Board -2022 -Mtg -03-Doc 07 -Annex C 1
Report to the Board
7-8 December 2022
Annex C: Initial estimated cost of HPV programme relaunch 2023 -2025
HPV Expenditure Forecast Evolution
In addition to providing detail on the initial estimated cost of the HPV programme
relaunch 2023 ?2025, this annex sets out the changes to, and drivers of, the total
expendit ure forecast of the HPV vaccine program me included in the financial forecast
for the strategic period 2021 -2025. Total forecast expenditure (excluding COVAX
AMC) totals US$ 10.2 billion ( reducing from US$ 10.4 billion in the prior forecast) ?
see Doc 04a ? Financial Update, including forecast for details .
Figure 1: HPV expenditure forecast
Health systems strengthening: US $ 40 million forecast remains an estim ate of direct -HPV support - current HSS grants will be utilised to strengthen HPV programmes , but activities are often embedded in broader routine immunisation strengthening efforts
US$ 509 million ex penditure directly related to HPV Vaccine Programmes was
included in the prior financial forecast (v19.1) approved by the Board in June 2022.
The current financial forecast (v20) presented to the December 2022 Board for
approval includ es a US$ 102 m illion net increase in the HPV Vaccine Programmes
envelope resulting from two offsetting variances :
? US$ 65 million reduction in vaccine programme costs, principally driven by the
forecasted impact of permissive dose -schedule change from 2 dose to
permissive 1 dose regimen , in line with WHO SAGE recommendation .
? US $ 167 million vaccine programme costs, related to the HPV re -launch as
detaile d below funded from earmarked Canada funding ~$ US 60 million (CAD
75 million ) and allocation of existing resource s.

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Board -2022 -Mtg -03-Doc 07

Report to the Board
7-8 December 2022

Subject Human papillomavirus (HPV) Vaccine Programme relaunch
Agenda item 07
Category For Decision
Section A : Executive Summary
Cervical cancer is 70 -90% preventable through Human Papillomavirus (HPV)
vaccination, yet 342,000 deaths were recorded in 2020, with ~90% of th ese occurring
in low - and middle -income countries (LMICs) . HPV vaccine has amongst the highest
impact 1 and is the key intervention towards the ambitious WHO 2030 targets to
achieve cervical cancer elimination 2.
In 2021, global HPV coverage stood at 12%, whil e 9% in Gavi 73 and 4% in eligible
Middle -Income Countries (MICs) 3. Severe supply constraints have been the major
driver behind low coverage in LMICs and imped ed progress durin g Gavi 4.0 (2016 -
2020 )4. Other drivers includ e vaccine/operational costs; competing priorities; the
unique challenges of vaccinating adolescent girls (such as service delivery, gender -
related barriers, demand and trust, lack of existing touchpoints within the health
system); and COVID -19 pandemic disruptions including school closures .
HPV vaccination is critical to reduce cervical cancer , especially in lower -income
countries with high disease burden and weak secondary prevention programmes. It is
also a bridge to women and girls? health and an opportunity to positively impact gender
equity. The new WHO SAGE (Strategic Advisory Gro up of Exper ts on Immunization)
recommendation permitting countries to opt for a single -dose schedule and an
increased global supply provides a critical opportunity to inject renewed
momentum . To accelerate the number of girls reached with HPV, from 9.8 million
(2021) to the ambitious target of ?86 million by 2025, the fo llowing objectives have
been set: 1) accelerate quality introductions; 2) rapidly improve global and national
coverage; and 3) generate long term programmatic sustainability through building and
integrating HPV vaccination within routine delivery mechanism s and into Primary
Health Care (PHC).



1 Vaccine Impact Modelling Consortium (VIMC), 2022 2 To achieve this, 90% of girls should be fully vaccinated with HPV vaccine by 15 years of age ; 70% of
women should be screened using a high -performance test by age 35, and again by age 45; 90% of
those identified with cervical disease should receive appropriate treatment. 3 MICs -eligible countries refer to the 45 countries and economies that are eligible under the MICs
Approach : all former -Gavi, never -Gavi lower middle -income countries (LMICs) and never -Gavi -
International Development Association (IDA) - eligible economies). Uzbekistan/Nicaragua, whilst now
eligibl e for the MICs Approach, are reported as Gavi 57. 4 Original 2020 target was 40 million girls, only reached 7.1 million girls by end of 2020 ( Gavi APR 2020 )

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Board -2022 -Mtg -03-Doc 02b

Report to the Board
7-8 December 2022

Subject Strategy, Programmes and Partnerships: Progress, Risks and
Challenges
Agenda item 02b
Category For Information
Section A : Executive Summary
Context
This report provides a progress update on the implementation of Gavi 5.0 and
associated risks 1. WHO -UNICEF coverage estimates (WUENIC) for 2021 confirm ed
the Al liance?s expectations that 2021 would continue to see ongoing disruption of
routine immunisation (RI) , largely related to th e COVID -19 pandemic . The number
of zero -dose children in Gavi -supported countries has increased by 5% to 12.5 million ,
and routine immunisation coverage (diphtheria , tetanus , and pertussis third dose -
DTP3 ) decre ased by another percentage point (pp) in 2021 compared with 2020 . At
the same time, there are signs of resilience and recovery. Gavi -supported countries
delivered ~3.5 time s more vaccines in 2021 alone, than in 2020. The rate of DTP3
coverage decline slowed when compared to 2020. Further, one third of Gavi -supported
coun tries saw a DTP3 increase in 2021 . Positive trends in administrative data from a
subset of countries from the first half of 2022 suggest s more children are being reached
with DTP3 than in the same period in 2019 (pre -pandemic) . In addition, countries
managed to expand breadth of protection 2 whilst also delivering 1.65 billion COVID -19
vaccine doses. This is a testament to the hard work of countries and the Alliance , and
the critical role of the Alliance?s long -standing investments in strengthening health and
immunisation systems , especially so, in the wider context of the pandemic .
Questions this paper addresses
How is the Alliance perform ing against its mission , strategic goals and indicators ,
and h ow has the context of the COVID -19 pandemic impacted progress ?
What are the key risks and challenges being seen across the Alliance ?s strategic
performance, programmes and partnerships, and what actions are being taken to
address these?



1 Associated risks refer to the top risks in the Risk & Assurance Report 2022 (see Doc 5). 2 This measures the extent to which countries have introduced and scaled up Gavi -supported vaccine .
For further information see Annex A

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Board -2022 -Mtg -03 -Doc 03

Report to the Board
7-8 December 2022

Subject Country Programmes
Agenda item 03
No paper

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Board -2022 -Mtg -03-Doc 04a

Report to the Board
7-8 December 2022

Subject Financial update, including forecast
Agenda item 04a
Category For Decision
Section A: Executive Summary
Context
This paper presents the updated Financial Forecasts for Gavi 5.0 (2021 -2025), COVAX
AMC (2020 -2023) and Gavi 6.0 (illustrative) (2026 -2030) to the Board for approval
based on a recommendation from the Audit and Finance Committee (AFC).
The Gavi 5.0 forecast confirms sufficient financial flexibility given the uncertain context
with US$ 183 million available for future investments.
? The updated forecast includes the impact of the HPV relaunch (US$ 167 million) and
proposed revision to the Eligibility & Transition and Co -Financing policies
(US$ 80 million), both of which are being presented for decision at this meeting.
? The underlying forecast reflects a decrease of US$ 301 million in resources due to
the impact of macro -economic factors (noting no chang e to underlying pledges), and
a decrease in programmatic expenditures of US$ 317 million reflecting continued
disruption of routine immunisation due to the pandemic as well as greater visibility
on country needs and absorptive capacity (based on existing r esources in -country) .
? Key elements of Gavi 5.1 are still under development and therefore this updated
forecast does not include programmatic estimates related to regional manufacturing
diversification, a potential ongoing routine COVID -19 immunisation pro gramme, or
Gavi?s future role in pandemic preparedness and response, noting these elements
are pending further Board approval.
The COVAX AMC forecast reflects the status of ne gotiations with COVID -19 vaccine
manufacturers and includes a n estimate of US$ 1 .9 billion reduction in vaccine liability .
Included in the forecast is US$ 2.7 billion under the Pandemic Vaccine Pool, with
US$ 0.8 billion anticipated to be used in 2023, subject to AMC Investors Group
approval. Therefore, US$ 1.8 billion is anticipated to be available to respond to potential
future escalations in the pandemic.
Questions this paper addresses
Is there sufficient funding available to deliver on Board -approved priorities for Gavi 5.0
and COVAX AMC, with adequate financial flexibility remaining to respond to the
uncertain operating context?
What elements of Gavi 5.1 are included in the financial forecast, and which items still
require financial implications to be determined and reflected?

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Board -2022 -Mtg -03-Doc 04b

Report to the Board
7-8 December 2022

Subject Partners? Engagement Framework and Secretariat Budget
(2023 ?2024)
Agenda item 04b
Category For Decision
Section A : Executive Summary
Context
This paper presents the operating budget s for the Gavi Secretariat , COVAX AMC
(COVAX) and Partners? Engagement Framework (PEF) for the fiscal years 202 3 and
202 4 to the Board for approval based on a recommendation from the Audit and
Finance Committee (AFC) .
The proposed Secretariat budget for 2023 and 2024 is in line with the total Gavi 5.0
envelope included in the Board approved Financial Forecast , including the additional
budgets approved for the special initiatives (Malaria, Diagnostics and Middle -Income
Country strategy (MICs) ), with the US$ 45 million underspend from 2021 and 2022
rephased across the strategic period . This rephasing reflects the anticipated
acceleration of activities delayed due to the pandemic and higher inflation, as well as
provid ing a level of flexibility to enable the Secretariat to respond to uncertainties and
evolving needs given that we are still operating in the context of the pandemic as well
as enhanced global economic uncertainty. This flexibility will also enable certain
ope rating costs associated with Gavi 5.1 to be absorbed , specifically the human
papillomavirus (HPV ) vaccine relaunch and some of the potential costs relating to
regional manufacturing diversification (noting these are still to be determined) .
The Secretariat budget does not yet reflect the efficiency gains and synergies to be
realised through the new Operational Excellence approach . The Operational
Excellence framework is structured around 5I?s: Innovate (e.g. EVOLVE), Integrate
(e.g. COVAX Integration), Improve (e.g. simplify the way we work ), Invigorate (Gavi?s
culture and employee engagement ) and Inform (change management and
communication ). The full financial impact of the Operational Excellence initiatives and
related needed capabilities still need to be qualified and quantified . This will include a
holistic view of implementation costs (funded under the existing budget) , financial
benefits, impact on the organisation design and workforce, and a multi -year timeline
for execution.
The proposed COVAX budget is in line with the 2020 -2023 budget envelope approved
by the Board , with the US$ 10 million underspend from 2022 rephased to 2023 . The
Board has approved the COVAX mandate until the end of 2023 .
A potential COVID -19 vaccine programme from 2024 onwards as well as Gavi?s role
in pandemic preparedness and response (PPR) is being considered as part of Gavi
5.1. An in -principle decision on these Gavi 5.1 priorities is being requested by the

Gavi

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Board -2022 -Mtg -03 -Doc 01d

Report to the Board
7-8 December 2022

Subject Consent Agen da ? Updated as at 5 December 2022 DRAFT
Agenda item 01d
Category For Decision

Section A : Introduction
Ten recommendations are being presented to the Board under the Consent Agenda
for consideration. Detailed information on the items can be found in the relevant
Committee papers in a dedicated folder on BoardEffect at:
https://gavi.boardeffect.co.uk/workrooms/6459/resources/211597
Section B : Actions Requested of the Board
The Gavi Alliance Board is requested to consider the following recommendations from
the Gavi Alliance Governance Committee, Audit and Finance Committee and
Programme and Policy Committee.
Decision One ? Board Chair Rea ppointment
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 seco nd term through to 31 December
2025.
Decision Two ? Board Committee Chair Appointment
The Gavi Alliance Governance Committee recommends to the Gavi Alliance Board
that it:
Appoint Yibing Wu as Chair of the Investment Committee effective 1 January 2023
and until 31 December 2023.

 

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Board -2022 -Mtg -03 -Doc 02a FR

Rapport pour le Conseil d?administration
7-8 d?cembre 2022

Rapport du Directeur ex?cutif

30 novembre 2022
Chers memb re s du Conseil d?administration ,
Comme toujours, je suis tr?s impatient de vous voir ? Gen?ve dans quelques
semaines . Cette r?union du Conseil d'administration a lieu au moment crucial o?
l'Alliance s'engage dans ce qui correspond certainement pour certains ? une "nouvelle
normalit?" - tr?s diff?rente du contexte dans lequel nous op?rions avant la pand?mie.
L'ordre du jour de notre prochaine r?union refl?te bien la complexit? et le climat
d'incertitude dans lesquels nous poursuivons notre travail. La pand?mie continue
d'occuper le devant de la sc?ne, ce qui donne lieu ? un certain nombre d?hypoth?ses
qua nt ? l??volution mondiale de la situation sanitaire et des risques de perturbations ,
notamment au niveau de la vaccination . Parall?lement , nous assistons ? une
recrudescence des tensions g?o politiques, des probl?mes macro?conomiques et des
?pid?mies, ce qui ?videmment, a des r?percussions sur notre travail.
C?est ainsi que , lors de notre prochaine r?union, nous allons devoir, pour la premi?re
fois dans l'histoire de Gavi, modifier ? mi -parcours la strat?gie (Gavi 5.0) qui d?finit
nos priorit?s et nos programmes , pour passer ? ce que nous appelons Gavi 5.1. En
raison ?galement de l'?volution tr?s rapide de tout ce qui nous entou re , nous vous
demanderons de donner votre accord "de principe" ? un programme , celui qui
concerne la vaccination contre la COVID -19. De fait, nous reconnaissons ainsi que,
m?me si nous savons que beaucoup de choses vont encore changer au cours de
l'ann?e ? venir, y compris la demande des pays pour les vaccins contre la COVID -19 ,
nous savons aussi qu?il nous faut commencer ? nous projeter d?s main tenant si nous
voulons pouvoir soutenir les pays, de quelque mani?re que ce soit, au -del? de 2023.
Alors que nous cherchons ? avancer sur un certain nombre de fronts, nous devons
tenir compte des capacit? s des pays, aussi bien que de celles des partenaires de
l?Alliance et du Secr?tariat de Gavi , ainsi que de leurs limites . La p?riode actuelle
d'instabilit? mondiale va probablement se prolonger , et c'est pourquoi, en tant
qu'Alliance, nous devons continuer ? accorder la priorit? ? la vaccination syst?matiqu e
pour lui ?viter tout nouveau recul, au rattrapage des enfants qui ont ?t? laiss?s de
c?t?, et plus particuli?rement des enfants z?ro dose et des communaut?s oubli?es .
Par ailleurs, nous devons continuer ? faire preuve d'agilit? pour pouvoir nous adapter
aux nouvelles incertitudes et tirer parti des ?valuations et des enseignements tir?s de
la riposte ? la COVID -19 et de COVAX, afin de mieux r?pondre aux besoins des pays,
notamment en ce qui concerne les ?pid?mies ?mergentes ou en cours.
Il s'agit d'un v?ritable exercice d'?quilibriste, mais je suis convaincu que l'Alliance du

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Board -2022 -Mtg -03 -Doc 02a

Report to the Board
7?8 December 2022

Report of the Chief Executive Officer

30 November 2022
Dear Board Members,
As ever, I am very much looking forward to seeing you in Geneva in a week ?s time.
This Board meeting is taking place at a critical moment, when as an Alliance we are
embracing what must certainly be described as a ?new normal? for some ? quite
different from our pre -pandemic operating context.
We need look no further for evidence of the complexity and uncertainty in which we
continue to work than the agenda of our upcoming meeting. The pandemic continues
to loom large, presenting a number of possible trajectories and disruptions to global
health and immunisation. At the same time, we are witnessing increased geopolitical
tensions, macroeconomic troubles and disease outbreaks, all of which are impacting
our work.
As a result, at our upcoming meeting, for the first time in the history of Gavi we will be
evolving our programme strate gy mid -cycle into what we call Gavi 5.1. Also as a result
of the very fast -moving environment, we will be requesting you to approve an
?in principle? programme, that of COVID -19 vaccination. This is in acknowledgement
of the fact that, while we know much will evolve over the year ahead, including country
demand for COVID -19 vaccines , we also know we must start planning now if we wish
to support countries in any capacity beyond 2023.
As we look to move forward across a number of fronts, we must take into account the
capacity limitations among countries, Alliance partners and the Gavi Secretariat alike.
The current period of global instability is likely to continue, and therefore as an Alliance
we need to continue to prioritise avoiding further backslidi ng of routine immunisation,
catching up missed children , and reaching more zero -dose children and missed
communities. At the same time, we must continue to retain our agility in adapting to
new uncertainties, and leverage evaluations and learnings from COV AX and COVID -
19 response, so we can better respond to country needs ? especially with regards to
ongoing and emerging outbreaks.
This is quite the balancing act, however I strongly believe the Vaccine Alliance remains
well positioned to deliver. In many wa ys, the pandemic and COVAX have brought the
Alliance closer than ever before. Indeed, this experience has shined a light on how
impactful our Alliance can be when we work in lockstep. But not every member of the
Alliance was working on COVAX , and therefore we need to make sure that all Alliance
partners feel connected.

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Board -2022 -Mtg -03 -Doc 00a


Gavi Alliance Board Meeting
7-8 December 2022
Hilton Geneva Hotel and Conference Centre, Geneva, Switzerland
Monday 5 and Tuesday 6 December: Pre -Board meetings
Wednesday 7 December: 09.00 -18.00 (Board meeting Day One)
Thursday 8 December: 09.00 -17.00 (Board meeting Day Two)
Quorum: 14
Document List

No. Document
00a Document list
00b Agenda
01a Declarations of interest
01b Minutes
01c No Objection Consent Decisions
01d Consent Agenda
01e Workplan
02 a CEO?s Report ? To follow
02b Strategy, Programmes and Partnerships: Progress, Risks and Challenges
03 Country Programmes ? No paper
04 a Financial Update, including forecast
04b Partners? Engagement Framework and Secretariat Budget (2023 -2024)
05 Risk and Assurance Report
06 Gavi 5.1 (including Pandemic Preparedness and Response)
07 Human papillomavirus (HPV) Vaccine Programme relaunch
08 Gavi?s role in support to Regional and African Vaccine Manufacturing
09 COVAX: Key Strategic Issues
10 Gavi?s role in a future COVID -19 Vaccine Programme
11 a Funding Policy Review : Context and Health System Immunisation Strengthening
(HSIS) Policy
11b Funding Policy Review: Eligibility and Transition Policy and Co -Financing Policy

Board -2022 -Mtg -03-Doc 00b 1

Gavi Alliance Board Meeting
7-8 December 2022
Hilton Geneva Hotel and Conference Centre, Geneva, Switzerland
Monday 5 and Tuesday 6 December: Pre -Board meetings
Wednesday 7 December: 09.00 -18.00 (Board meeting Day One)
Thursday 8 December: 09.00 -17. 00 (Boa rd meeting Day Two)
Quorum: 14



Agenda




















Next Board Meeting : 30 -31 March 2023 (Board Retreat)
28 -29 June 2023
6-7 December 2023
---
Brenda Killen , Director, Govern ance and Secretary to the Board, +41 22 909 6680, bkillen@gavi.org
Joanne Goetz , Head, Governance, +41 22 909 6544, jgoetz@gavi.org
Please note that the Board meeting will be recorded. This recording will be used as an aid to minute the
meeting. A transcription of the full proceedings will not normally be made. Should a transcription be made it
will be used only as an a id to minute the meeting.