Sania Nishtar: Gavi reforms put countries in the driver’s seat

Gavi, the Vaccine Alliance is simplifying its processes and giving countries more control over their vaccination programs. These changes are part of a reform effort that Gavi started over the past year, in response to needed changes in the global health architecture. “When I came in in March 2024, the ministers of health told us, we want more agency. We want more control on our resources. We want you to reduce the administrative costs. We want you to make processes simple. So I came back, and that is what the Gavi Leap for reform was predicated on,” Gavi CEO Sania Nishtar told Devex President and Editor-in-Chief Raj Kumar during a Devex Pro Briefing on Monday. As part of what she calls “radical simplicity,” Gavi will be supporting countries through the use of two funding levers instead of 30, and will cut the number of contractors from 700 to around 60. It has also digitized its grant processes to reduce the burden on countries, while at the same time easing the administrative work of the secretariat. “Our processes were previously quasi-automated, largely manual, lots of Excel sheets, lots of desktop documents,” Nishtar said. These reforms allowed the organization to reduce its operating costs by 40%, but it also meant the loss of 33% of its staff. To give countries more agency, Gavi is allowing them to decide which vaccines to roll out — and when. Gavi will also continue providing countries with funds to help them roll out vaccines. But countries will now have more flexibility in choosing partners for this work. “The idea is more fundamental about the role of international agencies, especially agencies like us who provide support for programs to be delivered at scale,” Nishtar said. “The idea is not for us to be running the shop, so to speak, forever. The idea should be for us to provide catalytic support to make the investments that a country wants to make and lead, and for us to incrementally phase out.” Gavi has also floated the idea of a “merger at the last mile,” where international agencies can pool resources and reduce the administrative burden placed on governments from dealing with multiple agencies. “If you go to a country, you will see many international agencies operating there, each one of them well intentioned, each one of them with important … resources and technical expertise. But each one of us have our own budget line, our own bank accounts, our own audits, our own human resource, our own country visits, our own administrative arrangements, our own policies,” Nishtar said. Moving from rhetoric to action Nishtar hopes the reforms they’re making at Gavi would help contribute to conversations on reforming the global health architecture. “Every paper will tell you sovereignty matters and that countries should transition. But the devil is in the detail. How is that going to happen? You have to make those nuts and bolts implementation choices that will put countries in the driving seat. You have to actively demonstrate what a graduation looks like,” she said. “There are many conversations happening, but we now need to get down to the specifics,” she added. As for a possible merger between The Global Fund to Fight AIDS, Tuberculosis, and Malaria, and Gavi — which Nishtar said is the “most popular question” she’s often asked — “anything is theoretically possible.” She said there’s an independent body currently engaged in conversations with both organizations to look at areas where they can work together. And board members are also pushing both institutions to work more collaboratively. “Nothing is off the table, and they’re also looking at potential structural options. But the objective should be to serve countries better,” she said.