Third GAVI Board Meeting
Oslo, 13-14 June 2000
- Country proposal update and review process
- Polio Eradication and GAVI
- Financing Issues
- Vaccine Procurement Strategy
- Sustainable Financing
- Incentives for R&D commitment from industry "pull" mechanisms
- Research and Development
- Global Fund Administration and Procedures
- Fund Update
- The Vaccine Fund and the UNICEF Working Capital Account
- GAVI Structure and Management
- Board Composition
- Operations of the GAVI Secretariat
- Other matters
The Norwegian Minister of International Development, Anne Kristin Sydnes, welcomed the GAVI Board to Norway, emphasizing the importance that the Norwegian government attaches to GAVI because of the promise that it holds as an innovation in international development. She encouraged all participants to take active part in the Symposium to be held in the afternoon, at which Prime Minister Jens Stoltenberg would make the welcoming address (See Annex 1 Word document approx. 40kb) for annotated agenda, the Chairs summary, and Stoltenbergs speech).
Dr Brundtland introduced the topics for discussion over the two-day meeting (see Agenda ), and grouped them into three themes:
- Making a difference on the ground, quickly (country proposals, vaccine procurement, management relating to Global Fund);
- Strengthening and expanding the GAVI partnership (polio eradication, basic principles for GAVI structures, Partners meeting);
- Looking to the future (sustainable financing, research and development).
2. Country proposal update and review process
The Board approved review timeframes and process (see Annex 2 Word document approx. 27kb), recognizing the importance of responding to countries needs and situations. The Board:
- adopted measures to avoid conflicts of interest, acknowledging the necessity of including representatives of eligible countries on independent review committee;
- recommended that GAVI explore participation in the committee of representatives from Eastern and Central Europe;
- commended efforts to date to explore special arrangements to address the needs of the largest countries, and emphasized the need to secure more resources to "immunize every child";
- endorsed the need to rapidly expand the number of trained staff at country level (with immunization as well as health systems related skills), that would be funded by partner support through the lead agencies (WHO, UNICEF).
As the operations of GAVI move to on-the-ground efforts, the Board advised the Advocacy Task Force to focus on developing country activities.
3. Polio Eradication and GAVI
Considering the links between the GAVI and the polio eradication goals and objectives (see Annex 3 Word document approx. 24kb), the Board:
- requested that the GAVI Working Group and the core polio eradication group work closely together to develop practical and concrete strategies for strengthening the collaboration on a country-by-country basis.
- acknowledged that in two to three years time, as human and capital requirements for the polio eradication effort decline, partners must take on the leadership and advocacy challenge to redirect the newly-freed financial and human resources to address the GAVI objectives.
4. Financing Issues
4a) Vaccine Procurement Strategy
The vaccine procurement strategy has been designed by UNICEF to capture the best, and most current technologies that will facilitate access and increase safety, with a specific focus on the needs of the poorest countries (see Annex 4.1a Word document approx. 30kb). In this context, the Board:
- strongly endorsed the delivery of vaccine combinations;
- adopted the proposed innovative procurement strategy that engages the commitment of industry to the global goals of GAVI and provides a reliable and predictable procurement process. Increased attention is given to the needs of industry for longer-term planning, based on a competitive request-for-proposal approach;
- endorsed the proposed timeframe for procurement, including the target of product acquisition by end of November 2000 appreciating the time constraints;
- expressed its gratitude to vaccine producers for donating vaccines to GAVI and adopted a vaccine donation policy (see Annex 4.1b Word document approx. 30kb);
- discussed policy challenges related to tiered pricing in the developed countries, especially the United States;
- recognized that UNICEF is responsible for the implementation of vaccines procurement financed through the Vaccine Fund;
- recommended that the GAVI Financing Task Force continue to support the procurement policy development by:
- developing guidance for countries to use in selecting vaccines and vaccine presentation (WHO lead);
- improving process for demand forecasting including planning for new vaccine presentations;
- determining the potential impacts of limited capacity technologies such as lyophilization.
4b) Sustainable Financing
Board members from developing countries emphasized the importance of building national commitment from year one of Fund disbursements (see Annex 4.2 (Word document approx. 27kb) ). Recognizing the difficulty of ensuring and measuring national commitment, the Board:
- emphasized the central role of national governments and endorsed the concept of engaging the Ministry of Finance in the development of long-term plans for financial sustainability of immunization programs, recognizing that the World Bank has a primary responsibility to secure appropriate links with Ministers of Finance.
- endorsed the proposal to extend Fund resources beyond five years by a phased transition of support. This would provide greater incentives for countries to obtain support for immunization from other sources, including national governments, bank loans and bilateral funding.
Following the discussions of the donors to the International Development Association (IDA), the World Bank has committed to initially make $1 billion in IDA resources available for communicable disease control programs, and has announced its intention to move well beyond that level in the future as national and regional programs are developed. IDA financial and technical resources are a critical complement to the resources of other GAVI partners and the Vaccine Fund to build national commitment, immunization capacity and ensure sustainable financing and access to immunization with current and future vaccines.
The World Bank is committed to better design of projects to meet the needs of the social sectors, including immunization. This requires harmonization of activities at country levels including common approaches to assessment and outcomes measures.
The GAVI Board strongly endorsed the World Bank initiative to expand its support for communicable diseases through immunization and other cost-effective strategies.
WHO committed to promote the use of IDA loans for health at the country level, and to work to elaborate on the cost and benefit terms of using loans, as opposed to grants, for immunization services.
4c) Incentives for R&D commitment from industry "pull" mechanisms
The GAVI alliance has already adopted two key strategies to encourage increased commitment to vaccine research and development in industry, or "pull" mechanisms: the mobilization of partners and the Vaccine Fund to strengthen immunization services in low-income countries, and the purchase and introduction of available under-used vaccines.
The Board requested that the Financing Task Force research and report back to the Board about the specific actions that the Board can take to create further incentives in the form of "pull" mechanisms (see Annex 4.3 Word document approx. 31kb). Working with the Task Force on R&D where needed, the Financing Task Force was asked to identify:
- specific constraints of a few priority vaccine projects which can be overcome through Board actions;
- actions to promote the World Banks communicable disease initiative with access to an initial $1 billion of IDA resources;
- pros and cons of the R&D window of the Vaccine Fund being used as an additional pull mechanism;
In addition, the Board requested that the World Bank explore how IDA might provide a "pull" mechanism for the purchase of future products such as AIDS, malaria and TB vaccines.
5. Research and Development
The Board gave its strong endorsement for the need of a GAVI Task Force on Research and Development and voiced its support for the work that has been done to date by the pre-task force (see Annex 5 Word document approx. 29kb) . This task force will adopt a strategic approach in its advice to the Board, with activities to be implemented through existing partners.The task force will have three co-chairs, representing academia, industry and WHO. The selection of other task force members will be decided by the co-chairs with the Executive Secretary. In order to secure coordination, the members should be drawn from existing committees and panels in the R&D field and include experts with broad expertise of the vaccine field. In order to be effective, the task force should be limited to a small number of members.
After members are selected, terms of reference including specific goals and specific areas of focus will be developed by the task force, in close consultation with scientific community, for endorsement by the Board at the November meeting.
The Board requested a strong role for WHO in the task force. WHO will ensure that the activity of the task force will not overlap with that of the WHO Strategic Advisory Group of Experts (SAGE).
The Board recognized that the specific mentions of the need for vaccines against HIV/AIDS, malaria and tuberculosis in the GAVI strategic objectives are cited examples of vaccines that are needed in developing countries. The Research and Development task force will also consider other disease areas and new technologies that would improve safety and performance.
6. Global Fund Administration and Procedures
6a) Fund Update
In his speech at the Symposium, Norway Prime Minister Jens Stoltenberg announced a pledge from Norway to provide 1 billion kroner over five years to GAVI (approximately US$25 million per year), as part of the governments strategy to promote stronger health systems in low-income countries.
The United Kingdom announced that it would be purchasing 250,000 shares in the Vaccine Fund this year to vaccinate 250,000 additional children, at a value of £3 million (approximately US$5 million). The Department for International Development (DFID) will be reviewing its budget with the possibility of providing additional resources to GAVI in the future.
In the initial stage of the Vaccine Fund support process, countries which have relatively strong immunization systems and the infrastructure to absorb new funding will inevitably be best positioned to fulfill the requirements for Fund support to reach unimmunized children and introduce new and under-used vaccines. It will be important for GAVI partners to actively address the needs of countries with weaker systems, including the poorest countries and countries experiencing political and social unrest, in order to ensure that all children have access to full immunization services.
The first two rounds of proposal reviews in 2000 will provide the critical experience necessary to determine the most effective means of reaching all eligible countries. The Task Force on Country Coordination will provide appropriate background information the Board at its next meeting, including an analysis of the situation in the 27 countries that have not yet indicated when they will be submitting proposals to GAVI. Specific strategies to reach out to countries with special requirements will be considered at the November Board meeting.
6b) The Vaccine Fund and the UNICEF Working Capital Account
The funding needed by UNICEF to manage the increased workload related to the management of the resources from the Vaccine Fund, which represents a nearly 25% increase in the funds normally managed by UNICEF, is slightly less than US$2 million per year (see Annex 6 Word document approx. 85kb). The UNICEF budget proposal was approved by the Board, provided that it undergo due diligence through the GAVI Secretariat. Results of the due diligence will be forwarded to UNICEF, the GAVI Board and the Vaccine Fund Board.
The Board requested a transparent outline of the Vaccine Fund, its board, management and decision-making process, no later than August. The GAVI Working Group will provide the Board with this outline, including the relationship between the Vaccine Fund and the Working Capital Account (term may change) at UNICEF. A teleconference will be scheduled to discuss the proposal with the Board.
7. GAVI Structure and Management
7a) Board Composition
The Board decided to increase the number of Board members from 13 to 16 (15 + Chair) as follows:
- The Bill & Melinda Gates Foundation
- The World Bank
- OECD country governments (3) Currently representatives of Canada and the Netherlands; one seat vacant
- Developing country governments (2) Currently representatives of Bhutan and Zimbabwe, serving in their personal capacities
- OECD country industry Currently Aventis Pasteur
- Foundations Currently Rockefeller Foundation
- Research and Development Currently US National Institutes of Health
- Nongovernmental Organizations Currently PATH/CVP
- Technical Health Institute Currently vacant
- Developing country industry Currently vacant
In addition, the Board decided:
- to terminate the policy of alternates serving on the Board, i.e., if a Board member cannot attend the seat will be vacant;
- to institute a liberal policy for attendance by observers;
- enhance communication about Board proceedings.
7b) Guiding Principles
The Board adopted the Guiding Principles outlining the roles and responsibilities of the different entities of the Alliance (see Annex 7.1 Word document approx. 30kb). It is likely that a slight revision to accommodate decisions made in the future about the relationship between the Vaccine Fund and the Working Capital Account at UNICEF will be necessary.
The Board commended contributions made by regional staff to the GAVI process, including country support, and endorsed informal formations of regional partner groups to address specific concerns, such as the one developed in Africa (see Annex 7.2 Word document approx. 25kb).
7c) Operations of the GAVI Secretariat
The Board endorsed the document outlining the Operations of the GAVI Secretariat (see Annex 7.3 Word document approx. 32kb), and suggested that it could be signed by the Chair of the GAVI Board and the Executive Director of the Host Organization (UNICEF).
8. Other matters
The next Board meeting is 19th November in the Netherlands. The Board adopted a preliminary agenda for the Partners meeting on 20-21 November following the Board meeting. The Spring 2001 Board meeting will be held 20-21 June.
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