Gavi Needs a New Playbook to Deliver Impact in a Changing World

Since its launch in 2000, Gavi, the Vaccine Alliance, has leveraged three primary levers to expand equitable vaccine access in lower-income countries. First, Gavi supports introductions of new and underused vaccines. Second, Gavi helps scale equitable immunization coverage rates. Third, Gavi uses an income-based eligibility model to target support to specific geographies. 

Gavi’s future impact will continue to depend on how well it delivers across these primary levers. But disruptions on the horizon are exerting pressure on Gavi’s ability to deliver results and value for money in a rapidly shifting global landscape.

In a new CGD policy paper, released today, we call for a new playbook for Gavi to leverage its strengths, mitigate the impacts of disruptions, and remain fit-for-purpose in a changing world. (The paper was first posted in draft form last month and has been revised to incorporate feedback.) Below, we summarize the trends disrupting Gavi’s model and propose seven policy recommendations for Gavi’s board to adjust its approach in the upcoming 2026–2030 strategic period (known as “Gavi 6.0”).

Disruptions on the horizon

Several challenges are exerting pressure on Gavi’s current model, with important implications for its ability to deliver progress towards its mission.

Disruptions to vaccine introductions

Several challenges could undermine Gavi’s core strength in vaccine introductions if not adequately addressed. First, novel vaccines against high burden infectious diseases—such as tuberculosis—are projected to become available soon (see Figure 1), underscoring the need for Gavi and Alliance partners to lay the groundwork now to enable future successful launches.

Figure 1. Anticipated launch of first candidate per vaccine type in the pipeline

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Second, the growing portfolio of new—and potentially more expensive—vaccines will likely create additional challenges for countries already facing fiscal constraints.

Third, drawing from the experience of vaccine nationalism during the COVID-19 pandemic, countries in Africa and elsewhere are amplifying calls for regionally diversified manufacturing, regional procurement mechanisms, and greater power in global alliances.

Finally, the evolving global health architecture and rapidly shifting development landscape is reinforcing the need for greater alignment among global health mechanisms to maximize efficiency.

Disruptions to increasing equitable immunization coverage at scale

Gavi has historically struggled to effectively deliver vaccines in fragile and conflict-affected countries, which already constitute a near-majority of Gavi-eligible countries (25/54; 46 percent; see Figure 2)—including more than half of countries in the initial self-financing stage (17/28; 61 percent).

With an increasing prevalence of forced displacement, conflict, and instability, Gavi’s ability to revamp its approach in these settings will be critical to reach un-and under-immunized communities.

Figure 2. Breakdown of Gavi eligible countries by the World Bank’s conflict and fragility classification

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To date, Gavi’s support to address immunization delivery, including through health systems strengthening investments, has been small-scale, specific results have been difficult to parse, and support has been slow to disburse and channeled through international partners. Critical gaps in delivery infrastructure will continue to hamper efforts to expand vaccine coverage going forward.

Disruptions to the eligibility model

According to new CGD research, Gavi’s current GNI-based eligibility criteria does not adequately reflect countries’ ability to pay and is also not a good proxy for transition readiness based on countries’ capabilities across different health system functions. Additionally, the current approach does not align well with the burden of diseases, such as tuberculosis and HIV, for which vaccines may soon be available.

Further, former Gavi-eligible and never Gavi-eligible middle-income countries are already home to the highest concentration of un- and under-immunized populations (see Figure 3). And this trend is increasing.

Figure 3. Number of zero-dose children in 2021

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Next steps for Gavi

We offer seven policy recommendations for Gavi’s board to leverage Gavi’s strengths, mitigate the impacts of disruptions associated with the three levers, and enable greater agility and effectiveness in the next strategic period and beyond.

Tune in here to the CGD virtual event that builds on this analysis.