Return to December
2001 contents page
The new global fund and GAVI: similar
approaches or different?
Nine months after the first announcements
of the Global Fund to Fight AIDS, Tuberculosis and Malaria, Lisa
Jacobs assesses progress and compares the experiences of GAVI and
the new initiative
THE progress of GAVI and The Vaccine
Fund have been watched by many in the field of international public
health. Some of the most keen observers are those involved in setting
up the new Global Fund to Fight AIDS, Tuberculosis and Malaria.
The team that has been developing the
framework for the new Global Fund is meeting for the third and last
time this month and is expected to make some key decisions about
how the fund will work. Meanwhile, discussions at previous meetings
and negotiations have pointed to a basic outline for the fund's
operations and priorities. A number of the strategies developed
by the GAVI partners to provide money and new vaccines to countries'
immunization systems are being analysed and modified to fit the
needs of the new Global Fund.
Background to the initiative
The seeds for the new fund were
planted at the G8 Summit in Okinawa in July 2000, when the idea
for a global partnership to mobilize significant new resources to
fight the three major infectious disease killers first emerged.
In April 2001, UN Secretary General Kofi Annan issued a challenge
to the world for an "AIDS war chest" at the OAU AIDS summit in Abuja.
This challenge was accepted by world leaders in June 2001 at the
first UN General Assembly to focus on AIDS, and one month later
at the G8 Summit in Genoa.
Since then, a Transitional Working Group,
a body of nearly 40 representatives of governments of developing
and donor countries, nongovernmental organizations, the private
sector and UN agencies, has been formed to build the foundations
and working principles of the fund. Supported by a temporary secretariat
in Brussels, by December 2001 the group will have organised six
regional and thematic consultations with developing country health
officials, NGOs, and academia, to develop strategy and options papers
on how this fund should operate.
The GAVI "model" has been cited in a
number of these discussions and documents that are helping to frame
the development of the new disease fund. And as the fund moves closer
to reality, a number of its elements will be familiar to those who
have been involved with GAVI.
"No new bureaucracy", could be
considered a rallying cry amongst those involved in setting up the
fund. While basic decisions on the GAVI structure and its policy-making
systems were made even before the Vaccine Fund was created, its
aims of operating leanly and efficiently are considered equally
appropriate for the Global Fund to Fight AIDS, Tuberculosis and
The fine details are still being hammered
out, but it has become clear that policies for the new fund will
be decided by a small board with 18 members, the administrative
functions will be carried out by a small secretariat, and options
for policy and technical issues will be explored by task forces
or working groups, for consideration by the Board. A larger partnership
forum that meets every other year, such as those employed by GAVI,
Roll Back Malaria, and the Stop TB Initiative, will provide the
opportunity for a wide range of stakeholders to contribute to discussions
on how the fund will work.
Independent review of proposals
For GAVI, the Independent Review Committee
is considered to be an important component of the proposal process.
It is intended to provide neutral, consistent advice to the GAVI
Board about which country proposals are ready for approval and which
countries need more technical assistance before funding and vaccines
should be delivered. The new global fund will most likely develop
similar arrangements, although it will need to closely monitor the
review committee's workload, considering the potential number of
proposals being submitted to address the three diseases.
Country level partnerships
Country inter-agency coordinating committees
(ICCs) that were first developed to support polio eradication and
then broadened to focus on improving routine immunization systems
and prepare and implement proposals to GAVI and the Vaccine Fund,
have proven to be a robust mechanism for increasing collaboration
with national partners and ensuring that each country has full ownership
of its immunization plans. The global fund will encourage similar
partnerships, so that governments, NGOs, private sector organizations,
bilateral and UN agencies involved in fighting the three diseases
will work together to develop proposals, implement programmes and
The GAVI "share" system investing
in plans to increase immunization coverage and rewarding countries
for results achieved is being closely examined as a method
for disbursing funds from the new global fund. The details are still
at the early stage of development, but options are being explored
to fund programmes that measure indicators such as the percentage
of children who sleep under bednets to protect them from malaria,
the number of adults who have access to quality voluntary HIV testing
and counselling programmes, and the proportion of people with TB
infection that complete DOTS therapy. HIV incidence rates may also
be used as an indicator.
The structure of the board will be somewhat
different from that currently set up for GAVI. Country delegations
will make up the majority of the board 14 seats, with 7 seats
each from developing and industrialized countries. Civil society
rounds out the Board with 2 seats for NGO representatives and 1
each for foundation and private sector donors. The global fund board
will include UN agencies likely to be WHO, UNAIDS and The
World Bank but as ex officio, non voting members.
One ex officio seat would also be held by a person living
with HIV/AIDS or from a community living with TB or malaria. Constituencies
will develop their own processes for selecting board representatives
from among their members, with the option to rotate or renew members.
In order to move fast to reduce
the devastating impact and suffering caused by these diseases,
the new disease fund will focus funding efforts on scaling
up and increasing coverage of proven and effective interventions.
The fund will seek especially in its earliest phase
to maintain a focus on outcomes. However, past experience
has shown that in order to promote sustainability, focused
efforts must never lose sight of the broader context. The
fund will therefore encourage programmes that build on, complement,
and co-ordinate with existing regional and national programmes,
policies, priorities and partnerships, including poverty reduction
strategies and sector-wide approaches.
It works, and it's available now:
the Global Fund is likely to focus on existing interventions
of proven efficacy, such as this insecticide-impregnated bednet,
which protects children from malaria.
Many consider the start-up of GAVI and
the Vaccine Fund to have been extremely fast. Political pressure
on the Global Fund to Fight AIDS, Tuberculosis and Malaria is pushing
it to move even faster. At its final meeting this month, the transitional
working group will be exploring strategies for disbursing money
quickly possibly by identifying programmes that are ready
for implementation but lack resources, or providing seed money to
projects that look promising and will deliver rapid, measurable
results. With millions of people's health in the balance, the choices
will be watched with intense interest.
GAVI Communications Officer
Lisa Jacobs has been advising and assisting the temporary secretariat
of the Global Fund to Fight AIDS, Tuberculosis and Malaria, working
on a part-time basis.
Return to December 2001 contents