Gavi launches $9B replenishment target

Gavi, the Vaccine Alliance launched its replenishment campaign today in Paris. The organization is asking for $9 billion in new pledges, out of a total need of $11.9 billion, with $2.9 billion available in existing donor pledges, investment income, and leftover resources from the COVID-19 pandemic. So far, Gavi has received $2.4 billion in new pledges, with $1.58 billion of that coming from the United States. The amount will cover the work the organization plans to do from 2026 to 2030, which includes expanding vaccine coverage and introducing new jabs, and fully immunizing children who don’t have access or have not received a single dose of routine vaccines. Gavi CEO Dr. Sania Nishtar is “cautiously optimistic” that the organization will achieve its target, amid a crowded space for fundraising. She said they have a “very clear” plan articulating what they will do and have demonstrated impact and sustainability which are attractive to donors. She said every $1 donors invest in Gavi equates to $54 in economic returns. “We are an organization that gives them results. We work in the most difficult parts of the country. We operate at a very lean cost … and we are centered on a model that's built around sustainability,” Nishtar told Devex, ahead of the launch event. Unlike other organizations where “donors continue to throw money … with no end in sight,” she said Gavi operates with a cost-sharing model under which countries contribute to the cost of Gavi-supported vaccines. Such contributions grow as countries’ economies grow, and they are seen as having more ability to finance their own vaccines. “Countries pay 10% of their vaccination costs 15 years ago. Now they're paying around 40%, and this will increase, and then countries graduate from the model. So the donor investment is very catalytic in nature,” Nishtar said. “I'd like to say in humility, it's a very good investment model for donors,” she added. Gavi’s plans The financing will be crucial for Gavi’s future plans. In the lead-up to the replenishment campaign launch, its board approved the organization’s next five-year strategy, under which a few things are changing. This includes a revised eligibility policy with a “middle-income country dimension that will continue to receive support” from Gavi, Nishtar said. Gavi’s model defines countries’ support based on their gross national income per capita. Those that reach a certain GNI threshold enter an “accelerated phase” where they receive reduced support and eventually graduate from Gavi. However, this policy fails to take into account pockets of inequities within a country, especially for middle-income countries, which have a high percentage of zero-dose children. “Averages hide a lot of inequity,” Nishtar said, recognizing that GNI per capita “is an average number.” “The changes in the eligibility pathways will have huge implications for countries in terms of who stays in our fold, and for what duration,” she added. Another change is with Gavi's strategy for fragile countries — part of Gavi’s plans to be more responsive to evolving global contexts. Nishtar said they will make a funding window available for countries that aren’t eligible for Gavi support but are experiencing a humanitarian crisis. Previously, there was no way for Gavi to engage with these countries but it has invoked exceptions for particular countries, such as those in conflict or facing a disaster. “There will be many aspects of operationalizing the strategy, where we [will] work on the final nuances on how to work better in these settings because the standard Gavi policies and procedures for engagement with the country during times of peace and stability does not hold true for these settings,” Nishtar said. Programs coming and ending The Gavi board also agreed on the parameters for a $500 million First Response Fund — financing to be made available to countries as a rapid response mechanism to emergencies. According to a news release, the fund will be available to core Gavi-eligible countries, but “with potential for exceptions if needed.” It will mainly be used in cases of public health emergencies of international concern that don’t have existing vaccine programs. Funding could also be used to procure other medical items, such as personal protective equipment, and for other activities such as community preparedness and response. Nishtar said they set up the fund as part of learnings from COVID-19, and in her view, it should be a revolving fund “because pandemics will continue to come up.” “The money exists. The trigger points are very clear. We're ready to set this into operation whenever the need arises, and we will work towards creating the structure for replenishment,” she said. The First Response Fund is one of several financial instruments under Gavi's Day Zero Financing Facility for Pandemics that overall aims to provide up to $2.5 billion in surge financing primarily for faster vaccine response during major public health emergencies. Gavi is also launching the African Vaccine Manufacturing Accelerator, a $1 billion financial instrument set up to support sustainable vaccine manufacturing in Africa which was created in response to vaccine inequities during COVID-19. Nishtar said Gavi’s governing bodies will have oversight over the AVMA and the organization’s Day Zero Financing Facility. Gavi however is sunsetting its COVID-19 program by the end of 2025. Nishtar said the decision was made as there’s no country demand for the vaccines. Unspent COVAX funds are being repurposed for Gavi’s new programs, such as the AVMA, the Day Zero Financing Facility, and the “Big Catch-up,” a global initiative aimed at boosting childhood vaccinations and reversing the declines seen during the COVID-19 pandemic. It’s unclear at the moment how much of the unspent COVAX funds are going to these activities in total. And there have been questions about how much is left and how it will be spent. “We are going to make those calculations available as well, and those figures will also be part of what we will communicate in the coming days on the sidelines of the IO [investment opportunity] launch,” Nishtar said. Nishtar also said there are unspent funds because Gavi didn’t factor dose donations when fundraising. But the donations were “a good thing because it allowed Gavi to save some money.” Update, June 20, 2024: This article has been updated to reflect that Gavi has $2.9 billion available in existing donor pledges, investment income, and leftover resources from the COVID-19 pandemic.