GAVI Alliance Board Meeting, 30 November ? 1 December 2010 Doc #1 1b ?HSS Decision and Updates
ANNEXES 1 -3

FOR DECISION

GAVI Secretariat, 16 November 2010 1

ANNEX 1 HSS CURRENT FUNDIN G AND RESOURCE ALLOCATION 2010 -2015
The tables show the status of current HSS support and the resource allocation for HSS for:
- Low Income Countries (LIC) - As per the World Bank List (July 2010); countries with a GNI/capita
les s than $995 ;
- Low Middle Income Countries (LMIC) - As per the World Bank List (July 2010); countries with a
GNI/capita above $995 & below $1500 .
Two scenarios are presented:
1. With Cap -This scenario uses a notional cap for HSS (US$ 474 million). This al lows for the resource
allocation formula agreed at the June 2010 Board to be modelled. The scenario also takes into account
the current implementation rate of HSS programmes.
2. Without Cap - In this scenario no cap has been applied. This is an 'ideal wo rld' scenario (i.e there
are no funding restrictions). The scenario also takes into account the current implementation rate of
HSS programmes.
Resource Allocation Methodology

The new resource allocation method is calculated using the maximum potential amo unt of
funding is based on a country?s population and weighted against a graded gross national
income (GNI) scale 1. A floor of US$ 3 million is also applied as otherwise some very small
countries would be entitled to an unreasonably small amount of fundin g (in accordance with
the June 2010 Board Decision).

The resource allocation formula was developed by HLSP and is applied as follows:

Step 1
Allocation = Per Capita Allocation x Newborn Cohort (X)
(where per capita allocation = $5 per newborn if per capita income $365 and $2.5 if > $365)

Step 2 Replaces newborn cohort with overall population

Initial Allocation = Per Capita Allocation x Total Population
(where per capita allocation = $5 per newborn if per capita income $365 and $2.5 if > $3 65)
Allocation is then reduced pro rata
Final Allocation = (Initial Allocation x Total newborn cohort)/Total population) (Y)

Step 3 : Incorporates graduated equity factor

50% of Initial Allocation (population based) = Y/2 (A)
50% of Initial Alloc ation (equity based) = Total Population x Equity Index
(where equity index = (1/per capita income) (B)
1 Note ? some of the data for population and per capita income may not be consistent ? this may require further attention.
Data is taken from World Bank Development indicators (but there are gaps which were filled from a number of sources)

GAVI Alliance Board Meeting, 30 November ? 1 December 2010 Doc #11c ?Performance
Based Financing - IRIS

FOR DECISION

GAVI Secretariat, 16 November 2010

1


This paper describes the design of the proposed new performance based funding
window ? Incentives for Routine Im muni sation Strengthening (IRIS) . IRIS is
designed as a follow on program me to GAVI?s Immunisation Services Support
window. IRIS aims to incr ease accountability for results and value for money , while
minimising to the extent possible the reporting and management burden imposed on
countries. The objectives of IRIS are to:

? Improve routine immunisation coverage, as measured by DTP3
? Increase equi ty in immunisation coverage

The key design featur es of this programme are as follows:

? In their proposals to GAVI for IRIS support, c ountries will present detailed plans
for how performance incentives will be cascaded to lower levels of the system in
orde r to accelerate improvements in coverage and equity.
? Countries can receive an annual fixed payment, as well as performance
payments for achieving gains in DTP3 coverage.
? Countries will be responsible for managing activities conducted with IRIS funds.

Based on a simulation involving 13 of the 14 countries that qualify for IRIS support 1
(i.e., with DPT 3 coverage less than 70 percent) , it is estimated that IRIS will co st
approximately US $ 68 million over the 2012 -2015 period and support the
immunisation of 5.4 to 7.6 million additional children . Under this simulation, n ine of
the 13 countries would surpass 70% DTP3 coverage and thus qualify for GAVI
support for new and underused vaccines .

With regard to IRIS, the PPC recommends the following decision be taken by the
GAVI Board :

?Taking into account the potential risks associated with IRIS, the Board decides to:
1. Move forward with implementation of IRIS by opening a new window of support for
countries with DTP3 coverage of less than 70%;
2. Close th e existing ISS window, subject however to fulfilling any existing
commitments to eligible countries for ISS support;
3. Use WHO/UNICEF estimates as the data source to measure country progress
against the coverage milestones;
4. Conduct additional explorato ry work to provide the appropriate support to India
and Nigeria.?


1 For the costing estimate, India was not included as f unding for India has been accounted for through
the funding cap.

GAVI Alliance Board Meeting, 30 November ? 1 Decem ber 2010 Doc #11 d ? Co -financing Policy Revision

FOR DECISION

GAVI Secretariat, 12 November 2010 1


GAVI?s Co -financing Policy: Proposed Revision

1. Background

1.1. As part of the decision to adopt a co -financing policy in 2008, t he Board
requested that GAVI?s co -financing policy be reviewed following 2 years of
implementation to a sses s early experience. While the current co -financing
policy has been successful in several r espects, with strong compliance and
positive reactions from countries, there are ar eas where it needs adaptation .
For example, t he existing four country co -fina ncing groups 1 are no longer well
aligned with country income categories . Most importantly, the current co -
1 Fragile, poorest, intermediate, least poor ( see Annex 2)
Having reviewed and discussed the recommendations from the task team reviewing
GAVI?s co -financing policy, the Programme and Policy Committee recommends the
following decision be taken b y the GAVI Board:

?The Board approves the revision of the co -financing policy as follows. Beginni ng
January 1, 2012:

? Country groups to be divided into Low income group (GNI per capita at or below
World Bank low income threshold); Intermediate group (GNI per capita between
the low income group and the GAVI eligibility threshold); and, Graduating group
(GNI per capita above GAVI eligibility threshold). Each country will be reviewed
annually to enable transition s from one group to another based on GNI per
capita.
? Low income group co -financing, to be set at a minimum of 20 cents (US$) per
dose for all vaccines, and with no mandatory annual increases.
? Intermediate group co -financing, to be set at the higher of 20 cents per dose
(US$) or the amount paid for th e specific vaccine in the previous year . This
amount to increase annually by 15% per dose.
? Graduating group co -financing :
o For vaccines adopted prior to entering the Graduating group to be set at
an amount calculated on the basis of a linear increase over a four year
period from the amount paid in the first year in the graduating group to
the projected weighted average price of the vaccine the year after GAVI
support ends.
o For vaccines adopted after entering the Graduating group to be set in
2012 at 20 perc ent of the projected average price of the vaccine in 2016,
and shall increase linearly until it reaches 100% of the projected average
price of the vaccine the year after GAVI support ends.
? Countries moving between these groups will be given a one year grac e period to
plan for the associated changes in co -financing levels.

GAVI Alliance Board Meeting, 30 November ? 1 December 2010 Doc # 11e ? AVI Progress Report

FOR INFORMATION

GAVI Secretariat, 16 November 2010 1

This paper provides an update on the Accelerated Vaccine Introduction
initiative (AVI). It is for information only. A more detailed progress report
was presented to the Programme and Policy Committee in September) and
can be provided to Board members upon request.

Accelerated Vaccine Introduction (AVI) Progress Report

Background
1. The aim of GAVI?s Accelerated Introduction Initiative ( AVI) is to drive the
sustainable introduction of rotavirus vaccine and pneumococcal conjugate
vaccine in GAVI -eligible countries. Initial targets for th e initiative, set in 2008,
were to launch rotavirus vaccines in 44 countries and pneumococcal
conjugate vaccines in 42 countries by 2015. The targets are now revised to
align with the GAVI Alliance strategy 2011- 2105.

2. The AVI is coordinated by an interagency team (?AVI management team?)
consist ing of representatives of WHO, UNICEF, AVI Technical Assistance
Consortium (AVI TAC
1

) and the GAVI Secretariat. It is led by the GAVI
Secretariat and the Bill & Melinda Gates Fou ndation participate as an
observer. The management team has established a number of dedicated
sub -teams for key work areas including: strategic vaccine supply, large
countries, cold chain and logistics, and ad- hoc pneumococcal vaccine
introduction.
3. The A VI management team provides detailed reports to the Programme and
Policy Committee in addition a half day briefing session is scheduled prior to
each PPC meeting and AVI is standing item on the PPC agenda.

Progress since June
4. Following the Executive Com mittee approval of paused applications in August
2010, there are now 19 countries approved for pneumo introduction and one
country approved for rota introduction. Introduction is being planned for
pneumo in 13 countries over the next 12 months, and, in tot al, in 19 countries
over the next 24 months. For rota, introduction is being planned for 1 country
over the next 12 months.
5. The AVI management team and sub- team members ha ve been involved in
the development of the GAVI Strategy and Business Plan , including
1 A consortium of PATH, Johns Hopkins University (JHU), US Centers for Disease Control and Prevention (CDC)
and others

GAVI Alliance Board Meeting, 30 November ? 1 Decem ber 2010 Doc #11f ? Country Programme
Updat e

FOR INFORMATION

GAVI Secretariat , 16 November 20 10

1

Country programme update 2009

This paper provides a country programme update based on performance for 2009
and highlights programmatic achievements and challenges.

The Board is requested to note:

1) Programmatic achievements and challenges .
2) Prioriti es for 2011.


Country programme update 2009

Executive Summary

This paper provides a country programme update based on performance for 2009 1
and highlights programmatic achievements and challenges. (Some 2010 data is
included in this report to address is sues raised by the Programme and P olicy
Committee in October 2010 ).

Countries have made progress in new vaccine introduction in 2009 :

? 19 countries introduced pentavalent, 2 countries introduced pneumococcus
and 2 countries introduced rotavirus.
? GAVI eli gible countries reached an average DTP3 (WHO/UNICEF estimates)
coverage of 73% in 2009 compared to a global average of 82%.
? 16 countries qualified for ISS rewards based on DTP3 performance in 2009,
compared to 32 countries in 2006.
? Overall 38 countries reported on progress of HSS funded activities in 2009. 24
countries were recommended for continuing support by the IRC while 6
countries provided insufficient information; 8 countries were not due to receive
any further funding.

In 2009 the number of cou ntries required to co -finance increased from 32 to 49.
44 count ries had paid by the end of 2009 . The remaining 5 countries completed full
payment by October 2010.






1 It is not possible to bring the Country Progr am Update to the board earlier than the November/ December Board meeting each year because the annual Country P rogress Reports are received from mid -May to August, based on the financial planning cycles of countries. In addition the WHO UNICEF DTP3 coverage estimates used to assess country performance are provided by August each year . The reports are subsequently analysed by the Independent Revi ew Monitoring Committee. It would be difficult to prepare a rigo rous consolidated by July each year.

GAVI Alliance Board Meeting, 30 November ? 1 December 2010 FINAL MINUTES

1




GAVI Alliance Board Meeting
30 November ? 1 December 2010
Kigali, Rwanda


FINAL MINUTES

1 Welcome , Executive Session, and Approval of Outstanding
Minutes
Finding a quorum of members present 1, the meeting commenced at 8.30 on 30
November 2010. Mary Robinson, Chair of the GAVI Alliance Board, chaired the
meeting. The meeting began in executive session to discuss the appointment of a
new Chair. Dagfinn H?ybr?ten , Unaffiliated Board Member, did not attend this
session. The Board then moved into general session at 9.51.

The Chair noted that it was a wonderful opportunity to have the meeting in Rwanda
during the Mother and Child Health Week in Rwanda. She noted the success of the
launch event which took place on 29 November 2010 at the R oweser Health Clinic in
the Northern Province of Rwanda to launch the nationwide campaign focusing on
helping communities to make more informed health decisions.

The Chair highlighted recent GAVI news, including IFFIm?s entry into the Australian
bond market with the successful launch of a Kangaroo bond , and the recent drop in
price of the pentavalent vaccine. She welcomed the new Board members and
alternates who were attend ing their first Board meeting, and invited Leone Gianturco,
the Governance Committee?s nominee as the Italy/Spain constituency alternate, to
sit at the Board table as the constituency?s representative until his formal
appointment . The Chair recognised thi s would be the final meeting for Anders Molin
and thanked him for his time and dedication.

The Board considered approval of outstanding minutes (Doc #1 in the board pack).

Resolution One
The GAVI Alliance Board resolved to:

? Approve the minutes of its meeting on 16 -17 June 2010 .



1 Board member partici pants are listed in Attachment A .

GAVI Alliance Audit and Finance Committee Meeting, 29 November 201 0 FINAL MINUTES

1


GAVI Alliance Audit and Finance Committee Meeting
29 November 2010
Kigali, Rwanda

FINAL MINUTES

Finding a quorum of members present 1, the meeting commenced at 16:45 Kigali time
on 29 November 2010. Wayne Berson chaired the meeting.

1 Review of Minutes
The Committee reviewed the minutes of the meeting of 25 October 2010 (Doc #1 in
the committee pack).

Decision One
The GAVI Alliance Audit and Finance Committee moved to:
Approve the Committee?s minutes from its meeting on 2 5 October 2010 .

2 GAVI Alliance Financial Forecast Update
Barry Greene, Managing Director, Finance & Operations tabled the financial forecast
update (Doc #2) to be discussed at the board meeting on 30 November . The
Secretariat reviewed three scenarios that projected how GAVI could meet its funding
requirements under each scenario. D iscussion followed:
? The Committee observed that numbers in some summary tables in the
forecast document may appear not to add correctly because of rounding (to
one - tenth of a billion) and asked the Secret ariat to consider ways to minimise
any misperception in that regard. It noted that the more detailed underlying
numbers (expressed in millions) were also provided in the document.

? It would be helpful that the Board understand the firmness of the sources of
funding that are described as ?Assured Funding.? The Chair informed the
Committee that he had performed this analysis with the Executive Committee
on 4 November.

? The Board must also understand that a significant step change of funding is
needed in the short -medium term. While the summary numbers describe
needs through 2015, GAVI will require assured funding in the next couple
years , as is indicated in the year -by -year tables . On the other hand , it is
expected that as countries graduate or step up co -financing, there could be
some decrease in needs in the longer term.

1 Attendees are listed in Attachment A

GAVI Alliance Governance Committee Meeting, 29 November 201 0 FINAL MINUTES

1

GAVI Alliance Governance Committee Meeting
29 November 2010
Kigali, Rwanda
FINAL MINUTES
Finding a quorum of members present 1, the meeting commenced at 17:00 Kigali time
on 29 November 2010. Mary Robinson chaired the meeting.
1 Nomination of the Board Chair
The Committee began the meeting in executive session to discuss the nomination of the
Board Chair. Subsequently, the Committee moved into general session at 17.30 where
it took up this issue. Dagfinn H?ybr?ten did not attend either the executive session or
the general session during discussion of this issue.
Decision One
The GAVI Alliance Governance Committee moved to :
? Nominate Dagfinn H?ybr?ten as Chair of the Board with individual signatory
authority as of 1 January 2011 until 31 December 2012.

2 Approval of Outstanding Minutes
The Committee considered the minutes of its meeting on 4 October 2010.
Decision Two
The GAVI Alliance Governance Committee moved to :
? Approve the minutes of its meeting on 4 October 2010.

3 Nominations of Board and Committee M embers
Debbie Adams , Managing Director, Law and Governance reminded the Committee that
its nominations of Wayne Berson, Dwight Bush, and George W. Wellde, Jr for
reappointment would be tabled to the Board the following day . In addition, WHO
submitted the candidacy of Flavia Bustero to serve as its Board member, r eplacing
Anarfi Asamoa -Baah . Also, following Sweden ?s decision to transfer relationship
management with GAVI from SIDA to the Ministry of Foreign Affairs , Sweden forwarded
Anders Nordstr?m as its constituency?s candidate to succeed Anders Molin . Next , t he
1 Attendees are listed in Attachment A

GAVI Alliance Investment Committee Meeting, 11 November 2010 FINAL MINUTES
1


GAVI Alliance Investm ent Committee Meeting
11 November 2010
New York, NY, USA

FINAL MINUTES

Finding a quorum of members present 1, the meeting commenced at 1 0.06 New York
time on 11 November 2010. George W. Wellde, Jr chaired the meetin g.

1 Record of Unanimous Consent
The Committee reviewed the record of unanimous consent from 15 September 2010
(Doc #1 in the committee pack).

Decision One
The GAVI Alliance Investment Committee moved to:
Approve the record of unanimous consent from 15 September 2010 (concerning
approval of the Committee?s minutes from its meeting s on 1 February and 26 July
2010) .

2 Franklin Templeton Presentation
Brian Zeiler and Vivek Ahuja delivered a presentation on its investment outlook in
developing markets, parti cularly in Asia. They also described some of their
investment vehicles. Discussion followed after Messieurs Zeiler and Ahuja were
excused from the meeting:
? GAVI?s recipient countries are concentrated in Africa and Asia. The
Committee felt that GAVI ough t to ensure its portfolio contained an adequate
investment in these market s given they are projected to have higher economic
grow th levels than developed markets . However , it should feel comfortable
with the risk profile of these markets , the amounts inve sted , and the
investment products themselves, ensuring they have the right risk oversight
strategies, are benchmarked against the appropriate indices, and are
sufficiently liquid.

3 Portfolio Review
Jeanne Shen, Senior Director of Investments provided an ov erview of the portfolio,
highlighting asset allocation, net returns, option -adjusted spreads, sector and quality
comparisons, and due diligence efforts (Doc #2). Discussion followed:
? The portfolio is GAVI?s second largest ?donor? in 2010 year -to -date. Given
this, the Board should understand the potential downsides to dipping
excessively into the portfolio?s principal.

1 Attendees are listed in Attachment A

This study looks at barriers to child immunisation, focusing specifically on gender related barriers that may lie behind some of the well documented constraints to immunisation coverage.