CGDNOTE364|APRIL2024

OpportunitiesforaNewCompact

betweenGaviandPartnerCountries

AnastassiaDemeshkoandTomDrake

Healthaidinitscurrentformisfragmented,burdensome,andlackscountryownershipinhow

itisallocated.COVID-19stalledorset-backprogressonhealthgains;therearetighteningfiscal

pressuresonhealthforcountriesanddonors;andthereareincreasingcallstorebalancepower

dynamicsinglobalhealth.Gavi’snextstrategicperiod,knownas“Gavi6.0”,offersanopportunityto

redefinetheAlliance’sfinancingmodalitiesandrespondtothechallengesforthefutureofglobal

health;particularlyasitleadsintothe2030SustainableDevelopmentGoalsdeadline.

ThisCGDNoteoutlinesaproposalfora

NewCompact

betweenGaviandpartnercountries.We

outlineapackageofpolicyshiftsforGavitoconsider,inlinewiththecoreapproachofprioritising

countryownershipandfinancingofthehighestpriorityvaccineswhilehealthaidisprovided

atthemargin.Thesetofrelatedpolicyshiftscentreonreworkinghealthservicefinancing,and

arecomplementedbyadaptingpooledprocurement,strengtheningmarketshaping,ensuring

comprehensivecoverage,andadvancingdonorharmonisation.Aspartofthis,weoffernextstepsfor

howGavicanactontransitioningtotheNewCompactapproach.

ChallengesfacingGavianditspartnercountries

Atamacro-level,countriescontinuetorecoverfromthepandemicandrespondtoan

evolvingglobal

landscape

—growingconflictandfragility,thepolycrisisinvolvingclimatechange,anddeteriorating

macroeconomicconditions.

Publicbudgetsareunderpressure

duetoincreasingdemands,

economic

slowdowns

,and

increaseddebtrepayments

dueto

higherinterestrates

.Moreover,ministriesof

Thisnotedrawsonanin-progresspolicypaperledbyAlecMorton,JamaicaBriones,

PeteBaker,andTomDrake.ThanksalsotoJavierGuzman,JaneenMadanKeller,MorganPincombe,andOrinLevineforcomments.

healthinGavi-eligiblecountries

facetheirownchallenges

:

evolvingdemandsfromhealthsystems

,

anincreasinglycomplexburdenofdisease

,

vaccineinnovationthatrequiresnewimmunisation

platforms

,anda

fragmentedaidecosystem

whichworksagainstefficientandjoinedup

policymakingatthenationallevel.Thischallengingpoliticalandeconomiccontextmakeitdifficultforhealthaidtobedeliveredeffectively.

Developmentassistancecanhelpfillimportantgapsinhealthservicedelivery,butthereareseveralkeyissueswithcurrentpracticesthatunderminecountryeffortstowardseffective,sustainable

healthsystems.Thesehavebeendescribedmorecompletelyin

previousCGDpapers

,butinbriefinclude:fundingvolatility,aidfragmentation,thedisplacementofdomesticfinance,ineffectiveprioritization,thelackoftransitionplanning,andthelackofcountryownership.

Gaviitselffacesmultiplerelatedchallenges:funderswithnewpriorities(e.g.,ashiftfromacuteto

chronicdiseasefinancing,tighteningfiscalspacepost-COVID-19,redirectingfinancestoaddress

increasingglobalthreatsoutsideofhealth);expensivenewvaccinetechnologiesthatmayrequire

life-courseapproachestoimmunisation;andaclientbasewhichfaceslimitedopportunitiesfor

strongandsustainedeconomicgrowth.Newstrategiesforaddressingtheoutlinedchallengesfor

globaldevelopmentandhealthfinancingarecriticaltomaintainsocialandeconomicprogress.Of

note,the

FutureofGlobalHealthInitiativesprocess

hadproposedtheneedforsignificantshiftsin

currentoperatingmodelstowardsmoresustainable,country-centredeffortstodeliveringuniversalhealthcoverage,especiallyforGlobalHealthInitiatives(GHI)suchasGavi.Asaresultofthis,the

LusakaAgenda

outlinedkeyshiftsthatneedtobeacceleratedtoshapetheevolutionofGHIs.CGDhasalsoproposedpolicyrecommendationsforGavito

advanceequitableandsustainableimmunisation

inanevolvinggloballandscape

and

rethinkcountries’transitiontrajectoriesandeligibility

prospects

,giventhefiscalchallengescountriesface.

Despitedemonstratingitsabilitytoimprovehealthoutcomesthrough

leveragingvaccine

introductions,coverage,andcountryeligibility

,Gavi’sapproachneedsadaptingtomeetthe

demandsofthechallengesmentionedabove.Gavi’scurrentmodelincludes

co-financingpolicy

whichincentivisescountriestoincrementallyincreasedomesticfinancingforimmunisation,

settingcountriesonatime-boundpathtotransitionawayfromGavisupport.Undertheproposedrecommendationsforglobalinitiatives,Gaviwouldneedtorethinkthismodelofhealthservice

financingtodriveimprovementsinequitablecoverageandlong-termsystemsstrengtheningincountries.Gaviisalsoguidedby

healthsystemandimmunisationpolicy

thatcouldadapttobetterrealiseGavi’sprinciplesofcountry-driven,equity-focused,tailored-to-contexthealthsystem

strengtheningwithadditiveandcomplementarysupportforcountries.

OPPORTUNITIESFORANEWCOMPACTBETWEENGAVIANDPARTNERCOUNTRIES2

ANewCompactforfinancinghealthservices

CGDhaspreviouslyoutlinedthepossibilityofa

NewCompact

toaddresscurrentglobalhealthchallengescomprisingthreepillars:

?Locallyledevidence-informedprioritisation.Countryinstitutionsaresupportedtosethealthpriorities,drawingonrelevantavailableevidence.

?Domestic-firstresourceallocation.Countryownership,includingfinancing,ofthecorepackageofhighpriorityservices.

?Consolidatedsupplementaryaid.Donorsworktogetherandwithcountryleaderstodesignatop-uppackage,bothintermsofadditionalhealthservicesandothercross-cuttingsupport.

IntheNewCompactdomesticfinancesshouldsupportessentialhealthservicesandhealthaid

shouldprimarilybeusedtoexpandthepackageofaffordableservicesatthemargin(seeFigure1).

Insteadoftargetingthemostcost-effectiveinterventions,donorsshouldsupportcountriestohavestrongandeffectiveprioritisationprocessesanddirectanyadditionalfinancialsupportforhealthservicestothosethatwouldotherwisenotbecoveredbydomesticfunds.

Figure1.Illustrationofprioritisedhealthbenefitspackagewithaid

investmentatthemargin

OPPORTUNITIESFORANEWCOMPACTBETWEENGAVIANDPARTNERCOUNTRIES3

ThisNewCompactwouldaddresschallengestohealthaidmentionedabove,andencouragebetterplanningandprioritisationbycountriesanddonors,leadingtomoreoverallhealthforthemoney.Ascountries’healthfinancingimproves,healthaidfocusedatthemarginisnaturallycrowded

out,offeringaseamlessaidexitstrategyforthrivingcountriesandensuringthesustainabilityoffinancingforcountriesthatcontinuetoneedsupport.Perhapsmostfundamentally,theapproachempowersnationaldecisionmakersandnationalpolicyprocesses.

HowaNewCompactbetweenGaviandpartner

countriescouldwork

WhiletheaboveconceptframesaNewCompactatthecountrylevel,withasinglecountryand

multipledonors.Inthisbriefwefocusonoutliningacorrespondingsetofpolicyshiftsbutfroma

singledonorperspective,inthiscaseGavi.Here,theNewCompactwouldprioritisecountrydelivery

andfinancingofthehighestpriorityvaccinationprogrammes,asdeterminedthroughacountryled

evidence-informedprioritisationprocess(seeFigure2foranillustrationofcost-effectiveness-based

prioritisation).Alongside,Gaviwouldprovide

tailoredtechnicalassistance

toensurehighcoverageandquality,andadaptpooledprocurementplatformstosustainvalueformoneyandconsistencyofsupply.

Figure2.Illustrationofanexampleofvaccineprioritisationandfinancing

basedoncost-effectiveness

Datasources:

DALYsavertedper1000vaccinatedindividualsinLMICsbetween2000and2030;

totalvaccinatedindividuals

percountry;andtotalcostsforGaviandcountryfinancingarrangementsweregatheredfrom

Gavi’swebsite

fromdecisionlettersandpartnershipagreementsforeachcountry.Notewhilethisfiguredrawsonrealdata,itisforillustrationonly,sinceprioriti-sationwouldneedtobedoneatthecountrylevel.

OPPORTUNITIESFORANEWCOMPACTBETWEENGAVIANDPARTNERCOUNTRIES4

BuildingonthethreeprinciplesunderpinningtheNewCompactconcept,outlinedabove,Figure

3summarisesasetofpolicyshiftsgroupedintofivethemesthatGaviandpartnercountriescould

pursue.Theseare‘buildingblocks’,wherethecoreoftheNewCompactisthetopblock;Rework

HealthServiceFinancing.Ensuringcomprehensivecoverage,advancingdonorharmonisation,

adaptingpooledprocurement,andstrengtheningmarketshapingarecomplementarypolicyshiftsthatarenotstrictlynecessarytoimplementtheNewCompactfinancingchanges,butwouldsupporteffectiveimplementationandmitigatepotentialrisks.Thepolicyshiftsaredescribedinmoredetail—includingtheirspecificbenefits,challenges,andrisks—inAppendix1.

Reworkhealthservicefinancing.ThecoreelementoftheNewCompactistoreorganisevaccinefinancingbyfocusingcountryownershipofthemost-cost-effective,high-priorityvaccinesandshiftingGavifinancingtowardsthenextmostcost-effectiveservices,includingnewvaccine

introductions,aswellasothersupportingactivities.Countrieswouldprogressivelytakeoverfundingresponsibilitiesinformedbylocalpriority-settingprocesses,drawingoncost-effectivenessand

otherkindsofevidence,accordingtotheirpreferences.Thisshiftiswouldbeanaturalextension

toGavi’s

FullPortfolioPlanning(FPP)model

,adoptedaspartoftheGavi5.0strategy,whichaimstoensurethatGavisupportiscatalytic,builtuponcountryco-financingcommitments,andaligned

withnationalimmunisationpriorities.Morespecifically,countrieswouldhavefirmlyembedded

financingarrangementsforcoreserviceswhileGaviwouldfinanceor

co-finance

marginallycost-effectiveservices.Gavicouldoffertechnicalassistanceforthistransition,includingstrengtheningevidence-to-policyprocesses,

integrationofvaccinepolicyfunctionswiththewiderhealthsystem

andsupportto

improvepublicfinancialmanagement

.Tocomplementincreaseddomesticfinancing,Gaviresourcesmayberedirectedtootherprioritiestostrengthencountryhealthsystems.These

savingscanbereinvesteddomestically,allowingfortheinclusionofpreviouslyexcludedservices,expandingthescopeofprotection.

Ensurecomprehensivecoverage.EquityisanorganisingprincipleforGaviandakeyfeatureoftheNewCompact.CountriesandGavimightagreethatimplementinghighcoverageimmunisation,

includingunderservedorhardtoreachpopulations,isapriorityandGavicouldprovidetechnical

andpoliticalassistancetocountriesthroughouttheNewCompacttransitionforachievinguniversalcoverage,includingidentifying,prioritising,andmonitoringmarginalisedcommunities.Where

necessary,Gavicouldsupporttargetedverticalvaccinationtopopulationswhichpublicservicesareunabletoreach(e.g.,refugees).

Advancedonorharmonisation.TheNewCompactemphasisescountriestakingtheleadinshaping

theirhealthsystem’sdevelopment,challengingthedonorcommunitytoadjust.Toaddressduplicationandconflictsamongdonors,aligningfundingcyclesandstreamliningrequirementscouldreduce

burdenoncountries.Country-levelmulti-donorcommitteescouldenhancecoordinationlocally.

WhileGavialonecannotimplementthisagenda,itcanplayaprominentroleduetoitscredibilityandimportanceintheglobalhealthlandscape.Gavi’salignmenttocountry-levelprogressandleadershipwouldbenefitfromcountriesclearlycommunicatinglocaldemandsandfundingcycles.

OPPORTUNITIESFORANEWCOMPACTBETWEENGAVIANDPARTNERCOUNTRIES5

Adaptpooledprocurement.Underthecurrentmodel,countriesbenefitfromGavi’sbuyingpowerandprocurementexpertisetoaccessfairpricesandreliablevaccinesupply.Newprocurementmodels

maybeneededtosustainthesebenefits.ThiscouldmeananadaptationofGavi’scurrentprocurementpracticesenablingtheuseofrecipientcountrycommitmentsinadditiontodonorfundstofacilitate

pooledprocurementorthenascentinitiativefromAfricaCentresforDiseaseControlandPrevention,couldstepintosupportcountrieswithvaccineprocurement.Notably,adaptedGaviprocurement

mechanismscouldalsomeanthat

formerornever-Gavieligiblecountries

couldbenefitwideningthesupportGavicanprovide.

Strengthenmarketshaping.TheNewCompactmaintainsandpotentiallycreatesmorespacefor

Gavitostepupitsroleinmarketshapingandensuresufficientresourcingforits

VaccineInvestment

Strategy

.Asexistingcost-effectivevaccinestransitiontocountryresponsibility,Gavimayfocus

moreonensuringaccesstoinnovativevaccines,forexamplethroughcarefullydesigned“pull”financingsuchasvalue-based

AdvanceMarketCommitments

(AMCs).However,Gavi’srolein

innovationmustalignwithcountryprioritiesandactions.Countriescouldclearlycommunicatetheirnationalneedsandreadinessforinnovativetechnologiesanddesignconduciveregulatoryenvironmentstosupporttheiruptake.

Figure3.PolicyshiftsfromGaviandpartnercountriesifadoptingthe

NewCompact

OPPORTUNITIESFORANEWCOMPACTBETWEENGAVIANDPARTNERCOUNTRIES6

Potentialbenefits–Whydothis?

TheNewCompacthasthepotentialtocreatespaceforcountry-leddevelopmentofcomprehensive

immunisationsystemsfitforthelong-term.ItalignswithGavi’skeyprioritiesandmayyieldvariousbenefitsinlinewithcurrentandupcomingorganisationalstrategy.First,thecentringofcountry

ownershipandsystems—includingevidence-informedprioritisationandfinancialmanagement—createsspaceforinstitutionalstrengtheningwhileexpandingimmunisationprogrammes.Inotherwords,itallowsadualfocusonbothshortandlong-termhealthgoals.Improvedprioritisation

shouldresultinmorehealthforthemoney.Similarly,areducedroleforaidincoreservicesshould

amelioraterisksoftransitionoutofGavisupport.Second,withcoreinterventionsbeingfinanced

throughdomesticavenues,theapproachpotentiallyfreesupresourcesandopportunitiesforGavi

toacceleratenewvaccineintroductions,furthersupporthealthsystemstrengtheningofnewand

existingarchitecture,step-upmarketshapingactivitiesandexpandalighterfootprintofservicestoawiderbaseofcountries.Third,thecomplementaryshiftstowardsadaptedpooledprocurementandstrengthenedmarketshapingarelessresourceintensivetoscalethanvaccinefinancingandcouldallowGavitoserveamuchwiderbaseofpartnercountriesthanitcurrentlydoes.Thiscouldincludecountries

notcurrentlyeligible

forGavisupport.NotablythesearealsoareaswhereGavihasaclearadvantageinbeingabletofulfilafunctionthatcountriesarelessableto.

Challengesandrisks

Whiletherearesignificantpotentialbenefitstothepolicyreformsoutlinedhere,thereareimportantchallengesandrisks.Perhapsthemostsalientistheriskthattransitioninghigh-valuevaccinesoutofdirectGavifinancingresultsinreduced

healthoutcomesorimmunisationofat-riskpopulationsand

vulnerablegroupsinparticular

.Thiscouldmanifestinmultiplewaysfrominadequatebudgetingor

politicalwill,tosupplychaininterruption,todeliveryfailures.Capabilitiesofcountry-levelinstitutionsandprocessesforevidenceinformedpriority-settingwillvaryanditmaybeachallengetocorrectly

knowwhichvaccinesaremostcost-effectivewhere.Moreover,itwillbepracticallychallengingfor

Gavitomakebespokeagreementsbasedonthisinformationwitheachpartnercountry.Whilemany

challengeswillbetechnicaloroperational,somecouldariseastheresultofdifferencesinpriorities

betweenGavianditspartnercountriesanddeliberatepolicydecisions.Forexample,countriesmay

decidetointroduceanout-of-pocketpaymentforvaccines,amelioratingbudgetimpactandaverting

trade-offswithotherpublicservices,butlikelyreducinguptakeinlower-incomegroups.Lastly,Gavi

reliesonnarrativesoftheprovisionofhighlycost-effectiveservicesforadvocacyandfundraising.Withadifferentmodelforimpactmorenuancednarrativeswillneedtobedeveloped.

Nextsteps

Stakeholdersincludingdecision-makersinlow-andmiddle-incomecountries,academics,

researchers,globalhealthdonors,andmultilateralorganisationsallhavearoletoplayinrealisingaNewCompactforglobalhealthfinancing.ForGavispecifically,weidentifythefollowingpotentialareasforaction.

OPPORTUNITIESFORANEWCOMPACTBETWEENGAVIANDPARTNERCOUNTRIES7

1.DevelopaNewCompactpolicyframework

ThisbriefdoesnotofferanimplementablepolicyframeworkandfurtherworkisneededtodeveloppolicyspecificswithcloseconsultationbetweenGaviandpartnercountries.Apolicyframework

wouldneedtoarticulatehowcountry-ledevidence-informedprioritisationwouldinformvaccinefinancingandbeclearaboutlinkstocurrentframeworks—suchasthe

VaccineFundingGuidelines

andthe

healthsystemandimmunisationstrengtheningpolicy

—toensurethatsufficienttechnicalassistanceandotherkindsofsupportbeyondvaccinefinancingareavailable.

2.Pilotfinancingreformswithpartnercountries

Followingaprocessofengagementwithpartnercountries,GavicouldpilotaNewCompactapproachwithasmallnumberofinterestedcounties.CountriesnearingtransitionawayfromGavisupportandwithstrongexistingfunctionsforevidence-informedpriority-settingarelikelytobegoodcandidates.Thiswillrequiredetailedjointlyownedtransitionplans,tailoredtechnicalassistanceandperhaps

temporaryarrangementsforprocurementsupport.Anoutlineofthepotentialstagesofthepilot

processisinFigure4.Successofthepilotislikelytobeassessedthroughanadaptedversionofthe

evaluationframeworkinGavi’s

VaccineInvestmentStrategy

andintermsofstakeholderperceptions

Figure4.Illustrativestagestowardspilotingfinancingtransitionwithpartnercountries

OPPORTUNITIESFORANEWCOMPACTBETWEENGAVIANDPARTNERCOUNTRIES8

3.Refinestrategiesformultilateralapproachestosupportvaccine

procurementandcatalysenewvaccineinnovation

TosecurethebenefitofpooledprocurementundertheNewCompact,Gavimayexploreflexible

optionsforcontinuedparticipationtopooledprocurementforcountriesaftertransitionorGavi-

ineligiblecountries.Notably,middle-incomecountries(MICs)andtargetpopulationsforinnovativevaccines(i.e.,adolescentsoradultsfordiseasessuchasmalariaandtuberculosis),

maybenefit

fromGavisupport

.Gavi’s

MICsApproach

couldparticularlybenefitbyusingtheNewCompactasa

mechanismforsustainablevaccineintroductionsandpreventionofbackslidinginvaccinecoverage.Alternatively,Gavimayconsidersupportingregionalpooledpurchasingconsortiasuchas

the

oneledbyAfricaCentresforDiseaseControlandPrevention,

linkingplanstothenascent

African

VaccineManufacturingAccelerator

(AVMA).

4.Championrebalancingcountry-donordynamicsinmultilateralforumsandhigh-levelpoliticalengagement

PolicyreformofthekindoutlinedinthisbriefwouldrequiresignificantoperationalchangeforGavi.However,forsystemicchange,theresponsetocallsfromcountriestorebalancepowerdynamics

andreworkcomplexfinancingarrangementsmustentailcoordinatedactionfromdonors.Asa

prominentmultilateralGlobalHealthInitiative,withbroad-basedsupportandastrongreputationforeffectiveglobalhealthleadership,Gavihastheopportunitytoaddressitsownwaysofworkingwhilealsochampioningandleadingwiderdonorharmonisationefforts.

OPPORTUNITIESFORANEWCOMPACTBETWEENGAVIANDPARTNERCOUNTRIES9

Appendix1.SummaryofpolicyshiftsforaNewCompactbetweenGaviandpartnercountries

POLICYSHIFT

POLICYSPECIFICS

BENEFITS

CHALLENGESANDRISKS*

GAVI

PARTNERCOUNTRY

Rework

healthservicefinancing

?Agreenewco-financing

policiestosupportcountry-leddomesticfinancingofthemostcost-effectiveorhigh-priorityinterventions.

?Providetechnicalassistancetosupportbothdomestically-andGavi-financedvaccines.

?Provideadditionalfinancingandtechnicalassistancefornewvaccineintroductions.

?Adoptorstrengthenan

evidence-informedpriority-

settingprocessestodefine

prioritynationalhealthservices.

?Progressivelyassumeagreaterorfullshareoffinancingand

deliveryofthehighestpriorityvaccines.

?Domesticfinancingforhighvaluevaccinesensuresconsistent,

sustainablesupportforkey

vaccinationprogrammes.

Thereisaclearercompact

betweennationalpublicprovidersandtheirconstituentpopulationontheprovisionofvaccines.

Domesticfinancingofhigh-valuevaccinesmaymeanmoreGavi

resourcesareavailablefornewvaccineintroductions.

?Progressivetransitiontowardcountry-levelresponsibility.

?Locallydrivenapproachtoprioritysettingbasedoncontext-specificchallenges.

?Improvedcoordinationand

collaborationinhealthsystem

strengtheningbetweenGaviandcountry.

?Ineffectiveimplementation

orinsufficientfinancingfrom

governments,leavespopulationsundervaccinatedandatrisk.

?Countrieschoosetoimplement

withsomedegreeofout-of-pocketpayment,potentiallyresultingin

reduceduptakeparticularlyinlow-incomeormarginalisedgroups.

?Publicfinancingforvaccinesisredirectedfromotherimportantpublicservices,includingnon-healthservices.

?Limitedinstitutionalcapability

couldmeaninadequateplanningforthefinancingtransitionleadstotemporarygapsinvaccination

?Pooledprocurementisdisrupted,resultinginhighvaccinationcosts.

(continued)

OPPORTUNITIESFORANEWCOMPACTBETWEENGAVIANDPARTNERCOUNTRIES10

POLICYSHIFT

POLICYSPECIFICS

BENEFITS

CHALLENGESANDRISKS*

GAVI

PARTNERCOUNTRY

Rework

healthservicefinancing

?Agreenewco-financing

policiestosupportcountry-leddomesticfinancingofthemostcost-effectiveorhigh-priorityinterventions.

?Providetechnicalassistancetosupportbothdomestically-andGavi-financedvaccines.

?Provideadditionalfinancingandtechnicalassistancefornewvaccineintroductions.

?Adoptorstrengthenan

evidence-informedpriority-

settingprocessestodefine

prioritynationalhealthservices.

?Progressivelyassumeagreaterorfullshareoffinancingand

deliveryofthehighestpriorityvaccines.

?Domesticfinancingforhighvaluevaccinesensuresconsistent,

sustainablesupportforkey

vaccinationprogrammes.

Thereisaclearercompact

betweennationalpublicprovidersandtheirconstituentpopulationontheprovisionofvaccines.

Domesticfinancingofhigh-valuevaccinesmaymeanmoreGavi

resourcesareavailablefornewvaccineintroductions.

?Progressivetransitiontowardcountry-levelresponsibility.

?Locallydrivenapproachtoprioritysettingbasedoncontext-specificchallenges.

?Improvedcoordinationand

collaborationinhealthsystem

strengtheningbetweenGaviandcountry.

?Ineffectiveimplementation

orinsufficientfinancingfrom

governments,leavespopulationsundervaccinatedandatrisk.

?Countrieschoosetoimplement

withsomedegreeofout-of-pocketpayment,potentiallyresultingin

reduceduptakeparticularlyinlow-incomeormarginalisedgroups.

?Publicfinancingforvaccinesisredirectedfromotherimportantpublicservices,includingnon-healthservices.

?Limitedinstitutionalcapability

couldmeaninadequateplanningforthefinancingtransitionleadstotemporarygapsinvaccination

?Pooledprocurementisdisrupted,resultinginhighvaccinationcosts.

Strengthen

marketshaping

?Stepuproleinincentivisingvaccineinnovationby

creatingclearvalue-

basedmarketdemand

commitments.

?Increasesupportthe

creationofenabling

environmentsfornewvaccineintroductionse.g.through

supportingregulatoryreform

?Clearlycommunicatenationalneedsandreadinesstouptakeinnovativetechnologies.

?Considerdesigningaconduciveregulatoryenvironmentto

supportuptakeofinnovativetechnologies.

?Domesticfinancingofhighpriorityvaccinesleadstoincreased

budgetaryspacefornewvaccinesinGavi’sVaccineInvestment

Strategy.

?Clearerrolesforcountry

financingofessentialvaccines

andmultilateralincentivisationofinnovation.

?Provisionofclearreturnoninnovationinvestmentfor

manufacturers

?Multilateralprocurement

facilitationmechanisms(eitherthroughAfricaCDCorGavianditscorepartners)maystrugglewiththecomplexityofsecuringcommitmentsfrompartner

countries.

?Investingininnovationis,insomesense,agambleonfuturegains,withanopportunitycostofhighercovera