When Gavi’s board meets in Accra, Ghana, next week, advancing discussions on a new five-year strategic period, known as “Gavi 6.0,” will be a top agenda item. But conversations about Gavi’s future direction are also taking place against the backdrop of a leadership transition and a rapidly changing global landscape that is surfacing challenges for its existing model.
As part of an ongoing CGD project on Gavi’s future, together with our colleagues, we’ve compiled a series of analyses and recommendations for Gavi’s board to consider in its upcoming strategy discussions.
In an overarching piece, we examine disruptions on the horizon and propose recommendations across Gavi’s three primary levers for impact: vaccine introductions, immunization coverage, and country eligibility. In additional pieces, we dive deeper into one of the levers, exploring country eligibility and transition projections, and then zoom in on the trend of growing regionalism, assessing Gavi’s ongoing efforts to support African vaccine manufacturing.
Here’s a topline summary and snapshot of our proposed actions for Gavi’s board:
Adopt a new playbook to remain fit-for-purpose in a shifting global landscape
To maximize returns from its three primary levers for impact, Gavi needs to adopt a new playbook. Since its launch, Gavi has successfully introduced new and underused vaccines. Despite bright spots, it has been less successful however at driving equitable immunization coverage at-scale, particularly in some middle-income countries and in fragile and conflict-affected settings. And while Gavi’s income-based eligibility model has worked reasonably well to date, the prevailing macroeconomic context is creating challenges for its current approach.
To address disruptions on the horizon, Gavi needs a series of bold reforms. These include:
- incorporating “life course platform building” as an explicit objective for Gavi 6.0;
- replacing existing financing arrangements with an envelope financing approach that is driven by local priorities;
- recalibrating the global-regional balance in vaccine manufacturing and procurement;
- creating a mechanism across Gavi and other global health initiatives to assure integrated approaches to disease control that optimize value for money and simplify implementation for countries;
- establishing a stand-alone subsidiary that operates in fragile and conflict-affected settings with high-risk appetite;
- leveraging Gavi’s experience, including in market shaping, to accelerate innovations for immunization systems and primary health care more broadly; and
- revisiting its eligibility policy to better align with countries’ ability to pay and disease burdens.
Read the full paper here
Evolve Gavi’s eligibility, transition, and co-financing model for the post-COVID era
The prevailing macroeconomic context, marked by high levels of debt, is creating challenges for Gavi’s current approach. Specifically, using an income-based threshold as the primary criterion for eligibility is no longer fit-for-purpose.
We used updated economic growth data to map countries’ prospects for transition from Gavi between 2023 and 2040. Our projections based on two different inflation scenarios are roughly similar to pre-COVID estimates and suggest that about 10 countries could transition from Gavi support by 2040. But this upcoming cohort of transitioning countries will lose access to Gavi funding under particularly challenging fiscal conditions.
We also found that roughly 40 countries are likely to remain eligible for Gavi support through 2040, raising questions about whether donors’ long-term funding commitment is aligned with realistic expectations about economic growth trajectories. Further, nearly 50 percent of Gavi-eligible countries are classified as fragile and conflict-affected. Delivering in these settings will be increasingly important to achieving Gavi’s mission in the future.
To be responsive to country-specific challenges and adapt to the changing global landscape, Gavi needs to evolve its approach to eligibility, transition, and co-financing. Specifically, Gavi should:
- rethink criteria for eligibility and align on core principles to determine how best to evolve the overall approach;
- re-examine its approach to prioritization of resources and value for money;
- modify its operating model and modalities of engagement, especially in fragile and conflict-affected settings; and
- align and clarify approaches with other global health mechanisms.
Read the full paper here
Set up the proposed African Vaccine Manufacturing Accelerator for success
Amidst growing momentum to recalibrate the global-regional balance in manufacturing, the Gavi Secretariat is rapidly advancing plans for a proposed African Vaccine Manufacturing Accelerator (AVMA). This includes a financial mechanism, modeled as an advance market commitment, to help bring African-made vaccines to market.
But before this mechanism, and Gavi’s broader efforts under AVMA, get off the ground, there are several issues that need further consideration by Gavi’s leadership and board. Specifically, we call on Gavi to:
- Explicitly acknowledge—and accept—trade-offs between the proposed twin objectives to build a sustainable African vaccine base and ensure improved pandemic response capacity and supply resilience.
- Clearly define the enabling ecosystem required for AVMA’s success. When it comes to regulatory systems, for instance, Gavi should seek to address regulatory issues as part of the design of the proposed mechanism by supporting regulatory authorities through earlier milestone payments and considering alternate regulatory pathways.
- Right-size the timeframe in view of longer-term sustainability.
Gavi 6.0 is a key moment to advance bold reforms to ensure Gavi continues to remain fit-for-purpose in a rapidly changing global landscape. We hope Gavi’s board and leadership will seize this opportunity.
There are more analyses and policy ideas laid out in the links above—we hope you’ll dig in. And, as always, we’d welcome your feedback. Stay tuned for more work on Gavi over the coming months.
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.
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