The Board of Gavi, the Vaccine Alliance today announced a series of decisions that will help lower-income countries tackle backsliding from the COVID-19 pandemic and be better prepared to respond toUS future health emergencies. The decisions were taken during a two-day meeting hosted by the Government of Ghana in Accra, Ghana, from 6-7 December.

Concrete action in support of African vaccine manufacturing, future pandemic response

Following more than 18 months of close collaboration between Gavi, the African Union and Africa CDC, the Board today approved the establishment of the African Vaccine Manufacturing Accelerator (AVMA). AVMA is an innovative financing mechanism aimed at establishing a sustainable African vaccine manufacturing industry capable of improving the region’s resilience in the face of pandemics, outbreaks and other health emergencies as well as the health of global vaccine markets. AVMA was designed through an extensive consultation process that involved partners, donors, industry, civil society, and others.

Gavi, as one of the largest purchasers of vaccines in the world, is thus sending a powerful signal to global markets that it will support African vaccine manufacturing. AVMA aims to make up to US$ 1 billion available to manufacturers at key moments in the development process as a way of helping offset high start-up costs and provide assurance of demand. By focusing on “priority” antigens, product profiles, and vaccine platforms, as well as constructing clear incentives for both “fill and finish” and drug substance production, AVMA will also support global vaccine markets by targeting clear unmet needs and help establish a thriving, sustainable, end-to-end African vaccine manufacturing ecosystem.

AVMA is the final pillar of Gavi’s regional manufacturing strategy, with the first three pillars approved by the Board in December 2022. With this Board approval, Gavi can now consult widely on the final operational framework for AVMA, including the establishment of an inclusive steering committee, and processes for governance, monitoring and course-correcting as needed. These final pieces will be reviewed by the Board in June 2024, following which AVMA will be officially launched in that same month during an event co-hosted by France and Africa CDC, alongside with European and international partners.

Building even further on the theme of ensuring learnings from the COVID-19 pandemic are met with concrete actions, the Board also approved a US$ 500 million investment in a First Response Fund, part of a broader Day Zero Financing Facility, to ensure financing is immediately available from the start of a future pandemic. This decision responds to one of the challenges of the COVID-19 pandemic, where it took time to fundraise in support of the effort to ensure equitable access to vaccines, slowing down the ability to respond quickly to countries’ needs, and contributing to vaccine inequity.

This investment is combined with Board approval to dedicate US$22 million to support pandemic prevention, preparedness and response activities across a broad coalition of vaccine-related partners and processes, including countries, civil society, strengthening immunisation and outbreak response activities, and aligning with international pandemic-related deliberations and mechanisms. This effort seeks to ensure a coordinated playbook for potential pandemic response, coverage of any gaps, and increased transparency and knowledge sharing across the full ecosystem. This Board decision will help create an inclusive approach, ahead of a potential future emergency, to ensuring all partners are ready to contribute in a coordinated response.

“Today’s historic decisions illustrate the very best of our Alliance – collaboration across the full range of immunisation partners, constantly seeking to learn and improve, and most importantly, taking concrete action,” said Professor José Manuel Barroso, Chair of the Gavi Board. “Gavi has worked closely with the countries, the African Union, Africa CDC, G7, G20, and other donors, WHO, UNICEF, civil society, industry, and experts to put into place innovative mechanisms that have the power to reshape our approach to regional manufacturing and pandemic response, and we are grateful for the continued commitment of our Board to the effort to ensure no one is left behind with immunisation.”

Supporting countries to recover from the COVID-19 pandemic

Gavi’s Board also recognized the need for exceptional support to countries to close immunity gaps created during the COVID-19 pandemic, approving an initial amount of US$290 million to provide fully funded doses to help countries “catch-up” children who missed routine vaccinations. The amount approved is an initial estimate and is likely to evolve as countries finalise their plans. Given the urgent and one-time nature of this push, the Board recommended a permissive approach that waives country co-financing requirements, but strongly emphasized the need for robust country plans with risk mitigation measures including assessments of in-country vaccine stocks, phased supply to avoid wastage, and strengthened Alliance capacity to provide technical support.
Funding for AVMA, the First Response Fund, supporting a pandemic ready coalition of vaccine partners, and routine immunisation catch up activities is planned to be secured from COVID-19 savings available through the Gavi COVAX AMC’s Pandemic Vaccine Pool, and has been extensively discussed with the donors to this mechanism.

Expanding access to new vaccines

The Board approved the inclusion of the new multivalent meningococcal conjugate vaccine (MMCV) into the Gavi portfolio, which means at-risk countries will now be able to conduct mass preventive campaigns against multiple strains of meningococcal meningitis and then introduce the vaccine into routine programmes. Gavi has already helped countries to conduct outbreak response, preventive campaigns and routine vaccinations with the meningococcal A conjugate vaccine, leading to the near elimination of meningitis A outbreaks – a remarkable achievement. The new vaccine will help countries protect against additional strains before they become a larger issue, particularly significant as countries deal with an increasing number of outbreaks of several infectious diseases. Both vaccines are currently available for use in the Gavi-funded global emergency stockpile of meningitis vaccines.

The Board also confirmed the proposed shortlist for Gavi’s 2024 Vaccine Investment Strategy, which will determine the new vaccines that the Alliance plans to introduce over the next strategic period from 2026-2030. The shortlist includes vaccines against tuberculosis (TB), group B strep, shigella, dengue, and potentially continued support for COVID-19, as well as the establishment of a stockpile for vaccines against hepatitis-E. The Board also approved the exploration of a learning agenda for vaccines against chikungunya and mpox, where Gavi will work with partners to continue to monitor the epidemiological situation. This Board decision now allows Gavi to work with partners to develop investment cases related to these vaccines, which will come back to the Board for approval in 2024.

“These decisions allow our Alliance to continue to execute on our core mission, expanding access to lifesaving vaccines,” said David Marlow, CEO of Gavi, the Vaccine Alliance. “Gavi can now make these new innovations available to the lower-income countries that need them the most, helping protect millions more against deadly infectious diseases.”

Following extensive country and partner consultations throughout 2023, the Board also met on the sidelines of the formal meeting to discuss the design of the Alliance’s next five-year strategic period. The consultation process will continue through the first half of 2024, with the final strategy discussed for approval in the first half of US2024. This strategy will inform the investment case for Gavi’s replenishment, which will seek to raise funds in support of the Alliance’s work during the 2026 to 2030 strategic period.

France and Africa CDC to host high level event in support of Gavi replenishment, AVMA launch

At the Board meeting, the representative of the Government of France, on behalf of President Emmanuel Macron, announced that France, alongside with its African, European and international partners, will co-host a high level event in France in June 2024 for the official launch of the African Vaccine Manufacturing Accelerator. Dr Jean Kaseya, Director General, Africa CDC, subsequently announced that Africa CDC will co-host the event. The representative of the Government of France also announced that France, on this occasion, will host the launching of Gavi’s investment case, in support of its replenishment, which will raise funds for immunisation in lower-income countries for the 2026 to 2030 strategic period.

“France is honored to co-host, together with our African, European and international partners, a high-level event to take place in France in June 2024 to celebrate the collective success of Gavi and AVMA. Learning lessons from the Covid-19 pandemic, building health sovereignty in support of partners’ regional production agenda, and achieving vaccine equity must remain our top priorities On this occasion, we will be thrilled to support Gavi’s leadership and unique contribution to global health by launching its 2026-2030 investment case,” said Chrysoula Zacharopoulou, French State Minister for Development, Francophonie, and International Partnerships

Appointments and Process Updates

• Omar Abdi, Deputy Executive Director for Programmes at UNICEF, was appointed Vice-Chair of the Board, replacing Sarah Goulding, Assistant Secretary and Principal Specialist, Gender Equality, Department of Foreign Affairs and Trade (DFAT), Australia