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Joint GAVI Alliance & Fund Executive Committee meeting

06 May 2008

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1. GAVI’s vaccine investment strategy

Andrew Jones and Nina Schwalbe of the GAVI Secretariat introduced the latest work on the development of a comprehensive vaccine investment strategy for the GAVI Alliance. Though no consensus was sought Alliance and Fund Executive Committee members made the following comments for consideration on further development of the strategy:

  • Although it was appropriate to seek guidance from the Executive Committee, the decision on a vaccine investment strategy should be the purview of the full Boards.
  • The key objectives of the strategy should be to reduce mortality with a specific but not exclusive focus on child mortality, in order to contribute to the achievement of Millennium Development Goal 4. The strategy should also place strong consideration on country preferences, combined with globally available information with consideration for those interventions that are most likely to be sustainable.
  • Our consideration of a vaccine investment strategy should be grounded in key GAVI policies, in particular the gender policy, which will be before the boards for adoption in June.
  • GAVI Partners and donors should build upon ongoing discussions with other international partnerships and strategy work areas to discuss how best to move forward with regard to comprehensive approaches to disease and mortality reduction strategies where appropriate.
  • Since inception, GAVI has focused introducing and expanding access to new and underutilised vaccine; the strategy should reflect this as a core part of GAVI’s work going forward. The strategy should also place higher priority on those vaccines that allow GAVI’s investment to add value and have a catalytic effect.
  • The strategy should build upon other GAVI strategic objectives and outcomes, including gender equity, equity for the poor, integration of health services, and strengthening country immunisation and health systems.
  • Recognize that, as with other vaccines GAVI is currently supporting, some vaccines under consideration may require additional substantial country level systems-related work.
  • GAVI’s vaccine investment strategy should not focus on current routine EPI vaccines which are already delivered through routine immunization services as these are the responsibility of countries.
  • Before the Board will be able to make a firm decision on what future vaccines to support, the strategy must provide a cost analysis for each option proposed, as well as the proof that future investments will not compromise GAVI’s support for all currently supported vaccines. A full overview of GAVI’s financial obligations through 2015 to which GAVI has already committed and expected income over this period should be presented before any additional vaccine investments are considered.

DECISIONS
The GAVI Alliance Executive Committee:

  1. Suggested the Secretariat to reflect the above individual input as they proceed with subsequent work on the strategy, and to present the boards with a document that provides clear options for investment against anticipated income and already agreed to obligations through 2015. Complete information should allow the Secretariat to provide possible options along with a single recommendation, for the GAVI Alliance and Fund joint Board meeting in June. Input from the Independent Review Committee and the GAVI Working Group and others should help to inform the recommendation.
Documents Presentations
2. Update on Accelerated vaccine introduction (AVI) initiative and extension of ADIP clinical trials and WHO funding

Nina Schwalbe of the GAVI Secretariat updated the boards on the development of a strategy and support system to accelerate the uptake and sustain introduction of vaccines for rotavirus, pneumococcal and Hib. She then introduced a request to extend certain key ADIP and WHO activities, primarily related to clinical trials and communications. Discussion followed:

  • Board members thanked the Secretariat for the overall clarity and sensible recommendations provided in the report.
  • Board members emphasised that the ADIPs have been instrumental to the timely development of vaccines for rotavirus and pneumococcal, as well as the increased uptake of Hib vaccine, because they have ensured effective communications between all stakeholders. GAVI’s future system to support the development and roll-out of vaccines should continue this.
  • The final AVI proposal must clearly take into account which activities are appropriate for GAVI support and which are not, and how partners can best contribute to the effort.
  • The proposal should include well-supported cost estimates for activities proposed for GAVI funding and also indicate estimates for non-GAVI supported AVI activities.
  • In addition to rotavirus and pneumococcal conjugate vaccines, the AVI should be designed to be able to support activities for the introduction of Hib vaccines, and potentially other vaccines that GAVI will decide to support in the future.
  • The AVI proposal should also address long-term sustainability, and indicate how the activities can be supported post-GAVI.
  • The costs and activities proposed for AVI should focus on accelerated introduction. The proposals should be peer reviewed by the ADIP management committee, among others.

DECISIONS
The GAVI Alliance Executive Committee:

  1. Took note of the no-cost extension granted to Rotavirus Vaccine Programme for clinical trial activities that extend into 2010.
  2. Approved the extension of select PneumoADIP activities that extend into 2009 – 2010 and a budget of $1,583,434 for these activities.
  3. Approved the extension of select Hib Initiative activities until 2010 and a budget of $1,161,822 for these activities.
  4. Approved a budget of $1,348,200 for WHO for work plan activities to be conducted in the second half of 2008.
Documents Presentations
3. IRC report and recommendations (new proposals)

Dr. Ciro de Quadros, Chair of the Independent Review Committee (IRC) team for new proposals introduced the recommendations of the IRC from its March 2008 review, including several recommendations on GAVI policies. Discussion followed:

  • Although the IRC recommends that GAVI evaluate the impact of new vaccines such as rotavirus and pneumococcal on country cold chain systems and capacity, it should be noted that all the countries recommended for approval during this review have provided information stating they have sufficient capacity to introduce their requested vaccines.
  • Industry groups from both industrialised and developing countries are aware of and willing to address the issue of supplier capacity to meet demand for rotavirus vaccine. A reliable assessment of this demand will be the most important step to ensuring that supplier capacity is adequate.
  • Partners have been heavily involved in briefing the IRC on new developments in systems and supply issues, and have clearly taken IRC comments and recommendations into account in their work. The IRC feels that this collaborative relationship with partners is helping to increase GAVI’s responsiveness to country needs.

DECISIONS
The GAVI Alliance Executive Committee:

  1. Endorsed budgets for multi-year programmes for New Vaccine Supply totalling: US$ 205,017,500 (including budgets for non-vaccine costs of vaccine introduction totalling: US$ 2,650,000).
  2. Endorsed budgets for multi-year programmes for Immunisation Services Support totalling: US$ 1,204,000.
Documents Presentations
4. Cash management plan

Kevin Grant of the GAVI fund provided an overview of the cash management plan, which provides a comprehensive picture of GAVI’s multi-year programme endorsements, and financial liabilities to countries. Discussion followed:

  • Although timing on disbursements may vary slightly based on modifications to a country’s programme, multi-year country budgets tend to provide a relatively accurate reflection of the total amount that will be disbursed for each country and programme.
  • Authorized the transfer of up to $25 million for pentavalent procurement
Documents Presentations
5. Any other business

Kevin Grant of the GAVI Fund introduced a request for additional financing to fund pentavalent procurement. Lisa Jacobs of the GAVI Secretariat introduced a budget request for “Civil Society Organisation type A funding.” Discussion followed:

  • Board members urged a more proactive approach to promoting CSO type A support to countries, emphasising that involvement of civil society organisations will be critical to the strengthening of country health systems.
  • Endorsed the process to review country requests for “CSO type A support”
  • Approved a budget of $1.2 million for “CSO type A funding” for 2008 and delegate to management authority to disburse funds, based on the above process.
  • Authorised the transfer of up to $25 million for pentavalent procurement account.

DECISIONS
The GAVI Alliance Executive Committee:

  1. Took note of the no-cost extension granted to Rotavirus Vaccine Programme for clinical trial activities that extend into 2010.
  2. Approved the extension of select PneumoADIP activities that extend into 2009 – 2010 and a budget of $1,583,434 for these activities.
  3. Approved the extension of select Hib Initiative activities until 2010 and a budget of $1,161,822 for these activities.
  4. Approved a budget of $1,348,200 for WHO for work plan activities to be conducted in the second half of 2008.
Documents Presentations
6. Executive Session

Executive Committee members discussed the following issues during executive session:

  • Future operations of the US entity: The Executive Secretary presented three options for the entity required in the US to allow continued private sector operations. Executive committee members endorsed the management preferred second option (independent but closely affiliated US entity for private philanthropy), subject to legal clarification on option 3, the ability of the Foundation alone to continue fund raising, though that would be weighed against the likelihood of this being an effective solution given the US fund raising base and that there be accountability for staff through the Alliance CEO.  [NOTE: Both GAVI Fund and the multilaterals’ external legal counsel have subsequently confirmed that foreign 501c3 organisations cannot give tax deductions to US citizens, implying significantly reduced capacity to raise funds from private US sources.]
  • UNICEF Audit: The Executive Secretary updated the Executive Committee on the audit status. Twenty-four out of 27 recommendations are now closed. Of the three open recommendations, those recommendations relating to governance will be dealt with by the new governance arrangements, as previously agreed by the Board. Those relating to hospitality and travel exceptions are handled by a log of exceptions open to board members. The Alliance Executive Committee Chair noted that this was the same as the arrangements for the Global Fund to Fight AIDS, Tuberculosis and Malaria. The Chairs of the Boards and the Audit and Finance Committee have been informed of progress. The Executive Secretary noted the professionalism and thoroughness of the UNICEF auditors that had helped address and strengthen internal controls to the benefit of the Alliance, and the new Foundation. The Executive Secretary also informed the Executive Committee of UNICEF's intention to undertake an exit audit at the end of the hosting arrangements.  The Executive Committees noted and welcomed the update.
  • PAHO: The Executive Secretary updated committee members on discussions with PAHO on vaccine pricing and access to GAVI support by middle income countries, noting that discussions were ongoing. The Executive Committees confirmed that GAVI should pay no more for vaccines and supplies than prices offered to UNICEF, stressing the importance of tiered pricing to ensure that vaccines remain affordable to the poorest countries.  The Executive Secretary agreed to keep the Executive Committees and Boards informed. Paper(s) related to eligibility, pricing etc. would be presented in due course.
  • The Executive Secretary noted the extent to which GAVI Work Plan and other funding currently flows to multilateral partners. Executive Committee members noted that this amount was likely to at least triple between 2008/2009. Whilst there is no fundamental question that funds could and should flow to a broad group of Alliance partners, the Executive Secretary was asked to come back to the boards with a proposal to improve the availability of robust and independent scrutiny. The future combined Alliance Board is likely to be better placed to ensure continuing and improved transparency and accountability on GAVI funding to the multilateral and other partners and stakeholders.