This page will be updated in the first quarter of 2023 to reflect the Vaccine Investment Strategy (VIS) 2024. For more information in the meantime, please scroll down to “Related downloads” or contact the VIS team:

Every five years, Gavi takes stock of available and expected vaccines to develop a new vaccine investment strategy (VIS). The VIS sets new priorities for our vaccine support programmes in a transparent manner through in-depth, evidence-based analysis and extensive consultations. The rationale for using five-year cycles is to provide predictability to our decision-making process.

The Alliance recently developed a new VIS for the 2021–2025 strategic period (“VIS 2018”). The assessment and evaluation of vaccine candidates were completed in three distinct phases.

  • Phase one prepared the ground for the VIS by developing a decision-making process and analytical plan, identifying and categorising vaccine candidates, and setting out a first set of evaluation criteria.
  • Phase two shortlisted vaccine candidates for use in routine immunisation programmes, set criteria for evaluating vaccine investments in epidemic preparedness and response, and identified an approach for inactivated polio vaccine (IPV) support beyond 2020.
  • Phase three: in the final phase, recommendations for new vaccine investments were developed and presented at the Gavi Board meeting in November 2018.


In April 2017, WHO conducted a landscape analysis, which identified candidate vaccines for consideration in VIS 2018. The inclusion criteria included public health relevance to low- and middle-income countries and expected licensure by 2023. The latter was used to ensure that the vaccines would likely be available during the next strategic period.

The vaccines considered in VIS 2018 fit into one of the following three categories:

  • vaccine investments for endemic disease prevention through planned, preventive immunisation;
  • vaccine investments for epidemic preparedness and response; and
  • IPV support post-2020, as a global public good.

Vaccines/products linked to current investment

New vaccine/product

Endemic disease prevention
  • Diptheria, tetanus & pertussis containing boosters
  • Hepatitis B (birth dose)
  • Cholera (preventive immunisation)
  • Meningococcal (multivalent conjugate)
  • Rabies
  • Malaria*
  • Hepatitis A
  • Dengue
  • Influenza (maternal)
  • Respiratory syncytial virus maternal vaccine and monoclonal antibody
Epidemic disease preparedness and response  
  • Pandemic influenza (initial in-depth briefing)
Polio eradication
  • IPV (post-2020)

*Malaria was not subject to investment decisions in VIS 2018 as the malaria vaccine implementation programme is still ongoing, but was treated as a comparator.  


Phase one

In November 2017, the Gavi Board approved a set of criteria to be used for evaluating vaccines for endemic disease prevention.

Evaluation criteria for vaccines for endemic disease prevention through planned, preventive immunisation




Ranking criteria:

Health impact

Total future deaths averted in the 2020-2035 period, and per 100,000 vaccinated
Total future cases averted in the 2020-2035 period, and per 100,000 vaccinated

Value for money

Vaccine procurement cost per death averted
Vaccine procurement cost per case averted

Equity and social protection impact

Disproportionate impact of disease on vulnerable groups
Special benefits of vaccination for women and girls

Economic impact

Direct medical costs averted
Indirect costs averted

Global health security impact

Epidemic potential of disease
Impact of vaccination on antimicrobial resistance (AMR)

Secondary criteria:

Other impact

Total under-five deaths averted in the 2020-2035 period, and per 100,000 vaccinated
Total DALYs averted in the 2020-2035 period, and per 100,000 vaccinated
Vaccine procurement cost per disability-adjusted life year (DALY) averted

Gavi comparative advantage

Degree of vaccine market challenges
Potential for Gavi support to catalyse additional investment

Implementation feasibility

Ease of supply chain integration
Need for healthcare worker behaviour change
Feasibility of vaccination time point
Acceptability in target population
Long-term financial implications

Alternative interventions

Optimal use of current and future alternative interventions (prevention and treatment)

Broader health system benefits

No specific indicator – evaluated on a case-by-case basis

Financial implications:

Vaccine cost

Total procurement cost to Gavi and countries, 2020-2035

Operational cost

Incremental in-country operational costs per vaccinated person

Additional implementation costs

Additional costs for introduction

Data sources used in the evaluation included consultations with in-country stakeholders, peer-reviewed literature, expert and partner input, health impact modelling and analytics developed for the VIS process.

Phase two

Based on the analysis of each vaccine against the criteria included in the Board-approved evaluation framework, in June 2018, the Gavi Board shortlisted six vaccine candidates for endemic disease prevention for further consideration and investment case development:

  • multivalent meningococcal conjugate vaccine;
  • hepatitis B birth dose;
  • oral cholera vaccine for planned, preventive immunisation;
  • diphtheria-, tetanus- and pertussis- (D,T&P)-containing boosters;
  • respiratory syncytial virus (RSV) immunisation products; and
  • rabies post-exposure prophylaxis.

At this time the Board also deprioritised dengue, hepatitis A and maternal influenza vaccines. More information on the rationale for shortlisting and deprioritisation can be found in the June 2018 report to the Gavi Board.

For the six shortlisted candidates, Gavi undertook further in-depth analyses including extensive consultations with country stakeholders and vaccine and disease experts, as well as financial analyses to inform investment recommendations. Detailed investment cases for each of the six vaccines can be downloaded below.

Phase three

In November 2018, the Gavi Board reviewed the final investment cases and decided to extend support for oral cholera vaccine to 2020, as well as to support a learning agenda for cholera in the 2019–2020 period.

In addition, the Board decided that, subject to availability of funding for the 2021–2025 strategic period and alignment with the final parameters of Gavi’s next strategy, from 2021 Gavi would:

  • make available support for D, T & P-containing booster vaccines, hepatitis B birth dose and human rabies vaccines for post-exposure prophylaxis;
  • expand the existing meningococcal programme support to include multivalent (ACW-containing) conjugate vaccines, subject to availability of a licensed product, WHO prequalification and SAGE recommendation;
  • expand support for the oral cholera vaccine programme to include planned, preventive immunisation;
  • support a learning agenda for D, T & P-containing booster vaccines, hepatitis B birth dose, human rabies vaccines for post-exposure prophylaxis and multivalent meningococcal conjugate vaccines, to commence in 2019; and
  • support RSV immunisation products contingent on availability of a licensed product, WHO prequalification and SAGE recommendation, and support pre-introduction activities (including demand generation).

Further details on the specific support that was conditionally approved are available in the November 2018 report to the Board.


In June 2018, the Gavi Board approved an approach and set of evaluation criteria for vaccines for epidemic preparedness and response. This builds on the approach for evaluating vaccines for endemic disease prevention but also includes criteria that are unique to epidemic risk reduction.

Recognising that many diseases may be categorised as having both epidemic and endemic characteristics, assessment against one or the other framework will be determined by the public health goal and the type of investment (ie planned preventive immunisation, such as routine immunisation, versus a stockpile or similar intervention). More information can be found in the June 2018 report to the Gavi Board.

The framework for epidemic preparedness and response is intended to structure the assessment and decision-making process around four critical questions.

  • Disease risk and burden: is the epidemic potential of the disease sufficient to prioritise a stockpile or similar investment?
  • Vaccine impact and feasibility: would the vaccine be feasible to use and impactful as part of epidemic preparedness and response?
  • Fit for Gavi and partners: what is Gavi’s comparative advantage and how can Gavi’s expertise contribute to the funding and delivery of this vaccine?
  • Financial implications: what is the appropriate scale of the stockpile (or related intervention) and what would be the financial implications of an investment?

Evaluation criteria for vaccines for epidemic preparedness and response




Disease risk & burden

Epidemic potential of disease

Transmission route

Reproductive rate (R0) and generation time

Timing of symptoms and infectivity

Disease transmissibility and human transmission

Human/animal interface

Global risk

Frequency of outbreaks

Endemic potential

Risk of the disease becoming endemic

Disease burden

Total cases/year

Total deaths/year

Case-fatality rate or severity of disease

Cases of long-term disability

Disease impact on equity, society and economy 

Disproportionate burden of disease in vulnerable groups

Special benefits of vaccination for women and girls

Health system impact – healthcare workers and services

Social disruption – impact on vital services
Economic impact – cost of epidemics (direct & indirect)

Additional factors to be considered in disease risk and burden scenarios include: evolutionary potential of the pathogen, vector burden, impact of climate change and demographic changes. 

Vaccine impact and feasibility

Epidemic risk reduction/ mitigation

Efficacy of vaccine

Time to immunity

Indirect effects (herd protection/transmission blocking)

Implementation feasibility

Ease of storage

Dosing schedule

Acceptability in the target population

Considerations relating to timely delivery and use (composition of stockpile and factors influencing timely case detection and verification, including surveillance and the availability of rapid, effective diagnostics)

Long-term benefit

Cross-strain protection

Duration of protection

Stockpile attributes

Availability of medical countermeasures/alternative interventions

Stockpile turnover and value

Fit for Gavi & partners

Gavi comparative advantage

Burden in Gavi-supported countries as a proportion of global burden

Need for Gavi financing and market shaping

Complementarity with other initiatives


Vaccine stockpile cost

Annual cost of global stockpile

Operational cost

Incremental in-country operational costs per outbreak response

Gavi works with WHO to identify candidate vaccines to be considered for Gavi support on an ongoing basis. Once preliminary safety and immunogenicity data is available for a candidate vaccine (usually in phase 2a/b), a “living assessment” is developed. This includes preliminary information on disease risk and burden, vaccine impact and feasibility, and determines whether Gavi’s engagement has a comparative advantage.

A full investment case for decision by the Gavi Board is triggered by one of the following: a defined pathway to licensure, an updated WHO recommendation or an urgent public health need (eg disease epidemic). Recommendations on investment could be taken to the Board for decision as part of the VIS or as standalone investment cases.

Pandemic influenza preparedness

Based on the approach approved in June 2018, pandemic influenza met the trigger criteria for an investment case. In response to a Board request, Gavi worked with WHO to develop a gap analysis and detailed briefing on pandemic influenza preparedness, including an assessment of potential vaccine supply and demand interventions.

In November 2018, the Board approved the development of a “learning agenda” for pandemic influenza. The aim is to assess the feasibility and impact of immunising healthcare workers with seasonal influenza vaccine to support epidemic and pandemic influenza preparedness.

Further details on the assessment and approved learning agenda are available in the November 2018 report to the Board.


Gavi’s investment in IPV beyond 2020 was also considered as part of VIS 2018. However, VIS evaluation criteria, such as lives saved and value for money, do not adequately capture the unique role of IPV in preventing the re-emergence of poliovirus. As a result, Gavi has conducted a tailored assessment and consultation process for IPV support beyond 2020.

Our engagement in IPV post-2020 is guided by three main principles.

  • Polio eradication constitutes a global public good. IPV is the global “insurance policy” to mitigate the risk of poliovirus re-emergence after global certification.
  • Gavi support should be aligned with SAGE recommendations.
  • The level and duration of Gavi support should balance the risk of IPV programme discontinuation with the principles of country ownership.

An investment case was brought to the Gavi Board in November 2018. Due to the importance of supporting the polio eradication initiative, the Board signalled its approval of support for IPV post-2020, subject to alignment with the final parameter setting for Gavi’s 2021-2025 strategy and sufficient funds being available following Gavi’s next replenishment. The Board emphasised that this investment must be additional to other Gavi investments, while recognising the full programmatic integration of IPV into Gavi’s immunisation approach. The Board also stressed the importance of close collaboration between Gavi, the Global Polio Eradication Initiative (GPEI) and polio partners and requested GPEI to include IPV costs within its 2019-2023 programmatic strategy.

In addition, the Board approved in-principle support for IPV-containing whole-cell pertussis hexavalent vaccine (containing antigens against diphtheria, tetanus, pertussis, hepatitis B, Haemophilus influenzae type b and IPV). This will be contingent on the availability of a licensed product, WHO prequalification, SAGE recommendation and positive market attributes (including maintaining healthy vaccine markets).

Further details on the specific support approved can be found in the November 2018 report to the Board.

The next VIS will be developed in 2023, while consideration of vaccines for epidemic preparedness and response will be ongoing. VIS 2018 has identified some questions and gaps in the process of assessing the value of the candidate vaccines. The Gavi Secretariat will work to convey these to the research community ahead of the next VIS process.

For further information about the VIS process, please contact

Related downloads

08 Vaccine Investment Strategy document (28 Nov 2018)


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
Agenda item: 08
Category: For Decision
Report to the Board
28 -29 November 2018

12 Gavi s support for IPV post 2020 and for India 2019 2021 (28 Nov 2018)


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.
(IPV) POST -2020 AND FOR INDIA 2019 -2021
Agenda item: 12
Category: For Decision
Report to the Board
28 -29 November 2018

12 Vaccine Investment Strategy methodology document (29 Nov 2017)


Board -2017 -Mtg -3-Doc 12

Section A: Introduction
? The Vaccine Investment Strategy ( VIS ) is Gavi?s bespoke prioritisation
approach for new investments in vaccines. It is developed every five years
to inform Gavi?s strategic and funding cycle. Twice before, Gavi has
developed a VIS and as a result added ne w vaccines to its portfolio and
committed to other types of vaccine investments .1
? The VIS 2018 ha s three phases: 1) development of an evaluation approach
for v accines for endemic disease prevention through routine immunisation
(for decision at this meeting ); 2) narrow ing of these candidates to a shortlist ,
and development of an evaluation approach for vaccine investments for
epidemic response ; (for Board decision in June 2018 ); 3) final
recommendations including details on the scope and nature of Gavi?s
investment (for decision at the end of 2018).
? A Steering Committee (SC) 2 provides scientific and technical input into the
VIS process. The SC met on 11 -12 September 2017 (meeting summary in
Appendix 5) and provided guidance on the overall VIS methodology, the list
of candidates and the evaluation approach as described below.
Section B: Vaccine Investment Strategy: methodology
Stakeholder consultations
1.1 The Secretariat conducted initial consultations with Gavi Board members
and via a survey to Alliance stakehold ers (160 responses) . S ummary
findings from these consultations are in A ppendix 2. Questions focused on
the relative importance of different types of vaccine investment s (e.g.
routine immunisation versus outbreak response), strategic consideration of
specif ic development objectives (e.g. global health security) , evaluat ion

1 In 2008, Gavi?s Board prioritised Japanese encephalitis (JE), rubella, HPV and typhoid conjugate
vaccines. In 2013, Gavi?s Board made investment decisions for three vaccines: expanded yellow
fever campaigns; support for a global stockpile of oral cholera vaccine, including the opportunity to
generate impact data; and investment in a ?learning agenda? for rabies vaccine. The Board
requested monitoring of new data on maternal influenza vaccine impact and a re -assessment of
the RTS,S malaria vaccine once it h ad been recommended for use by SAGE, and subsequently in
2015 approved funding for implementation pilots conducted by WHO. 2 List of members in Appendix 4
Agenda item: 12
Category: For Decision
Report to the Board
29 -30 November 2017

13 Pandemic Influenza Preparedness document (28 Nov 2018)


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

Section B: Detailed Briefing on Pandemic Influenza
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 -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.
Agenda item: 13
Category: For Decision
Report to the Board
28 -29 November 2018

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Last updated: 5 Oct 2023

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