Introducing CGD’s Work on Gavi 6.0
2024 is a pivotal year for Gavi as it formulates its next strategy, known as “Gavi 6.0”, gears up for its upcoming replenishment, and welcomes a new CEO. These milestones provide the board and leadership with an opportunity to revisit Gavi’s approach and operating model to ensure continued impact in a shifting global landscape.

A New Playbook for a Changing World

Multiple disruptions in the broader global health and development landscape are putting pressure on Gavi’s ability to advance global immunization goals. Gavi needs a new playbook to remain fit for purpose in its next strategic period, 2026–2030, and beyond.

Five Areas for Reform

Below we highlight five areas for reform in Gavi 6.0, drawing on a new body of research by CGD colleagues that dives into specific disruptions on the horizon and proposes policy actions for Gavi’s leadership and board to consider.

The fiscal challenges of the post-COVID-19 era have exposed shortcomings in Gavi’s income-based eligibility model. With Gavi’s current approach, a cohort of 40 lower-income countries could remain eligible for Gavi support well beyond 2030—the end of the Sustainable Development Goals era.

Proposed action: Gavi should revise its approach to eligibility and transition to reflect these realities, guided first and foremost by alignment on the broader purpose of the model and clarity on core principles underpinning Gavi’s longer-term direction.

Read the analysis on countries’ eligibility and transition trajectories and a summary of implications for Gavi.

The global locus of under-vaccination is increasingly shifting towards middle-income countries (MICs), which do not qualify for traditional Gavi support. And coverage rates have eroded in some MICs that have transitioned from Gavi support. Still, Gavi’s support to MICs has been small-scale to date.

Proposed action: Gavi should operationalize broader engagement with MICs, building on its comparative advantage in market shaping. This support could include enabling an expanded cohort of countries to access more affordable vaccine prices and supporting a global coordinating hub to shape a forward-looking immunization innovation agenda.

Read the paper on expanding Gavi’s engagement with MICs and analysis on vaccine coverage rates in former Gavi-eligible MICs.

Gavi’s recently approved $1 billion African Vaccine Manufacturing Accelerator (AVMA) offers a pathway to support ongoing efforts to diversify manufacturing, alongside broader efforts to recalibrate the global-regional balance in procurement.

Proposed action: Gavi should explicitly acknowledge the trade-offs between investing in sustainable routine immunization manufacturing and resilient supplies for health emergencies; work closely with partners to create the enabling ecosystem including regulatory arrangements; and set realistic ambitions given the timeframe and budget envelope.

Read commentary on foundational questions and key considerations for AVMA, plus analysis on the role of regulation in advancing African vaccine manufacturing.

Current global health financing challenges alongside growing calls to shift the center of gravity for decision-making and prioritization underscore the need to test new approaches that put countries in the driver’s seat.

Proposed action: Gavi should pilot a new compact with select partner countries that prioritizes country-led financing of the most cost-effective vaccines, with external aid provided “at the margin.”

Read more on the New Compact approach.

Sustainable immunization programs—for both routine vaccination and outbreak response—require strong health systems. Yet, to date, the impact of Gavi’s investments in these areas has been mixed.

Proposed action: Gavi should leverage its role in scaling new technologies and market shaping to fill critical systems-level gaps to improve immunization—and health service—delivery. In addition, Gavi’s new First Response Fund should be complemented by a more comprehensive approach to financing pandemic preparedness and response.

Read the analysis on Gavi’s role in scaling innovations for immunization and health systems and Gavi’s role in the broader landscape of pandemic financing

Analysis and Commentary

  • Five Areas for Reform in Gavi 6.0
    Gavi is facing several important milestones in 2024: developing its next five-year strategy, known as “Gavi 6.0,” gearing up for i...
  • Opportunities for a New Compact between Gavi and Partner Countries
    This CGD Note outlines a proposal for a New Compact between Gavi and partner countries. We outline a package of policy shifts for ...
  • What Is Day Zero Financing? A Global Security Perspective for Pandemic Response
    This note presents the concept of Day Zero Financing, a proposed solution for how the world should respond to future pandemics. It...
  • Opportunities for Gavi to Enhance Vaccine Access in Middle-Income Countries
    The global locus of undervaccination is increasingly shifting from the poorest countries in the world—which are eligible for suppo...
  • After Graduation, How Do Gavi-Eligible Countries Fare?
    In global development and global health circles, the euphemism “graduation” refers to the “transition” to “sustainability,” anothe...
  • Opportunities for New Gavi CEO
    Today, Dr. Sania Nishtar assumes her role as Gavi's new CEO. A lot has changed—both within Gavi and in the external environment—si...
  • A Bigger Role for Gavi in Scaling Innovations
    For nearly 25 years, innovation has been core to Gavi’s success in accelerating vaccine introductions in lower-income countries. B...
  • The Road to “Gavi 6.0”: A New Strategy for a Changing World
    Join CGD for a virtual panel discussion, building on new research and analyses, to examine how Gavi can adopt a new playbook to ma...
  • A New Playbook for Gavi
    For nearly 25 years, Gavi has delivered impact and value for money and remained one of the most successful global health initiativ...
  • Vaccination Data Is Becoming Systematically Biased
    Child vaccination is one of the most powerful and cost-effective tools to save lives. But just how good is the data that we’re usi...
  • Projections of Eligibility and Transition Trajectories for Gavi’s Next Strategic Period and Beyond
    The prevailing fiscal outlook alongside broader shifts in the health landscape have important implications for countries’ eligibil...
  • What’s Next for Gavi’s Unspent COVAX Funds?
    Ann Danaiya Usher et al.
    In the aftermath of the COVID-19 pandemic, Gavi faces an unprecedented situation. Billions of dollars that it raised back in 2022 ...
  • The Role of Regulation in Advancing African Vaccine Manufacturing
    Regulation plays a vital role in ensuring the quality, safety, and efficacy of vaccines—and a strong regulatory system is key to s...
  • What Does the Future of Global Health Financing Look Like?
    Join us to discuss the future of global health financing within the broader global health architecture. The event will bring toget...
  • Accelerating Vaccine Manufacturing in Africa
    One of the most salient lessons from the pandemic is the need to diversify manufacturing capabilities and bolster supply resilienc...