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Board -2023 -Mtg -02-Doc 08
Report to the Board
26 -27 June 202 3

Subject Gavi?s Role in Pandemic Prevention, Preparedness and
Response
Agenda item 08
Category For Decision
Section A : Executive Summary
In December 2022, as part of the Gavi 5.1 discussions, the Gavi Board supported the
Alliance?s engagement in four key targeted additional Pandemic Prevention
Preparedness and Response (PPPR) areas building on its existing role, experience
and comparative advantage: 1) retain and enhance required capabilities for the next
pandemic; 2) financial innovation 3) resilient routine immunisation (RI) programmes;
and 4) diversification of regional manufacturing. The Alliance is institutionalising,
embedding, and coordinating activities in line with these areas to strengthen the
Secretariat?s an d Alliance?s preparedness and response to public health events
(PHE) 1 while simultaneously contributing to the evolving global PPPR ecosystem and
political discourse.
This paper provides an update on the Secretariat?s work with the Alliance and other
part ners, including the Coalition for Epidemic Preparedness Innovations (CEPI ) and
regional institutions, to advance global, regional, and local mechanisms for PPPR and
highlights progress in the four targeted PPPR areas. It also requests the Gavi Board
provide a time limited approval for Global Virtual Pooled In ventories (GVPIs) for Ebola
Sudan and Marburg candidate vaccines to be deployed for expanded access. The
GVPIs will serve a dual purpose of accelerated outbreak response and incentives to
manufacturers to accelerate vaccine development.
Questions this paper addresses
? How is the Alliance engaging with and influencing the dynamic PPPR ecosystem?
? How is the Secretariat working alongside the Alliance and other partners to
advance the four targeted additional PPPR areas?
? Does Gavi have a role to play to ensure timely access to pre -licensed vaccines for
expanded access and to complement partners? actions to help accelerate vaccine
access and bolster outbreak response?



1 Public health events include outbreaks, epidemics, and pandemics.

gavi.org
FINACIAL UPDATE, INCLUDING FINANCIAL FORECAST
BOARD MEETING
Assietou Diouf
26 -27 June 2023
Table of contents
COVAX AMC and COVID -19 forecast
F orecast risks and opportunities
Gavi Core 5.1 financial forecast 1
2
4
3
5
Gavi 6.0 forecast
Annex
Board Meeting, 26 -27 June 2023

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Board -2023 -Mtg -02-Doc 05
Report to the Board
26 -27 June 202 3

Subject Approach for Gavi 6.0 strategy design and the road to
replenishment
Agenda item 05
Category For Information
Section A : Summary
Context
The Gavi 6.0 strategy will set out the Alliance?s vision, mission, strategic goals,
objectives , operating principles , and critical enablers for the 2026 -2030 period . Th e
strategy is being developed against a backdrop of poly -crises such as climate change
and growing fragility and conflict and a n increasingly constrained donor environment .
The process will encompass three phases from contextual trends and the vision for
Gavi 6.0 (until October 2023) ; to discussion of strategic options (October 2023 -
January 2024 ); to making trade -offs and finalising the new Gavi strategic ?one -pager?
framework (January 2024 - May 2024) . Building on early discussions at the Board
retreat in March 2023 , t his report presents an overview of the envisioned process to
design the new strategy, to be presented to the Board for approval in June 2024.
Aligned with the Gavi 6.0 strategy development process, t his report also outlines the
road to replenishment which would take account of the issues which are particularly
salient for donors in the context of numerous upcoming elections . These notably
includ e the changing landscape of global health architecture, fiscal challenges, and
the need to proactively orchestrate replenishments and develop a shared narrative
with other international organisations . The proposed process will be implemented in
phases from the Mid -Term Review (MTR) in Madrid in June 2023 to a listening phase,
followed by the December Board meeting with a discussion on the Gavi 6.0 strategy ,
an Investment Opportunity launch event in Q3 2024 based upon the Gavi 6.0 strategy 1
and a pledging conference in Q4 2024/Q1 2025 . The plan would be to set in motion a
proactive resource mobilisation process so that the design reflects an appreciation of
the funding landscape.
Questions this paper addresses
? What will be the process to design Gavi 6.0?
? What will be the approach to the replenishment for Gavi 6.0 ?
? How are the strategy design and replenishment linked ?

1 To be presented to the Board for approval in June 2024

Board -2023 -Mtg -02 -Doc 06 -Annex A
1
Report to the Board
26 -27 June 2023

Annex A: Implications and Anticipated Impact
1. Anticipated impacts of a potential Hexavalent support decision
1.1 Financial impact s
Financial impact on the Gavi Alliance
Table 1: Additional cost of Hexavalent to Gavi versus currently used (Pentavalent+IPV )

Gavi vaccine costs ( US $M) as per latest
financial forecast (v20.1 )
Gavi 5. 1 Gavi 6.0 Total
IPV $874 M $77 3M $1,647 M
Pentavalent $492 M $42 5M $917 M
Total $1 ,366M $1 ,198M $2 ,564M
Additional cost to Gavi if Hexavalent
supported (a,b)
$29 M-$6 3M $357M -$430M $387M -$492M
% Increase versus [Pentavalent + IPV] 2% -5% 30% -36% 15% -19%
(a): the range of additional cost reflect s the base and high demand scenarios and includes the saved
ancillary costs to Gavi
(b): the additional cost includes a one -time switch grant based on US$ 0.25/child in birth cohort in the
year of introduction or US$ 30,000 (whichever is higher)
? The main driver of the increase in cost to Gavi is Hexavalent?s price
premium 1.
? In a highly unlikely scenario where all Gavi 54 eligible countries gradually
switch to Hexavalent by 2030, the additional cost to Gavi is estimated to
reach US$ 1 15 million in Gavi 5.1 and US$ 7 00 million in Gavi 6.0.
o Th is scenario assumes an optimistic supply availability outlook and a
gradual linear uptake of Hexavalent demand 2.
o Hexavalent price used in this scenario is lower than the base demand
scenario because we expect that higher demand would lead to improved
economies of scale and a more competitive environment 3.
1 This cost of this programme includes two additional doses of IPV (as part of a combination vaccine) that are not
currently supported . There may also be additional service delivery costs that are not currently reflected in the
forecast. 2 The uptake of Hexavalent demand was assumed as a linear increase , constrained by supply availability. This
approach is different than the base/high demand forecasts used to estimate the financial implications in Table 1,
which are based on a bottom -up mod el that assesses the likelihood of a country switching to Hexavalent (see
Appendix 1 ? Table 2 ). 3 Using the known cost of Hexavalent (not assuming competition), the additional cost to Gavi is estimated to be
US $ 117 million in Gavi 5.1 and US $ 793 million in Gavi 6.0 .

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Board -2023 -Mtg -02-Doc 06
Report to the Board
26 -27 June 2023


Subject Hexavalent Investment Case
Agenda item 06
Category For Decision
Section A : Executive Summary
Content
In November 2018, the Board approved i n-principle support for whole -cell Pertussis
Hexavalent vaccine (Hexavalent), a combination vaccine that includes six antigens
already covered by Gavi support via Pentavalent and standalone Inactivated Polio
Vaccine ( IPV ). This approval was subject to a vaccine being licensed, recommended
for use by WHO, WHO prequalified, and with market attributes met that support the
successful implementation of Hexavalent. This topic is now being brought back to the
Board, since the support conditions laid out in the 2018 decision are now evaluated
as having been met , based on current market information (see Appendix 2 to May
2023 Doc 06 ) ? and the programme was endorsed unanimously by the PPC during its
May 2023 convening .
Support for Hexavalent (4-dose series )1 is expected to provide considerable
programmatic ease and reduce ancillary costs , among other benefits . Furthermore,
the shift to this combination vaccine would support Gavi 5.1 and polio eradication
objective s. These benefits need to be weighed against estimated additional costs to
Gavi of US$ 29 -62 million in Gavi 5.1 and US$ 357 -430 million in Gavi 6.0 and
increased co -financing obligations of countries of US$ 0. 2-2 million in Gavi 5.1 and
US$ 34 -60 million in Gavi 6.0 compared to the currently supported
(3Pentavalent+2IPV ) schedule 2.
Conclusions
This governance cycle is a critical window of opportunity to ensure the availability of
Hexavalent to Gavi -supported countries. Declining or delaying support for Hexavalent
could lead to unrealised programmatic benefits and negative consequences for any
future Hexavalent product and other combination vaccine market s ? and potentially
jeopardise Gavi?s credibility with the manufacturer base.
Given that the favourable analysis of the value of Hexa valent demonstrates that it is
commensurate with it s financial implications , the Programme and Policy Committee
(PPC ) recommend s to the Board that Gavi open s a funding window starting Q3 2023 .


1 See Table 1 below for WHO -recommended schedules and Appendix 1 to May 2023 PPC Doc 06 for additional
details. 2 The lower figure in each range is the base scenario costs currently reflected in the financial forecast . The higher
figure in each range is based on the high demand s cenario. See Appendix 1 to May 2023 PPC Doc 06 for details.

Gavi Balanced Scorecard
J U N E 2023 ? B E T A V E R S I O N Doc 02b - Annex A
A balanced scorecard is a key tool for transparent &
systematic overview of Gavi?s performance
Provide a holistic, systematic,
high - level view of performance
with deep - dive modules for
governance fora ( incl. Board,
PPC, AFC) and partners
engagement to support
discussion and decision makingRoom to improve consistent,
holistic and systematic review
of performance across key areas
of priority for Gavi, both internally
and with governance bodies Context & Problem - statement Key objectives
? Doc 02b - Annex A

Board -2023 -Mtg -02-Doc 02b -Annex B 1
Report to the Board
26 -27 June 202 3
Annex B: Gavi Human Papillomavirus Measurement Framework
The Gavi HPV Measurement Framework was developed to provide a comprehensive
way to monitor progress of Gavi Secretariat and Alliance partners against the goals of
the revitali sation of the Gavi HPV program that was approved by the Gavi Board in
December 20 22.
The HPV Measurement Framework includes two sets of indicators, both of which are
outlined in this Annex:
1) The primary set of indicators for reporting on progress of the HPV program to the
PPC and Board, known as the HPV Scorecard. HPV Scorecard indicat ors are
noted in pink in the below diagram.
2) An expanded set of operational HPV indicators and operational forecasts for
detailed tracking purposes and to inform the narrative of the Scorecard. The
operational indicators are noted in grey in the below diag ram.
The indicators included in the HPV Measurement Framework are largely aligned with
existing Gavi measures including in the Gavi 5.0 Measurement Framework and Gavi
Balanced Scorecard.

HPV Scorecard
The HPV Scorecard includes indicators on HPV program impact and outcomes as well
as several high -level process indicators. Indicators have been selected via
consultations with business owners across the Secretariat with input from the global
HPV sub -team.

Board -2023 -Mtg -02-Doc 02b -Annex C

1
Report to the Board
26 -27 June 202 3
Annex C: Gavi 5.0/5.1 dashboard and update on key metrics
This is a technical report providing definitions of and progress against Mission and
Strategy Goal indicators in the new Gavi 5.0 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 Goal M1, and Strategy
Goals S1.4, S3.1, and SG4.
Note on target trajectories:
In the below graphs, the dotted lines represent the projected annual trajectory that was
forecasted when we set 2025 tar gets with the PPC/Board in May 2021; our assumption
was that coverage would return to 2019 coverage levels in 2021, with the exception of
India which would take until 2022. This was noted in a footnote in the PPC paper on
the 5.0 Measurement Framework at t he 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 thre e 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 t o reach the
10% reduction target by 2025 ? in 2021, Gavi
countries have achieved a 6% reduction from
baseline .

M.2: Number of future deaths averted with Gavi support ?
Updated Sept 2022

This indicator estimates the impact of Gavi -
supported vaccinations in terms of averting
future deaths from vaccine -preventable
diseases.
More than 1.2m future deaths were averted by
Gavi -supported vaccinations in 2021. The
cumulative number of deaths averted from 2000
through 2021 is more than 16.2m.
This indicator will be updated in Sept 2023.


59.2 57.5 55.7 Target: decrease by 10%
0
10
20
30
40
50
60
2019(Baseline) 2020 2021 2022 2023 2024 2025
1.2M
Target: 7 -8M
0M
2M
4M
6M
8M
2021 2022 2023 2024 2025

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Board -2023 -Mtg -02-Doc 02b

Report to the Bo ard
26 -27 June 202 3
Subject Strategy, Programmes and Partnerships: Progress, Risk s and
Challenges
Agenda item 02b
Category For Decision
Section A : Executive Summary
Context
In December 2022 the Gavi Board approved the update of the Gavi 5.0 strategy into
Gavi 5.1. Gavi 5.1 reaffirms the Gavi 5.0 core priorities such as catching -up on missed
children, reaching zero -dose children, and ensuring introductions of priority vaccines at
pace, including relaunching the human papillomavirus ( HPV ) vaccine and accelerating the
malaria programme launch. It also includes targeted additions from the pandemic and its
learnings with a potential COVID -19 vaccine programme from 2024 and an evolu tion of
Gavi?s role in Pandemic Prevention Preparedness and Response (PPPR). This report
provides a progress update on the implementation of Gavi 5.0/5.1 and associated
risks 1. As WHO -UNICEF estimates of national immunisation coverage (WUENIC) for 2022
wi ll be released in July, the paper provides quantitative updates on a limited number of
strategy indicators for which new 2022 data is available, as well as a more qualitative
perspective of progress. A holistic overview of performance is also captured in t he
Balanced Scorecard (See Annex A) . In addition to this bi -annual paper, the Secretariat is
looking into opportunities to share other existing information on country progress with the
Board on an on -going basis 2.
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?
? Should the timeline for disbursements of the Equity Accelerator Fund (EAF) be
extended to end 2027 as per the recommendation from the Programme and Policy
Committee (PPC) , recognising that the COVID -19 pandemic has had adverse impact
on design and implementation of EAF grants?
? What are the programmatic items with financial implications for Gavi 5.1 and 6.0 at
this Board meeting?

1 Associated risks refer to the top risks in the Risk & Assurance Report 202 3 which will be submitted for approval to the
Board in December 2023. 2 This includes the addition of a dedicated presentation by the Secretariat and core Partners on country programmes
delivery at the last PPC meeting as well as a technical briefing on country programmes to the Board at the upcoming
meeting .

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Board -2023 -Mtg -02 -Doc 03

Report to the Board
26 -27 June 202 3

Subject Country Programmes Delivery Presentation
Agenda item 03
No paper

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Board -2023 -Mtg -02-Doc 04
Report to the Board
26 -27 June 202 3

Subject COO and Financial Update, including forecast
Agenda item 04
Category For Decision
Section A: Executive Summary
Context
This paper presents the updated Financial Forecasts for Gavi 5.1 (2021 -2025), COVAX
AMC (2020 -2023) including COVID -19 immunisation programme (2024 -2025) to the
Board for approval based on the recommendation of the Audit and Finance Committee
(AFC).
The Gavi 5. 1 forecast confirms sufficient financial flexibility given the uncertain context
with US $ 109 million available for future investments. The forecast reflects a decrease
of US $ 161 million in resources and a decrease in programmatic expenditures of
US$ 12 5 million (before new items for decision).
? Changes to forecast: The decrease in forecast expenditure is driven by the
proposed rephasing of cash programmes into the next strategic period partly offset
by increased vaccine costs . W hile overall cash support to countries (Core and
COVAX COVID -19 Delivery Support (CDS) ) is forecast to remain at record levels
for the rest of the strategic period, the Gavi 5.1 H ealth Systems Integration and
Strengthening (HS IS) forecast s are US$ 268 million lower (US$ 15 0 million Health
Systems Strengthening (HSS) , US$ 14 0 m illion Equity Acce lerator Fund offset by
a US$ 23 million increase driven by Campaign Operational Costs ), reflect ing
absorptive capacity in certain co untries for HSS and to extend the time line into
2026/ 20 27 for countries to implement their EAF p rogrammes . These funds are now
forecast to be disbursed in the next strategic period but will remain available to
countries to utilise in Gavi 5.1 if absorption exceeds current forecasts (in which case
the forecast could be revised upwards again in a future cycle) . Therefore, the
resulting cash programme forecast reflects the current best estimate of
disbursement phasing and does not represent the active deferral of any underlying
programmatic activities . Increased vaccine procurement costs (US$ 151 million or
+3%) are driven primarily by increased demand for m easles & m easles -rubella
vaccines in response to coverage declines and increased outbreak risk. To balance
the rephasing of cash programmes into th e next strategic period, US$ 179 million
of IFFIm (International Finance Facility for Immunisation) proceeds will also be
deferred.
? Items for decision: the Board is asked to approve US$ 29 million expenditure in
the Gavi 5.1 forecast for the launch of the Hexavalent vaccine programme, noting
that the impact on Gavi 6.0 is forecast between US$ 357 ? US$ 430 million , as well
as a US$ 10 million time -limited envelope for a Global Virtual Pooled Inventory
(GVPI) for Ebola Sudan and Marburg candidate vaccines. As a result of countries?
EAF applications being delayed due to the pandemic, the Board is also requested
to approve the extension of the timeline to disburse the remaining EAF funds from

gavi.org
COO UPDATE
BOARD MEETING
David Marlow
26 -27 June 2023, Geneva, Switzerland
Executive Summary
2
? Operational Excellence ambition and approach endorsed by the AFC; presented at Governance Committee and Board
Closed Sessions
? Operational Excellence agenda continuing at pace while acknowledging need to balance running the business while
streamlining operations and improving ways of working; multi -year journey
? Increased transparency and connectivity between PPC and AFC discussions; careful sequencing and sharing of
information based on committee mandates. Additional opportunities for connectivity across multiple committees
? Financial forecast process strengthened
? Launch of Programme Leadership Team (PLT); enhanced cross -functional collaboration and ownership for
programmatic drivers impacting financial forecast
? More detailed and timely reporting from countries and partners : greater transparency of cash utilisation and
cash balances in -country
? New draft Balanced Scorecard providing improved holistic and systematic view of performance with relevant deep dive
modules available; will continue to evolve based on feedback and use
? Review and simplification of key policies underway; Ethics policy; PSEAH framework; Programme Funding Policy
? Strategy Operationalisation evaluation ; recommendations on strategy operating model; inform OE work and Gavi 6.0
Key Messages
Board Meeting, 26 -27 June 2023