Increase predictability & sustainability
Predictable and sustainable financing for immunisation programmes is at the core of the GAVI model.
Total resources mobilised to meet country demand (US$ millions)
In 2012, GAVI mobilised 100% of the resources required to finance country demand for GAVI support.GAVI Alliance, 2013
Signed grant agreements vs total pledges, 2011–2015 (US$ millions)
By the end of 2012, 91% of the donor pledges made for the period 2011–2015 had been signed as formal grant agreements.GAVI Alliance, 2013
Country investments in vaccines Average expenditure per child (US$)
This indicator measures the level of national financing made available for immunisation. The 2010 baseline value was revised in 2012 in order to ensure consistent methodologies across the years.WHO/UNICEF Joint Reporting Form and country annual progress reports 2012
Fulfilment of co-financing commitments Proportion of countries (%)
In 2012, 86% of countries required to co-finance met their commitments in a timely manner. While nine countries failed to meet all their commitments in 2012, only two did not make any contribution towards co-financing during the year.UNICEF Supply Division and the PAHO Revolving Fund, 2013
In 2012, GAVI continued to work towards securing the long-term sustainability of its programmes and to diversify its sources of funding.
During the year, GAVI continued to implement its co-financing policy, a vital part of its efforts to build country ownership and ensure the long-term sustainability of vaccine programmes. The Alliance also worked to ensure continued funding from existing donors, as well as to explore potential new sources of funding.
Involvement of the private sector is essential to GAVI’s bid to deliver funding for immunisation programmes. Matching Fund secured the support of four additional private-sector partners: the Children’s Investment Fund Foundation (CIFF), Comic Relief, LDS Charities and Vodafone.
Innovative finance mechanisms also help GAVI to secure predictable financing. By the end of 2012, the International Finance Facility for Immunisation (IFFIm) had raised US$ 3.7 billion on the capital markets. Through the Advance Market Commitment (AMC), 24 countries had embarked on the introduction of pneumococcal vaccines by the end of 2012.
Co-financing: promoting ownership and sustainability
The financing of GAVI-supported vaccines relies on a partnership between donors and implementing countries. Sharing the cost of vaccines promotes country ownership and helps to ensure that national immunisation programmes are sustained after GAVI support has ended.
Co-payments are determined by each country’s ability to pay for new vaccines. Low-income countries contribute the least, US$ 0.20 per dose, while intermediate countries increase their payments by 15% per year. Graduating countries are expected to take over the full cost of their vaccines after five years of incrementally increasing their contributions.
Of the 65 countries required to co-finance their vaccines in 2012, 56 had fulfilled their commitments by the year-end.
Of the nine countries that were in default in their payments, only two did not make any contribution towards their co-financing costs during the year. The remaining seven paid arrears from the previous year and/or made part payments towards their 2012 requirement.
Three highly committed countries chose to start co-financing their vaccines before the mandatory starting date, and many others are co-financing at higher levels than the minimum requirement.
Funds transferred by countries towards their co-financing commitments amounted to approximately US$ 47 million in 2012, accounting for 8% of the total value of vaccine support to the co-financing countries.
Preparing for graduation from GAVI support
Alliance partners are working in a variety of ways to assist graduating countries on their path to financial independence. In addition to regularly monitoring their co-financing performance, GAVI helps countries to identify bottlenecks that could hamper the graduation process and to secure continued access to low-priced vaccines after GAVI support has ended.
A 2010 fiscal space analysis confirmed that most graduating countries are in a position to assume the full cost of vaccines introduced with GAVI support. This form of analysis monitors changes in countries’ ability to pay for vaccines and identifies countries that may need more assistance.
In 2012, GAVI and its partners developed transition plans together with five graduating countries: Bhutan, the Congo, Georgia, Mongolia and the Republic of Moldova. While all five countries have favourable economic growth and should be able to take on the full cost of their vaccines, each will receive support from Alliance partners to develop comprehensive cost projections and arguments to help their ministries of health advocate for appropriate levels of investment for immunisation.
Transition plans are tailored to the needs of each country. For instance, in Bhutan the GAVI Alliance is assisting the Government to improve the management and bolster the capacity of the Bhutan Health Trust Fund, launched in 1998 to support the country’s vaccine programmes. If the recommendations are implemented, the Health Trust Fund is expected to be able to finance all current and future vaccines in the country’s routine immunisation programme.
Also in 2012, a new partnership was initiated with the African Development Bank to strengthen national capacity for more informed value-for-money investments in health. Further, GAVI initiated a new programme with the Sabin Institute to support advocacy for immunisation financing with parliamentarians.
GAVI’s 2012 funding base
GAVI’s 2012 funding base
Donor funding to GAVI amounted to US$ 1.23 billion in 2012, bringing the total amount of funding received by GAVI since its inception in 2000 to US$ 7.64 billion.
Direct and GAVI Matching Fund contributions
In 2012, direct contributions received from 15 donor governments (Australia, Canada, Denmark, France, Germany, Ireland, Japan, Luxembourg, the Netherlands, Norway, the Republic of Korea, Spain, Sweden, the UK and the USA) and the European Commission amounted to US$ 615.2 million. This means that the cumulative value of direct contributions received from national governments and the European Commission totalled US$ 3.15 billion for the period 2000–2012.
Foundations, private individuals and organisations contributed a further US$ 292.8 million to GAVI in 2012. GAVI received contributions from the Bill & Melinda Gates Foundation (US$ 268.8 million) and His Highness Sheikh Mohamed bin Zayed Al Nahyan (US$ 8.8 million). GAVI also received Matching Fund commitments from Absolute Return for Kids, Anglo American, “la Caixa” Foundation, the Children’s Investment Fund Foundation, Comic Relief, J.P. Morgan, LDS Charities and Vodafone. The cumulative value of private-sector contributions for 2000–2012 was US$ 1.82 billion.
GAVI drew down US$ 100 million in IFFIm funds in 2012, bringing the cumulative total funds received from IFFIm for 2006–2012 to US$ 2.3 billion. The UK, France, Italy, Norway, Australia, Spain, the Netherlands, Sweden and South Africa have all contributed to IFFIm.
Italy, the UK, Canada, the Russian Federation, the Bill & Melinda Gates Foundation and Norway have collectively pledged US$ 1.5 billion towards the AMC for pneumococcal vaccines. By the end of 2012, GAVI had received a total of US$395 million in AMC funds via the World Bank, US$ 224 million of which was received in 2012.
Increasing predictability and diversifying sources of funding
GAVI relies on the strong support of its donors to secure predictable and stable financing for national immunisation programmes. Securing sufficient resources also involves ensuring domestic funding and making savings through lower vaccine prices. GAVI’s co-financing policy requires countries to contribute a share of their vaccine costs, and market-shaping activities are aimed at minimising vaccine prices.
In line with the long-term funding strategy approved by the Board in 2012, GAVI is stepping up its efforts to broaden the donor base while ensuring continued support from existing donors. By approaching new public and private donors and developing new partnerships in Asia, the Middle East and among emerging economies such as Brazil, China, India, the Russian Federation and South Africa, GAVI is accelerating efforts to diversify its sources of funding.
During the year, a number of donors increased their contributions to GAVI. For instance, Sweden increased its 2012 commitment from US$ 37 million to US$ 55.5 million, and the OPEC Fund for International Development approved its first pledge of US$ 1.1 million in December 2012. The USA, which launched the Child Survival Call to Action initiative in June, increased its contribution from US$ 89.8 million in 2011 to US$ 130 million in 2012.
Predictable funding is essential to enable countries to plan and maintain their immunisation programmes, and to maximise the scope and impact of GAVI’s market-shaping activities. Norway joined other key donors in signing its first long-term direct agreement with GAVI in 2012, guaranteeing funding for the Alliance until 2015.
Building political support for the GAVI mission
In 2012, GAVI made important strides in mobilising political support for its mission. At the Partners’ Forum meeting held in December in Dar-es-Salaam, 17 members of parliament from across the world signed a declaration highlighting the importance of bipartisan support for global health and immunisation.
The UK All-Party Parliamentary Group (APPG) for Child Health and Vaccine Preventable Diseases helped to raise the profile of immunisation and development. It actively reached out to new members in the UK and to parliamentary counterparts in Europe with similar interests. In 2012, the APPG also met with developing country parliamentarians to advocate for greater commitment to increasing immunisation coverage and securing sustainable funding for immunisation.
In addition, several members of the European Parliament, Mary Honeyball, Seán Kelly, Véronique De Keyser, Bill Newton-Dunn and Marie-Christine Vergiat, launched a written declaration calling for the European Commission to increase its commitment to reducing the number of vaccine-preventable deaths in its future development assistance priorities.
GAVI reached out to current and potential partners in the Asia-Pacific region at the Asia-Pacific Development Summit in Jakarta, and led a high-profile panel discussion at the World Bank/International Monetary Fund annual meeting in Tokyo to engage ministers of finance on the economic benefits of immunisation. Both events provided useful opportunities to showcase the value of immunisation and GAVI’s public-private partnership model.
Accountability: top marks to GAVI for results and effectiveness
Based on its ability to deliver cost-effective results with a measurable life-saving impact, GAVI was ranked among the world’s top performers by the Australian Multilateral Assessment, published in March 2012. The Australian Government rated GAVI’s performance as either “strong” or “very strong” in seven categories, including strategic management, transparency, cost and value consciousness, partnership behaviour, delivering results and contributing to multilateralism.
A review conducted by the Multilateral Organisation Performance Assessment Network (MOPAN), a network of 17 donors, also commended GAVI for its effectiveness in increasing access to immunisation and for its results-oriented focus. The review, which was MOPAN’s first assessment of a global fund, positioned GAVI as one of the highest rated institutions. Among the organisation’s strengths, the review identified financial management, accountability checks, country ownership and relationship management. It also highlighted GAVI’s profile as a continuously learning organisation.
Similar evaluations have been conducted in recent years by the Swedish and UK governments; both gave GAVI top scores.
In 2012, GAVI improved its position in the “Publish What You Fund” transparency index by 28 percentage points, claiming 13th place – up from 35th in 2011. This index ranks 72 aid organisations across the world on the availability, accessibility and comparability of the information they publish about foreign aid.
With an overall score of 62%, GAVI was congratulated on its “publication of high quality, current activity data” and was called upon “to continue to lead on aid transparency”.
A review of progress and challenges since GAVI’s successful pledging conference in 2011 will be hosted by Sweden in October 2013.
GAVI’s innovative finance initiatives play an important role in helping the Alliance to secure long-term funding for immunisation and health system strengthening programmes. GAVI has pioneered three innovative finance mechanisms: the International Finance Facility for Immunisation (IFFIm), the Advance Market Commitment (AMC) and the latest addition, the GAVI Matching Fund.
These programmes help GAVI increase the predictability, visibility and sustainability of financing for immunisation. This speeds the introduction and expansion of vaccine programmes, makes GAVI’s work more efficient and ultimately helps to save more lives.
IFFIm: flexible financing provides funds when needed
IFFIm uses long-term donor pledges to issue vaccine bonds on the capital markets. The money raised from investors helps fund GAVI programmes to meet immediate country demand for vaccines.
IFFIm has raised US$ 3.7 billion from investors, helping GAVI shift through time predictable funding from IFFIm’s donors: the UK, France, Italy, Norway, Australia, Spain, the Netherlands, Sweden and South Africa.
This flexibility enhances the efficiency of GAVI’s operations and provides predictability for countries’ vaccine programmes. These attributes were cited by an independent evaluation of IFFIm that was published in 2011.
With the World Bank as its treasury manager, IFFIm continued its work in 2012. It maintained good access to the Japanese capital markets and raised US$137 million, despite a change in rating by Standard & Poor’s to AA+ from AAA. IFFIm’s AAA/Aaa ratings were reconfirmed by Fitch and Moody’s Investor Service as of the end of 2012.World Bank, 2012
New IFFIm Chair
New IFFIm Chair focused on diversification of donors and markets
In February 2012, René Karsenti, President of the International Capital Market Association, took up his position as IFFIm Board Chair, replacing the first Chair, Alan Gillespie. Karsenti brings to the post a wealth of experience in both the financial markets and global development. With the support of the GAVI Alliance Board, he sees IFFIm as an important cornerstone of GAVI’s long-term funding strategy.
One of IFFIm’s unique features is that it uses the capital markets to aid global development, and as such offers investors a socially-responsible investment opportunity.
IFFIm’s reputation in this market is growing: EuroWeek magazine announced that IFFIm’s 2008 inaugural “uridashi” bond issue in Japan was among the 25 most influential bond market deals of the past five years, helping to set a trend of ethically-themed bonds sold in Japan. To date, Japanese private retail investors have purchased the equivalent of US$ 2 billion in IFFIm bonds.
The GAVI Matching Fund: private- sector expertise, funds, advocacy
The GAVI Matching Fund gives businesses and foundations an opportunity to help GAVI fulfil its mission by bringing their resources to bear on immunisation programmes.
Under the initiative, the UK Government and the Bill & Melinda Gates Foundation have collectively pledged approximately US$ 130 million to match contributions from corporations, foundations, their customers, employees and business partners.
By the end of 2012, the GAVI Matching Fund had attracted eight partners: Absolute Return for Kids (ARK), Anglo American, the Children’s Investment Fund Foundation, Comic Relief, J.P. Morgan, the “la Caixa” Foundation, LDS Charities and Vodafone. Together, they helped raise US$ 78 million for GAVI immunisation programmes, almost a third of the way to realising the GAVI Matching Fund’s end-2015 goal. In early 2013, GAVI announced a ninth partner, the Dutch Postcode Lottery.
Private-sector involvement secures not just financial contributions, but also core business skills and products, such as supply chain expertise, technology and advocacy, to help GAVI overcome roadblocks in providing vaccines to the world’s poorest children and to enhance the efficiency of GAVI’s operations.
New partners bring new skills to support GAVI’s mission
GAVI Matching Fund partners help GAVI to increase efficiency and provide visibility to the cause of immunisation. This benefit is highlighted by three of the partners who joined the GAVI Matching Fund in 2012:
Vodafone is one of the world’s largest mobile communications companies and the GAVI Matching Fund’s first in-kind participant. Together, GAVI and Vodafone are exploring how mobile technology can help healthcare providers increase the take-up of vaccinations by, for example, updating health records and sending targeted alerts and reminders to parents and caregivers by mobile phone.
Comic Relief, a UK-based charity that funds GAVI and fights poverty and social injustice through entertainment, featured immunisation throughout its Sport Relief fund-raising campaign in 2012, including during a BBC telethon viewed by 6 million people. It also worked with its partner British Airways to make a seatback video shown on British Airways flights since autumn 2012 through to its Red Nose Day fund-raising campaign in spring 2013.
LDS Charities, the volunteer-driven relief arm of The Church of Jesus Christ of Latter-day Saints, supported the double roll-out of rotavirus and pneumococcal vaccines in Ghana in 2012 by arranging for 1.5 million text messages to be sent in support of the roll-outs. This was made possible through the efforts of 1,684 volunteers, who also distributed fliers throughout neighbourhoods. LDS Charities also funds GAVI programmes.
AMC the right vaccines
AMC: the right vaccines, at the right price, at the right time
The pneumococcal AMC was set up in 2009 to stimulate the supply of affordable pneumococcal vaccines adapted to the specific needs of developing countries. Long-term funding commitments from donors are used to guarantee the price of a share of the doses sold through the AMC, thus providing manufacturers with the incentive to invest in vaccine development and production capacity. In exchange, manufacturers sign legally-binding commitments to supply the vaccines at a reduced price for developing countries for at least 10 years.
GAVI, through the AMC, only funds pneumococcal vaccines that meet stringent criteria defined by an independent group of experts. For instance, manufacturers participating in the AMC must provide vaccines that offer protection against the most deadly disease strains that are prevalent in GAVI-supported countries.
As a consequence of unprecedented demand, GAVI faces short-term constraints in the supply of pneumococcal vaccines. In August 2012, UNICEF issued a new tender for pneumococcal vaccines under the AMC, which will be concluded in early 2013. This will help increase supply availability to better meet country demand.
By the end of the year, 24 GAVI-supported countries had started introducing pneumococcal vaccines as part of their routine immunisation programmes. By 2020, pneumococcal vaccines supplied through the AMC are expected to hae averted up to 1.5 million future deaths. An independent process and design evaluation of the AMC was carried out in 2012.