Report to the Board
Board -2020 -Mtg -3-Doc 06-Annex B

Annex B: Draft Gavi 5.0 Indicator Dashboard

Report to the Board
Board -2020 -Mtg -3-Doc 03-Annex D

Annex D : Update on Funding Policy Review
As part of operationalising Gavi 5.0, the Secretariat conducted a two -phase review of
Gavi?s existing funding policies: Eligibility & Transition Policy, Co -Financing Policy
and the Health System & Immunisation Strengthening (HSIS) Support
Framework 1. The purpose of this annex is to inform the Board of the status of this
Funding Policy Review (FPR) in light of the COVID -19 pandemic , and to provide
greater detail on the decision points in Doc 03 .
Scope , Context and Approach
1.1 The FPR is an integrated review to update the core policies which define Gavi
funding to countries 2. Until now, the se policies have been developed and
updated individually and separately . This concurrent review enabled an aligned
update to the funding policies, simplifying burdensome processes and
realign ing objectives and incentives .
1.2 The se three policies describe Gavi?s principles and approach to the
funding it provides. Implementation experience indicates that th ese policies
have function ed largely well under the stable ?standard? conditions for
which they were developed, alongside the Fra gility, Emergencies, Refugees
Policy 3 and Gender Policy 4.
1.3 The Eligibility & Transition Policy articulates which countries can access
Gavi support and how this support phase s out over time. It enshrines the key
principles of time -limited and catalytic support focused on the poorest countries
in the world, linked to a country?s ability to pay as proxied by its gross national
income per capita (GNI p.c.). It also provides a clear, institutiona lised pathway
for a country?s eventual exit from Gavi support. In conjunction, t he Co -
financing Policy helps build long -term financial sustainability of vaccines
introduced with Gavi support by requiring countries to invest resources to
procure a certain s hare of these vaccines.
1.4 The Health System and Immunisation Strengthening (HSIS) Support
Framework sets out the objectives, funding levels and essential requirements
for HSIS support (including how health system strengthening (HSS) support is
allocated acr oss countries), to contribute to sustainable improvements in
1 The HSIS support framework operates in a similar manner as a Gavi policy, but with a greater level of
detail. The FPR seeks to resolve this inconsistency with other Board -approved policies. This includes
health system strengthening (HSS) grants, vaccine i ntroduction grants (VIGs) and operational support
for campaigns (Ops). The review also covered the Cold Chain Equipment Optimisation Platform
(CCEOP), which is not currently part of the HSIS framework. 2 While the FPR recommends alignment of funding to cou ntries with funding for technical assistance
through the Partners? Engagement Framework (PEF), PEF itself is included in a separate 5.0
operationalisation workstream on ?Partnerships?. 3 The Fragility, Emergencies and Refugees Policy provides flexibilitie s to a country facing significant
challenges due to exceptional circumstances as identified by humanitarian and emergency response
partners. This policy went into effect in July 2017 and is not in scope for the FPR . 4 A revised Gender Policy (see Doc 04 ) is also being brought to the Board for approval at this meeting .
It is a programmatic policy designed to ensure that a gender lens is taken in Gavi?s approach to
supporting countries and country programming of Gavi?s support to ensure access to immunisatio n for
all.

1


Re port to the Board
Board -2020 -Mtg -3-Doc 03-Annex E

Annex E: Gavi 5. 0 MICs Approach and COVID -19
Introduction
1.1 In June 2019, the Board agreed that the Alliance?s approach to former
Gavi -eligible countries be institutionalised in Gavi 5.0. They requested
that the Secretariat develop an approach with the objectives of introducing
key missing vaccines and preventing backsliding in immunisation
cov erage levels post -transition. At that time, t he envisaged package of
support for former Gavi -eligible countries included political advocacy,
technical assistance, innovation, market shaping, and catalytic financial
support to jumpstart vaccine introduction s.
1.2 Building on this foundation, t he Board also request ed the Secretariat to
explore how some elements of this approach could be ex tended to
some 1 never Gavi -eligible middle -income countries (MICs ). The
engagement with never Gavi -eligible MICs would have a particular focus on
new vaccine introductions , thereby address ing the inter -country equity
challenge that is impossible to disregard in light of Gavi?s ambitious goal of
?leaving no -one behind wit h immunisation?. The Board approved a funding
envelope of up to 3% of Gavi 5.0 planned expenditure (approximately
US $ 300 million) for the delivery of the MICs Approach.
1.3 Following this decision last year , the Secretariat ha s been developing the
detailed MICs Approach in close collaboration with countries, donors,
partners, expanded partners, and other key stakeholders . The Secretariat
had prepared to bring this approach to the PPC and Board for decision in
May and June 2020 . Section 2 of this paper outlines the Approach that had
been developed prior to COVID -19 and Section 3 indicates the implications
of COVID -19 on this Approach and how the Secretariat will act in response .
The MICs Approach that had been developed prior to COVID -19
2.1 The MICs Approach , as had been prepared for presentation to the PPC and
Board, ha d two primary objectives: to prevent backsliding in vaccine
coverage in former Gavi -eligible countries , and to drive the sustainable
introduction of key missing vacci nes in both former and select never
Gavi -eligible countries . Alongside these primary objectives, the Approach
ha d a number of important secondary objectives: to improve inter - and intra -
country equity ; to maintain and improve access to sustainable vaccine
pricing ; to open up access to new technologies and innovations ; and to
mobilise and maximise domestic resourcing .
2.2 The Approach was designed to leverage the existing expertise and
activities of Alliance partners and expanded partners , as well as to build
1 Never Gavi -eligible countries in scope of the MICs Approach included countries with a GNI p.c.
up to $6,000 and that were missing at least one of three key vaccines (PCV, Rotavirus and HPV).
The Secretariat was also proposed the inclusion of some select s mall island states , in line with the
World Bank definition of IDA .

Report to the Board
Board -2020 -Mtg -3-Doc 03-Annex F

Annex F: Risk implication and mitigation
? COVID -19 creates unprecedented risks to the economies, health systems and
immunisation programmes of Gavi -supported countries. A failure to respond
adequately risks undermining the progress that has been made in
strengthening immunisation coverage, equity, financing and programmes in
current and former Gavi -eligible countries. If these countries see a sustained
backsliding in immunisation coverage, or even drop a vaccine, this will pose
serious questions about the sustainability of the Gavi model. The finan cial cost
for countries to address gaps in coverage or to reintroduce vaccines will be
significant. The approach described in this paper should help mitigate those
risks.
? There is a risk that if many countries are granted flexibilities, this could make
the exceptions in the FER policy common across the portfolio and thereby limit
implementation of Gavi?s standard policies. There is also a risk that the Alliance
will have to make decisions on adjusting support to countries rapidly and with
inadequate informa tion, which could result in suboptimal allocation of resources
or fiduciary risk. To mitigate this, the Secretariat will develop a clear approach
to determine when a nd how flexibilities are granted and new HSIS funding
applications will be subject to exter nal review to ensure that the requested
flexibilities are justified and proportionate. The Secretariat will systematically
track all flexibilities and develop a clea r approach to transition countries to
updated ?standard? policies post -COVID.
? There is a ri sk that the additional flexibilities will result in accelerated
expenditure from Gavi?s HSIS and PEF envelopes over the next 1 -2 years.
While this will help countrie s to respond to the pandemic, it would also mean
that additional funding would be required to ensure countries continue to have
access to adequate support in the latter years of Gavi 5.0. To mitigate this risk,
the Secretariat will continue to monitor the financial impact of the flexibilities
granted and report to the AFC, PPC and Board.
? There i s a risk that Gavi?s support is inadequate to mitigate the impact of
COVID -19 on countries? immunisation programmes and this could result in a
resurgence of VPD outbreaks and mortality. To mitigate this risk, the Alliance
will engage closely with other dev elopment partners to ensure a coordinated
approach to help countries maintain and restore immunisation programmes as
part of a PHC response. The Alliance will continue to monitor the performance
of immunisation programmes and report to the Board if further interventions are
needed.
? There is a risk that the Secretariat and Alliance partners may have inadequate
capacity to manage the COVID -19 response, while also maintaining existing
programmes and preparing for implementation of Gavi 5.0. To mitigate this risk,
the Alliance will seek to coordinate support for COVID -19 recovery with
implementation of Gavi 5.0, and will closely monitor if existing resources are
adequate or surge capacity is required.

1



Board -2020 -Mtg -3-Doc 03

Section A: Executive Summary
This report presents an overview of how the Alliance is delivering against its
Strategic Goals including a holistic view across the Alliance?s portfolio of support
to countries including vaccine programmes, Health System and Im munisation
Strengthening (HSIS) support and technical support provided under the Partners?
Engagement Framework (PEF) , and on the associated risks 1.
As the COVID -19 pandemic continues to unfold, this report also provides an
overview on the immediate impact on immunisation programmes and
achie ving the targets of Gavi 4.0 (Section B) , a brief update on the Alliance?s
proactive response to the crisis (Section C) and the potential implications on
Gavi 5.0 operationalisation (Section D) over the next 18 months . A detailed view
on the impact on immunisation programmes , Gavi?s response and the implications
on Gavi 5.0 was discussed at the 11 May 2020 Board meeting and is made
available to the Board through regular Situation Reports on BoardEffect.
At its 26 -27 May 2020 meeting the PPC discussed Gavi?s adaptive response to
the COVID -19 pandemic and was supportive of the three pillars of the
approach , i.e. the immediate support for country response, maintain ing and
restor ing immunisation services over the next 18 months , and responding to the
fiscal impact of the pandemic on immunisation programmes .
As part of that the PPC agreed with the importance of supporting former Gavi -
eligible countries to address the emerging risks of backsliding in
immunisation programme performance due to COVID -19. In response to these
developments, and in light of the pausing of the Gavi 5.0 Middle Income County
(MICs) approach for the duration of the pandemic , the PPC recommen ds that the
Board allocate targeted Gavi funding (excluding vaccine financing) to
mitigate backsliding risks, where well justified and needed, in these
countries. This time -limited and targeted support aims to specifically address the
unique circumstances brought about by COVID -19 and is therefore not expected
to create a precedent that might detract from Gavi?s sustainability approach.

1 Associated risks refer to the top risks described in the 2019 Risk & Assurance Report (see
https://www.gavi.org/news/document -library/gavi -risk -and -assurance -report -2019 ). The COVID -19
pandemic has led to an extraordinarily uncertain environment with a significant impact on Gavi?s
risk profile, as described on a high -level in the AFC update on risk management (Annex C)
SUBJECT :
STRATEGY AND IMPLICATIONS OF COVID -19 : GAVI 4.0
PROGRESS , C HALLENGES AND RISKS AND UPDATE ON
GAVI 5.0 OPERATIONALISATION
Agenda item: 03
Category: For Decision
Report to the Board
24 -25 June 2020

1



Board -2020 -Mtg -3-Doc 05


Section A: Executive Summary
Context
In the context of the broader COVID -19 response, the Gavi Board has expressed
its support for Gavi to partner with others to make affordable vaccines available
and accessible to those most in need and planning for deployment of vaccine s so
they can be delivered as soon as they are available.
Questions this paper addresses
? What progress has Gavi made together with partners in securing access to
sufficient and timely supply to suitable COVID -19 vaccines and planning for
future delivery inc luding potential requirements for cold chain equipment ?
Conclusions
The Access to C ovid Tools (ACT) Accelerator has been established as a
collaboration mechanism for COVID -19 diagnostics, therapeutics and vaccines.
Within the ACT Accelerator Vaccines Pillar, Gavi is leading a workstream on
vaccine procurement and delivery at -scale, while the Coalition for Epidemic
Preparedness Innovations (CEPI ) is leading on development and manufacturing
and WHO is leading on policy and allocation. All three partners have committed to
working together closely to support a seamless effort toward the rapid dev elopment
and equitable delivery of COVID -19 vaccines.
With regards to securing supply of COVID -19 vaccines , Gavi , together with
partners, has launched the COVID -19 Vaccines Global Access (COVAX) Facility.
The Facility aims to pool demand and resources tow ard securing access to future
supply of COVID -19 vaccines. All countries are invited to participate in th is global
Facility, which will utilise a mix of manufacturer -specific volume guar antees and
market -wide demand guarantee s. The Secretariat is continuing to work closely
with stakeholders to complete the design and begin operation alisation of the
Facility , including raising the necessary funding .
Coordination across the ACT Vaccines Pillar workstreams will be essential t o
ensure that characterist ics of developed vaccines are appropriate for Gavi -
supported countries . Early discussions have been initiated within the Alliance on
potential vaccine use scenarios and the country -level planning, training and
community and social mobili sation interventions that will be required for successful
SUBJECT : COVID -19 VACCINE DEVELOPMENT, ACCESS AND
DELIVERY
Agenda item: 05
Category: For Decision
Report to the Board
24-25 June 20 20

1




Board -2020 -Mtg -3-Doc 02
Rapport au Conseil
d?administration
24 -25 juin 2020


Le 17 juin 2020

Chers membres du Conseil d'administration,
Au d?but du mois, le Royaume -Uni qui s?est montr? si accueillant, a organis? le
Sommet mondial sur la vaccination 2020 , troisi?me conf?rence ? virtuelle - des
donateurs de Gavi . Cet ?v?nement a connu un succ?s remarquable, non
seulement parce que nous avons r?ussi ? d?passer l?objectif minimum de
7,4 milliards de dollars US que no us nous ?tions fix?, mais aussi parce qu?il a
permis d?exprimer concr?tement la solidarit? mondiale et de reconna?tre
l'importance de la vaccination et de la t?che accomplie par Gavi. Notre mission
n'a jamais ?t? aussi pertinente qu'aujourd'hui .
La COVID -19 a fait basculer notre monde, et nous auron s ? en affronter les
cons?quences sanitaires, ?conomiques et sociales pendant encore un certain
temps. Le SRAS -CoV -2, virus responsable de la COVID -19, s?est propag ? en
quelques mois dans 180 pays. Comme nous en avons d?j? discut? au sein du
Conseil d?administration , les ?pid?mies de ce genre sont une des cons?quences
in?vitables de l?? vol ution . Cette pand?mie met en lumi?re l'importance de la
vaccination dans la lutte contre les maladies infectieuses et les pand?mies , de la
r?silience des syst?mes de sant? et du r?le de Gavi pour la s?curit? sanitaire au
niveau plan?taire . Mais tout cela n?est possible que si nous parvenons ? atteindre
toute s les population s, ce qui confirme le bien -fond? de l?approche que nous
avons adopt?e pour Gavi 5.0 en d?cidant de centrer nos actions sur les individus
et les communaut?s les plus marginalis?s et de mettre en place des syst?mes
permettant d?atteindre ceux qui ont ?t? laiss?s de c?t? .
La COVID -19 a impos? de nouvelles fa?ons de penser et de travailler, ce qui est
valable ?galement pour les r?unions de gouvernance. Nous avons d? all?ger
notre ordre du jour . Afin de privil?gier les temps de discussion, nous avons
supprim? les traditionnels discours d? introduction et avons ouvert un forum de
discussion sur BoardEffect pour que les membres du conseil d'administration
puissent poster des commentaires et des questions sur les documents avant la
r?union. Richard Hatchett, directeur g?n?ral de la Coalition pour les innovations
en mati?re de pr?paration aux ?pid?mies (CEPI, pour Coalition for Epidemic
Rapport du Directeur ex?cutif

1



Board -2020 -Mtg -3-Doc 02

Report to the Board
24-25 June 2020


17 June 2020

Dear Board members ,
Earlier this month, the UK ? our gracious hosts ? convened Gavi?s third donor
pledging conference, the virtual Global Vaccine Summit 2020. The event was an
outstanding success, not only because we were able to exceed our target of at
least US$ 7.4 billion, but also because of the global solidarity and recognition of
the importance of immunisation and the work of Ga vi. Never has our mission
been more relevant than it is now.
COVID -19 has turned the world upside down with health, economic and societal
implications we will be grappling with for some time to come. SARS -CoV -2, the
virus responsible for COVID -19, was able to traverse 180 countries in a few short
months. As we have discussed at the Board, such outbreaks are an evolutionary
inevitability. This outbreak underscores the importance of vaccines in fighting
infectious disease and controlling pandemics, of resilie nt health systems and of
Gavi?s central role in achieving global health security. But we can only do that if
we reach everyone, and this reinforces our approach in Gavi 5.0 of focusing on
the most marginalised and building out systems to reach the unreache d.
COVID -19 has forced new ways of thinking and working, and that also holds true
for governance meetings. We have had to streamline our agenda. To maximise
time for discussion, we will not have our usual introductory presentations and
have set up a Discu ssion Board on BoardEffect for Board members to post
comments and questions on the papers ahead of the meeting. We will also have
Richard Hatchett, CEO of the Coalition for Epidemic Preparedness Innovations
(CEPI) addressing the Board. CEPI has become an e ven closer partner to Gavi
through our joint work on COVID -19 vaccines and their use of the International
Finance Facility for Immunisation (IFFIm) to channel support from Norway.
In the face of COVID -19, I would like to start with an acknowledgement of t he
health care workers globally who are on the frontlines of this pandemic, many
working without personal protective equipment (PPE) or other basic supplies.
Alliance partners including both WHO and UNICEF have lost invaluable staff to
Report of the Chief Executive Officer

Re port to the Report to the Board
Board -2020 -Mtg -3-Doc 03-Annex A


Annex A : Updated Alliance KPI dashboard
Classified as Internal
BOARD & COM M ITTEE ATTENDANCE
GENDER BALANCE
Partners3
1
2
3
4
5
6
7
SFA/PEF ACHIEVEM ENTS
CSO ENGAGEM ENT
PLEDGE CONVERSION
DONOR ENGAGEM ENT IN COUNTRY
END 2019TARGET: N/A EVALUATION ALIGNM ENT
END 2019TARGET: N/A COUNTRY REPORTING
END 2015TARGET: 85%
55%
END 2019TARGET: 50%
END 2019TARGET: 100%
END 2019TARGET: N/A
END 2019TARGET: 95%
Governance4
1
Secretariat & partners1
2
4
5
6
VACCINE INTRODUCTIONS
END 2019TARGET: 56 NEW VACCINE COVERAGE
END 2019TARGET: 90%
END 2019TARGET: 90% HSS PROPOSAL QUALITY
END 2019TARGET: 100% HSS FUND UTILISATION
END 2019TARGET: 75% HSS GRANT TARGETS
END 2019TARGET: 50% 34%
Secretariat
OPERATIONAL DEM AND FORECAST
PROGRAM M E FINANCE FORECAST
SPEED OF CASH GRANT DISBURSEM ENTS
END 2019 TARGET: 9 months AUDITS ON TRACK
END 2019TARGET: 80% RISK M ANAGEM ENT PLAN PROGRESS
END 2019TARGET: 60% OPERATING EFFICIENCY
TARGET: N/A?
END 2019 TARGET: +/-10%
END 2019TARGET: +/-10%
1
2
2016 ?2020 INDICATORS ALLIANCE PROGRESS
4
Gavi Programme and Policy CommitteeUPDATED: 29 April 2020
PARTNER GROUP PEF
PEF
CSO
DONORS
DONORS
COUNTRIES
TCA ACTIVITIES ON TRACK
0 EVALUATIONS
Health system strengtheningTargeted country assistanceStrategic focus areaPartners' engagement frameworkCivil society organisation
HSSTCASFAPEFCSO
END 2019TARGET: 90% 88%
END 2019TARGET: 40%
71%
82%
END 2018BASELINE: 25
END 2018BASELINE: 96%
END 2018BASELINE : 10%
END 2018BASELINE: 50%
END 2018BASELINE: 58%
2018BASELINE : 50%
END 2018BASELINE: 17.5 months
END 2018BASELINE :18 %
END 2018BASELINE : 87%
2017BASELINE $283k:
END 2018BASELINE : -10%
END 2018BASELINE : -19%
END 201 8 BASELINE: 32 %
END 2018BASELINE :89 %
END 2018BASELINE : 59%
END 2018BASELINE : 95%
END 2018BASELINE : 94%
END 2018BASELINE : 5
2017BASELINE : 92%
END 2018BASELINE : 87%
END 201 8 BASELINE : 42%
ON TRACKMODERATE DELAYS / CHALLENGESSIGNIFICANT DELAYS / CHALLENGES
11
TRACKING TREND ONLY
50%
95%
323
94% 61%
88%
96%
-6%
14%
278K
NO UPDATE AT THIS REPORTING PERIOD
3M EASLES CAM PAIGN COVERAGE
10.9months
4
5
6
3
2
1
2
45%
59
86%
No update
+17%
99% No update

Re port to the Report to the Board

Board -2020 -Mtg -3-Doc 03-Annex B



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




Classified as Internal
2
3
Improve sustainability3 Market shaping4 Accelerate vaccines1 Strengthen capacity2
2016 ?2020 INDICATORS STRATEGY PROGRESS
5
Gavi Programme and Policy CommitteeUPDATED: 29 April 2020
1
EQUITY: GEOGRAPHIC DISTRIBUTION
ROUTINE IM M UNISATION COVERAGE 1
2
3
4
5
EFFECTIVE VACCINE M ANAGEM ENT
DATA QUALITY
PENTA1 COVERAGE & DROP -OUT
INTEGRATED HEALTH SERVICE DELIVERY
CIVIL SOCIETY ENGAGEM ENT
2
3
4
1
COUNTRY INVESTM ENT IN VACCINES
COUNTRIES ON TRACK TO TRANSITION
INSTITUTIONAL CAPACITY
CO-FINANCING COM M ITMENTS
2
3
4
1
VACCINE PRICE REDUCTION
VACCINE INNOVATION
HEALTHY M ARKET DYNAM ICS
SUPPLY SECURITY
Measles -containing vaccine 1 stdose Percentage pointPentavalent 1 stdose Pentavalent 3 rddose
MCV1
PPPenta1Penta3
CURRENT: + 1PP 2020 TARGETPENTA3 85%MCV1:83% 2015 BASELINEPENTA3: 80% MCV1:78%
CURRENT: + 1PP 2020 TARGET 26% 2015 BASELINE16%
2020 TARGET43%** 2015 BASELINE16%
2020 TARGET 38% 2015 BASELINE28%
2020 TARGETPENTA1: 90% DROP-OUT: 4% 2015 BASELINEPENTA1: 86% DROP-OUT: 7%
2020 TARGET100% 2015 BASELINEN/A 2020 TARGET55%
100%2020 TARGET100% 2020 TARGET11/11
$15.57 2020 TARGET N/A1
2020 TARGET 10
2020 TARGET 6/11
55%2020 TARGET43%**
2020 TARGET **
2015 BASELINE45%
2020 TARGET 75% 2015 BASELINE63%
2015 BASELINEN/A
2015 BASELINEN/A
2015 BASELINE85% 2015 BASELINE7/11
2015 BASELINE$20
2015 BASELINE0
2015 BASELINE1/11
BREADTH OF PROTECTION
PENTA381%
CURRENT: + 1PP 2020 TARGET 63% 2015 BASELINE31%
52%
24% MCV181%
87%
45%
21%
8/11
10
3/11 4EQUITY: WEALTH
CURRENT: + 1PP 2020 TARGET 45% 2015 BASELINE35%5EQUITY: M ATERNAL EDUCATION
CURRENT: + 1PP 2020 TARGET 40% 2015 BASELINE30%
ON TRACKMODERATE DELAYS / CHALLENGESSIGNIFICANT DELAYS / CHALLENGES
2
NO UPDATE AT THIS REPORTING PERIOD
24
35%
32%
60%
7PP
35%
56%
1Not published due to commercial sensitivity** Revised baselines and targets Approved by the Board in November 2018
Indicators reported as originally defined
16%
TRACKING TREND ONLY/ DATA INCONCLUSIVE2
No update
No update
No update
No update

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Doc 03 - Annex C
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