Gavi Judith Kallenberg, Head of Policy Duke Global Health Fellows 6 July 2016

Accelerate equitable uptake and coverage of vaccines Increase effectiveness & efficiency of immunisation delivery as integrated part of strengthened health systems Improve sustainability of national immunisation programmes Shape markets for vaccines and other immunisation products To save children’s lives and protect people’s health by increasing equitable use of vaccines in lower- income countries MISSION AND STRATEGIC GOALS 2016– #vaccineswork

Gavi supports 73 countries, reaching ~80 million children per year Since 2000: 500,000,000 children immunized 7,000,000 future deaths averted

As economies grow, governments pay increasing share of vaccine costs US $0.20/dose (flat rate) Annual increase by 15% Increase to full financing Access to Gavi tenders (5 yrs) Eligibility threshold WB Low-Income Country threshold End of Gavi financing

Gavi-supported vaccines 5 Refers to the first Gavi-supported introduction of each vaccine. * Contribution towards cholera vaccine stockpile for outbreak response *

Gavi-funded vaccine uptake Number of national introductions or campaigns 6 #vaccineswork *Five countries have introduced pentavalent vaccine independently of Gavi financing. **Gavi has supported introductions of rubella vaccine into the routine systems in Lao People’s Democratic Republic and Nepal through vaccine introduction grants. Source: Gavi data as of 31 December 2015.

7 Vaccine introductions and campaigns in 2014

Vaccine Investment Strategy (VIS) Evidence-based approach to identifying new vaccines for Gavi support Evidence review, analyses, stakeholder consultations, independent expert advice Enabling predictable vaccine programming and investment decisions (rather than first-come-first-serve) Ensuring predictability of Gavi programs to help long-term planning by countries, industry and donors 8

VIS occurs every five years, aligned with strategic cycle and replenishment 9 VIS #1 HPV Rubella JE Typhoid conj. MenA VIS #2 YF mass campaigns Cholera stockpile Rabies/cholera studies Malaria – deferred Strategic period $$$ Strategic period VIS #3 $$$ RTS,S pilots?

Looking forward to VIS #3 Scope: licensure <5 years Expected candidates for consideration Returning candidates / incremental investments: Dengue (maternal) influenza rabies PEP Hepatitis E RTS,S 10 meningococcal multivalent Cholera DTP booster Hepatitis B birth dose Typhoid PCV catch-up Norovirus? ETEC? New : RSV Group B Streptococcus Data gathering to begin in 2017

CategoryVIS CriteriaPhase I Indicator Health impact Impact on child mortality U5 future deaths averted, 2015 – 2030 U5 future deaths averted per 100,000 vaccinated population Impact on overall mortality Total future deaths averted, 2015 – 2030 Total future deaths averted per 100,000 vaccinated population Impact on overall morbidity Total future cases averted, Total future cases averted per 100,000 vaccinated population Long-term sequelae Additional impact consid- erations Epidemic potential Epidemic potential of disease Global or regional public health priorityPresence of global / regional (UN) resolution on elimination or eradication Herd immunityHerd immunity threshold Availability of alternative interventions Current use of alternative interventions for effective disease control (prevention and treatment) and potential for scale up Socio-economic inequityDisproportionate impact on poor Gender inequity Disproportionate impact on one gender Disease of regional importance Burden concentrated in a subset of GAVI countries within the same region Implement- ation feasibility Capacity and supplier baseCapacity to meet GAVI demand and # of manufacturers by 2020 GAVI market shaping potentialGAVI demand (by volume) as % of global demand Ease of supply chain integrationPacked volume (cm3) Ease of programmatic integration Alignment with other vaccine schedules and significant change in health worker practices/behavior required Vaccine efficacy and safety Vaccine efficacy (as defined by clinical endpoints) and safety Cost and value for money Vaccine procurement cost 1 Total procurement cost to GAVI and countries, In-country operational costIncremental in-country operational costs per vaccinated person Procurement cost per event averted 2 Procurement cost per death / case averted Evaluation indicators (VIS 2013) 1. Procurement cost includes vaccine, syringe, safety box, and freight 2. Scoring based on cost per future death averted

Key policy questions for Gavi Outbreak response & stockpiles Countries in crisis / fragile settings Environmental sustainability 12

THANK YOU 13