1


Board -2024 -Mtg -02-Doc 00a


Gavi Alliance Board Meeting
6-7 June 202 4
Crowne Plaza Hotel , Geneva, Switzerland

Thursday 6 June: 08.30-18.00 (Board Meeting Day One)
Friday 7 June: 09.00 -17.00 (Board Meeting Day Two )

Quorum: 14

Document List

No. Document
00a Document list
00b Agenda
01a Declarations of interest
01b Minutes from 6-7 Dec ember 2023
01c Minutes from 11 January 2024
01d No Objection Consent Decisions
01e Consent Agenda
01f Workplan
02 CEO’s Report – To follow
03 Joint Alliance Update on Implementation of Gavi 5.1 Strategy, Programmes and
Partnerships
– No paper
03a Gavi 5.1 Strategy, Programmes and Partnerships : Progress, Risks and
Challenges
03b Joint Alliance Update on Country Programmes
04 Committee Chair and IFFIm Board reports – To follow
0 5 Gavi 6.0 – The Alliance’s Strategy 2026- 2030
06 Gavi 6.0 – Eligibility, Co -Financing and Transition Model, Middle- Income
Countries Approach and Health Systems Strategy – No paper
0 6a Future of Gavi’s Eligibility, Co
-financing and Transition Model and Middle-
Income Countries Approach
0 6b Health Systems Strategy

Board -202 4-Mtg -02-Doc 00b 1

Gavi Alliance Board Meeting
6-7 June 2024
Crowne Plaza Hotel , Geneva, Switzerland

Monday 3 June - Wednesday 5 June : Pre -Board meetings
Thursday 6 June : 08. 30 -18. 00 Board M eeting Day One
Friday 7 June : 0 9.00 -17.00 Board M eeting Day Two

Quorum: 14



A genda UPDATED
















Next Board Meeting : 4-5 December 2024
9-10 April 2025 (Board Retreat)
25-26 June 2025
3-4 December 2025

---
Brenda Killen , Director, Governance and Secretary to the Board, +41 22 909 6680, bkillen@gavi.org
Joanne Goetz , Head, Governance, +41 22 909 6544, jgoetz@gavi.org
Please note that the Board meeting will be recorded. This recording will be used as an aid to minute the
meeting. A transcription of the full proceedings will not normally be made. Should a transcription be made it
will be used only as an aid to minute the meeting.

1

Board -2024 -Mtg -02 -Doc 01a

Gavi Alliance Board Meeting
6-7 June 2024
Crowne Plaza Hotel, Geneva, Switzerland

Thursday 6 June: 08.30 -18.00 Board Meeting Day One
Friday 7 June: 09.00 -17. 00 Board Meeting Day Two

Quorum: 14
Declarations of Interest
Declarations
Section 5.5 of the Conflicts of Interest Policy for Governance Bodies states “Members involved
in decision -making processes on behalf of Gavi must take appropriate action to ensure
disclosure of Interests and Conflicts of Interest, and take the necessary action in respect
thereof.”
Section 6.2 of the Conflicts of Interest Policy for Governance Bodies further states, “The duty
to disclose [in 6.1 above] is a continuing obligation. This means that Members are obliged to
disclose any Interests and/or Conflict of Interest, whenever the M ember comes to know the
relevant matter.”
The following declarations were made by members of the Board on their most recent annual
statements .
Board members:
Member Organisational Interests Financial/Personal/Advisor Int/
Others










José Manuel Barroso,
Chair


















None









Hult – EF (Education First) (Visiting
Professor and Chair of Advisory
Council) ; Goldman Sachs (Chair of
International Advisors – from 1 April
2023) ; Princeton University z Princeton
School of Public Policy, LISD (Member
of the Advisory Council –from 01 April
2023) ; CAPRI, Center for AsiazPacific
Resilience and Innovation (Member of
the International Advisory Council from
01 April 2023) ; Catholic University of
Portugal (Visiting Professor at the
Institute of Political Studies and Director
of theCentre for European Studies) ;
The EUROPEAUM (Board Member) ;
WPLzWomen Political Leaders
(Advi sory Board Member) ; Jean Monnet
Foundation for Europe (Honorary
Committee Member) ; Global
Commission on Modern Slavery and

Board -202 3-Mtg -04 1
Minutes

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

1. Chair’s report

1.1 Noting that the meeting had been duly convened and finding a quorum of
members present, the meeting commenced at 10.15 Accra time on
6 December 2023. Prof Jos é Manuel Barroso, Board Chair, chaired the
meeting.

1.2 The Chair welcomed new Board and Alternate members attending their first
Board meeting , namely: Sai Prasad, Soleh Ayubi, Karin Berlin and Leila
Gharagozloo Pakkala.

1.3 He recognised His Excellency Budi Gunadi Sadikin, Minister of Health of
Indonesia , as a Gavi Board member -elect . He also welcomed His Excellency
Rakan Khaled bin Doshaish , Assistant Deputy Minister for Health of Saudi
Arabia , and Jean Kaseya , Director General of the Africa Centres for Disease
Control and Prevention (CDC) .

1.4 The Chair noted that the Gavi Implementing Country Caucus met on 4
December 2023 during which the members welcomed Sarah Goulding, Vice
Chair, as a special guest and discussed how to strengthen the role of the
Caucus. He also noted the All Chairs Group (ACG) met on 3 December 2023
during which the members discussed the recommendations being brought
forward to the Board at this meeting.

1.5 He acknowledged the work of the Board Committees noting the CEO Search
Committee, Governance Committee, and Audit and Finance Committee had
met earlier in the week.

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

1.7 The Board noted its minutes from 26 -27 June 2023 (Doc 01b) and
11 September 2023 (Doc 01c) which were approved by no objection on
18 October 2023 and 2 November 2023 respectively . They also noted a number
of Board and Committee appointments that had been approved by no -objection
consent since the June 2023 Board meeting (Doc 01d).

1.8 The Chair referred to the consent agenda (Doc 01 e) where nine
recommendations were presented for consideration. At the request of the Chair,
Brenda Killen, Director, Governance and Secretary to the Board , presented the
consent agenda decisions . The Board noted the financial implications of one
consent agenda item and queried if decisions with material financial
implications should be approved outside the consent agenda process. The

Board -202 4-Mtg -01 1
Minutes

Gavi Alliance Board Meeting
11 January 2024
Virtual Meeting


1. Chair’s Introduction

1.1 Noting that the meeting had been duly convened and finding a quorum of
members present, the meeting commenced at 14.00 Geneva time on
11 January 2024. Prof Jos é Manuel Barroso, Board Chair, chaired the meeting.

------

2. CEO Appointment

2.1 Jos é Manuel Barroso, Board Chair, introduced this item, noting that it had been
just six months since the CEO recruitment process had been relaunched and
the CEO Search Committee reinstated. He expressed his delight in being able
to present the outcome of the Search Committee and its recommendation, also
supported by the Governance Committee, that Dr Sania Nishtar be appointed
as Gavi CEO from 18 March 2024.

2.2 The Chair noted that both the Search Committee and the Governance
Committee had unanimously supported this recommendation.

2.3 He reference d the materials shared with the Board earlier that day and which
outlined the broad and inclusive approach which had been taken by the Search
Committee, supported by Russell Reynolds Associate s. They had followed a
rigorous and intensive process, during which candidates from all backgrounds
and all parts of the world had been considered. He provided information in
relation to the total number of applications received, those longlisted, shortlisted
and interviewed.

2.4 He recalled that the Search Committee had undergone unconscious bias
training and in this context each member of the Committee had been assigned
an ongoing role in the search which was designed to mitigate against the effects
of unconscious bias through the process.

2.5 The Board Chair noted that actions had been taken to build on lessons learned
from the previous recruitment process, not least the endorsement of the Search
Committee that the new CEO be provided with dedicated transition coaching
and advice as a critical factor to ensuring success in the role.

2.6 He noted that Dr Nishtar had demonstrated her expertise across all key
elements of the role and brings the emotional intelligence to lead the Secretariat
and the international recognition to maintain and raise Gavi’s global standing.
He also noted that the Search Committee had been impressed by Dr Nishtar’s

1


Board -2024 -Mtg -02 -Doc 01d

Report to the Board
6-7 June 2024

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


Since the December 2023 B oard meeting, seven decisions have been circulated
electronically for approval by no -objection consent in line with Section s 11 and 12 of
the Board and Board Committee Operating Procedures.
1) On 8 January 2024 , Board Members were invited to consider approv al of the
appointment of an Alternate Board Member and an Audit and Finance
Committee Member .

No objections were received prior to the end of 18 January 2024 and the following
decision was therefore entered into the record:

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

a) Appointed George Laryea -Adjea as Alternate Board Member representing
UNICEF, effective immediately and until his successor is appointed ; and

b) Appointed Onei Uetela (Alternate Board Member) to the Audit and Finance
Committee, effective immediately and until 31 December 2025 .


2) On 16 February 2024, Board Members were invited to consider approv al of the
European Investment Bank Letter of Credi Facility .

No objections were received prior to the end of 28 February 2024 and the following
decision was therefore entered into the record:

In accordance with Section 1 2.2 of the Board and Board Committee Operating
Procedures, on a no -objection basis, the Gavi Alliance Board:

Approved the activation of the European Investment Bank Letter of Credit Facility
in one or more transactions up to the full value of US$ 320 million for market
shaping transactions, which would be approved by the Market -Sensitive Decisions
Committee.

DOCUMENT ADMINISTRATION
VERSION
NUMBER
APPROVAL PROCESS DATE
1.0 Prepared by: Ethics , Risk and Compliance 19 March 2024
Reviewed by: Senior Leadership Team (SLT) Q2
Reviewed by: Audit and Finance Committee 30 May 2024
Doc 01e - Annex A
1. Purpose
1.1 In developing this Restrictive Measures Compliance Policy (hereinafter referred to as the
' Policy '), Gavi reaffirms its commitment to the mission of helping to save lives and
improving people's health. Our dedication extends to careful compliance with applicable
laws and regulations, donor commitments and ensuring that every action also aligns with
the ethical principles that guide our endeavors.
1.2 Gavi approaches compliance with the seriousness it deserves, understanding that while
restrictive measures are not intended to obstruct the provision of vaccines, promoting
health and other types of assistance, they do apply and necessitate thorough due
diligence. In navigating this regulatory landscape, we are conscious of the extensive array
of exceptions and licenses related to the restrictive measures in place and available to
balance the need to ensure delivery of life- saving vaccines and related activities.
1.3 This Policy provides guidance to enhance understanding and raise awareness among all
Gavi Staff, regarding their restrictive measures compliance responsibilities and how to
address the potential compliance risks they may encounter.
2. Principles
2.1 Commitment to operate ethically: Gavi is committed to upholding the highest standards
of ethical conduct, legal compliance, and social responsibility in its global operations. As
such, compliance with relevant restrictive measures is key to our mission and values.
2.2 Focus on Gavi’s mission: Gavi’s overarching focus will always be on providing health
support to those in need as defined in its mission and strategy . Compliance to restrictive
measures is an essential tool to ensure that the funds and activities conducted for global
health purposes and broader strengthening of health systems are not being diver ted.
Where there is potential disruption to fulfilling Gavi’s mission, we will seek necessary
exceptions and authori sations to ensure the provision of essential vaccines and related
support to countries without compromising these principles .
2.3 Risk based and principle -based approach: Gavi's approach to compliance with
restrictive measures is founded on a risk -based methodology, ensuring that our
compliance measures are proportionate, effective, and tailored to address potential risks.
In recognition of Gavi’s mission, we commit to avoiding unnecessary or excessive
restrictions that may impede the timely provision of vaccines and healt h system
infrastructure .
2. 4 Consistency and transparency: Gavi’s approach to restrictive measures compliance is
based on consistent application of measures across all activities and maintaining
transparency in dealings with third parties.
3. Definitions
3.1 Restrictive measures: a set of requirements arising from nationally -set, international or
UN- applied decisions (i. e., sanctions) that could restrict the provision of funds and
resources to designated entities or persons, as well as the broader restrictions on specific
business activities within particular economic sectors/territories .
Doc 01e - Annex A

1


Board -2024 -Mtg -02-Doc 01e

Report to the Board
6-7 June 2024

Subject Consent Agen da – as at 31 May 2024
Agenda item 01 e
Category For Decision

Section A : Introduction
Four recommendations are being presented to the Board under the Consent Agenda
for consideration. Detailed information on the items can be found in the relevant
Committee papers in a dedicated folder on BoardEffect at:
https://gavi.boardeffect.co.uk/workrooms/6459/resources/263982
Section B : Actions Requested of the Board
The Gavi Alliance Board is requested to consider the following recommendations from
the Gavi Alliance Governance Committee and the Gavi Alliance Audit and Finance
Committee .
Decision One – Board Committee Chair Appointments
Governance Committee recommendation to be shared with the Board after
Governance Committee meeting of 5 June 2024 .
Decision Two – Board and Committee Appointments
Governance Committee recommendation to be shared with the Board after
Governance Committee meeting of 5 June 2024 .
Decision Three – Appointment of Treasurer
Governance Committee recommendation to be shared with the Board after
Governance Committee meeting of 5 June 2024 .
Decision Four – Restrictive Measures Compliance Policy
The Gavi Alliance Audit and Finance Committee recommends to the Gavi Alliance
Board that it:

Approve the Restrictive Measures Comp liance Policy as set out in Annex A to Doc
01e.

Classified as Internal #
Gavi Alliance Board Workplan
Gavi Board Paper July-NovDecMar/Apr JuneNov/Dec Mar/Apr JuneNov/Dec Mar/Apr JuneNov/Dec
A.Strategy/Performance/Risk/MEL CEO's Report CEO's Report
DiscussionDiscussionDiscussion DiscussionDiscussion DiscussionDiscussion 2021-2025 Strategy Strategy, Programmes and Partnerships: Progress, Risks and Challenges Discussion DiscussionDiscussion Discussion Innovation TBD Information
Private Sector Engagement TBDInformationInformation
Civil Society and Community Engagement Approach TBD
Partners' Engagement Framework Strategy, Programmes and Partnerships: Progress, Risks and Challenges
Discussion DiscussionDiscussion DiscussionDiscussion DiscussionDiscussion Disease Surveillance and Diagnostics in Gavi 5.0 TBD
Risk and Asurance Report Risk and Assurance ReportDecisionDecisionDecisionDecision
2026-2030 Strategy TBD
Discussion DiscussionDiscussionDiscussion Funding Policy Review (Elegiblity, Transiation & Co-financing; Middle-Income Countries Approach; HSS Allocation Formula) TBDDecisionDecision
Health Systems strategy TBDDecision
Approach to Fragile, Conflict & Humanitarian Settings TBD
Discussion Measurement Framework (Targets & Indicators) TBDGuidanceDecisionDecision B.Vaccines & Sustainablity Typhoid TBD Pneumococcal AMC (Advance Market Commitment) TBD Vaccine Investment Strategy Vaccine Investment Strategy COVID-19 Vaccine Programme Update Country Programmes Delivery Update Information Gavi's role in Pandemic Prevention, Preparedness and Response TBD Day Zero Facility - First Response Fund TBDDecisionInformationInformationInformation African Vaccine Manufacturing Accelerator TBD DecisionInformationInformationInformation RSV Investment Case TBD Decision Market Shaping Strategy TBDGuidance
Decision C.Policy Transparency and Accountability Policy TBD Evaluation Policy TBD Donations Policy TBD GuidanceDecision D.Country Programmes
Nigeria TBD
Information
PNG TBD
Information
Strategic Partnership with India Strategic Partnerships with India
Fiduciary risk assurance and financial management capacity building Fiduciary risk assurance and financial management capacity building E.
Finance/Audit & Investigations Annual Accounts Annual Financial Report DecisionDecisionDecision Financial Forecast Financial Update, including forecastDecisionDecisionDecision DecisionDecision DecisionDecision
Budget Financial Update, including forecastDecisionDecisionDecisionDecision
Programme Funding Policy Consent Agenda
Treasury Governance Policy Consent Agenda
Treasury Risk Management Policy Consent Agenda
Independent Auditor Selection and Evaluation Policy Consent Agenda
Audit & Investigations Report Audit & Investigations ReportInformationInformationInformationInformation F.Governance
Board Chair Appointment Consent Agenda DecisionDecision
Board Vice Chair Appointment Consent Agenda DecisionDecision
Committee Chair Appointments Consent AgendaDecisionDecision Decision
Board and Committee Appointments Consent AgendaDecisionDecision Decision
IRC Appointments Consent Agenda
CEO Appointment Consent Agenda Decision
Secretary Appointment Consent Agenda
Treasurer Appointment Consent Agenda
Appointment of MD A&I Consent Agenda
Amendments to Governance Documents (Statutes, By-Laws, Committee Charters) Consent Agenda
Evaluation Advisory Committee Terms or Reference Consent Agenda
IRC Terms of Reference Consent AgendaDecision
Audit & Investigations Terms of Reference Consent Agenda
G. Reporting
Committee Chair Reports Committee Chair and IFFIm Board reports InformationInformationInformation InformationInformation InformationInformation IFFIm Chair Reports Committee Chair and IFFIm Board reports InformationInformationInformation InformationInformation InformationInformation Replenishment/Resource Mobilisaton Resource Mobilisation Update Discussion
Discussion Collaboration with other organisations TBD InformationInformation HR Report Closed Session InformationInformationInformation InformationInformation InformationInformation Annual Report on Implementation of the Gender Policy Annex to Strategy paper InformationInformationInformationInformation Board and Committee minutes Annex to Board pack/On BE as additional materials Information
InformationInformation InformationInformation InformationInformation H. Technical Briefing Sessions/Deep Dives
Evaluations
Gavi Forecasting/Resource Allocation
Country Performance - High Impact Countries
Country Performance - Fragile Countries
2026 2027
Last updated - 23 May 2024
Next Board Meetings: 4-5 December 2024
9-10 April 2025 (Retreat)
25-26 June 2025
3-4 December 2025
2024
2025
Board-2024-Mtg-02-Doc 01f

1


Board -2024 -Mtg -02 -Doc 02 _FR

Rapport au Conseil d’administration
6-7 juin 202 4

R apport de la Directrice exécutive
Le 30 mai 202 4

Chers membre s du Conseil d’administration ,

Cela fait un peu plus de deux mois que j'ai pris mes fonctions, mais nous avons déjà
accompli beaucoup de choses ensemble. Nous avons notamment jeté les bases du
renforcement de notre Secrétariat et de la reconstitution des ressources, dont la
réussite con ditionne le succès de la stratégie Gavi 6.0. J'ai le plaisir de vous présenter
ce rapport avant notre réunion de juin, au cours de laquelle vous aurez à adopter
grandes lignes de cette stratégie 6.0.

Ce rapport est divisé en deux parties. La première traite des mesures immédiates que
j'ai prises au cours des deux derniers mois pour répondre aux cinq priorités urgentes
que j'ai identifiées à l’issue de mes dix premiers jours à la tête de Gavi. La second e
présente les objectifs et les grandes lignes de mon plan d’action en 180 jours. Fondé
sur les informations recueillies et les analyses effectuées au cours des deux derniers
mois, ce plan d’action a pour but d’optimiser la capacité du Secrétariat à attein dre les
objectifs de la stratégie Gavi 5.1 et de préparer notre organisation à mettre en œuvre
la stratégie Gavi 6.0 pour la nouvelle période quinquennale et au -delà.

Les deux premiers mois : état d’avancement des cinq priorités

1. Développement de la sixième stratégie de Gavi : Gavi 6.0

Dès mon premier jour à la tête de Gavi, la priorité absolue a été l’élaboration de la
stratégie Gavi 2026 -2030 (Gavi 6.0), sixième cycle stratégique quinquennal de notre
organisation.

Le quatrième jour, j'ai organisé un atelier d'une journée sur le thème , "Prise de
recul sur Gavi 6.0 " ( Gavi 6.0 Step Back ) qui a été suivi de toute une série de réunions,
lesquelles ont ensuite permis d'établir un plan de travail au jour le jour . Ce plan de
travail a été suivi méticuleusement, ce qui a permis aux équipes de présenter des
analyses suffisamment détaillées pour étayer les discussions menées dans le but de
trouver un compromis lors de la retraite du Conseil d’administration, alimente r les
délib érations du Comité des Programmes et des Politiques (CPP), et enfin permettre
d’étayer les discussions lors de la réunion du Conseil d’administration.

En accompagnant ainsi les équipes du Secrétariat, j'ai surtout cherché à créer un
espace dans lequel les membres du Conseil d'administration se sentent libres
d'exprimer leurs divergences d'opinion sachant que, dans certains domaines, il va
falloir faire des choix qui vont nécessiter des compromis qui risquent d’être difficiles à
trouver. Seule une communication ouverte et transparente permettra d’atteindre un

1


Board -2024 -Mtg -02 -Doc 02

Report to the Board
6-7 June 202 4

Report of the Chief Executive Officer
30 May 202 4

Dear Members of the Board

It has been a little over two months since I took post, but we have already achieved
much together to lay the foundations for the strengthening of our Secretariat and for
the successful replenishment that we need to make the Gavi 6.0 strategy a success.
It is my pleasure to submit this report ahead of our June meeting, at which you will set
the broad parameters of that 6.0 strategy.

The report is organised in two parts. The first part deals with the immediate actions I
have taken over the past two months to execute against the five urgent priorities I
identified after my first ten days at Gavi. The second part sets out the objectives and
outline of my 180 -day plan, guided by evidence gathered and analyses undertaken
over the past two months, that will optimise the capabilities of the Secretariat to deliver
on our 5.1 goals, and prime the organisation to execute the Gavi 6.0 strategy an d
beyond.

The first two months: progress against five priorities

1. Supporting the development of Gavi’s sixth strategy: Gavi 6.0

Supporting the development of the Gavi 2026 –2030 Strategy (Gavi 6.0), the
organisation’s sixth five -year strategic cycle, has been an overriding priority since my
first day at Gavi.

On my fourth day in the office, I convened a ‘Gavi 6.0 Step Back’ full -day workshop ,
with a series of follow -up meetings, which then informed a daily workplan . This plan
has been followed in earnest, ensuring the teams were able to present detailed
analyses to support the Board retreat trade -off discussions, inform the Programme
and Policy Committee (PPC) deliberations, and ultimately support an informed
discus sion at the Board meeting.

My primary focus in supporting the Secretariat teams has been to create room to
acknowledge the difficult trade -offs required in certain areas, and to provide a space
in which Board members feel free to express differences of opinions . A durable
consensus must be born of open communication and transparency.

I have been steadfast in ensuring the Secretariat’s role is to provide the analyses and
information to inform Board discussions and decisions, but not to forge consensus.
This requires the Secretariat to provide transparent information with granular
analyses . This is a critical priority for me, and I have been working with the teams to

Board -2024 -Mtg -02-Doc 03a -Annex A 1
Report to the Board
6-7 June 202 4
Annex A: Technical report on Gavi 5.0/5.1 indicators
This is a technical report providing definitions of and progress against Mission and
Strategy Goal indicators in the Gavi 5.0/5.1 measurement framework. The technical
report is populated based on available data and updated bi -annually. The newly
available data for 2023 included in this report relates to Mission Goal M1 and Strategy
Goals S1.4, S3.1, S3.3, and SG4.
Note on target trajectories:
In the below graphs, the dotted lines represent the projected annual trajectory that was
forecasted when we set 2025 targets with the PPC/Board in May 2021; our assumption
was that coverage would return to 2019 coverage levels in 2021, with the exception o f
India which would take until 2022. This was noted in a footnote in the PPC paper at
the time (in May 2021 PPC meeting book: Doc 04 Gavi 5.0 Measurement Framework ):

To account for COVID -19 -related disruptions and recovery, it is assumed that vaccine
coverage returns to 2019 levels by 2021, with the exception of India, which we assume
returns to 2019 levels in 2022 and sub -national three doses of pneumococcal conjugate
vaccine (PCV3) scale up takes an additional year.


Gavi 5.0 Mission Indicators

M.1: Under -five mortality rate – Updated April 2024


By increasing access to immunisation and
enabling equal access to new and underused
vaccines, Gavi support is contributing to the
reduction in under -five deaths from vaccine -
preventable diseases.

Gavi countries saw an under -five mortality rate of
53.6 deaths per 1,000 live births in 202 2. At the
portfolio level we are well o n track to reach the
10% reduction target by 2025 – as of 202 2, Gavi
countries have achieved a 9% reduction from
baseline.


M.2: Number of future deaths averted with Gavi support – Updated September 202 3


This indicator estimates the impact of Gavi -
supported vaccinations in terms of averting future
deaths from vaccine -preventable diseases.
More than 2.4 million future deaths have been
averted by Gavi -supported vaccinations in 5.0
through 2022. The cumulative number of deaths
averted from 2000 through 2022 is more than 17.3
million .

This indicator will be updated in September 2024.

Board -2024 -Mtg -02-Doc 03a -Annex B 1
Report to the Board
6-7 June 202 4
Annex B: Ethics, Risk and Compliance update
1. Review of Gavi’s Risk Appetite Statement
1.1 In 2023, Gavi’s Board approve d changes to the Alliance Risk Appetite
Statement by reduc ing the current risk appetite (balanced) for V accine -
Preventable Diseases (VPD) outbreaks to low while maintaining the current risk
appetite (low) for campaigns undermining routine immunisation being of low
quality .
1.2 In 2024, the Ethics, Risk and Compliance office (ERCO) is pursuing a holistic
review of the Alliance Risk Appetite Statement through a two -phased approach:
1.2.1 Operationali sing , through development of guidance , the latest Board -
approved Risk Appetite Statement aligned with Gavi 5.1 strategy to help
Gavi’s staff interpret the Risk Appetite Statement and make conscious
and consistent risk -based decisions, in line with the defined risk appetite ;
and
1.2.2 Updating the Risk Appetite Statement following the approval of Gavi 6.0
strategy by the Board in June 2024 to ensure that the risk acceptability
levels applied by the Alliance as of 2026 are aligned with the new
objectives and strategic goals. Th e updated version of the Risk Appetite
Statement will be submitted for Board approval during the 2025
governance cycle and will come into force at the same time as the Gavi
6.0 strategy .
1. 3 Both the operationali sation of the latest Board -approved Risk Appetite
Statement and its update in light of Gavi 6.0 strategy will imply several in -depth
consultations with Risk Owners, Senior Leadership Team (SLT), Alliance
Partners and Board Committees members to ensure an inclusive review
process.
1.3.1 For the operationali sation of the latest Board -approved Risk Appetite
Statement (related to Gavi 5.1 strategy), Programme and Policy
Committee member s and Audit and Finance Committee members will
be consulted between Ju ly and October 2024 to review guidance related
to programmatic risk appetite ;
1.3.2 For the update of the Risk Appetite Statement considering Gavi 6.0
strategy, members of the Audit and Finance Committee and of the
Programme and Policy Committee as well as all relevant internal and
external stakeholders will be consulted from July 2024 to December
2025 to review and/or approve both the updated Risk Appetite levels and
the related operationali sation plans ; and
1.3.3 ERCO will share in advance a detailed consultation timeline with all
relevant stakeholders.

Board -2024 -Mtg -02-Doc 03a 1
Report to the Board
6-7 June 2024

Subject Gavi 5.1 Strategy, Programmes and Partnerships: Progress,
Risks and Challenges
Agenda item 03 a
Category For Information

Executive Summary
This report provides a progress update on the implementation of the Gavi
5.0/5.1 strategy, programmes and partnerships and associated risks 1. As
WHO -UNICEF estimates of national immunisation coverage (WUENIC) for 2023 will
be released in July 2024, the paper focuses on quantitative updates of strategy
indicators for which new 2023 data is available, as well as a more qualitative
perspective of p rogress 2. Early indications from administrative data suggest
countries have sustained coverage gains in 2022 into 2023 with a ~ 1% increase
in number vaccinated with third dose of diphtheria -tetanus -pertussis (DTP)
containing vaccine in 2023. However , the number of routine introductions of new
vaccines and planned preventative campaigns in 2023 are below target.
Despite delays in 2023, the Alliance remains on track in supporting countries to
reach introduction targets for the Gavi 5.0 / 5.1 period. The number of vaccine
preventable disease (VPD) outbreaks remains high, necessitating close
monitoring and continued support. The Alliance continues to work on delivering
its three Gavi 5.1 programmatic ‘must -wins’ . The revitalisation of the human
papillomavirus vaccine (HPV) programme remains on track to reach 86 million
girls by the end of 2025 if supply materiali ses as expected . The rollout of the
malaria programme is also on track with 22 applications approved to date, in
line with targets. To ensure a holistic approach to malaria prevention and control,
close collaboration between Gavi and the Global Fund to Fight AIDS, Tuberculosis
and Malaria (‘Global Fund’) is being stepped up (see Doc 0 8). Good progress has
also been made on the third must win: reaching zero -dose children by
accelerating implementation of the Equity Accelerator Fund (EAF) and
operationalising the Big Catch -Up (BCU). In 2023 countries contributed
US $ 215 million in co -financing, a 33% increase on 2022 , and did so in a timel ier
manner than before the pandemic. Co -financing accounted for 23% of the costs of
Gavi -supported vaccines, up from 10% a decade ago. To ensure successful delivery
of Gavi 5.1 priorities and get ready for Gavi 6.0, the Secretariat has continued to
implement its ambitious Operational Excellence (OE) agenda.

Action Requested of the Board
This report is for information only.
1 Associated risks refer to the mid -year update on top risks flagged in the 2023 Risk & Assurance Report. 2 See Annex A for the technical narrative on progress made against each strategic goal indicator as well as
appendix 1 for progress overview in the Gavi Balanced Scorecard .

gavi.org
JOINT ALLIANCE UPDATE
ON COUNTRY
PROGRAMMES
BOARD MEETING
Thabani Maphosa
Kate O’Brien
Ephrem Lemango
6 -7 June 2024, Geneva, Switzerland
Programme
performance
JOINT ALLIANCE UPDATE ON COUNTRY
PROGRAMMES

1


Board -2024 -Mtg -02-Audit and Finance Committee Chair Report
Report to the Board
6-7 June 2024

Subject Audit and Finance Committee Chair Report
Category For Information
Section A: Introduction
• This report provides the Board with an overview of the activities of the Audit
and Finance Committee (AFC) since the Committee Chair last reported to the
Board in December 2023.

• Since the last Board me eting, the AFC has met three times ( 14 February in
Copenhagen , 7 May and 30 May ) to consider Gavi recurring matters in
accordance with the standard workplan for Gavi 5. 1 and the Office of the
COVAX Facility as well as to consider new initiatives and Gavi 6.0 plans .

• In addition, the committee chair held several sessions with Secretariat staff in
relation to financial risk management with IFFIm and the Secretariat Treasury
team , the financial statements , Gavi 6.0 strategic cost estimate and the
appointment of a firm to conduct an external quality assessment of Gavi’s
internal audit function .

• The AFC was hosted by UNICEF in Copenhagen and members had the
opportunity to tour the supply division warehouse as part of the visit.

• Specific s ubjects reviewed are noted under Section B and matters to be
reviewed in upcoming meetings are presented under Section C.

• The AFC also had briefings and updates from the CEO and COO in closed
sessions at each of its meetings.

• The AFC has expressed its appreciation for the improvement in the quality of
materials provided by the Secretariat and the depth and transparency of the
analysis and data presented.

• AFC recommendations to the Board are attached as Annex A.

Section B: Subjects reviewed
1. Programme Update

• The AFC received presentations which provided an update on programmes .

gavi.org
—
Annual Evaluation
Report 2023
Appendix 1 to EAC Chair Report
Acronyms
Foreword
Section 1: Evaluation practice at Gavi1.1 Purpose of the evaluation function
1.2 Types of evaluations
1.3 Oversight, roles and accountabilities for Gavi’s evaluations
1.4 Gavi’s centralised evaluation workplan for 5.0/5.1
1.5 Use of evidence from evaluations
Section 2: Annual Evaluation Report 2023 dashboard 2.1 Evaluations completed or ongoing in 2023
2.2

T
racking EMR implementation
2.3 Evaluation-related reviews and syntheses
Section 3: Use of evidence from previous evaluations 3.1 Examples of the use of evaluation evidence
3.2 Overview: key insights from previous HSS evaluations
Section 4: Strengthening evaluations in Gavi 5.0/5.1  4.1

Measur
es introduced to enhance the credibility, independence
and utility in 2023
4.2 Learning from MOPAN assessments
Section 5: Looking to the future 5.1 Development of the Centralised Evaluation Workplan for Gavi 6.0
5.2 Learning from the upcoming Evaluation Function Review
5.3 Strengthening Gavi’s Evaluation Function for 6.0
References Annex A:

Details of completed or ongoing centralised evaluations in 2023
Annex B:


Details of completed or ongoing decentralised evaluations in 2023 3
4
7
7
8
8
9
12
14 14
19
20 2121
22
23 23


24
25 25
25
26
27 28
34
Table of contents
2
Annual Evaluation Report 2023
Appendix 1 to EAC Chair Report

1


Board -2024 -Mtg -02-EAC Committee Chair Report
Report to the Board
6-7 June 2024

Subject Evaluation Advisory Committee Chair Report
Category For Information
Section A: Introduction
• This report provides the Board with an overview of the activities of , and
guidance provided by , the Evaluation Advisory Committee ( EAC ) since the
Committee Chair last reported to the Board in December 2023 .
• At the in -person EAC meeting on 20 -21 March 2024, the EAC provided
guidance on: (i) progress of the commissioned Gavi 5.1 centralised evaluations
including the proposed centralised evaluation on sustainability/post transition ;
ii) the Zero -Dose Evaluation; (ii i) the Mid -Term Evaluation (MTE) of Gavi’s
2021 -2025 Strategy ; (i v) the COVAX Evaluation; (v) centralised evaluation work
planning for Gavi 6.0 ; (vi) the Evaluation Function Review planned for 2024;
and (vii) EAC engagement in Gavi 5.1 evaluations.
Section B: Overarching issues and guidance

• The EAC continue d to consider its remit, voice and practice in supporting a Gavi
evaluation portfolio of optimal independence, credibility and utility . The on -
going MOPAN assessment and the forthcoming Evaluation Function Review
will offer useful inputs into this process.
• The EAC provided guidance on the development of the Gavi 6.0 Centralised
Evaluation Workplan (CEWP) . Regarding stakeholder consultation, the EAC
encouraged the Secretariat to : (i) consult stakeholders and relevant partners ;
and (ii) map against other evidence generation functions such as Learning
Hubs , audit s, decentralised evaluations . On the proposed principles for the
Gavi 6.0 CEWP , the EAC advised to : (i) clarify the purpose of the proposed
principles for work planning; (ii) revisit content ahead of September 2024
meeting to align with policy aims o f credibility, utility and independence ; and (iii)
include issues of country representation/evidence partnerships . The EAC
provided feedback on potential topics for discussion at the September 2024
meeting related to principles, approaches, methods and data issues with
implications for evaluation work planning for Gavi 6.0.
• Regarding the Evaluation Function Review , the EAC advised for arrangements
to be put in place to ensure independence and oversight of the review ,
including : bringing in key stakeholders across Gavi’s Board, Programme and
Policy Committee (PPC) and Senior Leadership Team, and keeping them
informed early and throughout the process . EAC members also noted that this
review should consider the implications of all relevant developmen t trends (e.g.
Leave No One Behind, localisation, subnational focus, Lusaka Agenda, and
partnership ) and advised that a survey be added to the methodology for the

1
Board - 2024 - Mtg - 02 - Governance Committee Chair Report Report to the Board
6 - 7 June 2024
Subject Governance Committee Chair Report
Category For Information
Section A: Introduction
• This report provides the Board with an overview of the activities of the
Governance Committee (GC) since the Committee Chair last reported to the
Board in December 2023 .
• The GC met virtually on 26 February 2024 , in person on 16 April 2024, and will
meet again in person on 5 June 2024.
• In addition to some regular business such as Board and Committee
nominations, the recruitment of Unaffiliated Board Members and the
governance risk matrix, Committee discussions focused on ( i) the CEO
transition and onboarding process; (ii) Operational Excellence and Human
Resources; (iii) Board and Board Committee Evaluation ; (iv) Protection from
Sexual Exploitation, Abuse and Harassment (PSEAH) Policy ; (v) Human
Resources Sub c ommittee T erms of Reference ; (vi) Collaboration with the
Global Fund to Fight AIDS, Tuberculosis and Malaria; and (vii) P roposal for
governance of the Africa n Vaccine Manufacturing Accelerator (AVMA).
• At its meeting on 5 June 2024 the Governance Committee will discuss
proposals for Strengthening Implementing Country Constituency ; review the
proposed AVMA and Day Zero Financial Facility First Response Fun d
Governance ; the Appointment of the Treasurer; and c ollaboration with o ther
global health o rgani s ations.
• The GC Chair report is attached in the form of a presentation as Annex A .
Annexes
Annex A : Governance Committee Chair report
Additio nal information available on B oard Effect
App endix 1: Protection from Sexual Exploitation, Abuse and Harassment (P SEAH)
P olicy
App endix 2 : Human Resources Subcommittee Terms of Refer enc e

Gavi Alliance
Protection against Sex ual Exploitation, Abuse
and Harassment Policy
Version 1.0



DOCUMENT ADMINISTRATION



VERSION
NUMBER APPROVAL PROCESS DATE
1.0
Prepared by: Ethics, Risk and
Compliance December 2023
Review ed and approved by: Senior
Leadership Team February 2024
Review and a pproved by:
Governance Committee
16 April 2024
Effective from: 1 December 2024
Next review: As and when requested






2

Gavi Alliance
Protection against Sexual Exploitation,
Abuse and Harassment Policy
1. Purpose
1.1. Sexual Exploitation and Abuse are grave breach of trust, and a betrayal of Gavi’s
mandate for saving lives in often vulnerable contexts. Sexual Harassment and
other forms of Harassment are a manifestation of a culture of discrimination and
privilege based on unequal gender relations. Both underm ine the fundamental
rights of all those whom Gavi serves and everyone who works for Gavi to be treated
with dignity and respect.
1.2. This Policy introduces the Gavi Alliance (Gavi’s) approach to the protection of
children and adults against Sexual Exploitation, Abuse, and Harassment.
1.3. This Policy also serves to ensure effective implementation of the Ethics, Risk and
Compliance Charter as well as Gavi’s PSEAH Strategy (2023) and annual work
plan which outlines the priorities and activities to be undertaken each year to
advance Gavi’s pre vention of sexual exploitation, abuse, and harassment
(“PSEAH”) commitments and principles.
2. Principles and commitments
2.1. Zero tolerance: Gavi does not tolerate any form of sexual exploitation, abuse, or
harassment by governance and advisory officials, Gavi Staff or those of its partners
working on Gavi programmes. All Gavi Staff are explicitly prohibited from engaging
in any activity that results in any kind of sexual exploitation, abuse, harassment or
failure to follow good safeguarding practices towards any person, and in particular
children or at -risk adults. Gavi expects its partners to adopt a comparable
approach. Gavi w ill always respond to any known instance of sexual exploitation,
abuse or harassment in its programmes. Similarly, Gavi expects its own Staff to
pass on any reports of sexual exploitation, abuse or harassment to the appropriate
reporting channels and will not accept any failure by its Staff to do so.
2.2. Response to sexual exploitation and abuse: Sexual exploitation and abuse by
Gavi Staff constitutes gross misconduct. We expect the highest standards of
behaviour from all Gavi Staff, and we seek to prevent abusers entering our
organisation. Any Gavi Staff found to have engaged in sexual exploitati on or abuse
or failure to follow good safeguarding practices has committed gross misconduct
and will face disciplinary measures under Gavi’s Investigation and Disciplinary
Procedures which may result in summary dis missal. Examples of sexual
exploitation and abuse include transactional sex, soliciting transactional sex,
sexual assault, rape, or any type of sexual activity with a child. If Gavi becomes
aware of any sexual exploitation or abuse by non -Gavi staff working on Gavi
programmes, we will work with the appropriate partner organisation to ensure it is
properly addressed. This may ultimately involve referring the matter to the
appropriate law enforcement authorities. Sexual exploitation and abuse by
governance and advisory officials and third parties constitute breaches and may
result in appropriate sanctions.
2.3. Response to sexual harassment: Sexual harassment by Gavi Staff may
constitute gross misconduct. Any Gavi Staff found to have engaged in sexual
harassment will face disciplinary measures under Gavi’s Investigation and
Disciplinary Procedures. If Gavi becomes aware of any sexual harassm ent by non -
Gavi staff working on Gavi programmes, we will work with the appropriate partner
organisation to ensure it is properly addressed. This may ultimately involve

HUMAN RESOURCES SUBCOMMITTEE FEBRUARY 2024
TERMS OF REFERENCE
1. P U RP O S E A N D F U N C T I O N
The Human Resources Subcommittee (“Subcommittee ”) has been established as a
permanent Subcommittee of the Governance Committee to support the Governance
Committee in the efficient and effective fulfilment of its duties and responsibilities as they
relate to HR strategy, and in particular compensation and benefits, organisational culture
and wellbeing and mak ing recommendations to the Gavi Board on the Gavi Secretariat
human resources strategy and policy.
The Subcommittee shall not be deemed to be a committee of the Board in that its primary
role is essentially a consultative and advisory function and therefore shall be strictly
advisory in nature with no powers of decision -making or execution .
Words and expressions used in this terms of reference shall, unless the context requires
otherwise, have the meaning attributed to them in the Gavi Operating Procedures .
2. C O M P O S I T I O N , A P P O I N T M E N T A N D T E R M O F O F F I C E
The composition of the Subcommittee shall comprise the following :
• Governance Committee Chair ;
• Three additional members of the Governance Committee;
• The CEO.
Subcommittee members shall be appointed by the Governance Committee.
The Subcommittee shall choose its Chair from amongst its members .
The term s of the members on the Subcommittee is linked to the term of their office which
gave rise to their membership of the Subcommittee .
Members will serve on the Subcommittee in their individual capacities (and are not
required to bring the views of their organisation or constituency to bear on discussions).
Expert advisers may be invited to participate in Subcommittee meetings at the discretion
of the Subcommittee Chair from time to time. The role of expert advisers is to support the
Subcommittee on highly technical or specialised issues that come before the

1


Board-2024- Mtg-02-Investment Committee Chair Report
Report to the Board
6-7 June 2024

Subject Investment Committee Chair Report
Category For Information
Section A: Introduction
• This report provides the Board with an overview of the activities of the
Investment Committee ( “Committee” ) since the Committee Chair last reported
to the Board in December 2023. The Committee met twice in 1H 2024. Three
key topics covered were (1) portfolio performance; (2) private assets
implementation; and (3) sustainable investment review.
• All values are reported as of 31 March 202 4. The long- term portfolio value is
US$ 1 ,385 million including advanced contribution and cash held at custodian,
an increase of US$ 137 million from the value last reported at the December
2023 board meeting. The long- term portfolio does not have cash inflows so t he
increase is solely related to performance.
• For the trailing 12 months ending 31 March, the long -term portfolio delivered
+14.6% versus +11.0% , or +3.6% of excess performance. Calendar year 2023
performance was also very strong: +13.2% versus the policy index return of
+11.8% . or excess performance of + 1.4%. The long- term portfolio delivered five
consecutive calendar years of excess performance (2019 through 2023).
• Strong performance of global financial markets has been driven by a resilient
economy , consumer spending, and technological innovation. Sticky US inflation
and higher -for -longer interest rates pose a potential threat to the financial
market s in the second half of the year.
• Performance results were strong across the major asset classes in the long-
term portfolio. For the trailing twelve months ending 31 March 2024, f ixed
income (37% of portfolio) was the strongest performer on a relative basis,
outperforming its m arket benchmark by + 7.0%. Diversifiers (17% of portfolio)
outperformed its market benchmark by + 2.3%. Equities (45 % of portfolio) trailed
its market benchmark by - 0.5% but strong performance from the asset class on
an absolute basis helped overall portfolio performance. The private assets
allocation is de minimus (1%) and its illiquidity also means performance
measurement is less frequent.
• The private assets implementation that began in 2023 continues into 2024 as
part of a high priority, multi-year buildout. Private assets include private equity
and real estate. In 2023 the Investments team initiated the private equity
allocation , making commitments to three managers. Weighing the impact of
higher interest rates on real estate, the Committee’s guidance was to delay real
estate implementation until 2024.

1


Board -2024- Mtg-02-IFFIm Chair Report
Report to the Gavi Board
6-7 June 2024

Subject IFFIm Chair Report
Category For Information
Overview
• This report provides the Board with an overview of the activities of IFFIm’s
support to date for Gavi’s 2021 - 2025 strategic period and expected future
capacity.
• IFFIm has reviewed administrative aspects of is operations including the United
Kingdom’s annual rating of IFFIm as A+, Fitch’s revised outlook to stable, and
recruitment for the IFFIm Board.
• The IFFIm Board, in consultation with Gavi and the World Bank (IFFIm’s
Treasury Manager), are discussing the best approach to the replenishment for
the Gavi 6.0 strategic period.
• As part of continued efforts to maximise IFFIm's strategic value for Gavi, several
enhancements have been made to IFFIm in recent years. IFFIm continues to
be a valuable tool in Gavi’s financial toolkit, and its flexible model will be critical
in the Gavi 6.0 strategic period.
• Annexed hereto, is the IFFIm Chair Report to be presented and discussed
during the forthcoming Gavi Board meeting.
Annex
Annex: IFFIm Chair Report

1


Board -2024 -Mtg -02-PPC Committee Chair Report
Report to the Board
6-7 June 2024

Subject Programme and Policy Committee Chair Report
Category For Information
Section A: Introduction
• This report provides the Board with an overview of the activities of the
Programme and Policy Committee ( PPC ) since the Committee Chair last
reported to the Board in December 2023 .
• On 15 -16 May 2024, the PPC held an in -person meeting. During the meeting,
the Committee discussed a number of important topics for the Alliance and
agreed on recommendations which are being put forward to the Board at its
6-7 June 2024 meeting for consideration.
• The PPC Chair report is attached in the form of a presentation as Annex A , the
PPC recommendations to the Board are attached as Annex B , and a set of
over view slides on Gavi ’s Eligibility, Tra nsition and Co -Financing (ELTRACO)
model that were used by the PPC in its last meeting are attached as Annex C.
Annexes
Annex A : PPC Chair report
Annex B : PPC recommendations to Gavi Alliance Board
Annex C : Overview slides on ELTRACO model

Gavi 6.0 strategy one - pager (2026 – 2030)
1 Leaving no one behind with immunisation
EnablersMission 2030 Mission 2030 To save lives and protect
people’s health by
increasing equitable and
sustainable use of vaccines Mission indicators • Reduction in zero - dose children
• Children immunised
• Economic benefits unlocked tbc
tbc
tbc tbc
tbc
tbc
tbc • Under - five child mortality reduction
• Future deaths averted
(including disaggregated for climate - sensitive diseases)
• Future DALYs averted
• Country - led, sustainable: Bolster country leadership to sustainably finance and deliver
immunisation
• Community - owned, inclusive: Engage communities and civil society organisations in planning,
implementation and oversight of immunisation
• Zero - dose and missed communities, first priority : Prioritise children missing out on
vaccination, including among migrants, displaced and other vulnerable populations
• Gender - focused: Identify and address gender - related barriers to promote immunisation equity
• Differentiated, fragility - responsive: Target and tailor support to regional, national and subnational
needs, including fragile, conflict and humanitarian contexts • Integrated: Strengthen integration of immunisation and primary health care to reach missed
communities in support of U niversal H ealth Coverage
• Adaptive, resilient: Help countries leverage immunisation to address the challenges of global health
security , antimicrobial resistance and other major global issues
• Climate - sensitive : Support countries to adapt to the consequences of climate change and mitigate the
carbon footprint of the Alliance
• Innovative: Identify and scale up innovative products, practices and services to support Gavi’s goals
• Collaborative, accountable : Accelerate purposeful partnerships with regional and global health
institutions to collectively and efficiently respond to countries’ needs
Principles
IMPROVE PROGRAMMATIC AND
FINANCIAL SUSTAINABILITY OF
IMMUNISATION PROGRAMMES ENSURE HEALTHY MARKETS FOR
VACCINES AND RELATED PRODUCTSINTRODUCE AND SCALE UP
VACCINES
Goals1 3 4STRENGTHEN HEALTH SYSTEMS TO
INCREASE EQUITY IN IMMUNISATION2Goals
Objectives
Strengthen countries’ prioritisation and
optimisation of vaccine programmes,
appropriate to their context
Support countries to introduce and scale up
vaccines for prevention of endemic, epidemic
and pandemic diseases including beyond
infancy
Ensure equitable and timely access to
mechanisms to respond to outbreaks,
epidemics, and pandemics Strengthen regional, national and
subnational political and social commitment
to immunisation, including through increased
domestic public resources
Ensure sustainable transition through stronger
capacity of eligible countries to maintain
immunisation performance
Engage self - financing countries to maintain
performance and catalyse critical vaccine
introductions Drive healthy vaccine markets for Gavi -
supported and self - financing countries,
including acceleration of access to new high -
impact , affordable vaccines and delivery
innovations
Enhance regional vaccine supply security, in
support of regional manufacturing expansion
ambitions
Develop sustainable markets for vaccines
against outbreak, epidemic, and pandemic -
prone diseasesEnable countries to extend immunisation to
zero - dose children and missed communities,
integrated with primary health care, including
through addressing gender - related barriers and
building resilient demand
Ensure all children are fully immunised by
maintaining and strengthening routine
immunisation with vaccines required through
second year of life
Support countries to adapt systems to routinely
deliver vaccines to populations outside early
childhood through targeted and catalytic
interventionsObjectives
• Secure long - term predictable funding for Gavi programmes
• Deliver as one Alliance with strengthened accountability mechanisms
• Ensure global political commitment for immunisation and global health security • Ensure simple, efficient and agile Gavi operating model
• Drive digitalisation (including artificial intelligence), improved data and evidence
• Leverage the private sector and development finance institutions, including through innovative
finance mechanisms
Enablers A
B
CA
B
CA
B
CA
B
C
Doc 05 - Annex A

Board -2024 -Mtg -02 -Doc 05 -Annex B 1


Report to the Board
6-7 June 2024
Annex B: Narrative for Gavi 6.0, the Alliance’s 2026 – 2030 strategy
This document provides the strategic narrative for the Gavi 6.0 ‘one -pager
framework ’, providing more background for each of its key elements.

1. Vision: Gavi ’s vision of ‘leaving no one behind with immuni sation’
recognises the link to the SDG ambition and the critical contribution of
immunisation to it . The vision highlights the opportunity to reach all children
with immunisation by the end of the SDG era . It remains relevant for the 2026
– 2030 period, and in line with the Immunisation Agenda 2030 . It will therefore
remain unchanged.
2. Mission : In line with the vision, Gavi’s mission continue s to be ‘to save
lives and protect people’s health by increasing coverage and equitable
use of vaccines ’. Th is mission was revised for Gavi 5.0 and put s ‘equity’ at the
heart of the Alliance’s strategy. It recognises that the access and use of
vaccines protect s people at all stages of life ; preventing both the primary
causes of mortality in children (including diarrhoea and pneumonia) and
cancers later in life triggered by vaccine -preventable infections (such as
cervical cancer from HPV and liver cancer from hepatitis B) , and protecting
against epidemics and pandemics .
3. Principles : Most principles remain unchanged or see targeted updates
compared to Gavi 5.1 . A new principle on climate change has been added.
3.1 “Country -led, sustainable: bolster country leadership to sustainably finance
and deliver immunisation .” This principle , alongside the second one, has been
moved up to signal the importance of country led approaches and community
engagement in Gavi 6.0 , including in priority setting for immunisation .
3.2 “Community -owned, inclusive: engage communities and civil society
organisations in planning, implementation and oversight of immunisation .”
3.3 “Zero dose and missed communities, first priority: prioritise children
missing out on vaccination, including among migrants, displaced and other
vulnerable populations .” This principle signals Gavi’s core focus on the equity
agenda, further described under Strategic Goal 2 ( Section 5). It will remain
Gavi’s core programmatic priority.
3.4 “G ender -focused: identify and address gender -related barriers to promote
immunisation equity .” Building on the learnings from Gavi 5.1, the Alliance will
continuously enhance its approach to gender -responsive programming and
gender equity, benefits both vaccinees and vaccinators (see Section 5).
3.5 “D ifferentiated, fragility -responsive: target and tailor support to regional,
national and subnational needs, including fragile, conflict and humanitarian
contexts .” Gavi -eligible countries have a wide range of performance, with an
increasing share facing significant systemic challenges. The Alliance will further
support countries to differentiate their interventions, prioritising, targeting and

Board -2024 -Mtg -02-Doc 05 -Annex C 1
Report to the Board
6-7 June 202 4
Annex C: Gavi 6.0 - High level approach to operationalising the new strategy
1. Following Board consideration of Gavi 6.0 in June 2024, the Secretariat
will start operationalising the new strategy, with the aim to conclude by
December 2025. Gavi 5.1 execution will, however, remain the priority over the
next 18 months. The operationalisation will build on lessons learned from recent
external evaluations 1. Based on early planning, the operationalisation will be
structured around five workstreams and informed by the latest financial forecast
for Gavi 6.0. The operationalisation will build on lessons learned from recent
external evaluations. A strategic coordination mechanism will ensure alignment
and progress of the workstreams in the Secretariat.
i. Workstream 1: Development of a theory of change and measurement
framework . The Secretariat will translate the Gavi 6.0 ‘one -pager’ into a
Gavi 6.0 ‘theory of change’. The theory of change will provide the basis for
the Gavi 6.0 measurement framework, including the indicators (incl. final
mission indicators) and targets that wil l be brought to the Gavi Board for
approval in 2025.
ii. Workstream 2: Finalisation of key sub -strategies. These sub -strategies
or approaches will include (i) the Health Systems Strategy (with work
already ongoing since September 2023; see Doc 06b ); (ii) Gavi’s new
approach to Fragile, Conflict, and Humanitarian settings; and (iii) Gavi’s
Climate Change approach. These will be developed in the second half of
2024 and first half of 2025. Gavi’s market shaping strategy is also subject
to updates in 2 025.
iii. Workstream 3: Updates of Gavi’s programmatic policies . The updates
will include the review of the Eligibility and Transition Policies; the Co -
financing Policy and the Health Systems and Immunisation Strengthening
Policy to hardwire the evolution of Gavi’s support into its funding policies.
These will be brou ght to Board for approval in the second half of 2024 and
first half of 2025.
iv. Workstream 4: Evolution of the Alliance partnership approach. This
will involve enabling the Partner Engagement Framework (PEF) to support
a new partnership agenda, including the consolidation of global and
regional funding mechanisms for strengthened coordination, accountability,
and impact. New partnerships at loc al and regional level will be designed
and implemented to deliver on Gavi 6.0 priorities, such as those focusing
on PHC and engagement in Fragile, Conflict, and Humanitarian settings,
including w ith the private sector. Additionally, the Alliance will continue
efforts to drive collaboration with other global health initiatives, such as the
Global Fund to Fight AIDS, Tuberculosis and Malaria in line with the Lusaka
Agenda, and forge new innovative f inancing partnerships, e.g. with
multilateral development banks.
1 Available here: https://www.gavi.org/programmes -impact/our -impact/evaluation -studies

Classified as Internal
gavi.org
GAVI 6.0 ‘STRATEGIC COST ESTIMATE’
AUDIT AND FINANCE COMMITTEE MEETING
Ian MacTavish, Finance Director and Chief Accounting Officer
30May 2024, Virtual
Doc 05 - Annex D
Classified as Internal
Context & Objectives: AFC review of Gavi 6.0 Strategic Cost Estimate
•Board-led process to develop
Gav
i 6.0 strategy over past 12
months
• Gavi Secretariat completed a
str ategi

c cost estimate of Gavi
6.0 strategy to inform the
discussion
• As a result, Gav
i 6.0 One Pager*
will be put forward for approval to
June Board, supported by
strategic narrative and indicative
strategic cost estimate
*- see Annex for draft Gavi 6.0 “one pager”
Context Objectives of the AFC discussion
• AFC to review and provide guidance on key
assumptions and potential financial risks and
opportunities which could impact delivery of Gavi
6.0 strategy
• Secretariat to provi de
update on source of funds
status ahead of replenishment event
• Not in scope: (i
) review of Gavi 6.0 strategic
priorities (ii) financial impact of strategic choices
not selected at April 2024 Board retreat (iii)
replenishment ask to deliver the strategy
Next steps:
• Feedback to Board (via AFC Chair briefing)
• Operationalisation of Gavi 6.0 strategy, including detailed 6.0 Financial Forecast reflecting outcome of
replenishment (2025 May AFC)
Audit and Finance Committee, 30 May 2024 2
Doc 05 - Annex D

Board -2024 -Mtg -02-Doc 05 -Annex E 1
Report to the Board
6-7 June 202 4
Annex E: Shortened versio n of the one -pager framework and comparison with Gavi 5.1

To provide flexibility while keeping essential information easily accessible, below is a shortened one -pager framework
(preliminary version) for certain communication purposes. Following the June Board meeting decision, the Gavi website would
be updated and feature a drop -down section that expands into the full version for each item described in the one -pager.
1


Board -2024 -Mtg -02-Doc 05 -Annex E 2
Report to the Board
6-7 June 202 4
In addition, below is a track -changes version of the one -pager, show ing the main changes from the 5.1 version to 6.0 (in blue):
Gavi 6.0 strategy one -pager (2026 –2030)
3
Leaving no one behind with immunisation
Enablers
Mission 2030
Blue: main evolution in Gavi 6.0 vs 5.1
Mission 2030 Tosavelivesandprotect people’s healthby increasing equitable and sustainable use of vaccines Mission indicators
•Reduction inzero-dosechildren •Children immunised •Economic benefits unlocked tbctbctbc tbctbctbctbc
•Under-five child mortality reduction •Future deaths averted(including disaggregated for climate -sensitive diseases) •Future DALYs averted •Country -led, sustainable: Bolster country leadership to sustainably finance and deliver immunisation•Community -owned, inclusive: Engage communities and civil society organisations in planning, implementation and oversight of immunisation •Zero-dose and missed communities, first priority: Prioritise children missing out on vaccination, including among migrants, displaced and other vulnerable populations •Gender -focused: Identify and address gender-related barriers to promote immunisation equity •Differentiated , fragility -responsive :Target andtailorsupport toregional , national andsubnational needs,including fragile, conflict and humanitarian contexts
•Integrated: Strengthen integration of immunisation and primary healthcaretoreach missed communities insupport of Universal Health Coverage •Adaptive, resilient: Helpcountries leverage immunisation toaddress the challenges of global health security,antimicrobial resistance andothermajor global issues •Climate -sensitive : Support countries to adapt to the consequences of climate change and mitigate the carbon footprint of the Alliance •Innovative: Identify and scale up innovative products, practices and services to support Gavi’s goals •Collaborative, accountable : Accelerate purposeful partnerships with regional and global health institutions to collectively and efficiently respond to countries’ needs
Principles
IMPROVE PROGRAMMATIC AND FINANCIAL SUSTAINABILITY OF IMMUNISATION PROGRAMMES ENSURE HEALTHY MARKETS FOR VACCINES ANDRELATED PRODUCTS INTRODUCE ANDSCALE UP VACCINES Goals 1 3 4 STRENGTHEN HEALTH SYSTEMS TO INCREASE EQUITY INIMMUNISATION 2 Goals
Objectives
Strengthen countries’ prioritisation and optimisation of vaccine programmes, appropriate to their contextSupport countries to introduce and scale up vaccines for prevention of endemic, epidemic and pandemic diseases including beyond infancy Ensure equitable and timely access to mechanisms to respond to outbreaks, epidemics, and pandemics
Strengthen regional , national and subnational political and social commitment to immunisation, including through increased domestic public resourcesEnsure sustainable transition through stronger capacity of eligible countries to maintain immunisation performanceEngage self -financing countries to maintain performance and catalyse critical vaccine introductions
Drive healthy vaccine markets for Gavi - supported and self -financing countries, including acceleration of access to new high - impact, affordable vaccines and delivery innovationsEnhance regional vaccine supply security, in support of regional manufacturing expansion ambitionsDevelop sustainable markets for vaccinesagainst outbreak, epidemic, and pandemic - prone diseases
Enable countries to extend immunisation to zero-dose children and missed communities, integrated withprimary health care , including through addressing gender -related barriers and building resilient demandEnsure all children are fully immunised by maintaining and strengthening routine immunisation with vaccines required through second year of life Support countries to adapt systems to routinely deliver vaccines to populations outside early childhood through targeted and catalytic interventions
Objectives
•Secure long-termpredictable funding forGavi programmes •Deliver as one Alliance with strengthened accountability mechanisms •Ensure global political commitment for immunisation and global health security •Ensure simple, efficient and agile Gavi operating model •Drive digitalisation (including artificial intelligence), improved data and evidence •Leverage the private sector and development finance institutions , including through innovative finance mechanisms Enablers
A
B
C
A
B
C
A
B
C
A
B
C

Board -2024 -Mtg -02-Doc 05 1
Report to the Board
6-7 June 2024

Subject Gavi 6.0 – The Alliance’s strategy 2026 -2030
Agenda item 05
Category For Decision

Executive Summary
This paper provides an overview and seeks approval of the Alliance’s 2026 -2030
strategy (‘Gavi 6.0’), grounded in its vision, mission, strategic goals, objectives,
operating principles and enablers. Led by the Board, the Gavi 6.0 design started in
March 2023, informed by a country -centr ic, consultative process. Gavi 6.0 will be an
ambitious yet realistic strategy that is based on Gavi’s core mandate, country needs
and capacity, fiscal context and the Alliance’s comparative advantage. Responding
to key contextual shifts in the world, sign ificant impact can be expected from Gavi
6.0 in line with the Alliance’s vision of ‘leaving no one behind with immunisation’:
• access to the widest, most innovative portfolio of critical life -saving vaccines
ever, vaccinating >500 million more children and adolescents, and saving 8 -9
million more lives;
• accelerating Gavi’s equity agenda, contributing to the Immunisation Agenda (IA)
2030’s ambition to reduce zero -dose children by 50%, integrated with primary
health care (PHC);
• enhancing Gavi’s eligibility, co -financing and transition model, ensuring it
protects Gavi’s investments and addresses inequities in access to vaccines in
middle income countries (MICs);
• stronger global health security building on the lessons from Gavi’s outbreak
response and COVAX. Ensuring that Gavi’s programmes make climate change
adaptation 1 and mitigation 2 part and parcel;
• streamlining the Secretariat operating model and revamping the Alliance model
for fragile, conflict, and humanitarian settings to better reach left behind children
with life -saving vaccines; and
• starting the next chapter in building new partnerships including with regional
organisations such as the African Union Commission and African Centres for
Disease Control and with other Global Health Institutions in line with the Lusaka
Agenda.
The document also presents the indicative strategic cost estimate for the new
strategy.

1 Climate change adaptation: The process of adjustment to actual or expected climate and its effects, in order to moderate harm or exploit beneficial opportunities. 2 Climate change mitigation: Human intervention to reduce emissions or enhance the sinks of greenhouse gases.

Board -2024 -Mtg -02-Doc 06a -Annex A 1
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6-7 June 2024
Annex A: Overview of the existing ELTRACO model and MICs approach, including
main challenges
The below consists of selected excerpts from the November 2023 Board briefing on
Eligibility, co -financing and transition model and MICs Deep -dive.
Figure 1: Overview of the current ELTRACO model and its three transition phases

Figure 2: Overview of the main elements of the ELTRACO



Board -2024 -Mtg -02-Doc 06a -Annex A 2
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6-7 June 2024
Figure 3: Gavi’s model has spurred country co -financing and domestic resource allocation for
immunisation

Figure 4: Gavi has already made a few amendments to the model to evolve with the need of countries

Board -2024 -Mtg -02-Doc 06a -Annex B 1
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6-7 June 202 4
Annex B: Definition of Gavi’s objectives and principles for the enhanced ELTRACO
and MICs model
The definition and prioritisation of the objectives and principles were reviewed by the
Board Task Team and endorsed by the Board at its retreat in April 2024.

Board -2024 -Mtg -02-Doc 06a -Annex C 1
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6-7 June 202 4
Annex C: Overview of the impact of different eligibility thresholds on countries’
eligibility status and transition pathways in Gavi 6.0

Board -2024 -Mtg -02-Doc 06a -Annex D 1
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6-7 June 202 4
Annex D: Overview of potential indicators for decoupling cash from vaccine support

Board -2024 -Mtg -02-Doc 06a -Annex E 1
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6-7 June 202 4
Annex E: Preliminary lessons learnt from the implementation of the MICs Approach

Board -2024 -Mtg -02-Doc 0 6a 1
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6-7 June 2024

Subject Future of Gavi’s Eligibility, Co-financing and Transition M odel
and Middle -Income Countries Approach
Agenda item 06a
Category For Guidance

Executive Summary
This report provide s an overview of the key shifts considered for the
enhanced eligibility, transition, and co -financing model (ELTRACO), and the
Middle -Income Countries (MICs) approach in Gavi 6.0. Gavi’s ELTRACO model
is widely regarded as a success story, with nineteen countries having transitioned
out of Gavi support to date. In response to the e volving context marked by a
challengin g macro -economic outlook, growing risks of unsuccessful transition of a
subset of countries, and growing inequities in access t o immunisation in lower
middle -inco me countries, the Board as part of the design of Gavi 6.0 1 has explor ed
opportunities to improve Gavi’s approach to building programmatic and financial
sustainability of immunisation programmes in the next strategic period . It provided
guidance that successful transitions should remain a cornerstone of the Gavi model
in the next strategic period and beyond, and therefore to significantly enhance the
current ELTRACO model and MICs approach. The enhanced model introduces six
main shifts to mitigate the risks of countries defaulting on their co -financing
obligations ; to slow down the acceleration of co -financing obligations 2 in Gavi -
eligible countries ; and to ensure successful transitions. The current MICs approach
becomes the new post -transition Catalytic phase of the ELTRACO model to improve
immunisation outcomes in a subset of Former - and Never -Gavi -eligible countries.
Lastly, a learning agenda is developed to test some elements of a transition by
vaccine model. At its May 2024 meeting, the Programme and Policy Committee
(PPC ) largely supported and further concretised the general ‘direction of travel’ from
the Board discussions , pending further detailed design deliberations as part of the
upcoming Funding Policy Review (FPR) , in particular on updating Gavi’s eligibility
indicators and threshold in Gavi 6.0 .
Action Requested of the Board
The Gavi Alliance Board is requested to :
a) Provide guidance on the additional recommendations provided by the Gavi
Alliance Programme and Policy Committee in May 2024 as an input into the
Funding Policy Review .
1 The future ELTRACO model and MICs approach in Gavi 6.0 have been an integral part of the Board’s
deliberations on Gavi 6.0, including through, a ‘virtual Board/PPC mini workshop’ in October 2023, a Board/PPC
Technical Briefing in November 2023, a Gavi 6.0 costing deep dive in April 2024 and the Board retreats in
December 2023 and April 2024. In addition, an informal Gavi 6.0 Board Task Team was established to shepherd
the development of the ELTRACO/MICs approach from January to March 2024. 2 Co -financin g in this document refers to co -financed and fully self -financed Gavi vaccines programmes by Gavi -
eligible countries , provid ing an overview of overall country financing .

Board -2024 -Mtg -02-Doc 06b -Annex A 1
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6-7 June 202 4
Annex A: Implications and Anticipated Impact

Risks and mitigation:
• Risk of insufficient or slow operationalisation of HS Strategy shifts by the
Alliance , including in -country stakeholders and partners. This is exacerbated by
the interdependencies with other important changes being introduced in Gavi 6.0
including implementation of EVOLVE (Doc 10a) and potential redesign of Gavi
policies, funding levers and processes. To mitigate, an implementation and
socialisation plan will be co -developed with Secretariat teams and Alliance
partners as part of operationalisation of the HS strategy.
• Risk that resources and capacities are inadequate to achieve all results:
There remains considerable risk that countries will not be able to accelerate
progress on all Gavi 6.0 goals given the projected reduction in the HSS funding
envelope compared to the original Gavi 5.0 budgets and constrained capacities at
the country, Alliance, and Secretariat levels. This will be particularly true if funding
efficiencies anticipated through funding levers consolidation are not materialised .
Without additional investm ent in vaccination touchpoints beyond infancy, it is also
likely that coverage rates will not reach levels of other Gavi -supported vaccines
and there is a risk that coverage of HPV vaccine may decline wants countries fully
utilise the vaccine introduction grants and campaign operational costs available in
the early years following introduction . Countries will need to mobilise domestic
resources for these efforts or leverage funding from other donors. The Alliance will
seek to mitigate this risk through the proposed approach to differentiate and
prioritise objectives across countries, and through enhanced partnership and co -
funding with other stakeholders.
• Risk that some shifts cause unintended reputational or programmatic
consequences , including in instances where Gavi significantly reduces a
country’s HSS ceiling or seeks to reduce support for recurrent costs (e.g., in
transitioning countries ), which could result in backsliding of immunisation
performance or pressure on other donors to support these costs in the absence of
government financing . Gavi intends to rol l out shifts in a phased approach and
prioriti se programme learning which will partially mitigate these risks and ensure
new approaches and policies do not credit undue complexity or harm towards
countries.
• Measurement risk and potential for misalignment of expectations with the
Board and key stakeholders: Even with greater investment and focus on
measurement, results of Gavi’s health systems investments will not always be
immediate, nor will they always be demonstrable through available data systems
or methods. Mitigation of this risk will require greater t ransparency and
communication from the Alliance on available data and causal pathways from Gavi
support to intended outcomes, as well as constructive and o pen dialogue with the
Board on reasonable expectations and outcomes from Gavi’s health systems
investments.

Board -2024 -Mtg -02-Doc 06b -Annex B 1
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6-7 June 202 4
Annex B: Gavi 6.0 cash funding and implications for countries
In Gavi 6.0 funding for ‘other cash -based programmes’, defined as the support that has
historically been provided for health systems through HSS, CCEOP, and EAF funding levers,
may be reduced by approximately 15% from the originally planned Gavi 5.0 level, based on
the indicative guidance from the Board during its April 2024 retreat 1. This reduction is driven
by two factors (and illustrated in the slide below) :

1. Efficiencies in the use of Gavi ’s cash grants through the anticipated consolidation of
funding levers , with the expectation this will allow countries to plan more strategically ,
better allocate resources and reduce duplication between funding levers. Costing for
Gavi 6.0 assumed this will allow countries to achieve the same results with a 10%
lower ceiling.
2. Board guidance to reduce support for higher performing countries .

In addition, the Board chose not to make additional investments in health systems to
strengthen touchpoints beyond infancy or strengthen delivery of integrated primary healthcare
services as part of the zero -dose agenda.



These calculations do not yet reflect changes to the eligibility, transition and co -financing
(ELTRACO) policy which may mean countries becoming newly eligible or having an extension
of eligibility for HSS support in Gavi 6.0. This is partially accounted f or within the costing of the
proposed changes to the ELTRACO policies but early analysis based on the PPC
recommendations suggests that some share of these changes would also need to be
1 Actual disbursement has been lower than planned due to disruption caused by the COVID -19 pandemic but this
was more than offset by US $ 1 billion in COVID -19 delivery support projected to be disbursed in Gavi 5.0 / 5.1.
This has been used to fund many health systems priorities including cold chain equipment ; demand -side
interventions; strengthening leadership management and coordination; and service delivery including for the Big
Catch -Up. If CDS is included, the reduction in available resources is significantly larger.

Board -2024 -Mtg -02-Doc 06b -Annex C 1
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6-7 June 202 4
Annex C: Health systems strategy problem statements and key questions

Board -2024 -Mtg -02-Doc 06b -Annex D 1
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6-7 June 202 4
Annex D: Draft framework for differentiation and programmatic sustainability


ISF = initial self -financing ; PT = preparatory transition

Board -2024 -Mtg -02-Doc 06 b 1
Report to the Board
6-7 June 2024

Subject Health Systems Strategy
Agenda item 06 b
Category For Guidance

Executive Summary
The purpose of this paper is to request Board guidance on the emerging direction
of Gavi’s first Health Systems (HS) Strategy. The final HS Strategy will come to the
Programme and Policy Committee ( PPC ) and Board for decision at the end of 2024.
Given the growing importance of health systems to many aspects of Gavi’s mission,
Gavi needs a clear HS Strategy that defines investment priorities and tradeoffs in
line with the Gavi 6.0 strategy and sharpens fo cus on the specific interventions
required to enhance immunisation delivery within a primary healthcare (PHC)
approach . This paper provides an overview and lessons from Gavi’s health systems
investments to date, and early thinking on a set of key shifts to address the problem
statements which were discussed with the Board in November 2023 . This paper has
been informed by guidance received from the Programme and Policy Committee at
its meeting on 15 -16 May 2024 , early direction from Gavi’s new CEO and by
consultations with countries and partners . It has been co -developed with the HS
Strategy Technical Advisory Group (TAG), which includes representatives from the
Bill & Melinda Gates Foundation, civil society organisations (CSOs), US Centers for
Disease Contro l (CDC), the Global Fund to Fight AIDS, Tuberculosis and Malaria
(Global Fund), UNICEF, the World Bank, and the World Health Organization (WHO).
The Health Systems Strategy has been an integral part of the Board’s deliberations
on Gavi 6.0, including through, a ‘virtual Board/PPC mini workshop’ in October 2023,
a Board/PPC Technical Briefing in November 2023, a Gavi 6.0 costing deep dive in
April 2 024, and the Board retreats in December 2023 and April 2024.
Action Requested of the Board
The Gavi Alliance Board is requested to provide guidance on early thinking on the
HS Strategy as described in this paper, including the proposed objectives , approach
to differentiation and to measurement .
Next steps/timeline
Following Board guidance on this paper, the Gavi 6.0 HS Strategy will be developed
in close consultation with the HS Technical Advisory Group and other stakeholders
as part of the Gavi 6.0 operationalisation process and will be brought to the October
2024 PPC meeting and to the December 2024 Board meeting for approval. The
strategy will be operationalised in 2025 for implementation starting in 2026 .

1 Report to the Board
6 - 7 June 202 4
Appendix 2: General Overview: Forecast Process and Governance including
anticipated impact
Impact on countries
Approval of the Financial Forecast enables funding to be allotted to programmes in
accordance with the Programme Funding Policy.
Risk implication and mitigation, including information on the risks of inaction
Determination of Gavi’s financial capacity to approve the recommended decisions
relies on the Financial Forecast.
Macro risks that may impact the reliability of the financial forecast are described below,
as well as the mitigation strategies in place to address these risks. Please refer to the
main paper for detail and range forecasts of specific risks and opportuniti es to the
forecast.
One of those risks arises from exposure to foreign currency exchange rate
fluctuations. In the forecast, non - USD pledges are valued at their USD equivalents
using the Bloomberg spot exchange rates when compiling the forecast (consistent with
the approach a greed with donors) or, where hedged, at the hedge rate. Pledges are
hedged progressively in accordance with the Board approved Treasury policy.
Gavi’s Cash and Investments Reserve provides a cushion for adverse fluctuations in
resources and expenditures. Gavi can also decline or defer funding requests based
on resource availability.
Risks associated with the financial forecast and mitigation
Factors that may impact the expenditure forecast include:
Demand volumes can vary significantly based on small changes in country
introduction assumptions. While the introduction assumptions made in the current
forecasts leverage the information readily available, there remains an inherent high
degree of uncertai nty on these assumptions. In addition, the assumptions on
introduction timing are often dependent on projections of when a country will no longer
be eligible for new Gavi support. This forecast represents the application of the current
Board approved Eligi bility and Transition Policy. Changes or exceptions to this policy
could vary demand significantly.
The expenditure forecast adjusts for performance risk at the portfolio level reflecting
the Secretariat’s current estimate of overall needs based on historic trends and
forecast country absorptive capacity. However actual expenditure could be higher or
low er than the financial forecast depending on actual country demand. Should
performance risk be lower than forecast, Gavi can decline or defer funding requests
based on resource availability.
Doc 07 - Appendix 2

gavi.org
FINANCIAL UPDATE, INCLUDING FORECAST
BOARD MEETING
Ian MacTavish
6-7 June 2024, Geneva, Switzerland
•2023 Statutory Financial Statements recommended to the
Board for approval by the AFC
• Majority of Gavi 5.1 Resources fully committed
• COVAX AMC Repurposing ongoing, outcome will be
significant
• It’s time for Organisational Effectiveness decisions!
2
Key Messages
Board Meeting, 6- 7 June 2024

Board -2024 -Mtg -02-Doc 08 -Annex A 1
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6-7 June 202 4
Annex A : Implications/Anticipated impact
• Risk implication and mitigation, including information on the risks of
inaction
○ Enhanced collaboration among Global Health Initiatives (GHIs) is essential to
mitigate potential risks due to fragmentation and competition among priorities
and resources and to increase impact , efficiency and sustainability , particularly
in a context of constrained resources .
○ Africa CDC is becoming an increasingly influential voice on matters pertaining
to public health on the African continent . Engagement helps promote mutually
beneficial posturing and programming , and avoids the risk of misalignment ,
which could undermine Gavi’s objectives in the geography with the greatest
number of Gavi -eligible countries .
• Impact on countries
○ Ensuring the collective and coordinated actions of GHIs are country -led and
demand driven will improve the efficiency and impact for countries and
communities , changing the power dynamic and increasing sustainability. The
efforts of the GHIs must not increase the burden on countries while improving
coo rdination towards greater financial and operational sustainability.
○ Africa CDC has a unique platform to engage at the most senior political lev els
of African Union member states . W orking with Africa CDC helps create a
positive enabling environment for immunisation in countries in Africa that
translates to increased emphasis on and support for the immunisation and
zero dose agenda .
• Impact on Alliance
○ Collaboration is core to how the Gavi model works as the Vaccine Alliance of
partners. While deepening the partnership with other GHIs, Gavi must ensure
that it brings the Alliance, not just Secretariat actions , into alignment with
country -led processes while also leveraging the strengths of each partner .
Clarifying the roles and responsibilities and mechanisms for coordinating
collective e fforts across partners early in the process will help to accelerate
efficient processes and impact .
○ Africa CDC is generally a complement to the Gavi Alliance, especially regional
and country offices of WHO and Unicef. The Gavi Secretariat has coordinated
with Alliance partners to ensure the collaboration does not create duplication
or confusion about roles and responsibilities . However, a s a maturing
organisation , it will take time for Africa CDC to carve out its niche , and for
Alliance partners to adapt accordingly .

Board -2024 -Mtg -02-Doc 08 -Annex B 1
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Annex B: Summary of 4 priority Gavi, Global Fund, GFF collaboration workstreams
and update on Gavi’s engagement with Global Health Initiatives on Research and
Development (R&D) , Market Shaping and Manufacturing


Objective
Key governance sessions
Deliverables
Interdependencies
Key open questions
Workstream overview | Malaria
Workstream Leads (Gavi + Global Fund)
Starting with malaria, develop a model for collaboration across the two organisations to strengthen the impact of our collective investments. Focus on complementary programming, communications, funding and replenishment approaches putting, countries first and optimising health outcomes. Seek to identify lessons for future collaboration on tuberculosis (TB) vaccines.
•Updated W HO normative guidance that guides prioritisation of program resources (including new vaccines, nets) to maximise impact according to context
•Working groups on Country Engagement and Health System Strengthening (HSS)
•8 April joint Gavi -Global Fund Board session on malaria vaccine work •Hope Johnson (Gavi)•Harley Feldbaum (Global Fund)
•Adopted Gavi and Global Fund Operational Principles and Partnership on Malaria. Ongoing
•Joint letter to WHO requesting strengthened normative prioritisation guidance to support country -level programming. Completed
•Ongoing alignment on modelling/data to inform decision -making.
•Collaborative engagement with countries and key stakeholders , including to foster Expanded Program for Immunisation (EPI) and National Malaria Control Program (NMCP) collaboration at country level.
•Develop a plan for bringing together core aspects malaria programming across Gavi, Global Fund with other technical partners (e.g., country planning, applications, technical reviews, monitoring, reporting and funding) to facilitate optimal programming of limited resources. Joint statement drafted, links to Country engagement workstream; Funding guidance on programming and cofinancing drafted
•Joint MEL plan (country and global levels) developed In progress
▪ How do we further ensure the availability and use of evidence and guidance to help countries determine the most effective mix of malaria interventions and new vaccines, by context and within resource constraints in the future?
▪ How do we best support an integrated approach to country planning, implementation and monitoring across NMCPs and EPIs considering separate funding envelopes and cycles?
▪ W hat lessons can we learn from the rollout of malaria vaccines for future collaboration on TB vaccines?
1 Objective
Key governance sessions
Deliverables
Interdependencies
•Strategic directions of all three organisations•Country engagement and ‘pathfinder’ countries
Workstream overview | HSS
Workstream Leads
•Alex de Jonquieres (Gavi)•Shunsuke Mabuchi (Global Fund)•Peter Hansen and Cicely Thomas (Global Financing Facility -GFF)
Map and increase alignment and coordination of respective investments in health systems, service delivery and key programmatic areas
•Health systems strengthening discussions at Strategy Committee and Board•Mutual participation in various strategy -setting forums, including: •Gavi 6.0 Health Systems strategy technical advisory group•Global Fund contributory Resilient and sustainable systems for health (RSSH) methodology review technical advisory committee•Global Fund RSSH metrics consultation
•Map current financing and technical collaboration on health systems, including areas relevant to Pandemic Prevention, Preparedness and Response (PPPR), across countries and programmatic areas, and synthesize lessons learned. Completed •Review key platforms / assets of each agency in health systems & PPPR space that could be leveraged by the other (e.g., Global Fund’s network of community, rights and gender experts, Global Fund’s Civil Society Organisation (CSO) partners and community health programs, Gavi’s Cold Chain Equipment Optimisation Platform (CCEOP) for solarisation at scale, Gavi’s Leadership, Management and Coordination (LMC) program, GFF Alignment Worki ng Group (AW G) and ministerial network. Completed •Areas for strengthened collaboration include: data & digital; health workforce including Community Health Workers (CHW) ; supply chain; lab and surveillance systems, service delivery integration along life course; equity and zero -dose; in -country governance. Planning in progress •Harmonise monitoring and evaluation (M&E) approaches: guidance, indicators and frameworks for health systems investments In progress (WHO led)
2

gavi.org
UPDATE ON COLLABORATION WITH OTHER
ORGANISATIONS
BOARD MEETING
Hope Johnson
Thabani Maphosa
6-7 June 2024, Geneva, Switzerland
2 Board Meeting, 6-7 June 2024
Keeping countries and communities central to our
collaboration
Guiding
Principles • Country led and demand driven
• Differentiated approach, leveraging the strengths of each Global Health Institution (GHI)
• Consideration for operating modalities of each GHI
High Impact
Workstreams • Malaria
• Health Systems Strengthening
• Country Engagement
Existing
collaboration • Investments and programming
• Legal, Audit & Investigation, Evaluations
• Resource mobilisation, communication, advocacy
Aligned
Communication • Consistent communication across Boards and Committees
• Clear narrative and strategic messaging to highlight distinct roles,
complementarities and impact
+ Enabling Functions (Gavi -Global Fund)

gavi.org
ROAD TO REPLENISHMENT
BOARD MEETING
Marie -Ange Saraka -Yao
6 -7 June 2024, Geneva, Switzerland
Protecting our future
Powered by
a unique and
innovative
model
Protecting
the World
Protecting
People
Protecting
Communities
Driven by
sustainability
• The African Vaccine Market Accelerator will build
resilience and support vaccine sovereignty
• Global health security preventing outbreaks and largest
investment in stockpiles against killer diseases like Ebola,
cholera and yellow fever
• >50% of Gavi’s vaccines will help countries adapt to the
threats of climate change and Anti -Microbial Resistance
• The widest portfolio in Gavi’s history with 24
life -saving vaccines for this generation of
children to be the most protected ever
• >100 million young women and girls
protected against cervical cancer , saving
1.5 million lives
• >50 million children will receive the new
malaria vaccine
• Gavi will facilitate 1.4 billion individual
contact points between families and
health services
• Gavi will strengthen health systems and
reach more women and zero -dose
children
• Over the next 5 years countries will fund
a record percentage of the costs of their
vaccines, contributing >US$ 4 billion
• By 2030, one in three of the 73 lower -
income countries originally supported by
Gavi will be fully funding their own
vaccine programmes
• Gavi will use its market power to pull
innovation form manufacturers
whilst reducing vaccine prices
across 50% of its portfolio
• Operational costs will stay lean: 97
cents of every $1 will go on buying
or delivering vaccines
* All numbers are provisional at this stage and will be
confirmed once Gavi 6.0 one -pager document is approved
2 Board Meeting, 6 -7 June 2024

Board -2024 -Mtg -02-Doc 10 -Annex A 1
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6-7 June 202 4
Annex A: Implications/Anticipated impact
The Vaccine Investment Strategy (VIS) facilitates strategic decision -making and is a
fundamental tool in fulfilling Gavi’s equity objectives . The rigorous process estimates
health and economic impact of the vaccines under consideration in Gavi -eligible
countries from 2026 -2040 and compares them to the expected impact of vaccines in
the current portfolio, thus providing a quantitative measure o f comparable anticipated
impact. The VIS process is meant to guide decisions for investment that could have
the highest public health impact in Gavi countries.
In this Governance cycle (PPC/Board in May/June 2024), final investment decisions
will be requested to be implemented from Gavi 6.0 subject to replenishment.
Investment cases include vaccines against endemic and epidemic diseases leading
to investments in routine/preventive programmes or stockpiles, respectively.
According to estimated timelines, the vaccines included in the investment cases would
be available for use by Gavi towards the end of the 6.0 period (Figure 1, Doc 10 ), thus
the recommendations presented to the PPC are for in -principle support. These in -
principle decisions allow Gavi to include the vaccine in the design of Gavi 6.0, identify
estimated costs for resource mobilisation and to provide a signal to manufactu rers and
countries regarding level of interest. The risks associated with these in -principle
decisions include the level of uncertainty regarding timelines, product characteristics,
supply and regulatory/policy recommendations. To mitigate these risks, the
Secretariat will continue to monitor the vaccine pipelines , potential demand and
progress of these products along regulatory and policy pathways to inform updated
investment cases that will go back to the PPC/Board for a final approval to start
planning and designing the vaccine programme/stockpile. Although Gavi could
consider deferring these investment decisions until information is more readily
available, this poses risks around funding not being available at the time of a future
decision, as well as negative impact on manufacturers’ continued inves tment in
development of new products and production scale -up that would impact the
timeliness and scale of supply availability and future market health.
Furthermore, the VIS recommendations from the PPC pose risks to countries , the
Alliance and vaccine development :
Impact on countries – Non -infant vaccines
• As more and more countries consider the introduction and sustainability of
additional vaccines outside the infant immunisation timepoint, it is important that
countries have sufficient financial support for their successful delivery. Vaccines
for dengue, tuberculosis and group B streptococcus target non -infant populations
(2yrs, 15yrs and pregnant women, respectively) and thus are expected to require
additional support to strengthen or d evelop additional immunisation touchpoints.
As products become available and updated investment cases are developed and
presented to the PPC/Board, t his additional support provided either by Gavi or
other stakeholders will need to be considered and weighed against other vaccines
and health interventions . If there is limited funding and appetite for this additional
support when these updated investment cases are reviewed there is a risk that

gavi.orgV a c c i n e I n v e s t m e n t S t r a t e g y 2 0 2 4
Annex B: Summary of recommendations
and costs
Gavi Board Meeting, 6 - 7 June 2024 Doc 10 - Annex B
Contents
1. Summary
2. Shigella
3. Group B Streptococcus
4. Dengue
5. Tuberculosis
6. COVID - 19 post 2025
7. Hepatitis E
8. Mpox
9. Costs
a. Vaccine procurement costs
b. Delivery costs
10. Comparison to existing portfolio
11. Country Survey
2 Board Meeting, 6 - 7 June 2024 Doc 10 - Annex B

Board -2024 -Mtg -02-Doc 10 1
Report to the Board
6-7 June 2024

Subject Vaccine Investment Strategy 2024 – Investment Cases
Agenda item 10
Category For Decision

Executive Summary
Th is paper presents for Gavi Board decision the Vaccine Investment Strategy (VIS)
2024 investment cases for tuberculosis, group B streptococcus and dengue as
routine/preventive vaccine programmes , and hepatitis E as a stockpile ; note the
non -extension of the current COVID -19 programme post 2025; and a
recommendation on the investment case for an mpox stockpile and response to the
current mpox outbreak. The actions have been informed by recommendations from
the Programme and Policy Committee (PPC), guidance from the VIS Steering
Committee, input from countries, as well as consultations with civil society
organisations (CSOs), technical partners, disease experts, academics,
practitioners, and vaccine manufacturers. This decision represents the third and final
decision point on VIS 2024, aligned with a decision on the Gavi 6.0 strategy.
Action Requested of the Board
The Gavi Alliance Programme and Policy Committee (PPC) recognised that this
Vaccine Investment Strategy (VIS) is taking place in a different global health and
fiscal landscape with significant pressures on health systems, vaccination schedules
and changing epidemiology due to climate change and urbanisation.
As the menu of vaccines available across the life course increases, countries may
require technical support to strengthen decision -making capacities on vaccine
prioritisation and optimisation , and support to strengthen their health systems to
deliver them.
The PPC also recognised the importance of the VIS for long -term market signalling
to manufacturers despite the many unknowns.
Considering this, t he Gavi Programme and Policy Committee recommend ed to the
Gavi Alliance Board , subject to the availability of funding for the 2026 -2030 period
following Gavi’s replenishment for that period, that it :
a) Approve in principle, support for a tuberculosis (TB) vaccine programme ,
contingent on the availability of a licensed product for adults/adolescents,
outcomes of regulatory and technical review processes (including WHO
prequalification and SAGE recommendation), and meeting the financial
assumptions used as the basis for the T B investment case set out in Annex B to
Doc 10 ;

Board -2024 -Mtg -02-Doc 11a -Annex A
Report to the Board
6-7 June 2024

Annex A: First Response Fund – Programmatic Parameters for Decision

Duration 7 years until end of December 2030. Subject to a Board decision
to continue the Fund, in 2030 donors will have the option to
withdraw or renew their funds for a further 5 years.
Use of
Funds
• Facilitate rapid vaccine access including procurement of
doses (and ancillaries such as syringes) for target priority
populations, including healthcare workers;
• Accelerate the delivery of vaccines, including the
procurement of additional cold chain equipment, community
protection measures, support for surge capacity and
pandemic response plan implementation at country level;
• Provide targeted support to maintain routine immunisation
and protect healthcare workers (such as the purchase of
personal protective equipment);
• Other uses, as approved by the Board, provided aligned with
the overall objective of the Fund.
Geographic
scope
Core Gavi -eligible countries, unless expanded on an exceptional
basis by the Board.
Eligibility The Fund will be restricted to the highest levels of public health
emergencies with a two -stage eligibility process:
1) An emergency will need to meet both objective eligibility
criteria:
− A WHO declared Public Health Emergency of International
Concern (PHEIC), or grade 2 or 3 emergency. A minimum of
80% of funding is reserved for PHEICs.
− The emergency relates to a disease / pathogen for which
Gavi does not have an existing programme or outbreak
response mechanism in place (unless exceptionally agreed
by the Gavi Board).
2) An emergency will also need to satisfy a further technical
assessment, based on clear criteria and informed by partner
consultations and risk assessments, with an associated
recommendation to disburse from the Fund made by an
internal steering committee chaired by the CEO.

Board -2024 -Mtg -02-Doc 11a -Annex B
Report to the Board
6-7 June 2024

Annex B : Arrangement s for the Governance of the First Response Fund
Context and scope
The First Response Fund would align with and leverage existing Gavi governance
processes . As a financing instrument, overall financial oversight would be the
responsibility of the AFC, with programmatic oversight from the PPC. This ensures
alignment with Gavi 's existing governance procedures . Similarly, best practices and
standard operating procedures linked to Monitoring, Evaluation and Learning and Risk
Management, would also be applied.
Structure

Figure 1: Governance structure overview

The above structure depicts the proposed “light touch” governance structure for the
Fund . Overall oversight of the Fund would rest with the Board , with decisions being
reviewed and recommended by the AFC and PPC on relevant matters as further
explained in the table below . As per standard Gavi governance , other committees
would be consulted as required (for example, the Market - Sensitive Decisions
Committee would approve any relevant market and/or commercially sensitive
decisions ).
Given the evolution of the Fund born out of COVAX Pandemic Vaccine Pool funds , an
advisory Investor s Forum would be established to assist the Board and its
Committees. This body, comprised of donors to the First Response Fund, would hold
an annual donor meeting and receive notifications of drawdowns under US$ 50 m illion
for which the AFC has also been notified . For disbursements over US$ 50 million, the
Investor s Forum would receive a consultation period of 72 hours in between AFC
review and approval by the Board, so that their views can be represented . The
Investor s Forum will also play a role in the formal reviews planned for 2027 and 2030.

Board -2024 -Mtg -02-Doc 11a 1
Report to the Board
6-7 June 2024

Subject Day Zero Financing Facility – First Response Fund
Agenda item 11a
Category For Decision

Executive Summary
Following the decision by the Gavi Board in December 2023 to approve the
establishment of a First Response Fund (the Fund) of up to US$ 500 million under
Gavi’s Day Zero Financing Facility for Pandemics (DZF) , the Secretariat has been
developing further financial and programmatic details in order that the Fund can be
operational in the second half of 2024 .
Following the Audit and Finance Committee ’s (AFC) review of the Treasury
arrangements and disbursement process , the Programme and Policy Committee’s
(PPC) review of the programmatic parameters and the Governance Committee’s
upcoming review of the governance arrangements , t his paper provides
supplementary information requested by the Board covering : i) the establishment of
a treasury management policy and function; ii) t he governance arrangements
including examples of the triggers under which the fund may be drawn in a public
health emergency and for what purposes ; and iii) f urther information on how the
First Response Fund is aligned with, and complementary to, other Pandemic
Prevention , Preparedness and Response ( PPPR ) surge financing initiatives .
Action Requested of the Board
The Gavi Alliance Programme and Policy Committee recommends to the Gavi
Alliance Board that it:
a) Approve the specifications of the programmatic design of the First Response
Fund of the Day Zero Financing Facility for Pandemics, including the Fund’s
programmatic parameters and eligibility criteria, as set out in Annex A to Doc
11a .
The Gavi Alliance Audit and Finance Committee recommend s to the Gavi Alliance
Board that it:
a) Approve the Gavi Secretariat as interim treasury manager of the Day Zero
Financing Facility – First Response Fund until 31 December 2024;
b) Note that the delegation of authority for release of funds will follow the existing
Board -approved Delegation of Authority ( DOA ) Policy;
c) Note that the Secretariat will recommend a long -term treasury management
arrangement for the Fund and a proposal on the use of interest income to the
AFC in the second half of 2024.

Board-2024-Mtg-02- Doc 11b 1


Report to the Board
6-7 June 2024
Subject African Vaccine Manufacturing Accelerator (AVMA)
Agenda item 11b
Category For d ecision

Executive Summary
In December 2023, the Gavi Board approved the establishment of the African
Vaccine Manufacturing Accelerator (AVMA) as an instrument to provide time- limited
financial support to accelerate the expansion of commercially viable vaccine
manufacturing in Africa, in accordance with a set of key terms. Following the Audit
and Finance Committee's review of the treasury arrangements and the Risk
Management Framework ; the Governance Committee’s review of governance
arrangements; and the Policy and Programme Committee ‘s review of the modified
key terms, the MEL framework and key dependencies, t his paper seeks approval
for the final operational arrangements for AVMA ahead of its proposed launch in
June 2024 including (i) a modification of the key terms approved in December which
refines the manufacturers eligib le for AVMA subsidies and (ii) its interim T reasury
arrangements.
The report provides supplementary information requested by the Board covering (i)
AVMA’s role in the broader ecosystem covering mapping of key dependencies, (ii)
monitoring and oversight covering legal and regulatory risks and intermediate
milestones and review points, (iii) governance and treasury arrangement s.
Action Requested of the Board
The Gavi Alliance Programme and Policy Committee recommends to the Gavi
Alliance Board that it:
a) Approve the amendments to the key terms of AVMA as set out in Annex A to
Doc 11b.
b) Note the AVMA MEL framework, including proposals for periodic course
correction as set out in Annex B to Doc 11b .
c) Note the key dependencies as set out in A nnex C to Doc 11b .
The Gavi Alliance Audit and Finance Committee (AFC) recommends to the Gavi
Alliance Board that it:
a) Approve the Gavi Secretariat as interim treasury manager of the African
Vaccine Manufacturing Accelerator (AVMA) until 31 December 2024.
b) Note that the Gavi Secretariat will recommend a long- term treasury management
arrangement for AVMA and make a proposal on the use of interest income to the
AFC, in the second half of 2024.

Board -2024 -Mtg -02-Doc 11b -Annex A 1
Report to the Board
6-7 June 202 4
Annex A: AVMA Base Proposal – updated key terms
This Annex provides an updated overview of key terms of the AVMA approved by
the Gavi Board (Board -2023 -Mtg -04 -Doc 10b - Annex A ). Updates are shown in bold
underline and primarily represent tighter definitions and an update to eligibility criteria.
Design
element
Proposal
Size Funding requirement of US$ 750 -1,000 million – with the upper end
of the range set to accommodate an ambitious outcome for African
products in terms of number of incentivised manufacturers and their
commercial volumes
Scope All Gavi Alliance supported vaccines (with differences in payments,
see “Incentives”), fill & finish -only (i.e. drug product), and “end -to-
end” drug substance + drug product.
Duration To be launched in June 2024 with a proposed duration of 10 years
(payments can continue for a period beyond the 10 -year mark,
depending on tender lengths) 1
Eligibility
Vaccine Type: Qualifying Vaccine that is WHO Prequalified 

Manufacturing Type: 
i) The Qualifying Vaccine is Fully Manufactured on the
African continent;
or 
ii) Fill & Finish of the Qualifying Vaccine is carried out in
a manufacturing facility on the African continent that
is Controlled by the holder of the WHO Pre -
Qualification of the Qualifying Vaccine .
Procure -
ment
pathway
Via successful Gavi -UNICEF tenders and fulfil all other eligibility
criteria
A potential AU pooled procurement mechanism may be
accommodated in the future, subject to determination in line with
AVMA’s governance arrangements )
Incentives Structure




• Milestone payment at WHO Prequalification
• Per -dose accelerator payment, paid per dose,
upon delivery of UNICEF tender

Board -2024 -Mtg -02-Doc 11b -Annex B
Report to the Programme and Policy Committee
15 -16 May 2024
Report to the Board
6-7 June 2024
Report to the Board
6-7 June 2024
Report to the Board
6-7 June 2024
Annex B : AVMA Monitoring, Evaluation and Learning (MEL) Framework

Table of Contents
1. Introduction ................................ ................................ ................................ ........ 1
2. AVMA Theory of Change ................................ ................................ ................... 3
2.1 Inputs ................................ ................................ ................................ ......................... 4
2.2 Outputs ................................ ................................ ................................ ....................... 4
2.3 Outcomes and objectives ................................ ................................ ........................... 4
2.4 Key assumptions ................................ ................................ ................................ ........ 8
3. AVMA reporting and review cycles ................................ ................................ 18
4. AVMA monitoring and evaluation metrics ................................ ..................... 19
4.1 Outcome metrics ................................ ................................ ................................ ...... 19
4.2 AVMA Logframe ................................ ................................ ................................ ....... 21
5. Learning agenda ................................ ................................ .............................. 23
5.1 Ecosystem learnings ................................ ................................ ................................ 23
5.2 Operational learnings ................................ ................................ ............................... 25
6. Definitions for Indicator Reference Sheets and Logframe ........................... 26
7. AVMA MEL Indicator Reference Sheets (short -hand version) ..................... 27
8. AVMA MEL Logframe ................................ ................................ ...................... 34

Table of Figures
Figure 1: AVMA Theory of Change ................................ ................................ ....................... 7
Figure 2: AVMA Reporting and review cycles ................................ ................................ ..... 18
Figure 3: AVMA Objectives and expected long -term outcomes ................................ ........... 20
Figure 4: AVMA MEL Indicators ................................ ................................ .......................... 22

Table of Tables
Table 1: Core components of the AVMA MEL Framework ................................ .................... 1
Table 2: Key assumptions for outcomes related to driving sustainable business models ...... 8
Table 3: Key assumptions for outcomes related to building capacities and capabilities that
improve PPPR ................................ ................................ ................................ .................... 13
Table 4: Key assumptions for outcomes related to sustaining a healthy global market ........ 15
Table 5: AVMA ecosystem learnings ................................ ................................ ................... 23
Table 6: AVMA operational learnings ................................ ................................ .................. 25
Table 7: Parameters of the MEL indicators ................................ ................................ ......... 26

Board -2024 -Mtg -02 -Doc 11b -Annex C 1
Report to the Board
6-7 June 2024
Report to the Board
6-7 June 2024
Annex C : Strengthening Vaccine Production in Africa: A Dependency Mapping for the
African Vaccine Manufacturing Accelerator (AVMA)
Table of Contents
1. Introduction ................................ ................................ ................................ ........ 2
1.1 Context ................................ ................................ ................................ ....................... 2
1.2 Objectives of this paper ................................ ................................ .............................. 4
2. Market design & demand intelligence ................................ .............................. 5
2.1 What are the primary challenges in connection with the AVMA, under this heading? . 5
2.2 How is Gavi contributing? ................................ ................................ ........................... 6
2.3 What action is underway in the wider ecosystem? ................................ ...................... 7
3. Access to finance ................................ ................................ .............................. 7
3.1 What are the primary challenges in connection with the AVMA, under this heading? . 7
3.2 What is Gavi doing to support this? ................................ ................................ ............ 8
3.3 What action is underway in the wider ecosystem? ................................ ...................... 8
4. Regulatory strengthening ................................ ................................ ................. 9
4.1 What are the primary challenges in connection with the AVMA, under this heading? . 9
4.2 What is Gavi’s contribution? ................................ ................................ ..................... 10
4.3 What action is underway in the wider ecosystem? ................................ .................... 10
5. Technology transfer and IP ................................ ................................ ............. 11
5.1 What are the primary challenges in connection with the AVMA, under this heading? 11
5.2 What is Gavi’s contribution? ................................ ................................ ..................... 12
5.3 What action is underway in the wider ecosystem? ................................ .................... 12
6. R&D and talent development ................................ ................................ ......... 13
6.1 What are the primary challenges in connection with the AVMA, under this heading? 13
6.2 What is Gavi’s contribution? ................................ ................................ ..................... 13
6.3 What action is underway in the wider ecosystem? ................................ .................... 14
7. Infrastructure development ................................ ................................ ........... 14
7.1 What are the primary challenges in connection with the AVMA, under this heading? 14
7.2 What is Gavi’s contribution? ................................ ................................ ..................... 15
7.3 What action is underway in the wider ecosystem? ................................ .................... 15
8. Conclusion ................................ ................................ ................................ ....... 15

Board -2024 -Mtg -02 -Doc 11b -Annex D 1
Report to the Board
6-7 June 202 4
Annex D: Arrangements for the Governance of AVMA
Context and scope
As a Gavi program me , AVMA fully aligns with existing Gavi governance processes. This
extends to Monitoring, Evaluation and Learning and Risk Management, where normal Gavi
Secretariat standard operating procedures are applied. This paper does not seek to describe
these processes , where the AFC, PPC and Board will execute all normal functions in relation
to AVMA, as per their respective charters.
Implementation of AVMA will be managed via a cross -functional group within the Gavi
Secretariat. This group will collaborate closely with Operational Partners (esp. UNICEF and
WHO) who support the implementation of AVMA in various ways. The longstanding Market
Shaping “Square -Group” of WHO, UNICEF and the Bill and Melinda Gates Foundation , will
help facilitate this coordination on operational issues.
The new Alliance Risk Working Group will facilitate enhanced coordination on shared
operational risk management . Additional information will be brought back to the Board in end
of 2024 , as part of the updated Gavi Risk Policy .
Two advisory forums are to be established to assist with AVMA's implementation and ensure
the two -way information flow required for its smooth operation. Consultations with donors and
other stakeholders confirmed that this solution aligns with their expectations for a forum to
receive information and provide input , see Fig.1. Terms of Reference have been provided to
the Gavi Alliance Governance Committee for endorsement . At its meeting on 5 June 2024,
the Governance Committee will be invited to review and endo rse the Terms of Reference for
these fora.
AVMA Operational and Governance Structure











AVMA Investors Forum (IF)
The IF will ensure AVMA’s ongoing alignment with the numerous other donor investments in
the broader African vaccine manufacturing ecosystem, on which AVMA’s success depends.
The IF will help in identifying synergies and avoiding risks stemming from any emerging
misalignment with other initiatives over the ten -year lifecycle of AVMA. The Investors Forum
will invite stakeholders and subject matter experts to its meetings as required (e.g., Africa
CDC).
Figure 1 AVMA governance

1


Board-2024-Mtg- 02-Doc 12

Report to the Board
6-7 June 2024

Subject Review of decisions
Agenda item 12
No paper

1


Board -2024 -Mtg -02 -Doc 13

Report to the Board
6-7 June 202 4

Subject Any other business and Closing remarks
Agenda item 13
No paper

gavi.org
CONSENT AGENDA
BOARD MEETING
6-7 June 2024, Geneva, Switzerland
Decision 1: Consent Agenda: Board Committee Chair
Appointment
2 Board Meeting, 6-7 June 2024
The Gavi Alliance Governance Committee recommends to the Gavi Alliance Board that it :
a) Appoint
David Sidwell as an Unaffiliated Board Member in the seat currently held by
Naguib Kheraj, effective 1 August 2024 and until 31 July 2027; and
b) Appoint
the following as Chair of the Audit and Finance Committee effective 1 August 2024:
• David Sidwell (Board Member) until 31 December 2025

gavi.org
JOINT ALLIANCE UPDATE ON
IMPLEMENTATION OF GAVI 5.1
STRATEGY, PROGRAMMES
AND PARTNERSHIPS
BOARD MEETING
Aurélia Nguyen
Thabani Maphosa
Kate O’Brien
Ephrem Lemango
6 -7 June 2024, Geneva, Switzerland
Balanced Scorecard | Programmatic strategic goals
Strategic goal 2 Strengthen health systems
Baseline2023
Healthy market dynamics n/a 10
Incentivise innovations n/a 10
Scale -up innovations n/a 3
Strategic goal 4 Ensure healthy markets
Gavi 5.0
mission indicators
Baseline
2020
5.1
Cumulative
Unique children immunised 1 0 >133 million
Reduction in zero -dose children 9 million (2019) 10.2 million (2022)
Future deaths averted 0 >2.4 million
Future DALYs 2 averted 0 >121 million
Economic benefits unlocked 0>US$ 35.8 billion
SG2
SG4
** Updated bi-annually or more (else updated annually)
On track Delays/challenges Significant delays/challenges No target / TBD
Strategic goal 1 Introduce and scale up vaccines SG1
Baseline
2019 2022
Breadth of protection 48%56%
Timely outbreak detection 25% 3 18%
Measles campaign reach 37.3% (2021) 70.2%
Gavi 5.1
Cumulative, as of Dec
2023 2023
New vaccine introductions** 42 13
• HPV introductions** 14 6
• Malaria introductions** 00
Baseline
2021 2023
Co -financing fulfilment 100% (2020) 100% 4
Preventing backsliding in
Gavi -transitioned countries 8 countries 5 8 countries
(2022)
Vaccine intro in transitioned &
never -eligible countries n/a (2022) 5
Strategic goal 3 Improve sustainability SG3
Baseline
2019 2022
DTP3 coverage 83%81%
Geographic equity of DTP3 67%62%
DTP dropout 6%6%
MCV1 coverage 81%79%
GBS 1.0
1. Children immunised covers only routine immunisation, not campaigns 2. Disability Adjusted Life Years 3. Baseline for timely outbreak detection is average of 2018 –2020; 25 % out of 18 – for additional details refer to the Annual Progress Report from Gavi ; 18%
out of 40 – for additional details refer to the Annual Progress Report from Gavi 4 . % of countries who have fully met their co -financing obligation. Excluding countries whose co-financing obligation was exceptionally waived, all countries have fully met their 2023 co- financing obligation so far, with the exception of South Sudan, which has agreed to use its government contribution to a multi -donor trust fund to pay its remaining 2023 obligation .5. Baseline for preventing backsliding set for 2021 as of July 2022

gavi.org
GAVI 6.0 – THE ALLIANCE’S
STRATEGY 2026 -2030
BOARD MEETING
Johannes Ahrendts
6 -7 June 2024, Geneva, Switzerland
The design of Gavi 6.0 has followed three phases led
by the Board and informed by extensive country -
centric consultations
March
Board
Retreat
October
Board/PPC
mini -workshop
June
Board Meeting
December
Board Retreat
April
Board
Retreat
June
Board
Meeting
Feb -March
Board Task
Team
Define opportunities for impact
and indicative level of ambition
for Gavi 6.0
October – December 2023
Finalise strategic choices and
the new ‘one -pager’ framework
January – June 2024
Review of key contextual
trends
March – September 2023
1 2 3
Launch of the
Investment Opportunity
20 June 2024
2 Board Meeting, 6 -7 June 2024

gavi.org
GAVI 6.0 –ELIGIBILITY,
TRANSITION AND CO-
FINANCING MODEL, MIDDLE -
INCOME COUNTRIES
APPROACH AND
HEALTH SYSTEMS STRATEGY
BOARD MEETING
Benjamin Loevinsohn
Adriana Jimenez Cuen
Alex de Jonquières
6 -7 June 2024, Geneva, Switzerland
Based on feedback, we are suggesting a new variation to the options proposed last time
In 6.0 Gavi can build on the success of its ELTRACO
and MICs model and ensure it remains fit for purpose
The ELTRACO / MICs model has workedwellto date to drive
financial and programmatic sustainability But the model is facing challenges
The
MICs approach was added in 5.0 / 5.1
Co-financing and resources allocation for vaccines, US$ billion, 2011-2025
19 countries
transitioned out of Gavi support
Sustainability, health impact and
equity challenged by:
• Challenging macro-economic
outlook
• Rapidly increasing co -financing
levels
• Limited programmatic
readiness to transition
• Growing inequities in access to
immunisation including in a subset
of Former - and Never - Gavi -
eligible countries
1,124
Transitioned countries, including India
Co -financing obligations
Gavi 3.0 1,6
3,2
Gavi 4.0 Gavi 5.0 / 5.1
0,8
0,8 1,9
1,3
0,4
Note: Co -financing refers to the cost paid by Gavi -eligible countries for Gavi vaccine programmes including fully self -financed ones
Board Meeting, 6- 7 June 2024 2

gavi.org
FINANCIAL UPDATE, INCLUDING FORECAST
BOARD MEETING
Ian MacTavish
6-7 June 2024, Geneva, Switzerland
•2023 Statutory Financial Statements recommended to the
Board for approval by the AFC
• Majority of Gavi 5.1 Resources fully committed
• COVAX AMC Repurposing ongoing, outcome will be
significant
• It’s time for Organisational Effectiveness decisions!
2
Key Messages
Board Meeting, 6- 7 June 2024

gavi.org
UPDATE ON COLLABORATION WITH OTHER
ORGANISATIONS
BOARD MEETING
Hope Johnson
Thabani Maphosa
6-7 June 2024, Geneva, Switzerland
2 Board Meeting, 6-7 June 2024
Keeping countries and communities central to our
collaboration
Guiding
Principles • Country led and demand driven
• Differentiated approach, leveraging the strengths of each Global Health Institution (GHI)
• Consideration for operating modalities of each GHI
High Impact
Workstreams • Malaria
• Health Systems Strengthening
• Country Engagement
Existing
collaboration • Investments and programming
• Legal, Audit & Investigation, Evaluations
• Resource mobilisation, communication, advocacy
Aligned
Communication • Consistent communication across Boards and Committees
• Clear narrative and strategic messaging to highlight distinct roles,
complementarities and impact
+ Enabling Functions (Gavi -Global Fund)

gavi.org
ROAD TO REPLENISHMENT
BOARD MEETING
Marie -Ange Saraka -Yao
6 -7 June 2024, Geneva, Switzerland
Protecting our future
Powered by
a unique and
innovative
model
Protecting
the World
Protecting
People
Protecting
Communities
Driven by
sustainability
• The African Vaccine Market Accelerator will build
resilience and support vaccine sovereignty
• Global health security preventing outbreaks and largest
investment in stockpiles against killer diseases like Ebola,
cholera and yellow fever
• >50% of Gavi’s vaccines will help countries adapt to the
threats of climate change and Anti -Microbial Resistance
• The widest portfolio in Gavi’s history with 24
life -saving vaccines for this generation of
children to be the most protected ever
• >100 million young women and girls
protected against cervical cancer , saving
1.5 million lives
• >50 million children will receive the new
malaria vaccine
• Gavi will facilitate 1.4 billion individual
contact points between families and
health services
• Gavi will strengthen health systems and
reach more women and zero -dose
children
• Over the next 5 years countries will fund
a record percentage of the costs of their
vaccines, contributing >US$ 4 billion
• By 2030, one in three of the 73 lower -
income countries originally supported by
Gavi will be fully funding their own
vaccine programmes
• Gavi will use its market power to pull
innovation form manufacturers
whilst reducing vaccine prices
across 50% of its portfolio
• Operational costs will stay lean: 97
cents of every $1 will go on buying
or delivering vaccines
* All numbers are provisional at this stage and will be
confirmed once Gavi 6.0 one -pager document is approved
2 Board Meeting, 6 -7 June 2024

gavi.org
VACCINE INVESTMENT
STRATEGY 2024 –
INVESTMENT CASES
BOARD MEETING
Marta Tufet
6 -7 June 2024, Geneva, Switzerland
PPC Recommendation: Support for learning agendas
and in-principle investments
2 Board Meeting, 6-7 June 2024
Vaccine PopulationIn
-principle
investment Learning
Agenda
Tuberculosis Adolescents/ Adults
 
Group B Streptococcus Pregnant women  
Dengue 2-16 years
Conditional
on burden data in Africa 
Hepatitis E
High-risk in outbreak
response  
from 5.1
Mpox 

from 5.1
Shigella Infants  
COVID-19 High-risk populations No continued investment post- 2025

gavi.org
INNOVATIVE DEVELOPMENT INSTRUMENTS: DAY ZERO
FINANCING FACILITY – FIRST RESPONSE FUND AND
AFRICAN VACCINE MANUFACTURING ACCELERATOR (AVMA)
BOARD MEETING
Augustin Flory
6 -7 June 2024, Geneva, Switzerland
AVMA and FRF - core pillars of Gavi’s PPPR support
2 Board Meeting, 6 -7 June 2024
Africa remains vulnerable to supply insecurity
Africa accounts for 0.1% of global vaccine
production; 30+ projects, yet most will fail to reach
long -term viability
African manufacturers may be unviable in early
years Capital, labour and operating costs up to 50%
higher for new entrants in Africa, highlighting the need
for substantial downstream support, until economies
of scale are reached
AVMA would offer up to US$ 1 billion in support:
Priming the industry for long -term sustainability
De -risking investments and bolstering sustainability will
support Africa’s vaccine sovereignty, pandemic
preparedness whilst building a substantial biotech sector
The African Vaccine
Manufacturing Accelerator (AVMA)
First Response Fund (FRF)
Contingency funds are needed immediately
This could reduce deaths by up to 74%, and
economic costs by up to 95%
~50% gap in the estimated ~US$ 4 billion
required for rapid response financing for
outbreaks and pandemics
The First Response Fund pre -positions up to
US$ 500 million of at -risk surge financing -
available within the first 50 days of an
emergency, for vaccine procurement and other
urgent uses in core Gavi -eligible countries. The
Fund complements other Pandemic Prevention
Preparedness and Response (PPPR) financing
mechanisms in the global architecture
1
2

gavi.org
REVIEW OF DECISIONS
BOARD MEETING
6 -7 June 2024, Geneva, Switzerland
Decision 1: Consent Agenda: Board Committee Chair
Appointment
2 Board Meeting, 6 -7 June 2024
The Gavi Alliance Board :
a) Appointed David Sidwell as an Unaffiliated Board Member in the seat currently held by
Naguib Kheraj, effective 1 August 2024 and until 31 July 2027 ; and
b) Appointed the following as Chair of the Audit and Finance Committee effective 1 August
2024 :
• David Sidwell (Board Member) until 31 December 2025