The prevailing fiscal outlook alongside broader shifts in the health landscape have important implications for countries’ eligibility for support from Gavi, the Vaccine Alliance. This analysis, based on recent economic growth data, explores countries’ transition and eligibility prospects between 2023 and 2040 and highlights two key takeaways. First, current projections are largely similar to pre-COVID estimates. However, the cohort of transitioning countries face more challenging fiscal conditions, with implications for governments’ abilities to sustain immunization financing and delivery. Second, roughly 40 countries are projected to remain eligible for Gavi support through 2040, raising questions about funding commitments beyond the Sustainable Development Goals era and the need for alternative pathways to sustainability.
In view of these trends, this paper offers four policy recommendations for Gavi’s leadership and board to consider during its next strategic period, known as “Gavi 6.0”: (1) rethink criteria for eligibility and align on core principles to determine how best to evolve the overall approach, which could entail incremental changes or substantive reform; (2) re-examine Gavi’s approach to prioritization of resources and value for money; (3) modify Gavi’s operating model and modalities of engagement, especially in fragile and conflict-affected settings; and (4) align and clarify approaches with other global health mechanisms.
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