gavi.org
COUNTRY PROGRAMMES
UPDATE
BOARD MEETING
Thabani Maphosa
7 -8 December 2022, Geneva, Switzerland
Segment distinctives and % of zero -dose children
2 Board Meeting, 7 -8 December 2022
? Large and federated
countries
? Extremely large birth
cohorts, zero -dose
children
? De -centralisation of health
to sub -national areas
? Higher programmatic
and fiduciary risks
? Intensive Alliance and
partner engagement
? 19 former Gavi -eligible
countries
? 26 never Gavi -eligible
lower middle income &
IDA -eligible economies
? Support differentiated
based on needs
? Includes
supporting fragile MICs
Middle -Income
45 countries
High Impact
5 countries
? Different country maturity:
priority; standard
? Priority: large birth
cohorts, weak system &
performance
? Standard: smaller birth
cohorts, strong
performance
? High numbers of countries
in accelerated transition
Core
40 countries
? Significant disruption to
immunisation services
? Limited health
infrastructure
? Limited pool of qualified
healthcare workers
? Sometimes inaccessible
to externals
? Low national coverage
(80%)
Fragile & Conflict
12 countries
~51% ~14% ~25% ~10%

gavi.org
Finance
BOARD MEETING
David Marlow, Assietou Diouf
7 -8 December 2022, Geneva, Switzerland
Key Forecast and Budget Highlights
US$ 183 m
Gavi 5.0: available for future
investments (after new investments)
? Decrease in resources due to market condition offset by lower forecast expenditure.
Flexibility remains to respond to uncertain context .
? Funding for HPV relaunch & updated Co -Financing, Eligibility & Transition policies reflected
No increase
Gavi 5.0: Secretariat budget
US$ 1.9 bn
COVAX: resources released
through negotiations
Secretariat capacity
Increasing risk for the Alliance
? Total budget remains within Board approved envelope ; with underspend rephased
? Average operating expense ratio for Gavi 5.0 remains 7.5%; increases for 2023 -2024
? Renegotiations to return ~ US$ 1.9 bn to the AMC
? C ombined exit costs and expiration forecast to date reduced to ~US$ 1.8 bn, with additional
risk of expiries based on 2023 demand (figures exclude in -country wastage)
? Efficiency and simplification with launch of Operational Excellence framework
? Holistic workforce plan to meet Secretariat resource capability needs and drive end to end
process effectiveness across all functions
2 Board Meeting, 7 -8 December 2022

gavi.org
RISK AND ASSURANCE
REPORT
BOARD MEETING
Jacob van der Blij
7 -8 December 2022, Geneva, Switzerland
The world continues to be uncertain and faces
unexpected shock after shock
? Immediate COVAX risks decreasing , but uncertainties persist with the pandemic not yet over;
? Lower sense of urgency with Omicron variant affects demand (and risk of vaccine expiries );
? Health systems and country capacity remain strained, posing risks to routine immunisation;
? The external world continues to be uncertain, requiring a shift from efficiency and ?just in time?
to resilience and ?just in case?
? The Russia -Ukraine conflict posing economic, geopolitical, supply, donor support and cyber risks.
Geopolitical tensions and rivalry have increased substantially, even involving nuclear threats;
? Increasing inflation and rising interest rates may lead to a global recession, cost -of -living crisis
and volatile financial markets, impacting Gavi finances, country fiscal space and debt crises;
? Increasingly visible impacts of climate change and food insecurity may disrupt routine
immunisation and raises the risk of disease outbreaks and future pandemics.
Gavi continues to operate with a high risk appetite, while relying on robust risk management
2 Board Meeting, 7 -8 December 2022

gavi.org
Gavi 5.1 (including Pandemic
Preparedness & Response)
BOARD MEETING
Aur?lia Nguyen
Johannes Ahrendts
7 -8 December 2022, Geneva, Switzerland
2022
April July July -
Sept
December
Board retreat:
take stock of
the impact of
the pandemic
on routine
immunisation
Gavi 5.1 mini -
workshop: reconfirm
5.0 priorities and
integrate C19
learnings
2 deep -dives
on
targeted
additions for
Gavi 5.1
Board
decision
on 5.1
Recap: Gavi 5.1 journey started in April ?22 led by the Board with
close PPC involvement
?Bringing it all
together?
consultation
November
Today
Gavi 5.1 is not a new strategy. A natural evolution of 5.0 serving as bridge to 6.0
Oct -
Nov
PPC
meeting:
guidance
on 5.1
Board Meeting, 7 -8 December 2022

gavi.org
HUMAN
PAPILLOMAVIRUS
(HPV) VACCINE
PROGRAMME
RELAUNCH
BOARD MEETING
Jalaa? Abdelwahab
7 -8 December 2022, Geneva, Switzerland
Board Meeting, 7 -8 December 2022
Gavi 4.0
2
2011 2012 2015 2019 2021 -22
1M GIRLS
REACHED
(Demos)
Start of HPV
NATIONAL
SCALE -UPs
SEVERE SUPPLY
CONSTRAINT
SUPPLY
CONSTRAINTS/
COVID -19
2016 2017 -18 2020
HPV 1 st
TENDER
DEMONSTRATIONS
PROGRAMME
? Girls reached: 9.8M
SUPPLY
CONSTRAINTS
FURTHER COVID -
19 DISRUPTIONS
HPV vaccination ? a high impact programme - has gone
through several setbacks requiring a relaunch for Gavi 5.1
Historical background
Gavi 5.0
? Introductions: 28 R outine & 9 MACs ? Gavi 73 coverage: 11% HPV1, 9% HPV2
? Large countries yet to introduce
? Mixed country -level performance
Reach to date

gavi.org
CONSENT AGENDA
BOARD MEETING
7 -8 December 2022, Geneva, Switzerland
Recommendation 1: Consent Agenda: Board Chair
Reappointment
The Gavi Alliance Governance Committee recommends to the Gavi Alliance Board that it:
a) Reappoint Jos? Manuel Barroso as an Unaffiliated Board member through to
31 December 2025 ; and
b) Reappoint Jos? Manuel Barroso as Board Chair, with individual signatory authority on behalf
of the Gavi Alliance, for a second term through to 31 December 2025 .
2 Board Meeting, 7 -8 December 2022

gavi.org
CEO BOARD
UPDATE
D R S E T H B E R K L E Y
In Baluchistan Province, Pakistan, a boat made
with plastic barrels carries a team to vaccinate
children with typhoid conjugate vaccine (TCV).
Credit: Gavi/2022/ Asad Zaidi
Council of Europe?s
2021 North - South Prize to COVAX
2 CEO Board Update
? Cited COVAX as ?a major actor
of global solidarity? in COVID -19
pandemic , contributing to
protecting public health and
building a more equitable world
? Prof Jos? Manuel Barroso, Chair of
the Gavi Board, attended award
ceremony in October 2022 on
behalf of Gavi Secretariat

Board -2022 -Mtg -03-Doc 02b -Annex A 1
Report to the Board
7-8 December 2022
Annex A: Gavi 5.0 Mission and Strategy indicator dashboard and Strategy
Implementation Indicators update
This is a technical report summari sing progress against Mission and Strategy Goal
indicators in the new Gavi 5.0 measurement framework. It is populated based on
available data and updated bi -annually. The newly available data for 2021 included in
this repo rt relates to Mission Goals M2, M3, M4, M5, and M6, as well as Strategy
Goals 1, 2, and 3.2.
This Annex also includes an update on the Gavi 5.0 Strategy Implementation
Indicators, which are more operational in nature. These indicators have been reviewed
by the Gavi 5.0 Measurement Framework Alliance Technical Working group but have
not yet been finalized. They will be finalized following the October /December 2022
governance cycle after addressing any comments raised by the PPC.
Note on target trajectories:
In the below graphs, the dotted lines represent the projected annual trajectory that was
forecasted when Gavi set 2025 targets with the PPC/Board in May 2021. As
communicated to the PPC and Board, t he assumption was that coverage would return
to 2019 cove rage levels in 2021, with the exception of India which would take until
2022. This assumption has proven not to be correct. Based upon 2022 trajectories,
the Secretariat may come back to the Board to review and adjust the targets.

Gavi 5.0 Mission Indicators
M.1: Under -five mortality rate

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.
Indicator will be updated for 2021 in
April 2023.
58 56
Target: decrease by 10%
0
10
20
30
40
50
2019(Baseline) 2020 2021 2022 2023 2024 2025

Board -2022 -Mtg -03 -Doc 06 -Annex A

1

Report to the Board
7-8 December 2022

Board -2022 -Mtg -03-Doc 11b -Annex B 1
Report to the Board
7-8 December 2022
Annex B: Co -financing Policy


Gavi Alliance
Co -financing Policy
Version 3.0



DOCUMENT ADMINISTRATION
VERSION
NUMBER APPROVAL PROCESS DATE
3.0
Prepared by: Marta Tufet, Head,
Policy
Reviewed by: PPC 1 November 2022
Approved by: Board [Full date]
Effective from: 1 January 2023
Next review: At the request of the Board
Updated
Section 6 and
7.3
Reviewed by: Gavi Programme
and Policy Committee 12 May 2016
Approved by: Gavi Alliance Board 23 June 2016
2.0
Prepared by: Robert Newman,
Policy and Performance
Reviewed by: Gavi Programme
and Policy Committee 4 May 2015
Approved by: Gavi Alliance Board June 2015
Effective from: 1 January 2016







Board -2022 -Mtg -03-Doc 11b -Annex B 2
Report to the Board
7-8 December 2022
1. Purpose & Objective
1.1 The purpose of this policy is to set out the requirements and procedures for
country co -financing of vaccines introduced with Gavi support for use in routine
programmes. Further information on the vaccines for which co -financing
applies can be found in the application guidelines.
1.2 This policy covers vaccine co -financing levels at different phases of the
transition pathway, compliance requirements and exceptions.
1.3 This policy only covers co -financing for vaccine procurement. The Framework
for Gavi Funding to Countries outlines the overall structure of Gavi?s support
to countries and other Gavi funding support is covered in the Health Systems
and Immunisation Strengthening (HSIS) policy.
1.4 The objective of this policy is to facilitate the mobilisation and sustaining of
domestic fin ancing for vaccines introduced with Gavi support.
2. Definitions
2.1 Co -financing share: The co -financing share represents the share of total costs
of co -financed vaccines borne by countries. It may differ from the price fraction
as the price fraction is applied to vaccines costs only, excluding devices and
freight.
2.2 Grace year: first year of preparatory or accelerated transition phase, during
which co -financing rules of the previous transition phase apply.
2.3 Starting fraction: the starting fraction is calculated by dividing a country?s total
co -financing for all co -financed vaccines by t he total cost of all co -financed
vaccines based on the weighted average prices of the presentations used by
the country. The starting fraction shall be calculated in year 1 of preparatory
transition to apply from year 2. The starting fraction will not incl ude the costs of
the malaria vaccine or other specific vaccines for which co -financing follows an
exceptional approach.
2.4 Price fraction: the price fraction applies to countries in preparatory transition
and first year of accelerated transition. It is ca lculated annually by increasing
the previous year?s fraction by 15% (i.e., a factor of 1.15). The price fraction is
applied to the price of a co -financed vaccine to determine the amount that a
country co - finances for that vaccine. Price fraction is also u sed for setting the
co -financing level of vaccines introduced by countries in accelerated transition,
in line with rules set out in section 4.
3. Principles
3.1 The following principles guide the application of the co -financing policy:
? Country -driven, pred ictable and sustainable beyond Gavi support:
Gavi support is country -driven, meaning that it bolsters country

1


Board -2022 -Mtg -03-Doc 11b

Report to the Board
7-8 December 2022

Subject Funding Policy Review: Eligibility and Transition Policy and
Co -Financing Policy
Agenda item 11b
Category For Decision

Section A: Executive Summary
Context
The Eligibility & Transition Policy and Co -financing Polic y are being reviewed as part
of the Funding Policy Review . An independent evaluation and subsequent analysis
and consultation concluded that these policies have been fundamental to the success
of Gavi?s sustainability model, but that some shifts could facilitate their implementation.
Given the current political, economic environment and timepoint in Gavi?s strategic
cycle, the review has shifted to address two urgent issues: 1) countries in accelerated
transition phase (ATP) face financial sustainability challenges that could impede their
successful transition from Gavi support; and 2) the initial high cost of the malaria
vaccine is a barrier to u ptake and public health impact . These issues are exacerbated
by slow economic growth and rising inflation, while the impacts of the pandemic,
ongoing war in Ukraine, and increasing debt burden have created an uncertain and
challenging fiscal and economic environment.
Questions this pap er addresses
This paper proposes to address these two issues via i) updates to the Eligibility &
Transition and Co -financing policies: extending the duration of ATP from five to eight
years and instituting a minimum 35% co -financing thr eshold for countries to move from
preparatory transition to ATP ; and ii) providing an exceptional time -limited approach
for malaria co -financing.
Additionally, the paper proposes two provisions in the co -financing policy: i) following
up from the discussion on the Fragility, Emergencies and Displaced populations policy
approved by the Board, for there to be no co -financing required for refugee
populations; and ii) formalising previous Board decisions which state that no co -
financing is required for outbreak response campaigns.
Conclusions
The Programme and Policy Committee ( PPC ) recommends to the Alliance Board to
approv e the updated Eligibility and Transition policy, the Co -financing policy , as well
as the exceptional time -limited approach for malaria co -financing.