GAVI Alli ance Board Meeting, 30 November ? 1 Decem ber 2 01 0 Doc #06a ? Resource Mobilisation Update

FOR INFORMATION

GAVI Secretariat, 26 November 2010 1
This document updates the GAVI Alliance Board on the implementation of GAVI?s
resource mobilisation strategy, including a review of:
? The step -change needed in funding levels for the 2012 -2013 period in order to
meet the overall funding requirements for 201 1-2015 ? Section 1
? An o utline of the new pledging and replenishment approach ? Section 2
? Outcomes of recent activities including the October 6, 2010 ?Saving Children?s
Lives: A Call for Action and Resources? meeting where the replenishment
process was laun ched ? Section 3
? Plans for a June 2011 pledging conference at which donors will be invited to
make multi -year pledges for the 201 1-2015 period ? Section 4
? Scope of activities that are planned beyond the pledging conference . These
includ e broadening the don or base, increasing and extending contributions,
delivering innovative finance, and securing increased private sector resources
? Section 6
This document is for information.

Resource Mobilisation Update
1. Resource needs 2011 -2015
1.1. A unique opportunity to d eliver on MDG4 and maternal and child
health : For the first time in history, we have the opportunity to deliver
new life -saving vaccines against the world?s biggest childhood killers
while, at the same time, further expand global immunisation coverage.
Ove r the next five years, support from the GAVI Alliance will help
immunise 243 million children in 72 countries, including 230 million with
pentavalent vaccines; 90 million with pneumococcal vaccines; and 53
million with rotavirus vaccines, while simultaneou sly strengthening
routine immunisation at large. Compared to the 256 million children
immunise d over GAVI?s first decade, a forceful acceleration of pace
between 2011 and 2015 will significantly advance the Millennium
Development Goals (MDGs) and MDG4, in particular.
1.2. Overall funding challenge 2011 -2015 : Estimates of country demand
indicate that between 2011 and 2015, the GAVI Alliance expects to
disburse a total of US$ 6. 8 billion to countries to meet their
immunisation plans . Of this amount, US$ 3. 1 billi on is already assured.
Therefore, GAVI?s overall 2011 -2015 funding challenge ? beyond
already assured resources -- is US$ 3.7 billion . Of this amount, US$
1.2 billion could be expected if donors maintain their contributions at
the overall average level for 2007 -2009. A further US$ 2.5 billion (an

GAVI Alli ance Audit and Finance Committee Meeting, 28 July 2010 FINAL MINUTES
1

GAVI Alliance Audit and Finance Committee M eeting
28 July 2010
Geneva, Switzerland and Washington, DC, USA

FINAL MINUTES

Finding a quorum of members present 1, the meeting commenced at 1 6.30 Geneva
time on 28 July 20 10 . The Committee revi ewed the minutes from its meeting on 25
May 2010 (Doc #1 in the committee pack) .

DECISION
The GAVI Alliance Audit and Finance Committee:
Approved the minutes of its meeting on 25 Ma y 2010

1 Executive Session with the External Auditor
The Committee met in camera, inviting Pierre -Henri Pingeon and Karina Vartanova
from KPMG , GAVI?s external auditor, to summarise the results of its audit
procedures with respect to the 2009 consolidated financial statements (Doc #4) .

2 2009 GAVI Alliance Consolidated Financial Statements
Tony Dutson, Senior Director, Finance & Chief Accounting Officer and Louis
Mkanganwi, Director of Financial Reporting , reviewed the draft 2009 consolidated
accounts of the GAVI Alliance (Doc #2) . Discussion followed:

? This is the first year tha t GAVI?s financials were consolidated within the Swiss
entity. 2 The Secretariat reported a smooth process and an excellent working
relationship with the external auditor.

? The Committee discussed GAVI?s accounting policies and various
components of the fi nancials including Promises to G ive from the IFFIm
Company, the AMC evaluation model, the transfer of assets and liabilities
from the GAVI Campaign (formerly the GAVI Fund), and residual matters of
changing the consolidating entity to the GAVI Alliance. The Committee also
discussed FAS 157 accounting and valuation of certain investments. The
Chair requested the Secretariat to clarify a number of items in the footnotes in
due course.

? The Committee considered the recommendation of the consolidated financia l
statements only. However, some committee members requested to receive
the Swiss entity standalone financials for information.


1 Atten dees are liste d in Attachment A 2 Previously, the GAVI Fund in the United States served as the consolidating entity and its 2008 consolidated
financial statements were tabled for information (Doc #3)

GAVI Alliance Board Meeting, 16 -17 June 2010 Doc 08 ? Next Steps on the Pneumococcal AMC

FOR DECISION

GAVI Secretariat , 2 June 2010 1
The decision to consider the recommendations of the October IRC after a
prioritisation exercise coupled with the new eligibility/graduation policies have
adversely affected the Strategic Demand Forecast (SDFs) for pneumococcal
vaccines and, consequently th e AMC programme in that the target demand of 200
million doses may not be reached .
The Programme and Policy Committee considered strategies for addressing this
issue with the PPC recommending to the Board that it:
? Approve grandfathering of the AMC deal to include all currently GAVI
eligible countries (2003 definition). These countries will be able to access
pneumococcal vaccines through GAVI at the AMC terms and conditions and
have access to AMC funding. However, graduated countries will need to
completely self finance the vaccine price (tail price) once GAVI support has
ended. Also, all countries must have achieved the DTP3 coverage above
70% in order to purchase under the AMC agreements.
? Approve channe lling through the GAVI Alliance from the World Bank the
AMC funding for purchase of pneumococcal vaccines for India.
It is important to highlight that, while these issues must be addressed, they are only
relevant in the context where:
1. GAVI is able to raise sufficient funding to meet country demand and thus
ensure maximum utili sation of the AMC funds.
2. India adopts pneumo within the expected timeframe.

Next Steps on the Pneumococcal AMC:
Accounting for the New Context
When the AMC was conceived, there were certain prevailing assumptions built into
the mod el. First, the model accounted for all countries that have been eligible for
GAVI support since 2003. Second, it assumed applications that were
programmatically and financially sound would be approved for funding; in other
words, would not have to be vet ted through a prioritisation process in a resource
constrained environment.

Times have changed. The board decisions of November 2009 with regard to
postponement of approval of the most recent In dependent Review Committee?s
recommendations (October 2009 ) and the newly adopted eligibility/graduation
policies have had an impact on the Strategic Demand Forecast for pneumococcal
vaccines and, consequently on the AMC programme.

The Programme and Policy Committee along with the Policy and Performance Team
wit hin the Secretariat have discussed ways to mitigate these factors and this paper
presents recommendations for the Board?s consideration. The Audit and Finance
Committee was also informed of the PPC?s recommendations.

GAVI Alliance Board Meeting, 16 -17 June 2010 Doc 12 ? Financial Outlook

FOR INFORMATION

GAVI Secretariat, 2 June 2010 1
This document is provided for information only and includes:

? An overview of GAVI?s financing needs for the period 2010 -20
? A summary of the GAVI Alliance?s 2009 draft consolidat ed financial
statements

Financial Outlook


Financing needs through 20 20

An overview of financing needs through 2020 indicates a levelling -off of country demand
at approximately US$1.1 billion per year in the years from 2016. This reflects the
graduation of previously eligible countries , pentavalent price reductions and the
reduction of pneumococcal price s towards the AMC ?tail price? (see table below).

If more aggressive assumptions of price reductions and co -financing are factored in, the
demand would reduce to a level of approximately US$0.8 billion per year towards 2020
(see page 5) .

FOR INFORMATION

The Programme and Policy Committee (PPC) of the GAVI Alliance Board has held
four meetings since the December 2009 board meeting. This paper provides a brief
summary of issues discussed.

The Board will be requested to approve the PPC?s recommendations with regard to
prioritisation, co-financing, health systems strengthening programme allocations,
and the advance market commitment.
Programme and Policy Committee Update
December 2009 ? June 2010

The Programme & Policy Committee (PPC) serv es as the principal advisory body to
the board on all GAVI programme areas and leads the development of new policies.
It is staffed by high-level technical experts from partner organisations and
constituencies, with knowle dge in areas such as epidemiology, public health,
research, health systems and financing. Over the course of the reporting period, the
chairing function of the committee passed from Sissel Hodne-Steen of Norway to
Gustavo Gonzalez-Canali from France. The committee held two face-to-face
meetings and two teleconferences since De cember 2009. Actions taken by the PPC
and key discussion items from all three meetings are summarised below.

Policies Endorsed for Board approval

Prioritisation policy: The PPC endorsed the scope of work and appointed a time-
limited task team to develop a policy on prioritisation in February 2010. The policy
was endorsed in May 2010 for presentation to the board in June 2010 (see Doc 09).

Co-financing: In February 2010, the PPC endor sed the scope of work and
appointed a time-limited task team to review the policy on co-financing and propose
revisions, if necessary. The work of the task team is divided into two phases ? the
first focusing on policy objectives and the sec ond in implementation. Objectives,
principles and a definition of ?financ ial sustainability? have been endorsed for
presentation to the June 2010 board (see Doc 07).

Supply strategy: In February 2010, the PPC endor sed the scope of work and
appointed a time-limited task team to re view and update GAVI?s vaccine supply
strategy looking specifically at innovativ e procurement strategies and how to achieve
the best value for money, while ensuring suffi cient supply. The work of this team
will commence in June 2010.

Advance market commitment (AMC): The PPC reviewed policy options to
address the impact of the November 2009 board decisions (eligibility, graduation and
funding pause) on the demand forecasts for pneumococcal vaccines that underlie
the AMC. An endor sed option is being presented to the June 2010 board (see Doc
08).

Health systems strengthening : The PPC recommend moving forward with the
platform, informing a board decision tak en in April 2010. Further, a system for

GAVI Alliance Board Meeting, 16-17 June 2010 Doc 16 ? Resource Mobilisation

FOR GUIDANCE

GAVI Secretariat, 2 June 2010 1
To save an additional 4.2 million lives and to have real impact on preventing
disabilities and chronic illness by 2015, the GAVI Alliance needs to raise US$ 4.3
billion over the next six years (2010 -2015). This entails raising an additional US$
2.6 billion ? beyond sustaining current levels of funding.

This resource challenge is significant but achievable if GAVI?s traditional
approach to resource mobilisation is re-engineered in ways described herein.
This paper presents the progress to date in implementing the strategies
approved by the GAVI Board in June 2009, lays out the Secretariat?s integrated
Communication, Advocacy and Resource Mobilisation (CARM) framework and
discusses quantitative targets for complementary resource mobilisation
approaches . These latter include traditional development assistance, innovative
finance and private finance. It is important to note that being able to draw down
on the level of Advance Market Commitment ( AMC) donor contributions is
contingent on a corresponding amount being spent by the GAVI Alliance. If the
GAVI portion of funds is not available, neither are the AMC donor funds to match
them.

Given the level of anticipated demand, total additional cash inflows of US$ 303
million will be required between 2010 and 2012 and US$ 776 million will be
required on average each year between 2013 and 2015 . W hile the se additional
funds will only start to be spent in two years time, pledges will be required in
2010, in order to allow GAVI to commit to new programmes . Followin g the
recommendation of donors at the High- Level Meeting on Financing Country
Demand in The Hague in March 2010, the GAVI Secretariat will organise a
pledging/light replenishment meeting in October 2010. This document clarifies
how an annually renewable, m ulti-year pledging mechanism would work and how
this would underpin responsible financing decisions.

Mobilising for GAVI?s success requires the support of all stakeholders. This
paper concludes with suggestions for enhanced Board support to GAVI?s
resource mobilisation strategy.


A Call to Action ? Resource Mobilisation 2010- 2015

GAVI faces historic demand from implementing countries at a time of unprecedented
fiscal constraints. Many of GAVI?s donors face major pressures on development
budgets due to difficult economic circumstances, other commitments to the
Millennium Development Goals (MDGs) and growing support to commit 0.7% of
national budgets to Official Development Assistanc e (ODA) targets. Some donors
have seen their budgets erode. M any are continuing to operate under extreme fiscal
pressure. Despite these challenges, most of GAVI?s historical donor base has
maintained or increased contributions to GAVI. This is due to GAVI? s ability to
produce evidence -based results that demonstrates a cost-effective, poverty -focused
approach to equity in immunisation access. These results, along with G AVI?s
innovative business model and cross -cutting impact on the MDGs, in particular the
health MDGs (4, 5 and 6), continue to galvanise and inspire its donor s.

GAVI Alliance Board Meeting, 16 -17 June 2010 Do c 06 ? AVI Prog ress Report

FOR INFORMATION

GAVI Secretariat , 2 June 2010 1

At the request of GAVI Board members, the Secretariat was asked to provide an
update on the Accelerated Vaccine Introduction (AVI) initiative

Accelerated Vaccine Introduction Progress Report

The objective of AVI is to drive the sustainable introduction of rotavirus vaccine and
pneumococcal conjugate vaccine (PCV) in GAVI -eligible countries. Initial t argets
were set for 44 countries to launch rotavirus vaccines and 42 countries to launch
PCV by 2015 1. The longer term scope for AVI is to establish an organisational
platform to support the introduction of future vaccines 2.

AVI Structure and Management

The management of AVI is conducted by the AVI Management Team (AMT) which
consists of representatives of WHO, UNICEF Supply Division (UNICEF SD) ,
UNICEF Program Division (UNICEF PD) , and the AVI Technical Assistance
Consortium (AVI TAC 3) led by the GAVI Secretariat . The AMT operates through bi -
weekly teleconferences ; with more in depth anal ysis and work carried out by sub
teams .4 (see Annex 1 for more details )

Activities are consolidated between the aforementioned organi sations through an
integrated workplan and activities are grouped into five high level work streams 5
(see Annex 2):

? Generate informed country decisions
? Ensure sufficient supply
? Secure financing
? Facilitate country introductions
? Establish platform for sustained use

AVI?s objective is primarily to deliver health impact through accelerating introduction
and uptake of new v accines. The ability of AVI to achieve this objective is affected
by internal and external factors, whose impact is reflected in adjust ment s to the work
plan and if necessary, to the objectives too .

The remainder of this report will provide short brief ings on each of the high level
work streams referenced above.
1 In view of the funding situation, the targets may need to be assessed and if necessary changed by the Board 2 As per the Vaccine Implementation Strategy (VIS) implementation plan endorsed by the Board on 29 -30
October 2008, subject to separate approvals of funding. (Section 11 of the Minutes) 3 A consortium of PATH, Johns Hopkins University (JHU), US Centers for Disease Control and Prevention (CDC)
and others 4 Supplemental information on this and other aspects of AVI operation is available from the Secretariat upon
request. 5 The AVI work streams are synonymous with the outcomes of the Strategic Goal 2 in the GAVI Work -plan

FOR INFORMATION

CEO report to the Board

June 2010

Introduction
This report focuses mainly on the key decisions we need to take at this Board. This
meeting brings together a series of choices and policies asked fo r by the Board in 2009.
The decisions we take at this board will det ermine our ?ask? for the upcoming resource
mobilisation meeting and also determine how we continue to support (or not)
recommended country proposals. These high level decisions will determine whether
children in developing countries will be vaccinated, or not.
There have been a number of important devel opments since our meeting in Hanoi in
November; it has been a busy six months, not least as we lead into the MDG summit in
September and ensure t hat the contribution which imm unisation and the Alliance can
make is recognised. All of us will hav e welcomed the announcement at GAVI?s tenth
anniversary at the World Economic Forum by Bill and Melinda Gates of a decade of
vaccines, with a ten-year commi tment of an additional $10 billion to research, develop
and deliver vaccines. We were pleased t hat the first pneumococcal vaccine supply
agreements under the Advance Market Co mmitment have been signed. We have made
significant progress on the health systems funding platform, with the Board?s approval in
April, followed by approval by the Board of the Global Fund to Fight AIDS, Tuberculosis
and Malaria, and approval of our first programme in Nepal. The Netherlands hosted a
successful donors? meeting in March, w here donors decided to gather again around the
time of the MDG Summit in order to give GAVI a firmer financial basis upon which to
plan. Our retreat in May helped set our strat egic directions for the next five years.
We have continued to raise the profile of immunisation and of the Alliance in key
forums, such as at the World Economic Foru m, the UN Secretary General?s retreat on
women and children?s health in New York in April, the Women Deliver Conference in
Washington DC, and ? we antici pate ? the G8 Summit in Muskoka later this month. In
these and other places, we are making the ca se for GAVI?s strong contribution to the
task of improving women and children?s health. This gives us the means to help shape
the global debate, ensure our ef forts are increasingly integrated with those of others,
and raise funds.
However all this is set against a developing global financial crisis that emerged in 2008
? the worst recession in at least a generatio n ? with the consequent economic and fiscal
challenges for our donors and implementing count ries alike. The decisions that the
Board has before it this m onth in Geneva are in part about responding prudently to
these challenges, while at the same time ? as we agreed at the Board retreat ?
maintaining our ambition and therefore our momentum.