Updated Gavi vaccine funding guidelines and approval of 6.0 strategy

Gavi Vaccine Funding Guidelines updated 

Gavi’s Vaccine Funding Guidelines (VFG) have been updated to reflect the addition of Ebola preventive vaccination, Hepatitis B birth dose vaccine, Human rabies vaccine for post-exposure prophylaxis and Multivalent Meningococcal Conjugate vaccines support within Gavi’s portfolio. These four programmes were previously approved by the Gavi Board but put on hold for multiple reasons including the COVID-19 pandemic, pending availability of suitable products, and/or appropriate policy recommendations. 

The latest expansion of Gavi’s vaccine portfolio is in line with Gavi’s commitment to ensure lower-income countries have access to impactful vaccines as soon as possible. Countries can now apply to introduce these vaccines. You can access the Gavi Vaccine Funding Guidelines in English here, a French version will be available by end June 2024. The Vaccine Funding Guidelines complement other Gavi Programme Funding Guidelines available. 

Gavi Board approves next five-year strategy from 2026-2030

The Gavi Board approved the Gavi 6.0 Strategy one pager at its meeting on Thursday, 6 June 2024. This marks the end of an 18 month, highly consultative process with countries at the centre in which the Alliance identified and prioritised opportunities for impact to ensure Gavi continues to build on our successes to date in supporting countries to leave no one behind with immunisation. Click here to see the Gavi 6.0 one-pager.

The 6.0 strategy is the Gavi’s most ambitious strategy yet, and will aim to:  

• increase access to the widest, most innovative portfolio of critical life-saving vaccines ever, vaccinating >500 million more children and adolescents, and saving 8-9 million more lives;
• accelerate Gavi’s equity agenda, contributing to the Immunisation Agenda (IA) 2030’s ambition to reduce zero-dose children by 50%, integrated with primary health care (PHC);
• enhance Gavi’s eligibility, co-financing and transition model, ensuring it protects Gavi’s investments and addresses inequities in access to vaccines in middle income countries (MICs); 
• strengthen global health security, building on the lessons from Gavi’s outbreak response and COVAX. Ensuring that Gavi’s programmes make climate change adaptation and mitigation part and parcel;
• streamline the Secretariat operating model and revamping the Alliance model for fragile, conflict, and humanitarian settings to better reach left behind children with life-saving vaccines; and
• start the next chapter in building new partnerships including with regional organisations such as the African Union Commission and African Centres for Disease Control and with other Global Health Institutions in line with the Lusaka Agenda. 

To deliver on the above, focus will now shift to operationalization of the strategy so that the Alliance and the countries it supports are set up for success when the new strategy starts in 2026. 

Proposed shifts to eligibility, transition, and co-financing model (ELTRACO), and the Middle-Income Countries (MICs) approach

Gavi’s ELTRACO model is widely regarded as a success story, with nineteen countries having transitioned out of Gavi support to date. In response to the evolving context marked by a challenging macro-economic outlook, growing risks of unsuccessful transition of a subset of countries, and growing inequities in access to immunisation in lower middle-income countries, the Board as part of the design of Gavi 6.01 has explored opportunities to improve Gavi’s approach to building programmatic and financial sustainability of immunisation programmes in the next strategic period. It provided guidance that successful transitions should remain a cornerstone of the Gavi model in the next strategic period and beyond, and therefore to significantly enhance the current ELTRACO model and MICs approach. The enhanced model introduces six main shifts to mitigate the risks of countries defaulting on their co-financing obligations; to slow down the acceleration of co-financing obligations in Gavi-eligible countries; and to ensure successful transitions. The current MICs approach becomes the new post-transition Catalytic phase of the ELTRACO model to improve immunisation outcomes in a subset of Former- and Never-Gavi-eligible countries. Lastly, a learning agenda is developed to test some elements of a transition by vaccine model. At its May 2024 meeting, the Programme and Policy Committee (PPC) largely supported and further concretised the general ‘direction of travel’ from the Board discussions, pending further detailed design deliberations as part of the upcoming Funding Policy Review (FPR), in particular on updating Gavi’s eligibility indicators and threshold in Gavi 6.0.

See below for the overview of the six proposed shifts for Gavi-eligible countries under the enhanced ELTRACO model:

1. Introducing price sensitivity for Initial-Self Financing (ISF) countries
2. Updating Gavi’s eligibility threshold (impact on preparatory and accelerated transition countries, as well as some former-Gavi countries)
3. Pacing co-financing increase for countries in preparatory transition (PT)
4. Minimum number of years of vaccine support for countries in accelerated transition (AT)
5. Decoupling the transition from vaccine and cash support for countries in accelerated transition (AT)
6. Further differentiating co-financing rules for countries facing humanitarian crisis

The proposed evolution of the MICs approach: the new ‘Catalytic phase’

1. In the new model, the MICs approach would become the ‘Catalytic phase,’ with overall indicative financial implications of US$ 250 million for Gavi 6.0.
2. The Catalytic phase mainstreams the current MICs approach into the ELTRACO model
3. The first and main objective of the Catalytic phase would be to drive the sustainable introduction of key missing vaccines
4. The second objective would be to prevent and mitigate backsliding of routine immunisation
5. Finally, fragility support is retained