Opinion: If Gavi plans a ‘sunset,’ let it be a thoughtful transition

In 2025, the global health landscape is defined by paradox. After years of calls to decolonize the sector — shifting power and resources to the countries most affected by health crises — donor countries are now retreating, driven not by justice but by populist retrenchment. This contradiction is starkly visible in the evolving role of Gavi, the Vaccine Alliance and other global health institutions. These shifts have reignited urgent debates about power, sovereignty, and the sustainability of health systems worldwide. Gavi has long been a model of multilateral cooperation, saving millions of lives through immunization programs across low- and middle-income countries. Its leadership now speaks of a future where countries take full ownership of their health systems — a goal aligned with the principles of decolonization. Yet this moment of transition is happening amid sweeping aid cuts from traditional donors such as the United States, whose recent drastic reduction in funding to global health institutions has sent shock waves. As Gavi CEO Dr. Sania Nishtar recently wrote in The Lancet: “Although our aspiration is to put ourselves out of business, there is no timetable for doing so.” Her words underline an urgent tension: Is Gavi’s potential “sunset” a thoughtful, just transition — or a response to donor retrenchment that risks destabilizing progress? Sunsetting vs. donor withdrawal The distinction between a well-planned exit strategy and abrupt donor withdrawal is critical. Decolonization is about equity, sovereignty, and partnership. It is a deliberate, collaborative process aimed at building sustainable systems with country leadership at the helm. Donor withdrawal, however, can look similar on the surface but is often motivated by nationalism, isolationism, or fiscal austerity — resulting in program disruptions and fragile health infrastructures. Consider the U.S. announced withdrawal from the World Health Organization earlier this year. This decision, couched in nationalist rhetoric, has reduced critical funding and jeopardized global cooperation at a time when pandemic preparedness and vaccine equity remain paramount. Similar trends loom over Gavi: Without clear, coordinated transition plans, countries risk being left to maintain complex immunization programs without the necessary resources or technical support. The implications are profound. Immunization programs require trained health workers, reliable cold chains, vaccine supply, and strong governance. These systems cannot simply be switched overnight. If donors pull back without bridging these gaps, decades of progress risk unravelling. Vaccination coverage could decline, outbreaks may increase, and public confidence in health systems could falter. The ongoing restructuring at UNICEF offers a cautionary tale. Its restructuring plan, the “Future Focus Initiative,” involves deep budget cuts and office consolidations that, according to internal staff, have been implemented with limited transparency or strategic clarity. The resulting low morale and operational disruptions serve as a warning for other multilateral agencies facing similar pressures. Poorly managed transitions can do more harm than good, particularly in contexts where health needs are already acute. How can a donor transition be done right? First, exit strategies must prioritize justice and partnership over expediency. Countries cannot be expected to absorb donor costs overnight. Instead, bridge financing from development banks and innovative mechanisms should cushion fiscal shocks, allowing gradual and predictable reductions in aid. Second, investing in domestic health workforces is critical. Sustainable immunization depends on a well-trained, compensated cadre of public health personnel, supported long-term beyond the life of external funding. “If Gavi decides to formalize a sunset, it must do so through a clear, jointly developed road map with partner countries.” --— Third, strengthening supply chains is essential. Vaccine delivery relies on complex cold chain logistics and last-mile distribution, which require durable infrastructure and local capacity. Public-private partnerships and regional vaccine manufacturing efforts, such as those emerging under the African Vaccine Manufacturing Accelerator, must be scaled up. Fourth, empowering regional institutions, such as the Africa Centres for Disease Control and Prevention, to assume greater technical support and coordination roles is vital. The 2024 Abidjan Declaration by nine African nations highlights the continent’s ambition for vaccine self-reliance, but this vision demands sustained funding, political backing, and strong governance. Fifth, transitions must be governed transparently, with mechanisms to prevent elite capture of resources and ensure accountability to communities. Shifts in funding and responsibility must serve equitable public health goals, not entrench new inequalities. These principles underscore that a just transition is not merely about “ending aid” but about transforming it. It means redesigning global health cooperation to align with country priorities and autonomy. It means donors and multilateral agencies planning for scale-up and exit with equal care, centering local leadership and capacity-building. If Gavi decides to formalize a sunset, it must do so through a clear, jointly developed road map with partner countries, governed by transparent criteria, clear timelines, and an unwavering focus on empowerment. Otherwise, what could be a historic milestone risks becoming yet another chapter in donor abandonment. We have seen the consequences of rushed, politically motivated aid exits before: fragile health systems, resurgence of preventable diseases, and erosion of public trust. These outcomes do not advance global health equity; they set it back. The optics of donor exit may resemble decolonization, but the motivations and impacts are diametrically opposed. The international community must resist conflating populist retrenchment with the justice-oriented goals of decolonization. One is a retreat that risks collapse, the other a deliberate path toward sovereignty and sustainability. They look alike only superficially. However, they lead to profoundly different futures. Global health leadership must clarify this distinction — and act accordingly. Transition is not synonymous with abandonment. It must be a deliberate, just reconfiguration that strengthens systems, supports local capacity, and deepens partnerships. If Gavi’s sunset is inevitable, let it be a sunrise for justice — a signal of a truly sovereign, equitable global health future.