
? Level 4: Earning more than US $ 32 per day
People living on less than US $ 8 per day (Level 1 and 2 population) are at an increased
risk of suffering irreversible health and catastrophic financial conseq uences from
illness . This represents the ?vulnerable population?.
1 Factfulness: Ten Reasons We're Wrong About the W orld --and Why Things Are Better Than You Think;
by Hans Rosling , Anna Rosling R?nnlund, Ola Rosling; 2018
Further details on Hans Rosling?s four levels of income :
?Level 1?: These one billion people live off less than US $ 2 per day. They get
around on their own two barefoot feet, cook over an open flame like a cookfire,
fetch water in a bucket, and sleep on the ground. They cannot afford to buy
food, or access to health services.
?Level 2?: This is the income group where th e majority of the world's people
lives today (3 billion people), getting by on US $ 2-8 a day. Members of this
group may have minimal possessions like a bicycle, a mattress, or a gas
canister for cooking at home. If faced with illness the out -of-pocket spen ding
will eat up their minimal savings and throw them back to the extreme poverty
of level 1.
?Level 3?: People in level 3 live on anywhere from US $ 8 a day to US $ 32.
They have running water, might own a motorbike, and their meals are a rich
and colourful mix of foods from day to day. Like level 1, roughly one billion of
the world's people live on level 4.
?Level 4?: These 1 billion people live off US $ 32 a day or more and have
running water (both hot and cold) at home, a vehicle in the driveway, and plen ty
of nutrients on their plate. They have also likely had the chance to finish twelve
years of school, or more.

Re port to the Board

Doc 1 1 ? Annex B: Supplementary contextual analyses

Annex B: Supplementary contextual analyses
This document provides a number of more detailed, contextual analyses as additional
background to the two key questions that will inform Gavi post -2020 Strategy:
1. How will the Alliance ensure continued progress on equitable coverage
in the countries that are yet to transition?
2. How can the global community engage non -Gavi countries to address
growing inequities and maximise the impact of their domestic
investments in immunisation?
3. How will the Alliance ensure continued progress on equitable coverage
in the countries that are yet to transition?




Re port to the Board

Doc 1 1 ? Annex B: Supplementary contextual analyses

1



Board -2018 -Mtg -2-Doc 11
Report to the Board
28-29 November 2018


Section A: Introduction
? Gavi, the Vaccine Alliance, was founded in 2000 to accelerate access
to new and underused life -saving vaccines in the world?s poorest
countries suffering high rates of child mortality and morbidity. Building on
the Alliance?s impressive success in bridging the gap b etween rich and poor
countries in terms of access to vaccines, the scope of Gavi?s work has
steadily expanded. It has been called upon to play a key role in introducing
and scaling -up inactivated polio vaccine (IPV) as well as in outbreak
response by fundi ng stockpiles of vaccines for diseases with epidemic
potential. The Alliance?s current strategy is committed to further accelerate
vaccine introductions as well as support equitable coverage of routine
immunisation services, recognising that about 20% of c hildren in Gavi -
eligible countries 1 do not receive a full course of even basic vaccines and
that immunisation coverage rates among these countries are quite uneven.
As the world moves from the Millennium Development Goals (MDGs) into
the Sustainable Develo pment Goals (SDGs), the Alliance?s 2021 -20 25
strategy (?Gavi 5.0?) is an opportunity to contribute to the SDG vision of
?healthy lives? and ?leaving no one behind ?. In this context, Gavi?s current
mission will be more relevant than ever in the years ahead .
? The PPC provided feedback on the questions and context related to
the development of Gavi strategy 2021 -2025. It emphasi sed that the core
focus for the Alliance will remain on its current mission of accelerating
access to vaccine s and increasing equitable coverage in the world?s poorest
countries . PPC members noted that the key question will be ?how? to do so
in a rapidly changing environment and with a diverse and fragile portfolio of
countries. The PPC also noted that the Alliance may need to broaden its
engagement in certain areas and articulate how it will contribute to global
priorities such as Universal Health Coverage and Global Health Security.
This might also entail engaging additional countries which are lagging
behind on immunisation and help the m make better use of their domestic
resources for immunisation so that vulnerable children everywhere are
reached with life -saving vaccines .

1 Throughout this document the term ?Gavi -eligible? refers to Gavi -72 countries unless mentioned
differently
SUBJECT : GAVI 5.0 : T HE ALLIANCE?S 2021 -20 25 STRATEGY
Agenda item: 11
Category: For Guidance

1



Board -2018 -Mtg -2-Doc 12

Section A: Introduction
? This report three decisions by the Board related to Inactivated Poliovirus
Vaccine (IPV), as recommended by the Programme and Policy Committee
(PPC) in October 2018. The first two decisions (Section B) pertain to
potential IPV suppo rt post -2020 , and request the Board to approve support
for IPV in Gavi -70 countries from 2021 that takes into account the principles
retained by the Board in June 2018. The Board is also asked to provide an
in-principle decision to support IPV -containing w hole -cell pertussis
Hexavalent vaccine (Hexavalent ) when it becomes available, as part of
future IPV support. Lastly, the Board is requested to approve a recent
funding reque st from the Government of India to cost -share IPV for three
years (2019 -20 21) due to a significant, unanticipated price increase .
Section B: Support for IPV post -2020
Gavi?s engagement in IPV
1.1 The Board?s first decision related to engagement with IPV was taken in
November 2013 when it approved a funding e nvelope for all Gavi IPV
eligible countries as part of the polio eradication ?Endgame? strategy 1. With
this decision, the Board approved a series of policy exceptions including
waivers to Gavi?s Co -financing policy and Eligibility and Transition policy.
Financing was provided by GPEI (Global Polio Eradication Initiative) donors
as it was considered core to the GPEI programme and Gavi had not
included IPV in its 2016 -2020 strategic period budget.
1.2 A number of subsequent Board decisions have been made related to IPV
(see Appendix 4 ), wi th the latest in June 2018, where the Board approved
to exceptionally fund IPV with core Gavi resources through 2020, with the
caveat that it did not imply Gavi support for IPV post -2020 . At this time, the
Board was supportive of the following principles to guide Gavi?s
engagement with IPV post -2020: p olio eradication is a global public good
and IPV is the global ?insurance policy? to mitigate the risk of poliovirus re -

1 Of 73 countries, 70 are currently supported by Gavi: Ukraine was not supported as IPV was
already introduced in 2006; Georgia opted for a combination vaccine not supported by the Alliance;
and India, although eligible, agreed to fund their own programme but later requested and was
provided one -time catalytic vaccine support from GPEI donors that ended in 2016.
SUBJECT: GAVI ?S SUPPORT FOR INACTIVATED POLIO VACCINE
(IPV) POST -2020 AND FOR INDIA 2019 -2021
Agenda item: 12
Category: For Decision
Report to the Board
28 -29 November 2018

1


Re port to the Board
Doc 13 ? Annex A: Implications/Anticipated impact

Annex A : Implications/Anticipated impact

Risk implication and mitigation
? Should the PPC/ Board choose not to support any activities contributing to
global pandemic influenza preparedness , despite partner activities and
investments , there is a risk that in a pandemic there would be global inequity
in access to and use of pandemic vaccines and consequently Gavi -
supported countries would be disproportionately impacted in t erms of
morbidity, mortality and disruption .
? Although Gavi could invest in interventions to increase pandemic influenza
vaccine supply , the se would be incremental to PIP and , given the limitations
of current technology , would represent high cost s and uncertain impact s.
For this reason, Gavi investment to increase pandemic vaccine supply
capacity and availability is not recommended at this time. Further
information on the risks/ anticipated impacts of this intervention is outlined
in Annex B of the October 2018 PPC Paper (Doc 06c ).
? Rega rding new technology, there is a risk that the impact of Gavi investment
at this time would be diffuse given uncertain timelines and technical/
scientific barriers. For this reason, Gavi investment is not recommended.
However, were Gavi to be absent from d iscussions on new technology there
is a risk that future products would not reflect the needs and use context of
Gavi supported countries, thus the Gavi Secretariat intends to continue to
engage with partners to monitor developments in new technology.
? The recommendation of a learning agenda to assess the feasibility and
impact of routine immunization of healthcare workers with seasonal
influenza vaccines as an approach to strengthen countries? pandemic
preparedness has risks associated with feasibility, methodology (including
identifying study designs which enable the key questions to be answered),
and securing buy -in from countries in the context of competing priorit ies .
Although the potential risk of duplication with initiatives such as PIVI is
recognis ed , this is mitigated by close collaboration with key partners such
as WHO, PIVI, B ARDA and others who have clearly articulate d the gaps
and incremental value of Gavi?s engagement in this area.

Impact on countries
? Support for the learning agenda has implications for countries . For countries
engaged in a learning agenda, it will require resources to be committed for
activities which may have system benefit but which are unlikely to yield
significant health benefits outside of a pandemic. They will also be expected
to share experiences and knowledge with counterparts.
? Given the systemic links between pandemic influenza preparedness and
preparedness for other emergin g infectious diseases, there are risk s of
potential duplication with global, regional and national efforts (such as,
regulatory strengthening through the African Vaccine Regulatory Forum
[AVAREF ] and similar initiatives and activities relating to the WHO Joint
External Evaluations) . Within the Secretariat, increased knowledge of the
product and policy landscape of vaccines for epidemic preparedness and
response and strong relationships with partners will mitigate these risks .

1



Board -2018 -Mtg -2-Doc 13

Section A: Summary
? This report presents a detailed briefing on pandemic influenza in response
to the June 2018 Board request as part of the Vaccine Investment Strategy
(VIS) 2018. It includes a review of the landscape, gap analysis and
preliminary assessment of potential opt ions for Gavi engagement.
? The Board is asked to approve a learning agenda (with financial implications
of approximately US $ 4 million from 2019 -2022 ), to be developed with
WHO, on the use of routine immunisation of healthcare workers with
seasonal influenz a vaccines to strengthen countries? pandemic
preparedness.

Section B: Detailed Briefing on Pandemic Influenza
Introduction
1.1 The Gavi Board approved a n approach and set of evaluation criteria for
considering vaccine investments for epidemic preparedness and response
in June 2018, within the overarching Vaccine Investment Strategy (VIS)
2018 .1 This approach comprises three steps : firstly, identification, with
WHO, of vaccines for consideration; secondly, development of a ?living
assessment ? as vaccine development progresses ; and finally, a full
investment case for Board consideration . Progression through each stage
is determined by pre -defined triggers . 2
1.2 Given that p andemic influenza meets the ?trigger? for an investment case 3,
the Board requested the Secretariat, in consultation with WHO and experts,
to prepare a n extensive briefing on pandemic influenza preparedness and
bring a related investment case if appropriate .4 As pandemic influenza is an
outlier in terms of both the exceptional global threat that it poses and the

1 https://www.gavi.org/about/governance/gavi -board/minutes/2018/6 -june/minutes/07 --- vaccine -
investment -strategy --- short -list/ 2 A ?living assessment? would be developed once preliminary safety and immunogenicity data is
available for the vaccine (Phase 2a/b ). An investment case would be developed once there is a
defined pathway to vaccine licensure in the short -term (e.g., 1 year), major public health need or
update of a WHO use recommendation. 3 Based on the availability of licensed product(s) and WHO recom mendation 4 The focus of this briefing is on pandemic influenza, however seasonal influenza is important for
pandemic preparedness as demand for seasonal influenza supports global manufacturing capacity.
SUBJECT : PANDEMIC INFLUENZA PREPAREDNESS
Agenda item: 13
Category: For Decision
Report to the Board
28 -29 November 2018

1


Re port to the Board
?
Doc 14 ? Annex A: Implications
Annex A: Implications
Financial implications
? A strategy to strengthen YF diagnostic capacity including diagnostic market
shaping, technical assistance (TA) , quality assurance/quality control
(QA/QC) assessments, sample transportation, and coordination would
require an estimated US$ 13.5 million during 2019 -2021.
? This estimate includes approximately US$ 8.2 million for the procurement
and distribution of laboratory reagents, supplies, and equipment, of which
US$ 4.6 million would be for 2019 -2020. In addition, approximately
US$ 5.3 million would be needed for TA, QA/QC testing, sample
transportation, and WHO global and regional YF laboratory coordination
during 2019 -2021, of which appro ximately US$ 3.5 million would be for
2019 -2020. The Gavi Secretariat will seek to absorb the 2019 estimated
costs of approximately US$ 1.7 million for TA, QA/QC testing, sample
transportation, and WHO global and regional YF laboratory coordination
within the existing approved PEF budget .
Risk implications and mitigation
? If the problems with YF diagnostic capacity in Africa are not addressed, there
is a risk that YF outbreaks will be detected late, leading to larger outbreaks
that require more resources, including vaccines, to contain; result in more
morbidity and mortalit y; disrupt routine immunisation more; and have
greater potential to spread to additional countries, as occurred with the
2015 -2016 Angola outbreak, in which international travellers imported
yellow fever into China, the Democratic Republic of Congo, Kenya, and
Mauritania.
? YF serologic tests are unable to distinguish between antibodies formed in
response to YF infection and antibodies formed in response to YF
vaccination, and the latter can persist for relatively long periods of time. An
individual?s vaccin ation history is necessary for interpreting serologic
results, but that information is often not available or is uncertain. As a result,
as vaccination coverage improves there will be an increased risk for false
positive test results that could prompt unne cessary reactive mass
vaccination campaigns that unnecessarily disrupt routine immunisation.
Improving YF laboratory capacity in Africa so that molecular testing for YF
RNA is readily available for appropriately timed specimens would help to
offset this ri sk.
? There is a risk that at least some of the governments of countries at high risk
for YF in Africa, may not provide funding for at least some portion of the
costs of the supplies, equipment, and services supported through this
initiative. Similarly, the re is a risk that countries may not sustain their YF
laboratory capacity after the end of Gavi support.
o Initial discussions with laboratory directors from Nigeria, Cameroon,
Chad, Benin, Togo, Cote d?Ivoire, Mali, and Uganda have been

1



Board -2018 -Mtg -2-Doc 14

Section A: Introduction
? This report requests the Board to approve funding for strengthening yellow
fever diagnostic capacity in Africa , as recommended by the Programme and
Policy Committee (PPC) in October 2018. It is proposed that YF diagnostic
capacity would be strengthened thr ough a diagnostic procurement
mechanism based on Gavi?s existing application, review, and approval
processes. This investment would facilitate implementation of the Gavi -
supported Eliminating YF Epidemics (EYE) strategy and allow more efficient
and effecti ve use of vaccine.
? Timely, reliable identification and confirmation of YF allows more rapid
containment of outbreaks and better prioriti sation of preventive vaccination
efforts in the context of the finite YF vaccine supply. As illustrated during YF
outbre aks in Angola, the Democratic Republic of Congo (DRC) , and Nigeria
over the last few years, major gaps in YF diagnostic laboratory capacity
exist. A key gap is a lack of validated, commercially available YF diagnostic
tests.
? A Gavi Alliance effort to use i ts market shaping capabilities to improve
availability of YF diagnostic tests would be part of a multifaceted approach
to improving YF laboratory capacity that would also address : i) the need for
laboratory technical assistance, ii) quality assurance/quali ty control
assessments, and iii) solutions to critical sample transportation and
laboratory coordination bottlenecks. This approach would be integrated with
broader Gavi efforts to improve the availability and quality of immuni sation
data and strengthen h ealth systems. Efforts to improve YF laboratory
capacity would seek to incorporate count ry co -financing in the medium and
long term , and establish the conditions under which Gavi no longer needs
to provide funding in order to ensure the sustainability of timely, reliable YF
diagnostic capacity.
Section B: Facts and Data
1. Gavi? s engagement with yellow fever control
1.1 In 2015, the Gavi Board authori sed allocating US$ 278 million for YF
vaccine in the Gavi 2016 -2020 budget. In December 2016, the Gavi Board
approved an increase in expenditure on YF vaccine of up to US$ 150 million
SUBJECT : GAVI SUPPORT FOR YELLOW FEVER DIAGNOSTIC
CAPACITY
Agenda item: 14
Category: For Decision
Report to the Board
28 -29 November 2018

1



Board -2017 -Mtg -2-Doc 15

Section A: Introduction
? The purpose of this document is to update the Board on progress in
developing an Accountability Framework for the exceptional support for
Nigeria agreed to by the Board in June 2018.

? We are seeking feedback and guidance on the key elements of the
Account ability F ramework incl uding the overall approach and proposed
indicators.
Section B: Facts and Data
Background and Process
1.1 In June 2018, the Board requested the Secretariat and Alliance partners, in
consultation with the government, to develop an Accounta bility Framework
(AF) by November 2018 . The Board emphasis ed that Gavi support to the
National Strategy for Immunisation and Primary Health Care System
Strengthening (NSIPSS ) will be contingent on Nigeria meeting the
conditions set forth in the Accountabil ity Framework .
1.2 Consultation on the AF only began in early September , after the final
reimbursement was made on 20 Augu st. A working group was established
to conduct an analysis of existing accountability frameworks and a
Taskforce, chaired by WHO , was set -up to develop the NSIPSS
Accountability Framework outline. This has been a highly consultative and
collaborative process, with strong participation from all key stakeholders.
1.3 Additionally to the continuous in -country work, joint missions on vaccines
and health financing were conducted in September by the World Bank, the
Bill & Melinda Gates Foundation and Gavi. Two intensive in -country retreats
with the participation of all stakeholders including Gavi Alliance senior
m anagement led to a draft Accountab ility Framework, which was shared
with the Programme and Policy Committee (PPC) .
1.4 In its deliber ations 1, the y emphasised the importance of clearly defining
which indicators were absolutely non -negotiable requirements

1 Other comments were made, which can be found in the minutes of the PPC discussions
SUBJECT : NIGERIA ACCOUNTABILITY FRAMEWORK
Agenda item: 15
Category: For Guidance
Report to the Board
28 -29 November 2018

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Board -2018 -Mtg -2-Doc 17
Report to the Board
28 -29 November 201 8

















SUBJECT: REVIEW OF DECISIONS
Agenda item: 17
No paper

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Board -2018 -Mtg -2-Doc 18
Report to the Board
28 -29 November 201 8

















SUBJECT: CLOSING REMARKS AND REVIEW OF BOARD
WORKPLAN
Agenda item: 18
No paper

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Board -2018 -Mtg -2-Doc A

Section A: Introduction
? This report is an update on progress made in 2018 on imp lementing Gavi?s
gender policy. It covers the programmatic, cor porate, governance,
communications and advocacy dimensions of Gavi?s gender focused work.
? The goal of Gavi?s gender policy is to 1) increase immunisation coverage by
supporting countries overcome gender -related barriers to ac cessing
immunisation services and 2) promote equal access and utilisation for all
girls and boys, women and men to immunisation and related health services
that respond to t heir different health need s.
Section B: Facts and Data
1. Gender Policy at a glance
1.1 Gavi has had a Gender policy since 2008 . It was revised in 2013 , at which
point the Secretariat committed to conduct the next review and u pdate of
the policy in 2019, including an external evaluation.
1.2 The Secretariat has initiat ed the external evaluation process and the
evaluator has been selected. T he main objectives of the evaluation is to
assess the strengths and weaknesses of the 2013 gender policy including
the des ign, objecti ves, goals and theory of change. The evaluation will also
assess the e ffectiveness and efficiency of Gavi?s implementation and
management of gender at th e global and country level , through conducting
country case studies and interviews .
1.3 Final recommendations from the evaluation are expected in early 2019. The
evaluation will provide evidence -based findings which will inform the update
to the g ender policy . The outputs from the external evaluation will be
shared with the Programme and Poli cy Committee (PPC) at its April 2019
meeting and a recommendation on an updated policy will be brought to the
PPC and Board for decisi on in October and November 2019 .
2. Gender and Gavi Programming
2.1 Gavi?s strategic framework for 2016 -2020 calls for an i ncreasing focus on
sustainable coverage and equity of immunisation and includes an indicator
on maternal education status as a proxy for women?s empowerment. This
indicator tracks the differential level of coverage of third dose of d iphtheria -
SUBJECT : ANNUAL REPORT ON IMPLEMENTATION OF THE
GENDER POLICY
Agenda item: A
Category: For Information
Report to the Board
28 -29 November 2018

Gavi

Board meeting
28 -29 November 2018
Previous Board decisions Key developments Alliance update Meeting agenda
www.gavi.org
CEO Board Update
Seth Berkley, MD
28 November 2018, Geneva, Switzerland
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MTR Update
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Reach every child
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2018 MTR - 200 of our partners will convene for a high -level
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Board meeting
28 -29 November 2018
Previous Board decisions Key developments Alliance update Meeting agenda
www.gavi.org
CEO Board Update
Seth Berkley, MD
28 November 2018, Geneva, Switzerland
Change image
Board meeting
28 -29 November 2018
Previous Board decisions Key developments Alliance update Meeting agenda
Board meeting
28 -29 November 2018
1
KEY DEVELOPMENTS
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