Lessons learnt from the Accelerated Vaccine Introduction (AVI) Project (published 2012)
This report presents the findings and lessons learnt from a review of the AVI project undertaken by Cambridge Economic Policy Associates for GAVI. The AVI initiative was established in 2008 with two core goals to be achieved over the period 2009-2015:
(i) broaden and speed-up access to rotavirus and pneumococcal vaccines;
(ii) create a platform for introducing other new vaccines.
The initiative was established to build on and implement the work started by the Accelerated Development and Introduction Plans for rotavirus and pneumococcal vaccines and the Hib initiative. The AVI is hosted within the GAVI Secretariat and its activities are delivered through its Partners – WHO, UNICEF and the Bill & Melinda Gates Foundation as an observer – and a competitively selected outsourced entity AVI Technical Assistance Consortium.
The objectives of this review were to:
- review the achievements of the AVI initiative to date;
- assess the effectiveness and value-added of the AVI design in the context of the GAVI Alliance Strategy 2011-15 and the current governance structure;
- identify the strengths and weaknesses of the model, document lessons learnt, and provide options for improvement; and
- consider potential applications of the model to other areas of GAVI’s work, such as Health Systems Strengthening.
CEPA used a mixed methods approach to this review. This included a desk based review and analysis; extensive stakeholder consultations (including a short email questionnaire on AVI value added to the AVI Management Team members); some quantitative analysis; and a comparison with a matrix management model.
The review underscores the added value of the AVI in terms of:
(i) providing a needed coordination and communication platform amongst the Partners and the GAVI Secretariat;
(ii) enhancing the focus and priority placed on this important set of activities. Further, the initiative is unique in its attempt to identify, cost and house all of the necessary activities related to vaccine introduction across countries, in a single framework.
Despite difficulties, which are outlined in the report, the AVI initiative has succeeded in delivering many important activities necessary for accelerating vaccine introduction in countries. Planned country introductions of pneumococcal and rotavirus vaccines have surpassed the original AVI targets, even if it is difficult to identify and isolate the contribution of AVI specifically.
The key lessons learnt from this review are that any future model for supporting new vaccine introduction should have, as a minimum, the following attributes:
- clarity and agreement on the concept and scope, ideally documented in (i) concept note and strategy; (ii) costed multi-year work plan and budget; and (iii) results framework;
- better defined terms of reference for the management team and its components, including roles and responsibilities for the Partners and entities to whom aspects of the work is outsourced;
- agreed management and decision-making process, accountability and reporting lines;
- sufficient resources to manage and deliver the work; and
- methods for sharing information and improving transparency of its activities across Partners and the wider Alliance stakeholders.