Report to the Board
Board -2021 -Mtg -4-Doc 10-Annex B

Annex B: High level Theory of Change

Outcomes Objectives Key Activities
These outcomes
represent the elements of
an effective and
sustainable national
immunisation system.
What changes in the
immunisation
programme are needed
to achieve the outcome?
What key activities are needed to achieve the
objective?
INTRODUCE & SCALE
Breadth and equity of
protection against
vaccine -preventable
diseases are expanded
through effective
prioritisation, introduction,
and scaling of vaccines
via the routine
immunisation system.
1. Introduction of
Typhoid and Cervical
Cancer Vaccine
1.1 Introduction of TCV vaccine in states
- Sub -national prioriti sation for vaccine roll -out
to ~20% of the target population (~80% for
catching up to the previous cohorts, and
remaining for RI)
1.2 Surveillance sites for TCV
- Additional surveillance sites for more data
on vaccine efficacy and disease burden: 3 in
UP, 1 each in Rajasthan, MP and Bihar
1.3 Introduction of HPV vaccine in states
- Identification and alignment on roll -out
strategy (catch -up, RI, timelines, etc.)

EXTEND & REACH
Community -centred
immunisation services
build resilient demand for
immunisation, including
addressing gender -related
barriers, and regularly
reach zero -dose children
and missed communities
integrating them into the
routine system.
2. Building resilient
demand for Routine
Immunisation Services
2.1 Behavioural intervention for generating
demand
- National centre of excellence on demand
(NCED) (strengthening a domestic institution)
for planning and coordination
on comprehensive demand intervention s
- Continue evidence based and data
driven investments in SBCC
2.2 Demand Generation for new vaccine
introductions
- Partnership with UNICEF, local CSOs and
private sector organisation s for demand
generation for the new vaccines (TCV and
HPV), under the coordination of the NCED
2.3 Organi sed mobili sation and reminder
process:
- Integration of reminder process with
electronic micro plan s
- Mechanisms like mobile reminders to track
individual household mobilization
2.4 Evidence generation for demand
- 10 -12% of the demand budget for impact
assessment studies and evidence generation
through pre -post evaluation surveys and
regular monitoring
3. Delivering routine
immunisation service in
hard -to-reach areas
3.1 Digiti sation of beneficiary and due -list
process creation
- Expansion of C oWIN app for RI: providing
technical ass istance and capability building
- Strengthening annual micro
census/community level headcount in the
planning unit area

Report to the Board
Board -2021 -Mtg -4-Doc 10-Annex C
Annex C: High level budget




Gavi 5.0 Assumption - Risk &
Opportunities (especially in the
context of COVID/COVAX)
Total Gavi 5.0 2022 2023 2024 2025 Gavi 6.0 (
2026-2030)
Total Gavi
5.0 & 6.0
Expenditure type
(millions) $199 $32 $34 $52 $82 $51 $250
Vaccine programmes
HPV & TCV risk: limited capacity of the
country to introduce new vaccines in the
context of Covid given severity of last wave
HPV specific risk: risk of delayed
introduction pending the resolution of court
case on HPV;
HPV specific opportunity to introduce HPV
to the states which are ready and in demand
$66 $0 $0 $18 $48 $49 $116
HSS (see break-down below) $133 $32 $34 $34 $34 $2 $134
Core HSS $118 $30 $30 $30 $30 $0 $118
TCV surveillance $5 $0 $2 $2 $2 $2 $6
TA $10 $3 $3 $3 $3 $0 $10
Total disbursements
Risks: Inablity for the country to bring its
focus beyond maintain and restore activities
due to prolonged Covid 19 impact
Continued Covid impact on health systems
may also present a challenge in moving back
to 2019 baseline and country trajectory for
zero-dose reductions

Report to the Board

Board -2021 -Mtg -4-Doc 10-Annex D
1


Annex D: India Accountability Framework
Overview
Gavi intends to build upon the strong foundations from previous strategies with India
as they relate to measurement, reporting, and accountability . The accountability
framework will be grounded in the final India Strategy Theory of Change and will
encompass the more detailed monitoring and learning plan developed for the strategy.
The framework speaks to both accountabilities across fund implementing entities and
Government of India (Go I).
Programmatic monitoring and accountability
While the final set of metrics, baselines and targets will be agreed upon over the
coming months as interventions are finalised and the monitoring and learning plan
elaborated upon , the following topics will be included at a minimum:
? Zero dose: Reduction in zero -dose children over the strategy period
? Vaccine introductions: Vaccine introductions and rate of scale -up across States
? Vaccine programmes: Coverage and drop -out
? Programmatic investments : A selection of metrics mapped to the finalised theory
of change, to include demand, role of CSOs, service delivery and data related
investments
? Sustainability: Such as the t ransition of human resources / role s to GoI budgets
over the course of the strateg y and integration of programmes into State budgets
? Oversight and accountability: Monitoring of IAGs
Progress against t hese metrics will be regularly reviewed as part of the accountability
and reporting mechanisms described below and formally reported to the Gavi
Secretariat.
GoI have previously raised their support and willingness to facil itate more
documentation around lessons learned and particularly best practices that may be of
interest to the broader Gavi portfolio. This is something we are seeking to capitalise
upon to a greater degree in the next strategy . This may involve further reviews, case
studies, efforts to capture learnings for peer -reviewed journals, evaluations and impact
assessments.
Financial monitoring and accountability:
As part of the quarterly financial reporting, the G oI will continue to take responsibility
to complete the consolidation exercise of a tailored financial reporting template across
the funding recipients and submit to Gavi for approval .
Operating in heightened fiduciary risk environments may be required to achieve the
objectives of the new strategy. In such cases additional assurance mechanisms
should be discussed with Gavi and implemented to ensure appropriate oversight is in
place .
In addition to the annual performance reviews (e.g. JA?s MSD?s) , the detailed budget
and workplan will be thoroughly reviewed and updated as required but at a minimum
on a bienn ial basis.

1



Board -2021 -Mtg -4-Doc 10
Report to the Board
30 November - 2 December 202 1

Section A: Executive Summary
In June 2021 , the Board signalled strong support to continue Gavi?s strategic
partnership with India for five years (from 2022 to 2026) . Since then, a better
understanding of COVID -19 impact s on routine immunisation systems (resulting in
an increase in zero -dose children in 2020 ), has reinforced the case for supporting
India?s ambitious immunisation agenda. This paper presents the case for catalytic
investment s in reaching zero -dose and under -immunised children , as well as
equity -focused vaccine introductions , in India during the p eriod 2022 to 2026.
Timelines and proposed investment amounts were refined b ased on Programme
and Policy Committee (PPC) and Board guidance and further consultations with
the Government of India and partner s, resulting in a modest shift of ~US$ 20 million
from vaccine introductions to the zero -dose agenda.
Based on the October PPC recommendation, t he Board is requested to
approve the renewal of the strategic partnership with India , including
proposed investments of US$ 250 million to introduce the two equity -
focused vac cines ( human papillo mavirus ( HPV ) and typhoid conjugate
vaccine ( TCV )) and to reduce the number of zero -dose children by 30% in the
period 2022 -2026 .
Section B: Content
Context
1.1 At its June 2021 meeting , t he Board signalled universal support to
renew Gavi?s strategic partnership with India for five years from 2022
to 2026 . It agreed that the partnership should focus on zero -dose and
under -immunised children , as well as on missing introductions of HPV and
TCV . The Board provided guidance to ref ine timelines , recalibrate
investment amounts for vaccine introductions in light of the pandemic , and
to keep some level of flexibility with regards to the allocation of funding
within the new vaccine support (NVS) and health systems support (HSS)
envelopes. On zero -dose, the Board reiterated the importance of
sustainably reaching missed children with a full course of vaccines and
highlighted the need to work more extensively with commun ity -based and
civil society organisations (CSOs) at the local level . Th is updated proposal
incorporates this guidance.
SUBJECT : STRATEGIC PARTNERSHIP WITH INDIA
Agenda item: 10
Category: For Decision

R Report to the Board
1
Board -2021 -Mtg -4-Doc 07a -Annex B

Annex B: Update on the Operation alisation of the Humanitarian Buffer
1. Background
In March 2021, the Board approved the Secretariat reporting back to the Programme and
Policy Committee and Board by end 2021 on the operationalisation of the COVAX
Humanitarian Buffer. The Board requested that this report include available key
performance metrics, the number of requests received, and update on delivery support
funding , a s well as a report back on activities undertaken to ensure the Humanitarian
Buffer is a measure of last resort.
Financing for the COVAX Buffer , which includes both the Humanitarian Buffer and the
Contingency Provision 1, at 5% of COVAX AMC funding , was approved by the Board in
March 2021. The Board also approved in March delegating decision making on
Humanitarian Buffer dose allocation to the Inter -Agency Standing Committee (IASC)
Emergency Directors Group, following which, applications for the Huma nitarian Buffer
opened in May 2021. Gavi has work ed closely with Alliance partners, UNICEF and WHO,
as well as the humanitarian sector to operationalise the Humanitarian Buffer.
2. Humanitarian Buffer as last resort
The Humanitarian Buffer is a mechanism established within the COVAX Facility to act as
a measu re of ?last resort? to ensure access to COVID -19 vaccines for high -risk and
vulnerable populations in humanitarian settings. It is a real -time allocation of up to 5% of
doses procured through the COVAX Facility , based on demand. The Humanitarian Buffer
is only to be used where there are unavoidable gaps in coverage in national vaccination
plans and micro -plans, despite advocacy efforts. National governments are responsible
for ensuring access to COVID -19 vaccines for all people within their respective terri tory.
The ?first resort? for all populations of concern, irrespective of legal status, is that they are
included in national vaccination plans and reached during the implementation of those
plans. Gavi Alliance , IASC partners, civil society and others have been and will continue
to advocate with national governments to ensure the inclusion of all populations
regardless of their legal status in line with the WHO Strategic Advisory Group of Experts
on Immunization (SAGE) ?Values Framework? and ?Roadmap for Prioritizing Uses of
COVID -19 Vaccines in The Context of Limited Supply? and will advocate for the revision
of national plans and micro -plans if required.

Since the outset of 2021, both high -level global advocacy and national level advocacy
has been carried out to ask for the in clusion of populations at risk of being left behind in
national vaccination plans and to remind governments that the COVAX Humanitar ian
Buffer is not an alternative to state obligations. This has included, for example, inclusion
of relevant language in the UN Security Council resolution 2565, COVAX briefing UN
Resident Coordinators in priority contexts, and country level bi-lateral advocacy by
1 As reported to the Board in September 2021, given the current levels of vaccine coverage among Facility participants
and the global prevalence of the new variants, the Contingency Provision is not considered an appropriate intervention
at this point, and in its absence the Humanitarian Buffer will continue to form the full scope of the COVAX Buffer.

1



Board -2021 -Mtg -4-Doc 07a
Report to the Board
30 November - 2 December 2021


Section A: Executive Summary
Context
In the context of evolving epidemiological, supply and demand uncertainties, and
of COVAX supply ramping up over the end of 2021 and into 2022, this paper
present s an update of the COVAX Facility?s approach to procurement and the
Alliance ?s role in COVID -19 vaccine delivery through to the end of 2021 and into
2022 . This paper builds on previous Board discussions and on two Programme
and Policy Committee (PPC) discussion s in October 2021 and November 2021 ,
and presents recommendations to the Board for approval.
Questions this paper addresses
What is the scope of Gavi's support to AMC countries in achieving their COVID -19
vaccination goals , in view of the WHO Global Vaccination Target of 70% by mid -
2022 and taking into account sources of supply beyond COVAX ?
What is the COVAX F acility?s approach to procurement of COVID -19 vaccine for
2022?
What are the key delivery challenges faced by AMC countries ? W hat has been the
Alliance?s role so far in the delivery space and how would it evolve going forward ?
What are the risks and trade -offs of Gav i?s continued involvement in COVID -19
vaccination ?
How is Gavi enga ging in ongoing discussions in pandemic preparedness,
response and financing?
Conclusions
Given the global goal , set by WHO, to achieve 70% C OVID -19 vaccination
coverage in all countries by mid -2022 , as well as the tight fiscal space and weak
health systems in many AMC countries , the Gavi Alliance has been provid ing vital
supply of COVID -19 vaccines and support for their delivery to meet countries?
vaccination ambitions . Basing ourselves on the lessons learned from 2021, Gavi
will s harpen its focus in 2022 on lower income countries who urgently need
support , while also putting in place solution s such as the Pandemic Vaccine Pool
to strengthen resilience in the face of potential supply and demand shocks . The
COVAX Facility is secur ing supply through Advance Purchase Agreements , which
enable flexibility in response to changing circumstances through the use of options
and make effic ient use of both donor funding and cost -sharing from countries . The
COVAX Facility will also continue to use dose -sharing as required. Overall, the
SUBJECT : COVAX: KEY STRATEGIC ISSUES
Agenda item: 07a
Category: For Decision

1

Board -2021 -Mtg -4-Doc 07b

Report to the Board
30 November - 2 December 2021

Section A: Summary
Context
To support the COVAX Advance Market Commitment (AMC) goal of frontloading
financing to encourage vaccine development and reserve access to support 92
AMC economies, a flexible fundraising approach was adopted to respond to an
ever -changing global environment, pandemic trajectory and vaccine landscape.
Two successive resource mobilisation rounds were organi sed within a year,
culminating in June 2021 with an event hosted by the Prime Minister of Japan
bringing the total amount mobilised to da te to US $ 10.1 billio n for the procurement
of 1.7 billion vaccine doses. In addition, US $ 799 m illion were mobilised to support
delivery.
Key lessons from a year of intense uncertainty driven by the pandemic evolution
point to the need for upfront cash as a prerequisite for supply security for AMC
economies. Despite an impressive mobili sation of support, cash has not been
provided fast enough to priorit ise COVAX vis a vis suppliers in a very competitive
market. With the foreseen evolution of the pandemic, m oney is need ed upfront to
mitigate significant uncertainty as we enter 2022 .
Questions this paper addresses
To support the implementation of COVAX Strategy (see paper 07a )
? What is the rationale for further resource mobilisation efforts in 2022, the
potent ial scenarios and sources of funding?
? How might Gavi proceed with a campaign with Board members? support to
achieve the resources needed for these scenarios?
Conclusions
The COVAX AMC fundraising strategy will focus on guaranteeing the certainty of
supply and mitigate risks for AMC economies into 2022 in three ways: a) ensuring
the existence of a financially frontloaded Pandemic Vaccine Pool of diversified
vaccines to manage risks and uncertainties as we enter a new phase of the
pandemic, building on lessons to date, saving additional lives , and supporting
lower income economies to get back on a path towards growth, with a particular
focus on low income countries ; b) funding the ancillary costs of dose donations,
ensuring a steady supply of syringes, safety boxes and global freight services ; and
c) in pursuit of country priorities, supplying funding for essential delivery rollout in
SUBJECT : COVAX : RESOURCE MOBILISATION UPDATE
Agenda item: 07b
Category: For Information

1



Board -2021 -Mtg -4-Doc 04


Section A: Executive Summary
Context
The Managing Director Audit and Investigations (A&I) is required to report to the
Board at least annually (detailed reports are made regularly to the Audit and
Finance Committee (AFC) throughout the year including special meetings on
COVAX ). Annex A presents a summary background on the activit ies of A&I for
newer Board members who may be unfamiliar with its scope of work and operation.
Questions this paper addresses
What is A&I doing to assess the risks related to the operation of COVAX and
COVID -19 delivery, and to evaluate management?s risk mitigation ?
What is A&I doing to assess the on -going risks of ?core Gavi ? and management?s
risk mitigation (recognising the significant focus within the Secretariat on COVAX)?
How is this affected by the ne ed for A&I to work remotely , especially with respect
to programme audits conducted in country?
What activity is being noted through Gavi?s whistleblower channels given the public
profile of COVAX?
Conclusions
A&I has undertaken significant work ? across audit, counter -fraud, and advisory
assignments - to understand the special risks, and their mitigation, on the COVAX
facility and the distribution of COVID -19 vaccines.
Whilst there has been significant focus on COVA X operations and COVID -19
vaccine deployment, A&I has maintained a regula r programme of activity , as
agreed with AFC, ensuring that there has been on -going coverage of the core Gavi
activities . T his balance will be maintained into 2022. Following suspension of
programme audits in 2020, these have recommenced in 2021 utilising local
consultants and , increasingly , with A&I staff travelling to country to engage with
programme and ministry management directly.
Regarding the receipt of whistleblower reports in 2021, th ese have increased
significa ntly compared to prior years ? though a large number are non -substantive,
misdirected, or anti -vaxxer in nature. Nonetheless, th os e which are well -intended
and well -directed provide insights which have been followed through, in
SUBJECT : REPORT FROM AUDIT AND INVESTIGATIONS
Agenda item: 04
Category: For Information
Report to the Board
30 Nov ember - 2 Dec ember 2021

1

Re port to the Report to the Board
Board -2021 -Mtg -4-Doc 06-Annex B


Annex B : 2016 -2020 Strategy progress dashboard with original indicator definitions

Classified as Internal
21%
55%
2
3
Improve sustainability 3 Market shaping 4 Accelerate vaccines 1 Strengthen capacity 2
2016 ? 2020 INDICATORS
STRATEGY PROGRESS
5
Gavi Board UPDATED: 15 September 2021
1
EQUITY: GEOGRAPHIC DISTRIBUTION
ROUTINE IMMUNISATION COVERAGE 1
2
3
4
5
EFFECTIVE VACCINE MANAGEMENT
DATA QUALITY
PENTA1 COVERAGE & DROP -OUT
INTEGRATED HEALTH SERVICE DELIVERY
CIVIL SOCIETY ENGAGEMENT
2
3
4
1
COUNTRY INVESTMENT IN VACCINES 1
COUNTRIES ON TRACK TO TRANSITION
INSTITUTIONAL CAPACITY
CO - FINANCING COMMITMENTS
2
3
4
1
VACCINE PRICE REDUCTION
VACCINE INNOVATION
HEALTHY MARKET DYNAMICS
SUPPLY SECURITY
Measles - containing vaccine 1 st dose Percentage point Pentavalent 1 st dose Pentavalent 3 rd dose
MCV1
PP Penta1 Penta3
CURRENT: + 1PP 2020 TARGET PENTA3 85% MCV1: 83% 2015 BASELINE PENTA3: 80% MCV1: 78%
CURRENT: + 1PP 2020 TARGET 89% 2015 BASELINE 79%
2020 TARGET 43%** 2015 BASELINE 16%
2020 TARGET 38% 2015 BASELINE 28%
2020 TARGET PENTA1: 90% DROP - OUT: 4% 2015 BASELINE PENTA1: 86% DROP - OUT: 7%
2020 TARGET 100% 2015 BASELINE N/A 2020 TARGET 55%
100% 2020 TARGET 100% 2020 TARGET 11/11
$15.20 2020 TARGET N/A 2
2020 TARGET 10
2020 TARGET 6/11
2020 TARGET N/A
2020 TARGET N/A
2015 BASELINE 45%
2020 TARGET 75% 2015 BASELINE 63%
2015 BASELINE N/A
2015 BASELINE N/A
2015 BASELINE 85% 2015 BASELINE 7/11
2015 BASELINE $20
2015 BASELINE 0
2015 BASELINE 1/11
BREADTH OF PROTECTION
PENT A3 81%
CURRENT: + 1PP 2020 TARGET 63% 2015 BASELINE 31%
52%
81%
25% MCV1 81%
87%
45%
10/11
11
5/11 4 EQUITY: WEALTH
CURRENT: + 1PP 2020 TARGET 45% 2015 BASELINE 35%
5 EQUITY: MATERNAL EDUCATION
CURRENT: + 1PP 2020 TARGET 40% 2015 BASELINE 30%
ON TRACK MODERATE DELAYS / CHALLENGES SIGNIFICANT DELAYS / CHALLENGES
2
NO UPDATE AT THIS REPORTING PERIOD
2 4
40%
38%
65%
7 PP
35%
56%
1 Performance reporting lags by approximately 2 calendar years ? current result is for performance year 2019 2 Not published due to commercial sensitivity NB: Graphics not drawn to scale
N o update
N o update

Indicators reported
as originally defined
N o update

1
Report to the Board
Board -2021 -Mtg -4-Doc 06-Annex C
Annex C : IRC/HLRP Recommendations
Independent Review Committee (IRC)
The Independent Review Committee has had a significant uptick in activity in 2021,
largely driven by its engagement to support the roll -out of C OVID -19 vaccines. To -
date, the IRC has been involved in the review of 117 applications, composed of 46 for
core Gavi business and 71 1 Covax -related requests, largely for additional cold chain
equipment to roll -out C OVID -19 vaccines supplied via the C OVAX Facility 2 (see Figure
1 below for the distribution of request types). The value of the requests received 3 is
over US$ 140 million 4, with US$ 100 million recommended for funding (see Figure 2
below for value by support type). Support for MCV introductions and campaigns
continues to drive vaccine requests, with 9 requests 5 for support reviewed to -date
worth an estimated value of ~US$ 60 million . Gavi -supported countries further their
efforts to prepare for withdrawal of OPV through the introduction and scale -up of IPV,
with 7 requests for support of IPV second dose reviewed to -date and an additional 4
anticipated through the end of the year.

DPRK, Kyrgyzstan and Syria were able to complete their full portfolio planning process
during the first half of 2021, resulting in requests totalling US$ 19 million for HSS and
CCEOP support, all recommended for funding by the IRC. DPRK was the largest of
the three requests at US$ 8.75 million with investments focused on tracking un -
immunised children, achieving >97% coverage of Pentavalent 3 vaccines in under -
performing provinces and improving and sustaining immunisation coverage in
disaster -prone areas. The application from Syria also had a strong emphasis on
coverage and equity, with 62% of the US$ 6.8 million budget targeted to strengthening
1 Includes 69 CCE requests and 2 requests for Covid -19 campaign support. 2 The IRC also participated in country readiness assessments for roll -out of Covid -19 vaccines led by the WHO. 3 Estimated application value includes support for v accines, commodities, and cash support (e.g., VIGs, Ops). 4 Excludes application values for IPV second -dose introductions and new support for yellow fever diagnostics. 5 Including 3 MCV introductions and 6 campaign requests.

Report to the Board

Board -2021 -Mtg -4-Doc 05-Annex D


Annex D: Annual report on the implementation of the Gender Policy
Section A: Introduction
This report describes progress made in 2021, the first full year of implementing Gavi?s
new programmatic Gender Policy. The policy seeks to identify and overcome gender -
related barriers to reach zero -dose children and missed communities with the full range
of vaccines, encompassing: (1) identifying and addressing underlying gender -related
barriers faced by caregivers, adolescents and health workers; (2) overcoming any
differences in immunisation coverage between genders; (3) encouraging and advocating
for w omen?s and girls? full and equal participation in decision -making related to health and
health programmes.
With gender disparities deepening in the COVID -19 pandemic, identifying and addressing
gender -related barriers to immunisation ha s become even more critical. At the same time,
work to design new Gavi investments has slowed, with country and partner capacity
stretched by rolling out COVID -19 vaccines. In this challenging context, the Gavi
Secretariat has focused on laying a strong foundation to roll ou t the Gender Policy at
scale, advancing work in six key areas in a newly developed Action Framework:
understand, advocate, identify, reach, learn and partner. This report also highlights
progress made at country level through existing strategic focus area investments and
partnerships, as well as reporting on progress to institutionalise gender equality within the
Secretariat.
Section B: Implementation of Gavi Gender Policy
1. Understand: work with partners to enhance capacity to understand, recognise and
address gender -related barriers to immunisation.
1.1 The Vaccine Alliance is coordinating capacity enhancement of its staff and
partners . Six online learning events were held to increase understanding and skills
on gender and immunisation. Subjects ranged from addressing gender -related
barriers in the roll -out of COVID -19 vaccines and conducting gender analysis, to
indicators and methods to collect data on social and beha vioural drivers to
immunisation uptake.
1.2 The World Health Organization (WHO) integrated learning on addressing
gender -related barriers into the course content for the Immunization Agenda
2030 Academy which has already train ed a first cohort of 256 learners. The United
Nations Children's Fund (UNICEF) is developing an innovative ?Journey to
immunisation? learning tool for designing gender responsive and
transformative interventions . The Secretariat has partnered with the Global
Wo men?s Institute to design and implement a short GenderPro course for country -
facing staff across the Alliance as well as a longer expert course for Alliance
gender focal points.
1.3 UNICEF is also building the capacity of Ministry of Health (MoH) staff in seven
countries in the use of human -centred design (HCD) , a highly effective approach

1



Board -2021 -Mtg -4-Doc 06


Section A : Executive Summary

This report provides an initial progress update on Gavi 5.0 , associated
opportunities and risks 1 and a final update on progress made in Gavi 4.0,
informed by the updated WUENIC 2 data released in July 2021.
Despite pandemic related disruptions to immunisation services, the Alliance
achieved or exceeded all of its Gavi 4.0 mission targets. Although there was a
decline of 4 percentage points in DTP3 coverage between 2019 and 2020,
disruptions appear to have been c oncentrated in Q2 2020 with the majority of Gavi -
supported countries showing restoration of services to pre -pandemic levels by the
end of 2020. This is a testament to the dedication of countries, supported by the
Alliance, to protect immunisation services during these challenging times.
However, the outlook remains uncertain with monthly administrative data
showing potential disruption, mainly in some Asian countries in 2021.
Although it is too early to say the extent to which these trends represent real
disruption rather than reporting issues, it is clear that the situation remains tenuous .
A real risk of backsliding remains, not only from potential future waves of
COVID -19 infections but also from the diversion of resources to COVID -19 vaccine
delivery. A synergistic approach to COVID -19 vaccination and routine
immunisation , clear guidance to c ountries, flexible and tailored support based on
country needs, and enhanced advocacy will be critical to mitigate these risks.

In light of ongoing risks and uncertainty, priorities and targets for Gavi 5.0
continue to be reviewed and will be adapted as required . The Board endorsed
a recalibrated set of priorities in Dec ember 2020, with the Alliance prioritising
access to COVID -19 vaccines; maintaining, restoring and strengthening routine
immunisation; reaching zero dose children and missed communities; and
safeguarding domestic financing for immunisation. Other areas of Gavi 5.0,
including new vaccine introductions and the approach for engaging middle -income
countries (MICs) , will advance at a slower pace than initially planned.

In order to support countries to simultaneously deliver routine immunisation and
COVID -19 vaccinat ions , while also catching -up missed children to prevent
outbreaks , the Alliance is seeking to increasingly take a joined -up view of these
intertwined priorities. Concretely, t his will require further integration and
1 Associated risks refer to the top risks in the Risk & Assurance Report 2021 2 WHO/UNICEF Estimates of National Immunization Coverage
SUBJECT : STRATEGY, PROGRAMMES AND PARTNERSHIPS:
PROGRESS, RISKS AND CHALLENGES
Agenda item: 06
Category: For Guidance
Report to the Board
30 Nov ember - 2 Dec ember 2021