Rafael Vilasanjuan 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”?

Gavi has changed a lot since COVID, so now is a good time to reflect on what the Alliance should prioritize going forward.

First, there are several issues that need to be tackled before Gavi can consider expanding its mission to focus beyond children under five. For example, it needs to take a careful look at how countries transition given challenges with the existing model. Gavi also needs to think carefully about how it prepares countries to transition. Specifically, it needs to develop an advocacy plan for how it can work with other partners to increase political will and push governments to fulfill their commitments to support successful transitions to full self-financing for immunization.

The second challenge lies in delivering immunization in fragile settings, which is very important from a civil society organization (CSO) perspective. There are ongoing efforts to contract directly with some CSOs, but there needs to be further consideration on what it really means to work in humanitarian contexts and what main barriers remain. This should involve close consultations with the biggest humanitarian actors, including UN agencies like UNHCR, but also non-UN organizations, such as the International Federation of the Red Cross and Médecins Sans Frontières. 

Gavi’s model of working through governments and with Alliance partners such as UNICEF and the World Health Organization is functioning very well in many places. However, to reach the unreachable, including zero-dose children in fragile areas, it needs to implement a system for supporting local CSOs. To achieve this, Gavi must develop a good understanding of what is needed, beyond the existing model, to work effectively in these contexts, which should include the role that CSOs can fulfill. Secondly, CSOs should be well mapped, with information on who is ready to respond and how they can reach communities in these fragile contexts. Coordination and engagement may be needed at the country level to achieve this objective.

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?

My advice is for Gavi to go for the low-hanging fruit—the things that are not fully working. The first thing is to make sure that we send Dr. Nishtar a clear message of what has been working well—and then focus on what isn’t working so well. For example, there has been significant backsliding on routine immunization during COVID, and there needs to be a focus on recovery. In certain cases, a boost of resources can help recoup lost ground—but part of the issue is that Gavi’s existing model must be modified so that routine immunization is achieved in all countries within its portfolio.

The second priority action should be modifying Gavi’s income-based approach to eligibility and transition. Specifically, Gavi should consider more public health related indicators to ensure the approach is based on the longer-term objective of building capacities and systems in countries to enable them to take full responsibility of their immunization programs, beyond just financing.

As part of these efforts, Gavi should put in place a direct dialogue with CSOs at the local and subnational levels. This has been achieved to some extent at the global level to help mobilize resources, but has not yet been fully actioned to engage partners at the local level—including to support vaccine delivery.

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

Success will require making the changes needed to fully implement Gavi’s strategic objectives. Some indicators for success could be how many additional children have received vaccinations, implementing clear strategies for reaching zero-dose children and unreached communities, and identifying new and different partners to deliver immunization in fragile and conflict-affected settings.

Given the current reality of scarce resources and fiscal stress, another indicator of success would be greater collaboration with other global health initiatives. There is a lot of talk about coordination, and there seems to be political will, but best approaches have not been implemented in practice. The more that global health initiatives can demonstrate that they understand that resources are limited and that they will be working together to deliver on joined-up strategies, the more Dr. Nishtar will be able to demonstrate successful leadership.