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Immunization is one of the best ways to improve health in developing countries. While the importance of vaccines is increasingly well-understood, significant challenges inhibit increases in basic immunization coverage, introduction of underused vaccines and development of new vaccines. Five innovative policy measures are being implemented to address these challenges: performance-based grants, a global vaccine purchasing fund, the new International Finance Facility for Immunization (IFFIm), public-private product development partnerships (PDPs) for development of new products, and advance market commitments (AMCs) to create incentives to develop and manufacture new vaccines. These policies have evolved separately, but together constitute a broadly consistent package of measures benefiting from the institutional umbrella of the Global Alliance for Vaccines and Immunization. In this new CGD brief, Owen Barder examines the underlying problems and assesses the policy response. He suggests that the approaches adopted for vaccines may usefully be extended to other areas of development assistance.