Sarah Goulding on Shaping the Agenda of Gavi’s New CEO

Sarah Goulding
June 10, 2024
Janeen Madan Keller and Morgan Pincombe introduce this blog, which is part of CGD’s new virtual forum, “Shaping the Agenda of Gavi’s New CEO.” The forum features a series of expert perspectives, including the response below, and is part of CGD’s broader work on priorities and policy options for Gavi during its 2026–2030 strategic period.

Gavi’s new CEO, Dr. Sania Nishtar, took the helm earlier this year—at a critical time. Gavi is embarking on its new five-year strategy, known as “Gavi 6.0,” and preparing to launch its next replenishment campaign.

To help shape the new CEO’s agenda, CGD invited contributions from experts across governments, civil society organizations, global health initiatives, humanitarian organizations, industry, and academia. We asked these experts to weigh in on key challenges and opportunities for Dr. Nishtar’s leadership.

The response below is from Sarah Goulding, Assistant Secretary and Principal Specialist Gender Equality, Australian Department of Foreign Affairs and Trade; former Vice Chair, Board of Directors, Gavi, the Vaccine Alliance. This response has been edited for clarity and length.

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

I see two key challenges for Gavi that its new CEO will have to face. First, Dr. Nishtar, will need to support the initiative in delivering on the promise, ambition, and commitments of Gavi 5.0, particularly around the recovery of health systems from the pandemic. Gavi 6.0 will, in many ways, build from Gavi 5.0 and 5.1. Fine-tuning efforts and learning what works to make progress towards relevant objectives in this current strategic period, such as the revitalization of HPV vaccines, will ensure ambitions are robust and effective for the next one.

Second, Dr. Nishtar must lead the charge to adapt and reform Gavi’s approach to eligibility and transition. Gavi’s current GNI-focused model does not reflect contemporary realities. Gavi’s model has been powerful and successful, but additional factors should be considered for countries transitioning through Gavi’s model. For example, countries with low coverage rates for the third dose of the diphtheria-tetanus-pertussis vaccine (DTP3) or at severe risk of debt distress are likely not poised to transition successfully.

Third, several countries that are not eligible for Gavi support are critical for immunization and health outcomes. Countries in the Asia Pacific that have never been eligible for Gavi support, such as Vanuatu, face increasingly frequent natural disasters due to climate change, with devastating impacts on health systems. Further, the majority of zero-dose children are in middle-income countries that have transitioned from or have never been eligible for Gavi support.

A key part of modifying Gavi’s eligibility and transition model will be to sufficiently tailor its support to different countries or tiers of countries. Notably, Egypt and Tuvalu are treated similarly under Gavi’s current Middle-Income Countries Approach, despite important differences between these countries, including the particular constraints on small island states.

Gavi’s role in scaling innovation is a global good and can be offered at varying degrees to benefit an expanded set of countries. For example, Gavi can provide significant and deeply tailored support to implementing new technologies in lower-income economies while enabling higher-income countries to access the innovations with domestic resources.

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?

As the first priority action, Gavi’s new CEO needs to focus on the Secretariat. The pandemic and the boom of COVAX had a significant impact on Gavi’s standard operations. Gavi must now focus on rebuilding, reconsolidating, and investing in its team because its ability to successfully deliver on its ambitions is in their hands.

Second, Gavi’s new CEO needs to invest in the Alliance and position Gavi as a core part of the global health ecosystem. The pandemic drove many fundamental changes, including the creation of new architecture and the negotiation of the Pandemic Treaty. The Alliance must now ask, how can we be stronger together and buttress our efforts? How can initiatives—including Gavi, the Global Fund, and Unitaid—be more than the sum of their parts and avoid the competitive dynamic introduced by the replenishment model? The world needs these initiatives to deliver as a collective—not as a series of islands in a disconnected ocean.

Third, Gavi’s new CEO should focus on reinvigorating its relationship with countries. Gavi’s model, as well as metrics to measure effectiveness and impact, should be country-driven and country-defined. The current operational model is part of a broader stovepipe grant system in which countries often have multiple, distinct, and disconnected grants from Gavi to strengthen their immunization systems alongside separate health grants from other financing mechanisms, such as the Global Fund, the World Bank, UNICEF, or Unitaid. This siloed approach creates additional burdens for countries. Gavi’s CEO can play an important role in reforming these systems and developing a more streamlined and country-centered operational model.

I share a deep, ambitious vision for what Gavi can offer and an unabating excitement about the impact of the institution. However, ambitions will not be reached if we keep doing business as usual. Now is the moment to be bold.

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

I think success for Gavi’s new CEO looks like alignment and inclusion. First, Gavi’s board, staff, the Alliance, and countries must be aligned on the future direction and level of ambition. They must share a common agenda.

Second, Gavi must be inclusive. It is significant that Dr. Nishtar will be the first female leader in Gavi’s history. Her leadership can crack open the glass ceiling of inclusive leadership models at a time of significant gendered leadership challenges within the health care system.

As Gavi’s first leader from the Global South, Dr. Nishtar’s leadership can also bring legitimacy and authority to Gavi’s strategy and operations. The initiative will be led by someone who understands what it means to be a minister in a country that is navigating complex conditions and who understands what it takes to drive effective change.

This is not a turnaround job; this is about building on strong foundations and taking Gavi forward into the next generation of innovation and ambition, while staying grounded in contemporary realities.

I have great faith in what Gavi can deliver as an institution in the realm of global health. I have incredible excitement for the impact that the new CEO is going to achieve through the depths of her authority, leadership, and credibility.


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.