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Board-2023-Mtg- 04-Doc 06

Report to the Board
6-7 December 202 3

Subject Committee Chair and IFFIm Board reports
Agenda item 06
To follow

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Board-2023- Mtg-04-EAC Committee Chair Report
Report to the Board
6-7 December 2023

Subject Evaluation Advisory Committee Chair Report
Category For Information
Section A: Introduction
• This report provides the Board with an overview of the activities of , and
guidance provided by , the Evaluation Advisory C ommittee (EAC) since the
Committee Chair last reported to the Board in June 2023.
• At the in -person EAC meeting on 4-5 October 2023, the EAC provided guidance
on: i) progress of the commissioned Gavi 5. 1 centralised evaluations including
the Zero- Dose Evaluation; ii) the Strategy Operationalisation Evaluation; iii ) the
Mid -Term Evaluation (MTE) of Gavi’s 2021 -2025 Strategy; iv) the COVAX
Facility Phase 2 Evaluation ; v) the current relevance of the centralised
evaluation on sustainability/post transition; vi) the operationali sation of the
changes to the Gavi Evaluation Policy; and vi i) EAC engagement in Gavi 5. 1
evaluations.
Overarching issues and guidance

• The EAC continues to consider its r emit, voice and practice in supporting a Gavi
evaluation portfolio of optimal independence, credibility and u tility.

• As discussions about Gavi 6.0 gather pace, the EAC welcomes opportunities
to engage with the Secretariat - both at leadership level and through the
Monitoring, Evaluation & Learning ( MEL) Department – and, with the G avi
Board and its C ommittees, to foster reflection on how to optimally shape and
plan evaluation activities going forward. The EAC sees strengths in current
practice underpinning credibility, utility and independence; has begun to
discuss areas where further reflection is warranted, including on the EAC’s
remit, voice and practice; and has begun the process of considering potential
future shifts. The MOPAN assessment and a forthcoming E valuation Function
review offer useful inputs into this process.

• There was broad agreement by the EAC on the proposed timeline and process
for the Evaluation Function review through 2024. However, the EAC also
requested additional visibility showing the alignment with the development of
the Gavi 6.0 evaluation workplan – specifically, the EAC is keen to ensure that
any changes to remit, voice or practice of the EAC that are agreed following
upcoming reviews are in place such that they can be operationalised during the
development of the Gavi 6.0 evaluation workplan, and aligned with other
aspects of Gavi 6.0 planning.

• On the supplier review , EAC members welcomed the progress to date on this
topic and requested that work continue on this topic with EAC focal points and

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Board-2023- Mtg-04-Doc 03

Report to the Board
6-7 December 2023

Report of the Chief Executive Officer
29 November 2023
Dear Board M embers
As we approach our December Board meeting in Ghana, I want to take the opportunity
to share my personal reflections on the past year and set the scene for our coming
discussions.
But first some minor housekeeping. For this first report to the Board as interim CEO, I
want to depart slightly from the previous format. Cognisant of the many demands on
your time, it is my hope that you will find this short narrative report and the
accom panying presentation ( PDF) an easily digestible guide for our discussions,
without recapitulating or pre- empting the detailed briefings and deliberations that lie
ahead.
I remain humbled by the trust that you all placed in me. And I am equally confident
that our core priorities ? delivering on Gavi 5.1 and the Operational Excellence
enablers; developing an ambitious Gavi 6.0 strategy; and preparing for a successful
repleni shment ? are broadly on track and the most prudent focus of our collective
endeavours in the evolving global context.
Gavi’s resilience in the face of uncertainty
Our Board meeting will take place against a backdrop of high global and regional
geopolitical tensions, turbulence in the global economy, and a host of interacting risk
factors and vulnerabilities that have the potential to materially affect immunisation
coverage and the incidence of vaccine- preventable diseases in many Gavi-supported
countries.
The past year has seen the continued re- emergence of vaccine-preventable diseases
such as cholera and measles in areas where they had previously been well controlled,
while the total number of outbreaks of vaccine- preventable diseases also continued
on an upward trend. The underlying, and often interrelated, drivers of this trend include
conflict and insecurity, health system fragility, gaps in routine immunisation coverage,
climate disorder, urbanisation and displacement.
At the same time, many Gavi -supported countries and our donors are feeling the
effects of global economic uncertainty and growing disquiet over geopolitical conflict,
which may have unpredictable knock -on effects for domestic political economies.
Our Alliance is more than 22 years old. In that time, it has weathered global storms
from the financial crash to the COVID -19 pandemic, helping to vaccinate more than

Board -2023 -Mtg -04-Doc 04 -Annex A 1
Report to the Board
6-7 December 202 3
Annex A: Technical report on Gavi 5.0/5.1 indicators
This is a technical report providing definitions of and progress against Mission and
Strategy Goal indicators in the Gavi 5.0/5.1 measurement framework. The technical
report is populated based on available data and updated bi -annually. The newly
available data for 2022 included in this report relates to Mission Goals M2, M3, M4,
M5, and M6, and Strategy Goals 1, 2, and 3.2.
Note on target trajectories:
In the below graphs, the dotted lines represent the projected annual trajectory that was
forecast when we set 2025 targets with the PPC/Board in May/June 2021; our
assumption was that coverage would return to 2019 coverage levels in 2021, with the
exceptio n of India which would take until 2022. This was noted in a footnote in the
PPC paper on the 5.0 Measurement Framework at the time (PPC -2021 -Mtg -2-Doc
04):
• To account for COVID -19 -related disruptions and recovery, it is assumed that
vaccine coverage returns to 2019 levels by 2021, with the exception of India,
which we assume returns to 2019 levels in 2022 and sub -national three doses
of pneumococcal conjugate vaccine (PCV3) scale up takes an additional year.

Gavi 5.0 Mission Indicators
M.1: Under -five mortality rate – Updated
April 2023


By increasing access to immunisation
and enabling equal access to new
and underused vaccines, Gavi
support is contributing to the
reduction in under -five deaths from
vaccine -preventable diseases.
Gavi countries saw an under -five
mortality rate of 55.7 deaths per
1,000 live births in 2021. At the
portfolio level we are on track to
reach the 10% reduction target by
2025 – in 2021, Gavi countries have
achieved a 6% reduction from
baseline.
This indicator will be updated in April
2024.

Board -2023 -Mtg -04-Doc 04 -Annex B 1
Report to the Board
6-7 December 202 3
Annex B: PNG no cost extension
Section A: Summary
This paper requests the Gavi Board support for a no -cost extension (NCE) of
Gavi’s tailored strategy for Papua New Guinea (PNG) until 31 December 2027,
which includes financing for new vaccine support, and recommends an external
evaluation of the tailored strategy in 202 6. The latter would make
recommendations about possible further Gavi support to PNG beyond 2027.
Larger questions about transition will be addressed as part of the Gavi 6.0
Strategy and the associated Funding Policy Review.
PNG is part of the Fragile and Conflict (F&C) Segment and has been in Accelerated
Transition since 2016. Despite its status as a lower middle -income country, Penta1
and Penta3 coverage in PNG is lower than the median of other F&C countries and is
far below the mean of countries in Accelerated Transition. Both coverage rates are
one third lower than what PNG achieved in 2013 and one half of what PNG achieved
in 2005, suggesting that improvements should be attainable.
In June 2019 the Board approved a specially tailored strategy that extended PNG’s
Accelerated Transition Phase until December 2025. The 2020 -2025 financial envelope
is US$ 60 million, accompanied by sustained amounts of targeted country assistance
(TCA). A ll support was contingent upon fulfilment of key commitments in a PNG
Accountability Framework.
COVID -19 was declared a Public Health Emergency of International Concern (PHEIC)
in January 2020 and this delayed implementation of the Gavi PNG Strategy. The Gavi
Accountability Framework was agreed in March 2023 as part of the PNG’s Full
Portfolio Planni ng (FPP) proposal. The key actions agreed to were to: (i) increase
vaccine financing; (ii) improve coverage rates; (iii) improve EPI staffing, (iv) strengthen
coordination and oversight; and (v) increase the use of data for decision making. The
country is progressing against vaccine financing and coverage rate targets but it is too
early to assess progress on other indicators. The first formal progress review will occur
in Q1 2024. Gavi’s Accountability Framework fits into the more comprehensive Health
Acco untability Framework that donors, partners and National Department of Health
(NDOH) are working on together to strengthen NDOH’s overall lead role for the health
sector.
To improve coverage rates and reduce the number of zero dose children, the
Government, as part of its 2022 National Health Strategy, and NIS plans to:
(i) introduce at least 2,000 village health assistants that would help increase coverage;
(ii) expand outreach and fixed site immunisation delivery in zero dose targeted areas
through the join tly financed DFAT, MFAT and Gavi, AIHSS program (which targets
provinces , mostly through direct CSO support, that have relatively strong Primary
Health Care delivery systems while supporting other provinces with weaker
structures); (iii) strengthen data reporting and utilization by training provincial data
focal points on eNHIS data validation and introduction and (iii) address key human
resource issues such as optimizing the provincial and district health structures and
increasing the number of village health assistants to a tot al of approximately 6,000 in

Board -2023 -Mtg -04-Doc 04 -Annex C 1
Report to the Board
6-7 December 202 3
Annex C : Timor Leste No Cost Extension
Section A: Summary
Timor -Leste transitioned from Gavi support on 1 January 2018. In 2019, an
exceptional, Board -approved strategy provided US$ 8.3 million of post -transition
support covering 2018 to 2023 in recognition of the weak capacity of the EPI
programme and the limited support (particularly HSS) that the country had received
over its brief period of Gavi eligibility.
2021 -2022 saw significant disruptions, border closures and delays across EPI due to
the COVID -19 pandemic. The shift of focus from routine immunisation to Covid -19
vaccination efforts impacted progress in implementation of this post -transition grant,
limiting planned activity to address weak system capacity, including weak financial
management . The no -cost extension will provide the opportunity to focus on critical
activities to address systemic weaknesses, with renewed government commitment to
the revised post transition plan (end 2025) developed in conjunction with partners.
On April 18, 2023, Timor -Leste submitted to the Gavi Board Chair a request for (i) a
2-year no -cost extension of the Gavi post -transition grant and (ii) reconsidering its
eligibility for Gavi full support due to its challenging economic context.
The Secretariat recommends that the PPC supports Timor Leste’s request for a
no -cost extension of Gavi’s post -transition support for Timor -Leste until 31 of
December 2025 . Based on Timor -Leste’s latest GNI per capita, which is 9% above
the projected 2024 eligibility threshold, the Secretariat is not seeking an exception
from the Board for Timor -Leste’s eligibility to Gavi support at this stage.
Section B: Review of Post Transition Grant to Timor -Leste
1. Economic context
Emerging from decades of conflict, Timor -Leste became a new sovereign state
in May 2002. Despite significant progress in poverty reduction, Timor -Leste
continues to face challenges, with economic growth reliant on government
spending and revenues from natu ral resources. Timor Leste’s economic
slowdown since 2016 has been recently exacerbated by the COVID -19 pandemic
and Cyclone Seroja entailing significant rebuilding efforts, consuming nearly one -
third of the government’s expenditure in 2021. Government spe nding has yet to
rebound to pre -pandemic levels. Ongoing concerns include the persistent low
domestic revenue, with an anticipated cessation of petroleum revenue. In
July 2023, the World Bank indicated that Timor -Leste’s GNI per capita was
US$ 1,970, 9% above the projected Gavi eligibility threshold of US$ 1,810 for
year 2024.

Board -2023 -Mtg -04-Doc 04 -Annex D 1
Report to the Board
6-7 December 202 3
Annex D : Summary of proposed support for vaccine doses for the ‘Big catch -up’
The PPC considered three potential options on how to finance additional doses
required for the Big Catch -Up: Option 0. Permissive approach to allow countries to
request additional doses as part of their routine programmes (which would need to be
co -financed); or Option 1. Fully fund additional doses required to catch -up up to ~30% 1
of children missed (at an aggregated portfolio level) during the pandemic; or Option 2.
Fully fund all additional doses that countries request for catch -up. The Secretariat
recommended Option 1 to the PPC. This was designed to balance alleviating the
potential barrier to catch -up posed by co -financing with limiting the risk from providing
fully funded doses to the Gavi co -financing model.
Given the one -off nature of this effort that is a direct result of the pandemic, and the
urgency to close critical immunity gaps, the PPC emphasised the need to be as
permissive as possible within bounds of financial feasibility . The PPC therefore
recommends to the Board to approve flexibility to provide fully funded catch -up
doses for children missed during the pandemic for an initial amount of
US$ 290 million subject to countries developing robust plans. It should be noted
that this amount is an initial estimate and is likely to evolve as countries finalise their
plans.
The primary risk with this approach is that it may incentivise countries to request large
number of fully paid catch up doses via unrealistic plans. These doses, which are
fungible in nature across catch up and routine programmes, could subsequently be
use d in routine programmes (thereby circumventing the need to pay co -financing) or
wasted if not deployed rapidly enough. This ultimately could erode the sustainability
of the Gavi co -financing model and country efforts to build sufficient fiscal space for
th eir vaccination programmes. There is also a risk that these doses may be used to
re -immunise already vaccinated children if countries feel there is no financial cost to
re -immunisation. Risk mitigation measures to protect core co -financing requirements
and prevent wastage would need to be put in place operationally, including:
1. Provision of fully funded doses for big catch -up to be time -limited to the 2024 -
2025 period.
2. Ensuring the robustness of the country catch -up plans and the implementation
support to countries by augmenting the capacity of Alliance at global, regional and
country level, including through the provision of project management support.
3. Assessment of in -country stock and scheduled deliveries to determine dose
requirements for catch -up.
4. Phased supply of additional fully funded catch -up doses with countries needing to
demonstrate the first round of catch -up activities occur as planned before additional
doses are provided. Phased supply also mitigates potential inequities across
1 This level of fully funded doses would enable countries to reach all children who were missed due to pandemic -
related backsliding as well as a portion of the children who would have been zero dose even without the
pandemic. NOTE: This threshold is at an a ggregate portfolio level

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Board -2023 -Mtg -04-Doc 04
Report to the Board
6-7 December 202 3

Subject Strategy, Programmes and Partnerships: Progress, Risks and
Challenges
Agenda item 04
Category For Decision
Section A: Executive Summary
Context
This report provides a progress update on the implementation of Gavi 5.0/5.1 and
associated risks 1 WHO -UNICEF estimates of national immunisation coverage
(WUENIC) for 2022 confirmed that Gavi -supported countries are, in aggregate, on the
road to recovery from the COVID -19 pandemic, with a three -percentage point (pp)
increase in the coverage of the third dose of diphtheria, pertussis and tetanus -
containing vaccine (DTP3). In 2022, Gavi -supported countries have reached roughly
the same number of children as they did pre -pandemic. In addition, the total number
of zero -dose children in Gavi -supported countries reduced by 2.2 million to
10.2 million in 2022, however, the number of zero dose remains above the 2019
baseline due to growing birth cohorts.
Questions this paper addresses :
• How is the Alliance performing against its strategic goals and indicators for
Gavi 5.0/5.1? What progress has been made against priorities?
• What are the key risks and challenges across the Alliance’s strategic performance,
programmes and partnerships, and what actions are being taken to address these?
• How should vaccine doses be funded under the big catch -up ?
• Should there be a no cost extension of Gavi support for Papua New Guinea (PNG)
and Timor -Leste to avoid the risk of backsliding?
Conclusions
The Alliance remains on -track to reach most mission indicator targets by the
end of the Gavi 5.0/5.1 period. However, whilst WUENIC data also confirms signs of
recovery in routine immunisation across Gavi -supported countries, the impact of
pandemic -related disruptions continues to be felt. This is particularly evident in the
continued high number of vaccine -preve ntable disease (VPD) outbreaks, for example
of measles . The Alliance continues to work towards delivering its Gavi 5.0/5.1 ‘must -
wins’ as part of d elivering on its 5.0/5.1 goals and objectives. The 2023 must -wins are
reaching zero dose -children; revitalising HPV; launching the malaria vaccine; and the
COVID -19 programme for 2024 -20 25 . The Alliance has also launched the ‘Big Catch -
Up’ to help restore immunisation coverage, catch -up children missed during the
1 Associated risks refer to the top risks in the Draft Risk & Assurance Report 2023 captured in Annex B.

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Board-2023-Mtg- 04-Doc 05

Report to the Board
6-7 December 202 3

Subject Country Programmes Delivery Presentation
Agenda item 05
No paper

Classified as Internal #
Gavi Alliance Board Workplan
Gavi Board Paper Type Jan-MarAprMay JuneJuly-Nov DecMar/Apr JuneNov/Dec Mar/Apr JuneNov/Dec Mar/Apr JuneNov/Dec
A.Strategy/Performance/Risk/MEL CEO's Report CEO's Report Discussion
DiscussionDiscussionDiscussionDiscussion DiscussionDiscussion DiscussionDiscussion 2021-2025 Strategy Strategy, Programmes and Partnerships: Progress, Risks and ChallengesDiscussion Discussion DiscussionDiscussionDiscussion Discussion Innovation TBDInformation Information
Private Sector Engagement TBDInformation InformationInformation
Civil Society and Community Engagement Approach TBDInformation
Partners' Engagement Framework Strategy, Programmes and Partnerships: Progress, Risks and ChallengesDiscussion
Discussion DiscussionDiscussionDiscussion DiscussionDiscussion DiscussionDiscussion Disease Surveillance and Diagnostics in Gavi 5.0 TBDDiscussion
Risk and Asurance Report Risk and Assurance ReportDecision DecisionDecisionDecisionDecision
2026-2030 Strategy TBDDecisionDecision
Discussion DiscussionDiscussionDiscussion Funding Policy Review TBDDecisionGuidanceDecision
Health Systems strategy TBDDecisionGuidanceDecision
Measurement Framework (Targets & Indicators) TBD DecisionGuidanceDecision Decision B.Vaccines & Sustainablity Typhoid TBD Information Pneumococcal AMC (Advance Market Commitment) TBDInformation Vaccine Investment Strategy Vaccine Investment StrategyDecisionDecision COVID-19 Vaccine Programme Update TBD InformationInformation Gavi's role in Pandemic Prevention, Preparedness and Response TBD TBDTBD Gavi's role in support to Regional and African manufacturing TBD TBDTBD C.
Policy Transparency and Accountability Policy Decision D.Country Programmes
Nigeria TBD
InformationInformationInformation
PNG TBD
Information Information
Strategic Partnership with India Strategic Partnerships with India
Information
Fiduciary risk assurance and financial management capacity building Fiduciary risk assurance and financial management capacity building
Information
Middle-Income Countries approach TBDInformation E.Finance/Audit & Investigations Annual Accounts Annual Financial Report DecisionDecisionDecisionDecisionDecision Financial Forecast Financial Update, including forecastDecisionDecisionDecisionDecisionDecision DecisionDecision DecisionDecision
Budget Financial Update, including forecastDecision DecisionDecisionDecisionDecision
Programme Funding Policy Consent AgendaDecision
Treasury Governance Policy Consent AgendaDecision
Treasury Risk Management Policy Consent AgendaDecision
Independent Auditor Selection and Evaluation Policy Consent AgendaDecision
Audit & Investigations Report Audit & Investigations ReportInformation InformationInformationInformationInformation F.Governance
Board Chair Appointment Consent AgendaDecision Decision
Board Vice Chair Appointment Consent AgendaDecision DecisionDecision
Committee Chair Appointments Consent AgendaDecisionDecision Decision Decision
Board and Committee Appointments Consent AgendaDecision DecisionDecision
IRC Appointments Consent AgendaDecision
CEO Appointment Consent AgendaDecision Decision
Secretary Appointment Consent AgendaDecision
Treasurer Appointment Consent AgendaDecision
Appointment of MD A&I Consent AgendaDecision
Amendments to Governance Documents (Statutes, By-Laws, Committee Charters) Consent AgendaDecision
IRC Terms of Reference Consent AgendaDecisionDecision
Audit & Investigations Terms of Reference Consent AgendaDecision
G. Reporting
Committee Chair Reports Committee Chair and IFFIm Board reports InformationInformationInformationInformationInformation InformationInformation InformationInformation IFFIm Chair Reports Committee Chair and IFFIm Board reports InformationInformationInformationInformationInformation InformationInformation InformationInformation Replenishment/Resource Mobilisaton Resource Mobilisation Update Discussion
DiscussionDiscussion
Discussion HR Report Closed Session InformationInformationInformationInformationInformation InformationInformation InformationInformation Annual Report on Implementation of the Gender Policy Annex to Strategy paper Information InformationInformationInformationInformation Board and Committee minutes Annex to Board pack/On BE as additional materials Information
InformationInformationInformationInformation InformationInformation InformationInformation H.Technical Briefing Sessions/Deep Dives
Malaria - Joint session with the Global Fund Discussion
Gavi 6.0 Deep Dive (TBD) Discussion
Gavi Forecasting/Resource Allocation Discussion
Complexity of Vaccine Manufacturing - presented by IFPMA/DCVMN Discussion
Country Performance - High Impact Countries Discussion
Country Performance - Fragile Countries Discussion
Mid-Term Evaluation Discussion
Discussion
2026 2027
Last updated - 22 November 2023
Next Board Meetings: 17-18 April 2024, Retreat
26-27 June 2024
4-5 December 2024
2024
2025
Board-2023-Mtg-04-Doc 01f

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Board-2023-Mtg- 04-Doc 02

Report to the Board
6-7 December 202 3

Subject Country Presentation - Ghana
Agenda item 02
No paper

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Board -2023 -Mtg -04-Doc 03 _FR

Rapport au Conseil d’administration
6-7 décembre 2023

Rapport du Directeur exécutif
Le 29 novembre 2023
Chers membre s du Conseil d’administration,
À l'approche de notre réunion du Conseil d'administration de décembre qui va avoir
lieu au Ghana, je souhaite partager avec vous quelques réflexions personnelles sur
l'année écoulée et poser le cadre de nos discussions à venir.
Mais tout d'abord, quelques informations pratiques . Pour la présentation de ce premier
rapport au Conseil d'administration en tant que Directeur exécutif par intérim, j’ai voulu
m’écarter quelque peu du format précédent. Conscient des nombreuses contraintes
de temps auxquelles vous êtes soumis , j’ai choisi de vous présenter un bref rapport
de synthèse accompagné de diapositives (sous format PDF) qui serviront à guider nos
discussions, sans pour autant reproduire ou anticiper les exposés détaillés et les
délibérations qui nous attendent.
La confiance que vous m'avez accordée m'emplit d'humilité. Je suis également
convaincu que nous sommes globalement en bonne voie pour atteindre nos objectifs
prioritaires (accomplissement de Gavi 5.1 et mise en œuvre des mesure s d’excellence
opérationnelle, élaboration d'une stratégie ambitieuse pour Gavi 6.0 et préparation de
la reconstitution des ressources) et que ce sont là les objectifs les plus pertinents dans
ce contexte mondial en pleine évolution.
La résilience de Gavi face à l'incertitude
La réunion de notre Conseil d'administration va se dérouler dans un contexte régional
et mondial de fortes tensions géopolitiques, de turbulences dans l'économie mondiale
et d'une multitude de facteurs de risque et de vulnérabilité interdépendants ,
susceptibles d'affecter lourdement la couverture vaccinale et l'incidence des maladies
évitables par la vaccination dans de nombreux pays bénéficiant de l'aide de Gavi.
L'année dernière a été marquée par la réémergence continue de maladies évitables
par la vaccination telles que le choléra et la rougeole dans des régions où elles étaient
jusqu’alors bien contrôlées, tandis que le nombre total d'épidémies de maladies
évitables par la vaccination a continué à augmenter . Parmi les facteurs sous -jacents
et souvent interdépendants de cette augmentation figurent les conflits armés et
l'insécurité, la fragilité des systèmes de santé, les lacunes dans la couverture
vaccinale de routine, les dérèglements climatiques, l'urbanisation et les déplacements
de population.
Parallèlement, beaucoup de nos donateurs et de s pays soutenus par Gavi ressentent
les effets de l'incertitude économique mondiale et de l'inquiétude croissante face aux