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Board -2020 -Mtg -6-Doc 09-Annex B

Annex B: Pledges to the Gavi COVAX AMC

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Board -2020 -Mtg -6-Doc 10-Annex A

Annex A

Table 1 ? Scenarios & implications for range of potential AMC support to India
(estimated)
Scenario % of AMC
support to
India 1
# doses to
India 2
Funding to
India 3
% India
population
covered 4
% AMC 91
population
covered 5
Low end of
range
10% ~95 - 125
million
~US$ 66 5
million
~3 -5% ~17 -22 %
High end of
range
20% ~190 - 250
million
~US$ 1.3
billion
~7 -9% ~15-20 %
Pro -rata (for
reference
only)
35% ~330 - 440
million
~US$ 2.3
billion
~12 -16 % ~12 -16 %

Table 2 ? Allocation of US $ 150 million in delivery support (CCE and TA) to
AMC 91
Current Scenario Amount Allocated
Cold Chain Equipment US $ 50 million
Technical Support US $ 60 million
CCE Reserve (e.g. UCC Support) US $ 10 million
Total Alloacted US $ 120 million
Amount held pending India COVAX AMC Board decision US $ 30 million

Low range scenario
US $ 15 m illion (10% of total allocation)
High range scenario
US $ 30 mill ion (20% of total allocation)
Currently estimated Govt needs for TA
above US $ 27 million for preparedness,
planning and delivering for COVID -19
vaccine rollout
The Government of India has already
submitted its needs for urgent TA and CCE
surpassing the maximum envelop e. The
Gov ernment has already mobili sed funds
domestically to supplement CCE , but gaps
remain .
Allocating US $ 15 million would not allow
for urgent gap filling of TA or CCE needs
Allocating US $ 30 million would allow for
similar pro rata allocation of prioritised
AMC56


1 AMC donor -funded doses , and implied estimated funds (actual funding amount will depend on
dose price) . Does not accou nt for cost -sharing . Does not include Buffer. 2 Ranges b ased on base case and high er price resource mobilization scenarios, as presented in
Paper 8. 3 Assumes indicative average fully loaded price of US$ 5.2 - 7 per dose , plus compensation scheme
estimated at US$0.10/dose . Actual price, and thus amount of funding allocated, will vary based on
available technologies. 4 Assumes 2 dose regimen . 5 Assumes 2 dose regimen .

1



Board -2020 -Mtg -6-Doc 10


Section A: Executive Summary
Context
In September 2020, the Gavi Alliance Board requested that the Secretariat present
the proposed approach for Gavi COVAX Advance Market Commitment (AMC)
support to India for COVID -19 vaccines and delivery at its next meeting in
December 2020. It recognised t hat India, given its large population size, second
largest number of COVID -19 cases in the world, contracting economy and role as
a global vaccine supplier, merits a tailored approach, recognising that the 92
economies included in the AMC (AMC92) include c ountries with Gross National
Income (GNI) per capita (p.c.) of similar value or higher than India (see Table 1 ).
Further, given that India accounts for 17% of the world population (35% of the
total COVAX AMC participants? population) , continuing COVID -19 cases in
India would pose a risk to global efforts to stop the pandemic.

Table 1
Country GNI 1 Population 2
India 2,130 1,380, 004, 000
Indonesia 4,050 273, 52 4,000
Nigeria 2,030 206,1 40 ,000

In October 2020, the Programme and Policy Committee (PPC) was requested to
provide guidance on the level of appropriate support within the presented
parameters and further conversations with the Government of India should take
place to align on a proposed package of support to be presented at the December
Board for approval .

Questions this paper addresses
? What is the appropriate level of support of COVAX AMC doses for India ?
? What is the appropriate level of delivery support for India?


1 2019 GNI pc constant USD ( WB Atlas) 2 World Bank 2020 Population projections
SUBJECT : COVAX AMC SUPPORT TO INDIA
Agenda item: 07
Category: For Decision
Report to the Board
15-17 December 2020

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Board -2020 -Mtg -6-Doc 11
Report to the Board
15 -17 December 20 20

















SUBJECT: REVIEW OF DECISIONS
Agenda item: 11
No paper

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Board -2020 -Mtg -8-Doc 08-Annex C 1

Annex C: COVAX Reporting Framework
Section A: Overview of the draft COVAX Reporting Framework
The Gavi Secretariat, in consultation with other stakeholders, is developing a Monitoring,
Evaluation and Learning (MEL) approach intended to cover both the COVAX Facility and
COVAX AMC 1.
The proposed MEL approach is holistic in nature, spanning from inputs through to impact
across the COVAX Facility and COVAX AMC . It is intended to support both accountability
and learning agendas and is complementary to the Secretariat?s Risk Management and
Assurance work . The proposal builds upon the lessons learned from the pneumococcal
Advance Market Commitment (A MC ) framework in term s of M&E approach and methods ,
making adaptations as necessary. The draft MEL approach includes the following:
? A core COVAX theory of change (with complementary, more detailed theories of
change forthcoming) ;
? A comprehensive set of performance and learning metrics ;
? A proposed Annual COVAX monitoring report;
? A multi -stage evaluation approach, to be informed by a COVAX Facility and
COVAX AMC Evaluation design, evaluability and baseline study commissioned at
an early stage ; and
? Country reporting requir ements for COVAX AMC eligible countries accessing Gavi
/ COVAX support (vaccines, cold chain equipment and additional technical
assistance) to monitor performance and facilitate learning over time.
It is hoped that a good quality and robust MEL approach a nd COVAX Reporting
Framework that speak to both learning and accountability needs will ultimately benefit
Gavi, broader ACT -A partners, donors and participants as well.
The draft COVAX Reporting Framework consists of topline performance metrics to be
shared regularly with the Gavi Board and COVAX Governance bodies. Where relevant,
we propose to integrate metrics and data sources made available by our partners (namely
CEPI , WHO and UNICEF ).
The MEL approach and COV AX Reporting Framework are drafts at present, due in large
part to several design and operational aspects of the COVAX Facility and COVAX AMC
still under development. As such, the draft COVAX Reporting Framework does not yet
include proposed baselines nor targets and flags certain indicators as still in development
phase / under discussion (TBC). Furthermore, as we evolve our understanding of the
different vaccine presentations themselves in terms of efficacy and beyond, we may have
to revisit certain assum ption s we have built into our theories of change and impact metrics.
1 Note that Gavi?s broader response to COVID -19 (for example, flexibilities introduced or exemptions granted in
response to the pandemic) is included as a specific theme under the proposed Gavi 5.0 learning priorities (as presented
in Annex E of Paper 1g) and will be complementary in nature.

Gavi
COVAX Facility Risk Framework
Citi Banking, Capital Markets & Advisory:
Global Public Sector Group
Strictly Private and Confidential
November 25, 2020

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Board -2020 -Mtg -6-Doc 08


Section A: Summary
Context
The COVID -19 pandemic continues to spr ead across the world, and with over 50
million people infected and 1. 5 million deaths, the ongoing crisis is having a
profound impact on people?s health and liv elihoods and their health worldwide . In
addition, r ecent COVID -19 vaccine trial preliminary successes have put an even
greater spotlight on vaccines as a solution to the pandemic, and the COVAX
Facility (?the Facility?) as the mechanism to achieve global access , ensuring that
low - and lower middle -income economies, as well as other IDA -eligible e conomies,
have access to COVID -19 vaccines at the same time as all wealthier economies.
Since Septembe r 2020 , the Secretariat has been working tirelessly to
operationalise the Facility, continuing to engage manufacturers, self -financing
economies, and AMC -elig ible economies, representing the principles of
collaboration and solidarity in response to COVID -19. Currently 189 countries are
committed or eligible to receive doses through the Facility, representing 90% of the
world?s population. The COVAX Facility portfolio currently includes three vaccines ,
and to date t he AMC has fundraised US$ 2.1 billion.
The Gavi Board serves as the decision -making body for the COVAX Facility. In
September, t he Board approved interim terms of reference for COVAX Facility
bodies, the allocation of US$ 150 million from core resources to prepare the 92
AMC -eligible participants (?AMC92 ?) to deliver COVID -19 vaccines , and the cost -
sharing approach to vaccine procurement for the AMC92 .
Following the pri nciple of safeguarding Gavi?s assets and reputation, the Facility is
being designed to avoid risk where possible, and residual risks are being actively
monitored and mitigated. However , it is also understood that operating at this
magnitude and speed carri es risks, and failure of establishing a successful Facility
will also affect Gavi?s overall reputation. Some key risks are outlined in this paper
and a full overview is included in section 3 of the Risk & Assurance Report ( see
Doc 06 ). The Gavi Secretariat, including the Office of the COVAX Facility, under
the guidance of the Board, continues to seek the right balance to successfully
deliver on the promise o f the Facility while minimising risks to Gavi core resources
and programmes.


SUBJECT: COVAX FACILITY OPERATIONALISA TION AND VACCINE
PROGRAMME
Agenda item: 08
Category: For Decision
Report to the Board
15 -17 December 2020

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Board -2020 -Mtg -6-Doc 09


Section A: Introduction and summary
This paper presents the strategy for the Gavi COVAX AMC replenishment. In doing
so, it presents the fundraising status to date following the launch of the COVAX
AMC at the Global Vaccine Summit in June 2020. With the prospect of COVID -19
vaccines being available in implementing countries early next year, it hig hlights the
need for immediate financing to accelerate and secure doses of the vaccines to
tackle the acute phase of the pandemic in the 92 AMC eligible economies (see
Annex A) , protecting the most vulnerable and helping to restart the world economy .
Final ly, it lays out the plan for the replenishment , including the narrative, the
funding scenarios, and the campaign .
: The hope for equitable access for AMC 92 economies
1.1 The COVID -19 pandemic has had a devastating impact : at least 50 million
people worldwide have been infected , with 1. 5 million deaths , and the
pandemic accelerating in many countries . T he world economy will shrink by
nearly USD 6 trillion this year alone , with negative growth in 150 countries ,
including in sub -Saharan Africa for the first time in quarter of a century . 1.6
billion students have missed school because of the pandemic, and 150
million people will be pushed into extreme poverty by 2021 .
1.2 To fast track a global solution, u nder the umbrella of Access to COVID -19
Tools (ACT) Accelerator, Gavi, the Vaccine Alliance has created the
COVAX Facility and the Gavi C OVAX AMC with our CEPI (Coalition for
Epidemic Preparedness Innovations) and WHO partners with one central
goal : to get effective, safe COVI D-19 vaccines to all participants regardless
of wealth on the same urgent timeline.
1.3 The Gavi Covax AMC has been set up as an innovative finance mechanism
to frontload financing of procurement of at least 1 billion vaccine doses for
low er income countries in record time . It draws upon Gavi?s experience of
rolling out increasing numbers of vaccines and reaching more people and
children over the years: >800m through routine immunisation, and >1bn
people through campaigns, mainly agains t diseases of epidemic potential.
In addition, Gavi and its partners ha ve increasingly expanded and
strengthened the health systems infrastructure to roll out vaccines. Most
importantly Gavi ?s unique experience in innovative financing, market
shaping and procurement at scale of vaccines and cold chains can be key
SUBJECT: AMC RESOURCE MOBILISATION
Agenda item: 09
Category: For Information
Report to the Board
15 -17 December 2020

1


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Board -2020 -Mtg -6-Doc 09-Annex A

Annex A : AMC eligible economies
? Low income : Afghanistan, Benin, Burkina Faso, Burundi, Central African
Republic, Chad, Congo, Dem. Rep., Eritrea, Ethiopia, Gambia, The Guinea,
Guinea -Bissau, Haiti, Korea, Dem. People's Rep., Liberia, Madagascar,
Malawi, Mali, Mozambique, Nepal, Niger, Rwanda, Sierra Leone, Somalia,
South Sudan, Syrian Arab Republic, Tajikistan, Tanzania, Togo, Uganda,
Yemen, Rep.,
? Lower -middle income : Angola, Algeria, Bangladesh, Bhutan, Bolivia, Cabo
Verde, C ambodia, Cameroon, Comoros, Congo, Rep. C?te d'Ivoire, Djibouti,
Egypt, Arab Rep., El Salvador, Eswatini, Ghana, Honduras, India, Indonesia,
Kenya, Kiribati, Kyrgyz Republic Lao PDR, Lesotho, Mauritania, Micronesia,
Fed. Sts., Moldova, Mongolia, Morocco, M yanmar, Nicaragua, Nigeria,
Pakistan, Papua New Guinea, Philippines, S?o Tom? and Principe, Senegal,
Solomon Islands, Sri Lanka, Sudan, Timor -Leste, Tunisia, Ukraine,
Uzbekistan, Vanuatu, Vietnam, West Bank and Gaza, Zambia, Zimbabwe
? Additional IDA eligibl e: Dominica, Fiji, Grenada, Guyana, Kosovo, Maldives,
Marshall Islands, Samoa, St. Lucia, St. Vincent and the Grenadines, Tonga,
Tuvalu.

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Board -2020 -Mtg -6-Doc 07 -Annex D 1
Annex D: Draft Theory of Change for the MICs Approach





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Board -2020 -Mtg -6-Doc 07 -Annex D 2
The theory of change (ToC) presented above is a high -level work -in-progress draft
for directional guidance from the Board. The aim of the MICs draft ToC is to
provide the Board with a picture of the MICs approach as currently
developed, acknowledging that the ToC is still a work in progress and will be
detailed in further stages. Given the deferral of the new vaccine introduction
agenda until June 2022, th e draft focuses largely on the backsliding objective. A
final, comprehensive ToC covering both objectives w ill be brought to the Board in
June 2022 , informed by the learning agenda and developed in collaboration with
key stakeholders . The draft ToC includes the following components:
Levers: The MICs approach will leverage, to varying extents, all of the inputs and
levers in Gavi ?s sphere of control , as laid out in the Gavi 5.0 ToC. For example, the
MICs Approach will look to mobilize resources towards immunisation, leverage
existing and new partnerships towards the MICs objectives, and to innovate
through the Innovative Financing Facility (in the longer term), all while taking a
continuous Alliance -learning approach to understand how best to engage
successfully in MICs.
Key interventions areas: Specific i nterventions will be developed and detailed
based on country needs and consul tations with partners and stakeholder s. Initially
these are expected to fall into in four categories: advocacy and political will building
(e.g., advocating to keep routine vaccination on the political agenda in a way that
prioritises equity, including by bringing the voices of the marginalised to the table) ;
technical assistance and support to enhance the immuni sation ecosystem (e.g.,
developing plans to communicate and engage communities towards the
resumption of safe vaccinations services) ; targeted inte rventions (e.g., restoring
coverage and catching up missed children via integrated service delivery and
innovations) ; and, in the longer term, an Innovative Financing Facility for
procurement. All of these interventions will take an explicit equity lens, p rioriti sing
missed communities and zero -dose children where relevant. In addition, these
interventions will be catalytic, aiming to mobilize additional resources towards the
MICs goals from domestic and other sources.
Outputs: These interventions are expe cted to lead to political commitment to
equitable vaccination; developed plans and strategies to maintain, restore, and
strengthen coverage, starting with missed communities; and strengthened
government capacity to deliver equitable immunisation programmes in the MICs
targeted by the Approach . In addition, t he Innovative Financing Facility, when it is
operationalized, will contribute, alongside other interventions, to increased access
to vaccines at sustainable prices. The intervention areas will work together to
generate these outputs: for example, the combination of advocacy alongside
catalytic targeted interventions will incentivize governments to contribute additio nal
resources to preventing and mitigating backsliding, thus strengthening political
commitment for equitable immunisation.
MICs objectives and outcomes: Ultimately, these interventions and outputs
contribute to the achievement of the two objectives laid o ut in the MICs Approach:
preventing and mitigating backsliding in former -Gavi countries, and supporting the
sustainable introduction of new vaccines in former and select never -Gavi

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Board -2020 -Mtg -6-Doc 07 -Annex E 1
Annex E : Draft Learning Agenda
In order to ensure that the MICs Approach is fit -for -purpose in its design, effective
in its implementation, and able to adapt in a timely way, a formal learning agenda
will accompany the implementation of the MICs Approach over the course of
Gavi 5.0.

Th is learning agenda will be informed by a clear set of use cases and key
priorities/questions, presented in draft form below. Following any additional
guidance from the Board, these use cases and questions will be further refined
and then used to develop a detailed learning agenda aligned with the broader Gavi
5.0 Learning System. The final learning agenda will be developed in close
collaboration with, and building on the experiences of, Alliance partners, and will
seek to formalise Alliance learning to date , while taking a forward -looking view at
how both past and future learning can inform the MICs Approach. Key questions
of strategic importance to the Board will be answered through the most appropriate
and robust methods 1, designed in coordination with Ga vi?s Measurement,
Evaluation, and Learning Unit, and following any guidance from the Evaluation
Advisory Committee as relevant. The learning agenda will also inform regular
updates to the Board on the MICs Approach.
Figure 4: Draft use cases and key questio ns:
Use cases
(under development)
Gavi 5.0 Learning Priority
Questions
(under development)
Additional detailed questions
(under development)
? To ensure that the planned MICs
Approach is relevant and
addresses the drivers of the
challenges identified (by 2021 for
backsliding, 2022 for full Approach)
? To support countries to
understand the root causes of
backsliding and barriers to
sustainable and equitable
introductions, and what is needed
to overco me them (by 2021 for
backsliding, 2022 for full Approach)
? To confirm if the support we are
providing through MICs is effective
and sufficient, recognizing the
heterogeneity of MICs contexts
(Ongoing, mid -term review 2023)
o If yes, can we deliver the same
outcomes more efficiently ?
o If no, is the policy or the
implementation the
bottleneck ?
o How can we adapt and
improve ?
Backsliding: Is there any
indication of backsliding on
coverag e in countries? If
so, what are the key drivers?
? How and why do drops in coverage exacerbate
inequities?
New vaccine
introductions: What are the
key enablers or bottlenecks
to equitable and sustainable
new vaccine introductions?
? How can new vaccines be introduced in a way that
reduces inequities?
? What can we learn from COVAX engagement on what it
takes to successfully introduce new vaccines in MICs?
? What can we learn from the targeted piloting of some
aspects of the Innovative F inancing Facility?
COVID -19: What is the level
of disruption and impact on
routine immunisation (RI)?
How well is Gavi responding
to support countries to
maintain, restore and
strengthen routine
immunisation / ease
disruption?
? How are the drivers of backsliding different in the COVID -
19 context?
? How have the barriers to sustainable and equitable new
vaccine introductions changed in light of COVID -19?
? What can we learn from the Alliance?s experience of
implementing MR&S in Gavi -eligible countries that is
relevant to MICs?
1 E.g., Monitoring, evaluation, portfolio level analytics, implementation research.