Consultation on Gavi’s Vaccine Investment Strategy (VIS 2024)

Summary

The Gavi CSO Constituency held a consultation led by Gavi to gather input from civil society organizations (CSOs) on the 2024 Vaccine Investment Strategy (VIS). The VIS aims to evaluate and prioritize new vaccines for Gavi’s portfolio, considering impact, cost-effectiveness, feasibility, and country demand. The consultation addressed investment options for vaccines targeting Shigella, Dengue, Tuberculosis, and Group B Streptococcus, a potential COVID-19 program post-2026, and stockpiles for Hepatitis E and Monkeypox. Key points included health impact, equity, strategic fit, value for money, market implications, and implementation challenges. Presentations on the VIS analysis progress were given, and input from the Gavi CSO Steering Committee was shared. This was the third consultation, following sessions in April and August 2023. Final VIS investment decisions will be made by the Gavi Board in June 2024.

WMD10

The consultation sought CSO input to shape strong investment cases for VIS 2024, prioritizing key needs and maximizing Gavi's impact

Chapters

Dr. Endie Waziri, the chair of the Gavi CSO Steering Committee, welcomed participants and highlighted the vital role of civil society in shaping global health strategies and ensuring equitable access to life-saving vaccines. She emphasised the importance of the Vaccine Investment Strategy (VIS) in guiding Gavi’s support for new or underused vaccines through a rigorous process of evidence-based analysis and extensive consultations. The VIS aims to evaluate the impact, cost-effectiveness, and feasibility of vaccines, ensuring that Gavi’s vaccine support programs prioritise the most critical needs.

Gavi provided an update on the progress of the VIS analysis since the December 2023 board meeting. They explained the methodology, which includes both quantitative and qualitative review of evidence of vaccines against both endemic and epidemic diseases, health and economic impact modelling, and consultations with independent experts, constituencies, key stakeholders at regional and national level including EPI programmes. The VIS aims to facilitate strategic decision-making on which vaccines to invest in, provide predictability to manufacturers and countries, and inform Gavi’s strategy and resource mobilisation. The feasibility of implementing new vaccination programmes is considered and alongside the investment cases for vaccine programmes, proposals for research on operational questions are developed. Gavi highlighted the key governance steps, evidence gathering, and consultations conducted, including a country survey and a meeting with the independent steering committee.

Presentations were made on the investment options for routine/preventive vaccine programmes , including Shigella, Group B Streptococcus (GBS), Dengue, and Tuberculosis (TB). For Shigella, the potential impact on stunting and long-term sequelae was highlighted, but market and feasibility risks were noted due to the young vaccine pipeline and low awareness of the disease burden. For GBS, a maternal vaccine, the high direct impact on mortality and morbidity, equity considerations, and the need for substantial investment in health system strengthening were discussed. For Dengue, the potential to address the increasing global burden, particularly in middle-income countries, was presented, but challenges around data availability and implementation were noted. For TB, the high health impact, value for money, and country interest were emphasised, along with the high investment required, feasibility challenges, and the need for stakeholder engagement were highlighted.

The consultation discussed investment options for a potential time-limited COVID-19 program from 2026 onwards. Three options were presented: discontinuing the program, continuing with a routine programme under Gavi’s regular co-financing policies, or continuing the existing routine program with exceptionally high costs. The key benefits, challenges, strategic fit, value for money, market implications, and feasibility considerations were discussed. The guidance from the Gavi CSO Steering Committee was to discontinue the programme, as country demand is likely to decrease, and a stockpile was not recommended due to the large size required and lack of broadly protective vaccines.

The consultation covered investment options for vaccine stockpiles for outbreak response , specifically Hepatitis E and Monkeypox (Mpox). For Hepatitis E, a stockpile investment by Gavi was presented as aligned with partner activities, having a high impact on equity and mortality in vulnerable populations, and coming at a relatively low cost. The Gavi CSO Steering Committee supported an investment in a stockpile when a prequalified vaccine becomes available in 2029. For Mpox, the analysis showed that an investment could address key evidence gaps and ensure access to vaccines in low- and middle-income countries facing outbreaks. Three investment options were discussed: monitoring the situation, engaging with partners and manufacturers, and signalling the intention to procure a vaccine for a stockpile contingent on regulatory approvals.

Action Items

  • Provide input on the investment cases for the shortlisted vaccines (Shigella, Dengue, Tuberculosis, Group B Streptococcus) to shape robust investment cases for the VIS 2024, considering the potential impact, cost-effectiveness, feasibility, and country demand.
  • Contribute to addressing evidence gaps and generating data to support the prioritisation of new vaccines, particularly for diseases with limited epidemiological data, such as Dengue and MPox.
  • Engage in discussions on the potential discontinuation or continuation of a COVID-19 program from 2026 onwards, considering country demand, prioritisation across different vaccines, and the high projected costs.
  • Provide suggestions on how Gavi and the Alliance can support countries in their vaccine prioritisation efforts, recognizing the need for countries to make trade-off decisions due to limited resources.
  • Contribute to the learning agendas proposed for various vaccines, such as understanding the burden of disease for Shigella, acceptability and uptake for TB vaccines in older age groups, and integration of maternal immunization with existing services for GBS.
  • Consider joining the Gavi Civil Society Constituency to stay informed and contribute consistently to efforts to improve global health outcomes and hold Gavi accountable for effective implementation of strategies.