Devex CheckUp: A $3B funding shortfall leaves Gavi’s board trying to fill the gaps

Amid a $3 billion funding gap, the board of Gavi, the Vaccine Alliance, has revised its strategy for the next five years. 

This comes in light of shortfalls at its high-level fundraising event last month in Brussels, where the organization raised between $9.5 billion and $10.5 billion  — short of its $11.9 billion to $13 billion target. The funding gap was widened in part by the unexpected loss of support from the United States, which U.S. Health Secretary Robert F. Kennedy Jr. waited until the replenishment event to confirm.

Internal documents — seen by Devex — that were distributed to board members before they met last week also show that the cost of Gavi’s work from 2026 to 2030 — known as “Gavi 6.0” — has since been raised from $11.9 billion to $13 billion.

The board approved a new approach to supporting children living in fragile and humanitarian contexts, confirmed it will introduce respiratory syncytial virus vaccines for pregnant mothers, and approved the creation of an mpox vaccine stockpile.

But the organization has also been forced into some difficult decisions. The board rescinded certain relief measures related to new vaccine introductions that were implemented last December, and now, co-financing exceptions for malaria vaccines will be more limited starting next year. The organization is also cutting 115 full-time roles.

“With 97 cents of every dollar invested in Gavi spent directly on vaccine programmes, any budget adjustments will inevitably involve difficult programmatic choices,” a spokesperson tells my colleague Sara Jerving.

While one of the internal documents forecasts Gavi won’t be able to save up to 2.5 million lives it had hoped to through vaccinations, the spokesperson says the organization “cannot confirm the number of lives affected at this point, as this will be subject to further decisions and countries’ priorities.”

Read: Gavi's board tasked with strategy shift in light of $3b funding gap

ICYMI: Robert F. Kennedy Jr. says the US is cutting funding for Gavi

Plus: Gavi pledges fall short about $2.9B as US pulls out

CheckUp will be taking its annual summer hiatus next week, and will be back on Thursday, Aug. 14. In the meantime, Devex will be sending out deep dives on some of the most pressing development topics. If you’d like to receive them, please sign up for the daily Newswire.

Forward looking

The Gates Foundation may be doubling its giving as it plans to wind down by 2045, which means spending $200 billion over the next 20 years. But the additional money is not likely to usher in a dramatic change in what the organization will support.

Speaking to Devex President and Editor-in-Chief Raj Kumar, Gates CEO Mark Suzman says the foundation intends to remain focused on innovations that can deliver practical, achievable results.

“If there isn’t a way to make this at a price point and at a timeline that's going to be useful and usable within low- and middle-income countries, I don't care how good the idea is, we're not going to be funding this,” he says.

And any initiative must fit within one of the foundation’s three goals, which include improving maternal and child health, while reducing preventable deaths; eradicating or bringing infectious diseases under control; or improving economic mobility and opportunity.

ICYMI: Bill Gates commits most of his fortune to Gates Foundation, closing 2045

Read: Gates CEO on what the next 20 years hold, and what it means for partners (Pro)

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Losing MOMENTUM

Maternal health gains are under threat as donors pull back support, leaving many countries worried that recent progress could be lost. That includes Malawi, which has seen maternal mortality fall in recent years from 381 deaths per 100,000 live births to 225.

U.S. funding played a critical role in achieving this progress. But since President Donald Trump took office, the United States has walked away from major maternal health programs it was supporting in the southern African country. That includes a five-year, $80 million initiative known as MOMENTUM, which was doing everything from updating hospital equipment to organizing community outreach to training health workers. The program was canceled in February, despite Secretary of State Marco Rubio’s pledge to preserve lifesaving maternal and child health programs.

That has created significant gaps, particularly in rural communities that relied on MOMENTUM for support. And the challenge is further exacerbated by the Trump administration’s wholesale elimination of support for family planning and reproductive health.

These programs were intertwined with maternal health efforts, including the procurement of commodities such as condoms. Without those supplies, the programs that do remain will face more demands on their rapidly shrinking resources.

Read: US funding cuts jeopardize Malawi’s maternal health advances

Background reading: The mess inside Rubio's 'lifesaving' waivers

RIP

The world lost a global health icon last week with the passing of Dr. David Nabarro at age 75.

Almost any time there was a crisis, United Nations leaders tapped him to guide the response. That included managing the cholera outbreak in Haiti, coordinating responses to the avian flu and Ebola, and leading efforts to prevent and contain COVID-19.

His experience also helped Nabarro identify gaps in global health, which led him to champion the creation of institutions to fill them, including the Global Fund to Fight AIDS, Tuberculosis and Malaria and the Scaling Up Nutrition Movement. Indeed, building food systems and addressing malnutrition would be central to his career.

Nabarro’s contributions won him a World Food Prize, a knighthood, and the devotion of the global health community.

Read: David Nabarro, who led fight against pandemics, malnutrition, dies

What we’re reading

Famine thresholds have been reached in parts of Gaza, according to U.N.-affiliated organizations, as the Israeli military continues to limit the flow of food aid to the region. [NPR]

Sussan Monarez, an expert on health technology and biosecurity, was confirmed by the U.S. Senate to lead the Centers for Disease Control and Prevention. [Associated Press]

With active outbreaks of cholera in both the Democratic Republic of Congo and Nigeria, at least 80,000 children are at high risk of the disease as the rainy season begins in the region. [ReliefWeb]