1. GAVI Alliance Board up-date on policies and programmes
Andrei Usatii,
Minister of Health of the Republic of Moldova,
GAVI Board Member for Developing Countries AMRO/EURO regions

2. The global effort to extend the immunization coverage to all children began in 1974, when WHO initiated the Expanded Program on Immunization (EPI) together with UNICEF and World Bank. This helped countries establish the necessary infrastructure to provide a limited package of recommended vaccines, which at that time included vaccines against TB, diphtheria, tetanus, pertussis, measles and polio.
The GAVI Alliance was created in 2000 in recognition of the fact that vaccines and immunization are uniquely cost-effective way of protecting health and adverting disability and death, that existing vaccines were underused in and/or not adopted to the needs of developing countries, that new vaccines were developed and that they could be better provided through a global financing mechanism and improved coordination between public and private sectors.

3. Mission and strategic goals 2011–2015
To save children’s lives and protect people’s health by increasing access to immunisation in poor countries
The vaccine goal
Accelerate the uptake and use of underused and new vaccines
The health systems goal
Contribute to strengthening the capacity of integrated health systems to deliver immunisation
The financing goal
Increase the predictability of global financing and improve the sustainability of national financing for immunisation
The market shaping goal
Shape vaccine markets to ensure adequate supply of appropriate, quality vaccines at low and sustainable prices 1 2 3 4
The GAVI Alliance is a public-private global health partnership with the mission to save children lives and protect people’s health by increasing access to immunization. Through it’s strategic goals, GAVI has helped accelerate access to underused vaccines. Through the introduction of Hib vaccine, Hib meningitis has been virtually eradicated in many sub-Saharan countries. The introduction of Rota and Pneumococcal vaccine in almost all GAVI countries will also demonstrate it’s impact in the near future. Through the pilot Advance Market Commitment (AMC) , pneumococcal vaccines are available to GAVI-eligible and graduating countries at no more than US 3.50 per dose – a greater than 90% reduction on the public market price in USA.
By aggregating demand for vaccines from developing countries, GAVI helped to attract new manufactures to the market, thus increasing healthy competition, securing supplies and bringing down vaccine prices in the long term.
Currently 53 GAVI- eligible countries can benefit from GAVI support for new and underused vaccines, immunization services and health systems, with another 20 countries “graduating” from GAVI support.

4. Board Composition 18 "representative" seats
UNICEF
WHO
World Bank
Bill & Melinda Gates Foundation
Governments Industrialised Countries (5)
Governments Developing Countries (5)
Vaccine Industry Industrialised Countries
Vaccine Industry Developing Countries
Research & Technical Health Institutes
Civil Society Organisations
9 "unaffiliated/independent" seats
GAVI CEO (non-voting)
The Board is comprised of 18 “representative” seats and 9 seats for independent or “unaffiliated” individuals. The Board “representative” seats ensure that institutions and constituencies can provide formal input into the development of all GAVI’s policies and the management of its operations. UNICEF, WHO, World Bank and Melinda Gates Foundation hold permanent seats on the Board. Constituency representatives serve on a time-limited basis. 2/3 of the voting members of the Board are representatives from key GAVI Alliance partner institutions and stakeholders and 1/3 of it’s voting members are independent (or unaffiliated).

5. GAVI governance – a mix of public and private
This composition is illustrated below, were you can easily see that there are 5 Board Members, representing developing countries. The DC governments constituency is currently represented by Anglophone Africa, Francophone Africa, Asia, Middle East, Latin America and Eastern Europe. 5

6. Board Nomination – appointed in December 2012 (for 3 years period of time) 2012-2015
Operate in good faith in the best interests of the GAVI Alliance
Ensure a strong advocacy role
To exercise care in the performance of the duties
Keep fully informed of the GAVI Alliance activities and strategic plans
Ensure commitment of the developing countries that implement GAVI programmes
Consult the policies and documents with the constituencies before their approval at GAVI Board
Inform countries about Board Decisions
Represent constituencies interests and concerns with reference to the policies adopted.
The main responsibilities of the Representative and Alternate Board Member are:

7. Board Committee Structure
The Board is the supreme governing body of the GAVI Alliance. Certain functions are reserved to the Board, including the setting of policies and strategies for the GAVI Alliance. The Board delegates certain activities and areas of work to 5 committees, comprising Board Members, Alternates, and in certain instance independent experts or partner representatives. I also want to mention that I have been appointed as member of the Program and Policy Committee at the last Board Meeting in November. The PPC serves as the principal advisory body to the board on all GAVI programme areas and leads the development of new policies. It comprises technical experts from partner organisations and constituencies, with knowledge in areas such as epidemiology, public health systems and financing. The decision to join this committee was actually taken in order to ensure a well-balanced decision-making between donor’s and recipient countries, so my engagement is increasing with GAVI Alliance. At the next Board meeting that will be held in June, Minister Ramsaram will be appointed as member of Governance Committee, that is responsible for ensuring the smooth operation of GAVI’s Governance structure and serves as a nominating body for new Board Members, evaluates and overseen the function of other committees and develops key Governance policies.

8. Developing country governments constituency for EURO/AMRO regions
Andrei Usatii (Representative) from Moldova and Bheri Ramsaram (Alternate) from Guyana represent these GAVI – eligible/graduating countries (14).
Armenia*
Azerbaijan*
Bolivia*
Cuba*
Georgia*
Guyana*
Haiti
Honduras*
Kyrgyz Republic
Moldova*
Nicaragua*
Tajikistan
Ukraine*
Uzbekistan*
As you may easily observe, countries marked with an asterisk are in graduating phase which means that our constituency is the largest in number of graduating countries (11 out of 14). These countries exceeded the eligibility threshold of Gross National Income per capita over 1500 $ US. My greatest engagement as GAVI Board Member is to ensure that this countries will not be left behind in order to ensure financial and programmatic sustainability of the Immunization Programs.

9. Constituencies aspects
The main challenge characteristic for both regions is that 11 out of 14 countries are in graduating phase
It is hard to advocate the interests of the constituency at GAVI Board when the main majority are not eligible for new support
Lack of commitment for consultation process from the countries (lack of inputs from country level)
Exchange of experience and lessons learned between the two regions

10. Main challenges from the constituency perspective
Financial affordability (other donors also phasing out from LMICs like Global Fund and GAVI is the main or last donor for vaccine support)
Insufficient advocacy efforts to mobilize additional resources, accompanied with weak planning and budgeting process
Access to quality-assured vaccines at an optimum and affordable price (self-procurement mechanism) for EURO region
PAHO RF –Revolving Fund

11. Policies approved by GAVI Board with impact on the constituencies:
GAVI engagement with graduating countries (BM, November 2013)
GAVI Alliance Strategy (BR, April 2014)
Polio and routine immunization ( BM, November 2013)
GAVI’s supply chain strategy ( BM June 2014)
Vaccine investment strategy (BM, November 2013)

12. Polio and Routine Immunization
Part of the Endgame Strategy for
The Board approved to support with IPV all GAVI eligible countries, regardless their graduation status.
No co-financing requirements
Eligibility for IPV support is not opening the window for other vaccines introduction in graduating countries.
In 2018, the Board will decide on co-financing requirements.
The importance of the Global Polio Eradication Initiative as well as GAVI;s complementary role through the Endgame Strategy for has been recognized at global level and endorsed during World Health Assembly in May 2013.
After a lot of debates and advocacy activities, Board Members came to a common idea that all GAVI countries should be eligible, calling them GAVI IPV countries.
By exempting of IPV co-financing requirements till 2018 when the policy will get back to Board for approval, GAVI demonstrated how flexible it is and committed to support its countries.

13. GAVI engagement with graduating countries
GAVI engagement with graduating countries was approved at the last GAVI Board Meeting, held in November 2013 with a lot of resistance from donors. In their opinion the financial and programmatic sustainability is a responsibility from the Government side. Several round tables have been organized with donors and discussions have been held in order to demonstrate how critical this additional support is to ensure gains achieved with GAVI support post-graduation.
A new framework for assessing all graduating countries was piloted in 3 countries (Honduras,Moldova and Papua New Guinea) in Q
At the PPC meeting in May 2014 the experience from the 3 countries were shared and it was agreed to proceed with all graduating countries.
2. These graduation support are based on the Multi-Partners Assessments conducted in graduating countries for EURO region and PAHO’s International EPI Evaluation for AMRO region. Based on these assessments the graduation plans are developed. GAVI engagement with graduating countries seek to prioritize the main critical areas from the transitional plans and cost them so that countries can take advantage of the last GAVI support in the most appropriate manner.
The Multi-partner mission (GAVI and WHO) was held in Moldova in February Based on the Assessment performed in March 2012, the team met with all national stakeholders and as a result a graduation plan with budgeted activities has been developed and agreed with all relevant actors.

14. GAVI Strategy for
The consultation process is still on-going.
A lot of discussion on changing the eligibility threshold and/or inclusion of other eligibility indicators, besides GNI per capita like, access, equity, coverage issues, etc.
The mission and objective remains the same
Long-term visions
30 countries will still be eligible by 2030 for full GAVI support
Coverage and equity
The consultation process regarding the development of the New GAVI Strategy for was very open and constructive, conducted on a web-based questionnaire as well as dissemination of questionnaires to the constituencies.
Of course that this change of the eligibility threshold will represent the fundamental basis for the new eligibility policy that should be in line with the Strategy
A lot of discussion on the long-term visions focus more on 2 areas: every child being fully immunized or every person free from vaccine-preventable diseases
Today there are 53 countries eligible for a full/new support, 20 countries are in graduating phase. ( 73 countries are receiving support from GAVI). In 2030 there will be 30 GAVI eligible countries and according to the analysis GAVI would progressively stop supporting countries with a majority of under-immunized children. All of that highlight the importance of continuing the collaboration and partnership between GAVI and graduating countries in the future.

15. Plans and commitment
Expand GAVI engagement with graduating countries to all GAVI graduating countries
GAVI support for access to appropriate pricing for GAVI graduates & other LMICs
Review of the co-financing policy (later in 2014)
Graduation policy
Eligibility policy
1. It is very important to increase donors awareness on the major need of further engagement with graduating countries in order to ensure the Financial and Programmatic Sustainability of Immunization Programs.
2. The second document “GAVI support for access to appropriate pricing for GAVI graduates” was developed as a specific requirement and major need from DC Board Members to ensure that countries may have access to GAVI prices after graduation, as the domestic funding required for a fully financing of new vaccines are very high and any additional challenge as increased costs of those new vaccine may endanger sustaining immunization investments after graduation from GAVI support. The idea is to develop a pooled procurement facility based on tiered pricing that would apply to GAVI graduating countries and later on, if approved by the Board to all LMICs. This exercise should be based on lessons learned from PAHO Revolving Fund and on it’s experience achieved through collective action and ownership with PAHO Member States.
3,4,5 The last three documents are on the Programme and Policy Committee workplan for October 2014 and April 2015 and will be finally approved at the Board Meeting in June 2015.

16. Sustainable Immunization Financing
Sabin Vaccine Institute Programme
“Sustainable Immunization Financing”:
Eastern Europe region: project will be
Implemented in 4 countries: Uzbekistan,
Georgia, Armenia and Moldova
Sabin’s Sustainable Immunization Financing (SIF) program helps countries provide this essential public good to their children. The program encourages key stakeholders: national governments (ministries of health and finance), parliamentarians, the domestic private sector, key civil society groups as well as external partners, to work together to identify sustainable financing mechanisms for immunization. Focusing on 12 African and 5 Asian, one Central Asian countries and in the near future to 4 countries in Eastern Europe, the program also forges links across the countries, encouraging cooperation and healthy competition at the global level.
The activities conducted through this project will increase countries ownership for Immunization Programs, peer-to-peer exchange between political leaders in order to ensure political commitment, resource mobilization and advocacy measures at country level.

17. Thank you
Thank you for your attention and I would also encourage you to tell me during your interventions the main messages that you would like me to share with Board Members, as well as your wishes and concerns.
GAVI/2011/Ed Harris