Questions & Answers about GAVI and the GAVI Fund

(Updated 2008)

1. What is the GAVI Alliance?

The GAVI Alliance is a public-private partnership created in 2000 to save children's lives and protect people's health by increasing access to immunisation in poor countries. Its partners include national governments, UNICEF, WHO, the World Bank, the Bill & Melinda Gates Foundation, the vaccine industry, research and technical health institutions, and civil society organisations (CSOs). The Alliance enables the partners to agree goals, share strategies, and coordinate efforts.

The GAVI Alliance is supported by the GAVI Secretariat in Geneva and Washington, DC, by four affiliated charitable entities: The GAVI Fund (the financing arm of the Alliance: tasks include asset management and investment, financial control, auditing and accounting), IFFIm (the International Finance Facility for Immunisation Company – a multilateral development institution designed to accelerate the availability of funds), The GAVI Fund Affiliate (assigns donor pledges to IFFIm for eventual GAVI programme disbursement), and the GAVI Foundation (provides certain contracting and administrative services to the GAVI Alliance Secretariat in Geneva). The GAVI Secretariat and GAVI Fund operate under the single leadership of the Executive Secretary and CEO. Each of the affiliated entities plays a specific and unique role to help support Alliance programmes and has its own Board.

2. Why was the GAVI Alliance created?

In spite of the significant efforts of individual organisations, at the end of the 1990s approximately 34 million children were born annually in countries and regions with no immunisation programmes or inadequate ones. In sub-Saharan Africa fewer than 50% of all children were being immunised. Three million lives were being lost each year to preventable infectious diseases.

The scale of the global challenge required concerted action. GAVI partners saw the need and an historic opportunity to pool their skills and resources to extend the coverage and effectiveness of global immunisation programmes, especially in the poorest nations.

The GAVI partners committed themselves to jointly accelerating access to existing vaccines, such as protection against hepatitis B and Haemophilus influenzae type b, and to new vaccines at late stages of development, such as protection against certain forms of pneumonia, meningitis and diarrhoea. They also committed to work jointly to strengthen health service delivery systems to help ensure the effectiveness of immunisation programmes.

3. Who funds the GAVI Alliance?

The GAVI Fund obtains public financing commitments from governments and the European Commission, and from the private sector, adding to its start-up grant from the Bill & Melinda Gates Foundation.

4. Why not just put more resources into UNICEF, WHO, NGOs, and other institutions already involved in immunisation work?

The GAVI Alliance model is designed to aggregate resources to create results beyond the capability of any single agency. It is also designed to make a rapid positive impact, using independent financial and administrative structures to ensure efficient transfer of support from donors to countries. GAVI provides support directly to country governments, not through other agencies. In addition, the inclusive nature of the Alliance encourages vaccine manufacturers to take a positive view of developing country markets and add relevant, affordable products to their portfolios.

5. How does GAVI differ from previous global immunisation programmes?

The GAVI Alliance differs in a number of ways:

  • It is an alliance of existing public and private sector interests with a specific focus, rather than an additional organisation that might be competitive or duplicative.
  • Each partner is committed to common goals and contributes specialist skills and resources to meeting them – fundraising, product development, health policy, field support, and so on.
  • Vaccine manufacturers are full partners, enabling joint planning between the public and private sector on a scale never before attempted.
  • GAVI attracts new and additional financial support for immunisation programmes.
  • Implementing countries are partners in and represented on the Board of the GAVI Alliance, enabling support that is linked to agreed performance targets.

6. What are the roles of the GAVI Alliance partners?

The role that partners play may vary according to specific country needs.

Developing country governments: identify immunisation needs; ensure that national health sectors develop effective, sustainable plans and programmes to extend the reach and quality of services.

Industrialised country governments: ensure that developing country health programmes – immunisation, in particular – receive an adequate proportion of Official Development Assistance (ODA) and that this is channelled through the sector coordination mechanisms.

Research and Technical Health Institutes: represent the knowledge and experience of the research community to the GAVI Board; keep the research community apprised of relevant policy directions being assumed by GAVI partners; provide technical staff for operations and help build capacity for research and development.

Vaccine industry: the International Federation of Pharmaceutical Manufacturers Associations (IFPMA) and the Developing Country Vaccine Manufacturers Network (DCVMN) help ensure development of and market access to advanced, high-quality vaccine products for poor countries; provide technical support from industry perspective.

Civil Society Organisations (CSOs): draw on extensive field experience to provide technical and advocacy support to national government programmes.

The Bill & Melinda Gates Foundation: promotes the benefits of immunisation and contributes substantially to the funding of programmes.

WHO: develops global policies and strategies for immunisation and vaccine development; provides technical health support.

UNICEF: sources and procures vaccines; acts as cause advocate and helps raise awareness and mobilise support for child immunisation within international, regional and national communities.

The World Bank Group: manages IFFIm donor account; helps implementing governments develop sustainable financing for immunisation services through lending and debt relief.

7. How is the GAVI Alliance organised? The GAVI Alliance Board defines policy for the Alliance and monitors all programme areas. It is composed of high-level partner representatives with four renewable members - WHO, UNICEF, World Bank and Bill & Melinda Gates Foundation – and 13 rotating members representing the interests of other Alliance partners. View current GAVI Board membership.

The GAVI Alliance Board

The Board is currently chaired by Mary Robinson, former president of Ireland and UN High Commissioner for Human Rights. It meets twice a year and holds periodic teleconferences to review progress and policies.

The GAVI Alliance Executive Committee, established in July 2003, is responsible for the supervision and implementation of GAVI activities. It includes four renewable members of the Board (WHO, UNICEF, World Bank and Bill & Melinda Gates Foundation); developing and industrialised country governments each have one representative rotating member; and the respective vaccine industries of the industrialised and the developing countries each have one rotating member. See Committees & Advisory Groups for members.

The Independent Review Committee (IRC) provides objective advice to the GAVI Alliance Board on country proposals and progress. The IRC is divided into two subgroups: the first of which reviews new applications for support, and the second of which monitors country yearly achievements. Members are selected for their broad expertise in health, specific knowledge of vaccines and immunisation and come from as wide a geographic spread as possible. See Committees & Advisory Groups for members and further details on two subgroups.

GAVI Working Group – technical experts from partner institutions – is responsible for implementing the GAVI Board’s decisions. It is chaired by the Executive Secretary and prepares policy recommendations for Board consideration, ensuring close coordination of partner activity. The Working Group currently includes 13 members. See Committees & Advisory Groups for members.

GAVI Time-Limited Task Teams are formed by the partners to address specific issues or tasks. Current groups include the ADIP Management Committee, the Civil Society Task Team, the GAVI Fund Executive Committee, the Audit and Finance Committee, the Investment Committee and the Development Committee. Former task teams have included the Financing Task Force (now replaced by a standing Immunisation Financing Think-Tank); the Joint IFFIm Group, the Supply Task Team and the Roles and Responsibilities Task Team. See Committees & Advisory Groups for further details.

Regional Working Groups: The Alliance relies upon regional working groups as focal points for programme coordination, consensus building, and advocacy at the regional and sub-regional level, and as a bridge for information flow between country and global levels. Regional working groups do not serve implementing functions; rather they help to coordinate implementation activities of partners. See Committees & Advisory Groups for further details and contact information.

The GAVI Secretariat is responsible for the day-to-day operations of the Alliance. This includes coordinating partner involvement, mobilising resources to fund programmes, programme approvals and disbursements, legal and financial management, and administration for the governing Boards. Offices are located in Geneva, Switzerland and Washington, DC, USA. The Executive Secretary reports to the GAVI Alliance Board and the Secretariat's budget is financed by GAVI Board members.

8. What is the GAVI Fund and how is it related to the GAVI Alliance?

The GAVI Fund is a member of the GAVI Alliance. It is an in-house financial facility that helps GAVI achieve its fundraising and disbursement objectives. It helps ensure that financial administration costs are kept low – approximately 89% of all funds raised go to support country programmes.

9. What kinds of support does GAVI provide?

GAVI provides time-limited funding (usually over five years) for the supply of vaccines and other forms of support to strengthen implementing country health systems and immunisation services. GAVI resources are also being used to investigate accelerating the development and introduction of vaccines against two diseases, rotavirus and pneumococcus, which are responsible for significant mortality in developing countries.

10. Who is eligible for GAVI support?

National governments in the world’s poorest countries (GNI in 2003 below US$1000) can apply for support. Currently this is 72 countries.

11. What is GAVI’s approach to strengthening immunisation services?

GAVI provides financial support to improve immunisation programmes based on funding applications submitted by individual countries. These reflect national priorities and are jointly developed by governments and national partners who together form an Inter-agency Coordinating Committee (ICC). ICCs are closely involved in programme implementation and in monitoring progress. Continuing support is based on meeting agreed performance goals. This country-driven GAVI model is notably different from traditional funding systems that mandate how resources must be used.

12. How much support do countries get ?

The amount of GAVI support depends on a country’s immunisation goals and population size. For example, up to US$14 million a year is allocated to a large country like Kenya to support the introduction of hepatitis B and Hib vaccines. Azerbaijan, a smaller country that already has good basic coverage, will receive up to US$200,000 a year to introduce hepatitis B.

13. What proportion of GAVI funding buys vaccines and how much goes on health services support?

GAVI allocations are based on proposals received from countries.

14. How does GAVI make funding decisions?

Funding decisions are made based on proposals received from countries. These are reviewed by an Independent Review Committee (IRC) which meets at the GAVI Secretariat in Geneva. IRC members are not connected with GAVI and are selected (primarily from low and middle income countries) for their expertise in public health and specific knowledge of vaccines and immunisation. They review proposals in accordance with the policies laid down by the GAVI Alliance Board.

The general criteria for funding are:

1. Well functioning Inter-agency Coordination Committee (ICC) or National Health Sector Coordination Body for health system strengthening (HSS)
2. Application submitted by Ministry of Health and endorsed by Ministry of Finance and the relevant national coordination body
3. Evidence that the proposed support from GAVI is synchronised with national planning and budgeting processes
4. A comprehensive Multi-Year Plan (cMYP) for immunisation is in place, synchronised with the Health Sector Strategic Plan, including:

  • Situation analysis of the immunisation programme
  • Rigorous analyses of the current and future costing and financing
  • Plan to reduce vaccine wastage and drop-out rates and a strategy for improving immunisation safety
5. A satisfactory report on the utilisation of GAVI support in the annual progress report (for funding continuation)

The IRC provides its recommendations to the GAVI Alliance Board. The Alliance Board then requests the Board of GAVI Fund to provide the finance to support approved proposals.

15. How does GAVI ensure that immunisation programmes are sustainable?

GAVI introduced the principal of co-financing in 2007 to help ensure the sustainability of country programmes that support the introduction of new vaccines. Countries are requested to contribute a set amount for the first new vaccine, according to their funding capability classification. For each subsequent new vaccine, the co-financed amount increases by US$ 15 cents per dose. These are minimum levels. Least poor countries are expected to scale up co-financing by 15% annually. Other countries can maintain current levels until 2010 after which they will increase gradually.

16. How does GAVI ensure injection safety?

GAVI supports the use of safe injection equipment, including its disposal, by bundling the supply of new and underused vaccines with auto-disable syringes and safety boxes.

GAVI provides additional support to countries that establish national plans to improve injection safety and waste disposal in the form of auto-disable syringes and safety boxes according to the standard EPI schedule (2-4-6 month spacings vs. an accelerated schedule of 2-3-4 months), or the equivalent cash grant for those that wish to procure their own supplies. This support is available to all countries for a maximum of three years and has been granted in 69 cases by mid-2007.

17. What is the status of R&D (Research & Development) projects under GAVI?

GAVI seeks to identify gaps in vaccine product availability and stimulate development of products to fill them. For example, the GAVI Task Force on Research and Development (R&D TF) undertook a wide consultation process in 2001 that identified three vaccines – pneumococcal, rotavirus and meningitis A/C conjugate – that should receive high priority. At that time the likelihood of their availability in the near future and the potential benefits of reducing morbidity and mortality in developing countries were both high.

18. If a country fails to meet performance targets, does GAVI reduce or end funding?

GAVI establishes an overall grant to support country programmes through the first two-year investment phase and releases this in three portions – immediately after programme approval, and following the receipt of satisfactory progress reports for the first and second years. This funding is intended to enable countries to improve immunisation services and is not dependent on achieving targets. However, further funding of US$ 20 per additional immunised child is only available once targets for this intial investment phase have been met and are verified by Data Quality Audits (DQAs).