Patrick Kuma-Aboagye on Shaping the Agenda of Gavi’s New CEO

What are the most pressing challenges facing Gavi as it embarks on its next strategic period, known as “Gavi 6.0”?

One of the key issues for Gavi is how to sustain the gains it has made so far, especially in maintaining coverage of existing vaccines and introducing new ones.

Another important challenge is how to achieve financial sustainability in the countries that are eligible for Gavi support. In the current post-COVID macroeconomic situation, a lot of the countries have had their resources depleted and face significant debt levels; it is becoming more difficult for countries to pay their share of immunization funding. As a result, countries are not progressing quickly through Gavi’s income-based transition model because of the economic downturn. Gavi must address the reality that economies in these lower-middle-income countries are quite unstable, and even less significant challenges can have a big effect on immunization. There really are no strategic reserves for shocks like the fuel crisis, Ukraine war, and the conflict in Gaza.

Finally, how do we sustain immunization coverage in fragile and conflict-affected states? Even when vaccines are available, deployment is a challenge. Wars and famine make it difficult to get vaccines to countries and deploy them effectively. There needs to be international consensus on ways to ensure essential services are still delivered in spite of whatever disaster has befallen a country.

What priority actions should be at the top of the new CEO’s agenda to ensure Gavi can deliver on its mission in Gavi 6.0 and beyond?

The most important action for Dr. Nishtar is advocacy. Advocacy is needed to ensure that development partners continue to replenish Gavi’s resource base, even as they deal with their own challenges. Broader advocacy is needed for countries like mine (Ghana) to see that health is an important investment to help ensure adequate financing is allocated to meet co-financing requirements.

Dr. Nishtar will also need to steer Gavi to further support inclusivity of Gavi-eligible countries, especially African countries. Gavi-eligible countries must be at the table in sub-regional bodies. Countries must also be involved on issues such as pricing for vaccines and incentives for local vaccine manufacturing to ensure sustainability. We saw a shortage of vaccines during the COVID-19 era, and countries that were not producing vaccines had difficulty obtaining them. Gavi should also support countries with advancing and streamlining regulation.

Finally, Dr. Nishtar should look to address some of the key areas in the Lusaka Agenda. The first priority highlighted in the agenda is supporting primary health care—the vehicle within which vaccines are deployed. Integrating immunization support with support for child health as well as primary health care and health systems strengthening will help safeguard immunization gains. Gavi should help facilitate an integrated system, while not going beyond its mandate.

The second focus of the agenda is health system strengthening, which Gavi already does, but can do more of because it is a very important vehicle to maintain gains even after countries graduate. A third focus in the agenda is R&D, which will be needed to ensure countries have access to technologies as well as the capabilities to produce some vaccines.

What does success look like for Gavi’s new CEO?

First and foremost, success for Dr. Nishtar means that more children are surviving and thriving. In addition, all—or a significant proportion—of Gavi-eligible countries should be able to meet their co-financing requirements.

Finally, success for Dr. Nishtar will be reflected in sustainable country transitions from Gavi support, underpinned by strong and resilient health systems and capabilities for local production. As an example, Ghana has been trying to graduate from Gavi support since 2017. But anytime its GNI goes down, Ghana is back at the start.