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April 20, 2001

Dear Colleague,

I am writing to you on behalf of the Global Alliance for Vaccines and Immunization’s (GAVI) Financing Task Force to request your input and comments on the attached draft paper entitled, Financial Sustainability of Childhood Immunization: Issues and Options.

Narrowly, this paper is intended to contribute to the development and preparation of financial sustainability plans required of countries applying to GAVI/The Vaccine Fund. Countries that receive funds for new vaccines or infrastructure development through the GAVI/The Vaccine Fund are expected to provide financial sustainability plans to the GAVI Board 2 years from the time of initial disbursement. These plans, which are to be signed off by the Ministry of Finance, will detail the long-term financial sustainability of the country’s immunization program when initial support from The Vaccine Fund ceases.

More broadly, this paper seeks to help donors and countries think about specific actions that can contribute to – or conflict with – a long-term goal of stable and adequate financing for childhood immunization.

Historically, discussions of financial sustainability have been characterized by considerable debate and divergence of opinion over definition and possible indicators. This paper departs from the traditional ‘self-sufficiency’ definition and suggests that GAVI may wish to consider financial sustainability to be ‘the ability of a country to mobilize and allocate sufficient financial resources on a reliable basis to achieve target levels of immunization performance,’

Through the attached paper, the GAVI Financing Task Force is seeking broad input from knowledgeable individuals and institutions about the characteristics of financially sustainable programs, and the appropriate indicators with which to measure progress toward financial sustainability.

In the first sections of the paper, the authors propose a set of eight dimensions of financial sustainability – encompassing both the efficiency of the supply chain and the stability of the funding structure – and identify promising actions that governments and donors can take to promote sustainability. In Section VI, the authors identify criteria for selecting useful indicators of financial sustainability, and list possible indicators.

This paper is intended to provide a framework for discussion, rather than to provide all the “answers.” In particular, the assessment of which indicators of financial sustainability are most appropriate is a task to be done in a participatory fashion, taking advantage of real-world knowledge about the availability of data and other factors across many countries. Table 1 in the paper is explicitly set up to invite such contributions: Reviewers are asked to use the table to show how well the various indicators stack up against the criteria. Contributions from a variety of reviewers will greatly assist the Task Force in its job of creating requirements for the financial sustainability plans that will best serve the larger objective of more effective immunization systems.

We would be grateful if you could please direct your comments to Ruth Levine ( with a copy to me ( by May 31, 2001. Alternatively, you may fax or mail your comments to:

Ruth Levine
The World Bank
1818 H Street, NW
Washington, D.C. 20433
Fax: 202.522-3135

Yours sincerely,

Violaine Mitchell
GAVI Financing Task Force


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