A Bigger Role for Gavi in Scaling Innovations for Immunization and Health Systems

For nearly 25 years, innovation has been core to Gavi’s success in accelerating vaccine introductions in lower-income countries. Building on this track record, Gavi has a high-impact opportunity to sharpen its focus on scaling innovations for systems improvement in its next five-year strategic period, known as “Gavi 6.0.”

This blog dives deeper into one of the recommendations in our recent CGD paper and offers three ways Gavi can invest more strategically in systems innovation to address important needs at the country level.

Gavi’s track record in innovation

Some of Gavi’s most recognizable innovations have relied on pooling financing and aggregating demand across countries to shape markets for vaccines. Most notably, Gavi implemented the $1.5 billion Advance Market Commitment for Pneumococcal Vaccines from 2008 to 2020 by leveraging donor funding to “de-risk” decisions for vaccine manufacturers to develop a vaccine to prevent strains common in lower-income countries. Other examples include facilitating pricing agreements with manufacturers to help countries access price reductions for newer vaccines, including rotavirus, HPV, and pentavalent vaccine.

Gavi has also played a critical role in rolling out innovations beyond vaccines. Gavi, alongside other funders, has made smaller investments to prove the value to countries of digital solutions for health workers, electronic health records for patients, drone delivery systems, automated reminders for parents, real-time supply chain data, and more. In some cases, and as with all areas of research and development, innovations sometimes fail in the field. And others that are effective at the subnational scale then stall due to a lack of reliable financing needed to scale their impact. Gavi has helped fill this gap in the past—and it has a key role to play in incentivizing the scaling of innovation going forward.

An exemplar to build on

India’s experience of nationally scaling real-time monitoring of cold chain equipment and vaccine supplies is a key example of the role Gavi has played—and can play—in scaling innovations for immunization supply chains. In 2012, the Bill & Melinda Gates Foundation (BMGF)’s Grand Challenges Exploration program issued small grants to two start-ups: Nexleaf and Logistimo. Competitively awarded grants of $100,000 helped these social entrepreneurs develop their initial product offerings. When they hit early milestones, BMGF followed with full Grand Challenges grants of about $1 million to each (see here and here). This funding allowed for further pilot testing at reasonable scale in India. 

Encouraged by early results, the government of India sought to scale these innovations across the country. The Indian government requested that Gavi allocate $20 million of its health systems strengthening funding to the UN Development Programme to implement these innovations at roughly 25,000 cold chain points. By 2018, India had deployed these systems across the country and started to see substantial reductions in vaccine stock outs and generate cost-savings from reduced vaccine wastage. Through this effort, India has achieved a level and scale of real-time information availability on cold chain equipment and vaccine supplies that is far more advanced than many other countries, including the United States.

In this case, BMGF did the early high-risk funding to help the innovations get started; then, Gavi played the critical role of scaling these innovations nationally once proven at smaller scale. This exemplar could illustrate the roles that different entities can play in scaling innovations for immunization systems.

Three recommendations for Gavi’s next strategic period

Addressing system barriers to immunization coverage will be critical to Gavi’s ability to deliver impact. Below we offer three recommendations to expand Gavi’s support to countries in scaling promising innovations that improve immunization and health systems and enhance immunization coverage.

1. Finance country-driven requests. In India, Gavi responded to expressed demand from the government, who identified both the system constraint to be addressed and the partners to work with. This approach put the onus on the innovators to focus on the government’s stated priorities—and built bottom-up demand for the innovation along the way.

Working in this way “de-risks” the financing for Gavi because demand comes directly from the country rather than an expert-based guess on the part of innovators with solutions in search of problems. This tailored approach, in contrast with a one-size-fits-all process, will require operational flexibility. But it is more likely to ultimately lead to sustainable use of the innovation and greater country ownership.

2. Create a financing envelope for systems innovations. Just as it does with new vaccines via its Vaccine Investment Strategy process, Gavi should allocate a set amount of financing to scaling systems innovations. This approach would send an important signal to both innovators and partner countries about Gavi’s role in enabling the move from pilot to scale on impactful innovations. As with vaccines, Gavi could set a few minimum thresholds for entering the marketplace to assure a baseline of proven effectiveness for each innovation, but not so many that it entirely removes risk-taking and unduly delays uptake.

Gavi’s board will need to decide how to finance this envelope—and when to “go it alone” versus “go together” with other financing partners. In many countries, the volume of Gavi financing for health systems strengthening is small relative to the size and scale of the gaps. In these cases, a better use of systems funds may be to focus on fully scaling a few impactful innovations at the national level rather than making small, incremental investments in the health system more broadly. At the same time, there may be areas such as supply chains, where pooling resources at a country level with other funders like the Global Fund could have the most impact.

3. Focus on financing to scale proven innovations. Gavi is best positioned to finance the scaling of proven systems innovations. Rather than making smaller investments to pilot innovations, Gavi can increase its impact on immunization systems by focusing on scaling proven innovations that align with countries’ priorities. In venture capital terms, systems innovations could be more reliably developed and scaled in an ecosystem where Gavi focuses on financing at scale (i.e., series E funding) and others provide the at risk early funding (i.e., seed and series A/B funders).

Emphasizing innovation in Gavi 6.0

Gavi has a prime opportunity to leverage its comparative advantage in market shaping and respond to country priorities by scaling critical innovations for immunization and health systems during the upcoming strategic period. Gavi’s most impactful path forward should start with dedicating resources to scaling proven innovations that are expressly demanded by countries themselves. 


CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions.