Update from the GAVI Secretariat - WHO · Guidance from the PPC in October 2010 ! PPC endorsed the appropriateness of the proposed supply and procurement objectives to foster well

Nina Schwalbe

Update from the GAVI Secretariat SAGE Meeting Geneva, 9-11 November 2010

SAGE Meeting 9-11 Nov 2010 – GAVI Update 1

Key Areas/Updates

!  GAVI 2011-2015 Strategy and Business Plan !  Development of new programs and policies

!  Prioritisation

!  IRIS

!  Co-financing

!  GAVI’s supply strategy revision

!  Next proposal round

!  Accelerated Vaccine Initiative/Advance Market Commitment update

!  Resource mobilisation


GAVI’s mission is underpinned by 4 main strategic goals and supported by 2 cross-cutting strategic functions

Mission

Cross-cutting strategic functions1

SG1. Accelerate the uptake of new and underused vaccines

SG2. Strengthen integrated health system delivery

SG3. Increase the predictability of global and national financing

SG4. Shape vaccine markets

Advocacy, communication and public policy

Monitoring and evaluation

SOURCE: GAVI Alliance

1 Capacity building cross-cutting strategic function dissolved as capacity building initiatives were incorporated directly into individual strategic goals


All activities and performance indicators in the 2011-2015 business plan cascade directly from GAVI’s mission and strategic goals


Strategic goals

Programme objectives

Programme objective 1.2.1



Strategic objectives

SG1 SG2 SG3 SG4

Mission

Strategic objective 1.1

Strategic objective 1.2

12 strategic objectives across the four main strategic goals

1 overall programme deliverable for each programme objective; 1-2 interim deliverables for each programme deliverable

3-4 programme objectives per strategic objective

Deliverable

Interim deliverable

Interim deliverable

Projects and activities


Within the business plan, the emphasis is on delivering against 5 immediate priorities


Overview Continuing to accelerate the uptake of new and underutilised vaccines

!  Introduce new and underused vaccines 120 introductions in total !  Continue to review the portfolio of vaccines to ensure that GAVI offers the

most cost-effective and greatest impact vaccines !  Continue to drive advocacy for new and underused vaccines

Mobilising the resources to meet demand for new vaccines

!  Scale-up resource mobilisation efforts with an aim of raising funding of US$ 5.1bn1 between 2011 and 2015

!  Broaden the donor base by securing 8-10 new donors2

!  Broaden the range of Innovative Finance products with a target of raising funding of US$ 1.5bn1 through Innovative Finance between 2011 and 2015

!  1Other than the proceeds of the IFFIm pledges for HSS Reducing vaccine input costs

!  Revise GAVI’s vaccine supply and procurement strategy !  Strengthen long-term supply and demand forecasting and improve vaccine

management !  Strengthen relationships with vaccine suppliers to ensure pipeline/

production decisions are informed by market needs Ensuring adequate country financing and delivery of introduced vaccines

!  Implement GAVI’s co-financing policy and support countries in efforts to find long-term financing solutions for vaccines and immunization

!  Support graduating countries’ transition toward full-funding of vaccine/immunization programmes

Continuing to improve aid effectiveness

!  Improve harmonisation and alignment with countries including synchronisation with country planning and budgeting cycles

!  Ensure highest levels of fiduciary transparency and accountability

1 New country introductions for 2011-2015 include: Penta (7 countries), Pneumo (40 countries), Rota (29 countries), Yellow Fever (3 countries), Meningitis A (10 countries), HPV (7 countries), JE (5 countries), Rubella (18 countries), Typhoid (1 country)

2 Direct donors that have not provided direct contribution to GAVI in the preceding 3 years, including G8 and other G20 donors


Furthermore, a specific set of activities and actions have been included to address outcomes from recent Phase Two Evaluation


Evaluation outcomes Key actions included in the business plan

""""

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Country financial sustainability Vaccine price GAVI’s role in health system strengthening Accountability Country communications M&E data analysis

!  Increased emphasis on driving down vaccine costs !  Support graduating countries in accessing affordable pricing and

continued supply of vaccines post- GAVI support

!  Market-shaping elevated to the level of strategic goal with specific programme objectives, deliverables, activities and budget

!  Combined emphasis on immunisation and service delivery !  Collaborative investment and implementation with partners at

the World Bank, Global Fund and WHO investment

!  Defined performance management of the business plan with regular reporting at the level of programme objectives

!  Allocation of a dedicated post for country communications within the Secretariat

!  Increased emphasis on communications through partner activity

!  Cross-cutting strategic function and revised M&E plan developed to ensure adequate focus and resources on M&E (incl. data warehouse, targeted studies and prospective evaluations)


Prioritisation: Objectives and criteria to rank new vaccine proposals

Objectives Criteria Indicator Weight

Maximizing health impact Deaths averted per 1000 Country and disease-specific death rate x immunisation coverage x vaccine efficacy

30%

Maximizing value for money Cost per death averted Vaccine price x doses/deaths averted (calculated as in health impact formula)

30%

Reinforcing financial sustainability of immunisation programmes

Government commitment to health

General Government expenditure on health as percentage of total government expenditure

25%

Supporting countries with the greatest need

Country income GNI per capita 15%

Equitable distribution of GAVI’s resources among countries

A maximum of one NVS proposal per round per country can be funded


Prioritisation: Objectives and criteria to rank cash based proposals

Objectives Criteria Indicator Weight

Supporting countries with the greatest need

System weakness* DTP3 coverage 50%

Overall health burden U5MR 25%

Reinforcing financial sustainability of immunisation programmes

Government commitment to health

General Government expenditure on health as percentage of total Government expenditure

25%

*Given the role of cash-based programmes in strengthening health systems in general as well as specifically for the delivery of immunisation services, proposals from countries with lower DTP3 coverage receive higher priority

!  A fixed share of the total available funding will be allocated to cash-based windows


Incentives for Routine Immunisation Strengthening (IRIS)

!  Builds on ISS design, with targeted changes !  Menu of options for cascading incentives down

!  Incentives linked to coverage gains

!  One portion of grant fixed, one portion at risk

!  Enhanced validation, building on WHO/UNICEF estimates

!  Objectives: !  Increase routine coverage, especially where <70%

!  Increase equity in coverage


Co-financing Policy revision: Simplified and better aligned to country incomes

Proposed Policy: Current Policy:

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GAVI’s supply strategy revision – Guidance from the PPC in October 2010

!  PPC endorsed the appropriateness of the proposed supply and procurement objectives to foster well functioning markets for GAVI vaccines:

Relationship between SUPPLY AND DEMAND

1.  Ensure sufficient supply of quality product is available to at least meet total GAVI demand

2.  Provide consistent, uninterrupted supply to GAVI countries

COST OF THE VACCINE to GAVI and Countries

3. Minimise the ‘fully loaded’* vaccine per course costs

4. Minimise the cost implications of products to GAVI countries

Appropriate and Innovative PRODUCTS

5.  Ensure procurement of appropriate products to meet GAVI country needs

6.  Foster an environment for innovative products

INFORMATION

7.  Provision of transparent and accurate information to inform GAVI portfolio choices, country product choices and the choices manufacturers make in production planning and capacity investments.

1/ The italicised terms require more precise definition * where fully loaded costs per course are defined as the unit price of the vaccine net of wastage, and including unit costs of freight, the syringe and safety box (if necessary)


Program Division

Supply Division

AVI TAC

AVI made up of Technical

Partners, led by GAVI

Secretariat

Accelerated Vaccine Initiative

AMT AVI Management Team

453$647$

AMT Sub-Teams

Logistics and Cold Chain

Large Country Introduction

Advocacy and Communication

Strategic Vaccine Supply

Special Studies

Pneumo Ad-hoc Group


Snapshot: Planned Vaccine Introductions

Rotavirus !  2011 Sudan

Pneumo !  2010 Honduras, Nicaragua, Guyana

!  2011 Kenya, Yemen, Sierra Leone, Mali, DRC, Congo Rep, Rwanda, Gambia, Cameroon, CAR

!  2012 Burundi, Malawi, Ethiopia, Madagascar, Benin, Pakistan


Pneumo AMC - update

!  4 AMC Registered Manufacturers: GSK, Pfizer, Serum Institute of India and Panacea Ltd.

!  23 March 2010: UNICEF entered into Supply Agreements with GSK and Pfizer:

!  2 vaccines deemed AMC eligible by the Independent Assessment Committee (IAC):

!  GSK’s Synflorix, 2 dose presentation, on 16 April 2010

!  Pfizer’s Prevenar 13, on 23 August 2010

!  70% of the AMC Funds remain unallocated.

Year 2010 2011 2012 2013 - 2021 Doses

Contracted 7.2 M 24.2 M 50 M 60 M


GAVI Funding Challenge 2010-2015

1.  Business Plan !  Brief overall presentation

!  Focus on ACPP and CSO engagement opportunities

2.  Countdown to the June 2011 Pledging Conference !  Financial scale up needed

!  Multi-faceted partnership with CSOs


Resource Mobilization: Call for Action and Resources

!  October 6, 2010: Call for Action and Resources Meeting

!  first step in a two-step process towards a pledging conference in June 2011.

!  Strong partner support, and CSO commitment to encourage political will.

!  June, 2011: Donor-wide appeal is scheduled to deliver

!  Call to action already delivered some early commitments

!  Additional US$400 million pledged (Canada, Australia, EC)

!  New donors: Japan announced intend to become GAVI donor; Korea signed first initial contribution and pledged scale up; China signalled interest in new role in GAVI

!  Donors committed exploration of IFFIM extension, expansion and other innovative finance instruments


16


Proposed revisions to the Strategy 2011-2015


SAGE Meeting 9-11 Nov 2010 – GAVI Update 18 18

The business plan includes 26 programme objectives across the 4 strategic goals and the 2 cross-cutting strategic functions

SG4. Market shaping

4.1.1. Strategically forecast the demand and supply for all vaccines in the GAVI portfolio

4.1.2. Ensure efficient and

effective vaccine procurement and supply chain management

4.2. Minimise costs of vaccines to

GAVI and countries 4.2.1. Develop instruments for

lowering price to GAVI and countries and/or encouraging development of appropriate products

4.1. Ensure adequate supply to meet demand

SG1. New and underused vaccines

1.1.1. Improve country decision-making structures, systems and processes

1.1.2. Ensure availability and use

of high quality programmatic and epidemiological data

1.1.3. Improve scientific

knowledge, and raise awareness amongst stakeholders

1.2.1. Improve the quality of country planning, GAVI applications and performance reporting

1.2.2. Prepare countries for

successful introductions of new and underused vaccines

1.2.3. Meet established quality

indicators for surveillance of diseases preventable by new and underused vaccines

1.2.4. Strengthen national

capacity for planning of behaviour change communication for new and underused vaccines disease control

1.1. Increase evidence based decision-making by countries

1.2. Strengthen country introduction to help meet demand

SG2. Integrated health system delivery

2.1.1. Ensure that constraints to immunisation and service delivery are identified and adequately addressed in National Health System policy and planning processes

2.1.2. Align GAVI funding with

country planning and budgeting cycles and improve financial management oversight of cash grants

2.2.1. Increase coverage and equity of routine immunisation in countries with DTP3 coverage of less than 70%

2.1. Contribute to the resolving of the major constraints to delivering immunisation

2.2. Increase equity in access to services, [including gender equity]

2.3. Strengthen civil society engagement in the health sector

2.3.1. Ensure active engagement of Civil Society Organisations (CSOs) in the Health Systems Funding Platform, Health Sector Coordination Committees (HSCCs) and Inter-Agency Coordinating Committees (ICCs)

SG3. Predictability of global and national financing

3.1.1. Integrate immunisation plans and budgets (cMYPs) into national planning and budgeting frameworks

3.1.2. Implement the co-financing policy

3.1.3. Support graduating

countries in sustaining investment in immunisation

3.2.1. Expand and extend direct donor commitments

3.2.2. Broaden the public and

private sector donor base

3.3.1. Grow and develop GAVI’s Innovative Finance product portfolio (incl. scaling of IFFIm)

3.1. Increase and sustain allocation of national resources to immunisation

3.2. Increase donor commitments and private contributions to GAVI

3.3. Mobilise resources via innovative financing mechanisms

Cross-cutting strategic functions

AC1.1. Position GAVI effectively to deliver on its mission

M&E

ME1.1.1. Ensure effective routine programme monitoring

ME1.1.2. Conduct targeted

studies to address key questions and meet critical information needs

ME1.1.3. Conduct full country

evaluations to evaluate the impact and cost-effectiveness of GAVI support to countries

ME1.1. Ensure that valid, reliable and useful measures of performance are available and used to support learning, management and release of funds

AC1.1.1. The value of immunisation, new vaccines, and GAVI is understood amongst key influencers and stakeholders

AC1.1.1.2. Mobilised and

empowered immunisation advocates to inform GAVI’s policies, support fundraising and help achieve its strategic goals

AC1.1.3.Increased influence in

development aid policy settings

ACPP


Update from the GAVI Secretariat - WHO · Guidance from the PPC in October 2010 ! PPC endorsed the appropriateness of the proposed supply and procurement objectives to foster well

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