GAVI Board Teleconference

11 September 2000

Topics:

• First Fund Disbursements to Countries
• Update on the Vaccine Fund
• Other Matters

Summary of Discussion

Dr Gro Harlem Brundtland welcomed the participants [see attached participant list] and stated that the substance of the day’s discussion would be the first disbursement of Vaccine Fund awards to the 13 countries that had been approved for support from the Vaccine Fund. In addition, the Board would be updated on the progress of decisions on administrative procedures of the Vaccine Fund.

First Fund Disbursements to Countries

Tore Godal outlined the figures that have been calculated for the first Fund disbursement, based on the approved country proposals and subsequent clarification information. In summary, the total value of support for the first round of countries would be an estimated US$27,184,984 for vaccines and supplies (depending on cost of vaccines), and US$3,379,730 for immunization services, for a total disbursement of an estimated US$30,564,714.

The Board approved the recommendations for the Vaccine Fund’s first disbursements to countries, as outlined in the documents prepared by the Secretariat. The decision was made to forward the recommendations to the Vaccine Fund Board, with the proviso that the precise award amounts to countries may be adjusted very slightly.

The Vaccine Fund Board approved this request later the same day.

The issue was raised that in this first disbursement, funding being provided for vaccines is far greater than funding provided for immunization services. This may be a reflection of the fact that some countries have delayed their requests for immunization services support, and that more countries in this first round are not eligible for this type of support, as compared to countries planning to submit proposals in later rounds. While it is too early to determine whether the appropriate emphasis is being given to each sub-account, it will be important to monitor whether the Vaccine Fund is providing appropriate resources to support infrastructure and health delivery systems.

The GAVI Board welcomed and endorsed the recommendations of the 8 September meeting in Geneva of UNICEF reps, WRs and ICC chairs to discuss mechanisms to channel the funds from the immunization services sub-account. The recommendations were:

• the preferred mechanism is directly to the government, to an account for health services that has appropriate checks and balances;
  
  
• in cases where such mechanisms are not in place to meet the needs for speed and flexibility, partners may be requested to assist as a stop gap measure; and this should be done in a manner that does not compromise government's control of the use of funds nor the partner's role in monitoring the outputs.

The Working Group is currently exploring additional areas of support from the Vaccine Fund, including: incentives for countries with greater than 80% immunization coverage; support from a third sub-account, such as research initiatives; and support to China, India and Indonesia. Negotiations are currently being held with Indonesia and India to ascertain appropriate systems for providing support to these countries from the Vaccine Fund; Mark Kane will provide a report of the discussions at the GAVI Board meeting in November.

Projections on Fund expenditures for the next two years will be provided to the Board at the November Board meeting.

Update on the Vaccine Fund

Jacques-François Martin reported that the Vaccine Fund has released the necessary funds to UNICEF for its administrative costs in supporting Fund-related activities.

The Agreement between the Vaccine Fund and UNICEF is close to being finalized. It will reflect a balance between the need for the Vaccine Fund to be represented as an independent decision-making institution, in accordance with U.S. laws on nonprofit corporations, and the need for the Vaccine Fund to be seen as guided by the technical expertise of the GAVI Board. The overall principles of this working relationship are consistent with the original intention. An updated draft Agreement will be circulated shortly to the Board and potential donors for input.

The Vaccine Fund is currently reviewing options for the Board constitution. It has been decided that a number of prominent individuals would be asked to join the Vaccine Fund Board, in order to provide the necessary advocacy and fundraising support. They would be asked to be available to meet once a year. In addition, the Vaccine Fund Board would have a smaller executive committee that would meet four times a year to attend to the managerial and administrative functions. The GAVI Board is invited to provide suggestions for Fund Board candidates.

The donations of vaccines announced by pharmaceutical companies in March of this year will be accepted by the Vaccine Fund. It is understood that the donations are not based upon stock at hand but upon longer-term commitments. The donated vaccines will be provided to those countries that are approved for support for new and under-used vaccines, and where the donated vaccine presentations are epidemiologically and logistically appropriate.

Other Matters

After the November Board meeting in the Netherlands, the next Board meeting will likely be in June 2001. The suggested exact dates are 20-21 June 2001.

Recommendation to the Vaccine Fund for first round of country support

Subsequent to the decision taken by the GAVI Board on 18 July 2000 the thirteen countries for which support was approved have now presented the clarifications necessary to calculate their awards. On the basis of the information received, the support to be granted to these countries for the year 2001 is shown in the table below:

The decision on support from the immunization services sub-account will result in immediate disbursement. The decision on support from the new and under-used vaccines sub-account will result in a tendering procedure by the UNICEF Supply division. UNICEF Supply Division is currently reviewing offers of vaccines and contributions. Supply Division is clarifying offers with all 11 companies that have made them. UNICEF Supply Division will have a product "catalogue" within 15 days – which will then be shared and discussed with the eligible countries so that allocation decisions can then be made in mid- to end-November.

Explanatory notes

1. The support under the immunization services sub-account has been calculated using the 1999 DTP3 baseline, with 50% of the investment support to be disbursed this year and the remaining 50% end 2001, conditional upon the receipt of a satisfactory progress report.
2. The exact financial implications of the decision regarding the new and under-used vaccines sub-account can only be calculated after the tendering procedure in October of this year. This estimate is based on current vaccine prices.
3. The provision of new and under-used vaccines for the year 2001 has been calculated on the basis of need for the full year (unless a specific request for support for only part of the year has been made). However, it can be anticipated that these vaccines will not be available in time to be used in the early part of the year. Adjustments of the deliveries and the consequences for subsequent deliveries will be made when further information about delivery times for these vaccines is available.
4. Issues arising from the clarifications process include;
   1. Wastage rates
      Current GAVI policy stipulates that wastage rates for combination vaccines must be less than 25% at the outset, and 15% within three years. It is proposed that exceptions to this policy be considered depending on the situation, e.g., when a country currently has considerably higher wastage rates (example Cambodia). However, countries with high wastage rates will have to accept lower priority for the combination vaccines if the supply of these vaccines is insufficient.
   2. Non replacement principle
      Countries that already pay for new and under-used vaccines cannot receive support for these vaccines from the Vaccine Fund (example Guyana ­ Yellow Fever).
   3. Updated multi-year immunization plan for Malawi
      Malawi’s current five year immunization plan will come to an end in the year 2000. The country is now in the process of updating its plan to cover the next five year period and GAVI has requested this updated plan be available before the delivery of the new vaccines.

    

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