1. Enhance Efficiency and Sustainability – Streamline funding mechanisms to ensure long-term financial sustainability.  
2. Ensure Equitable Vaccine Access – Prioritize support for low- and middle-income countries (LMICs) to maintain high immunization coverage. 
3. Strengthen Financial Sustainability – Implement co-financing mechanisms to encourage country ownership of immunization programs. 
4. Improve Transparency and Engagement – Involve key stakeholders in decision-making to ensure policies meet the needs of recipient countries. 
5. Align with Evolving Healthcare Needs – Adapt funding structures to respond to changing global health challenges and improve immunization infrastructure. 

For Gavi, it is important the civil society organizations (CSOs) are a part of the review of the funding policy because CSOs work directly with communities and marginalized groups, ensuring that funding policies reflect real-world needs and challenges. Their involvement ensures that funds are used effectively and equitably. Moreover, CSOs bring ground – level expertise in vaccine distribution, healthcare access, and program execution, helping Gavi refine its policies for maximum impact. They are actively involved in raising awareness, mobilizing support and advocating for sustained funding for immunization. They can highlight gaps in service delivery and ensure that funding policies are targeted towards the most vulnerable populations. 

The Funding Policy Review: Gavi conducted the first consultation with CSOs on the 2nd of April 2025.The consultation process engaged various stakeholders, including civil society organizations (CSOs), to gather input on proposed changes to the funding mechanisms. This document provides an overview of key discussion points, proposed shifts in policies, and their implications. 

1. Eligibility and Transition Policy

The policy review proposes a revised threshold for Gavi eligibility, raising it from $1,800 to $2,300 Gross National Income (GNI) per capita by 2026. This shift acknowledges the economic disparities among countries and aims to provide extended support to those still facing healthcare access challenges. 

Proposed Changes: 

• Increased eligibility threshold to allow more time for transition. 

• Additional programmatic support for countries at risk of unsuccessful transition. 

• A dedicated catalytic phase for supporting vaccine introduction and system strengthening. 

Implications: 

• More countries will qualify for extended Gavi support. 

• Strengthened healthcare systems to prevent backsliding in immunization coverage. 

• Greater predictability and planning for transitioning countries. 

2. Co-Financing Policy

Gavi’s co-financing policy mandates gradual financial contributions from recipient countries to ensure long-term sustainability. The revised policy seeks to balance affordability while encouraging country ownership of immunization programs. 

Proposed Changes: 

• Introduction of price exposure for specific vaccines, allowing countries to choose cost-effective options (e.g., HPV and PCV vaccines at 4% and 7% co-financing rates, respectively). 

• Capping co-financing obligations at 80% of vaccine costs for preparatory transition countries. 

• Extending co-financing waivers for fragile states to multi-year durations instead of annual renewals. 

Implications: 

• Greater financial flexibility for countries transitioning out of Gavi support. 

• More predictable and manageable financial commitments. 

• Increased investment in cost-effective vaccine procurement strategies. 

3. Health Systems and Immunization Strengthening Policy

To address funding inefficiencies and improve immunization delivery, Gavi is consolidating its health system funding streams into a single cash grant structure. This aims to simplify administration while ensuring strategic investments in immunization infrastructure. 

Proposed Changes: 

• Consolidation of funding levers into one comprehensive grant. 

• Establishment of guardrails to protect key investments, such as: 

• Minimum floor for cold chain equipment investments. 

• 10% allocation to CSOs to strengthen community engagement. 

• Dedicated funding for measles and rubella campaigns. 

• Revised allocation formula emphasizing a country’s ability to pay and immunization performance indicators. 

Implications: 

• More streamlined funding allocation and utilization. 

• Enhanced role of CSOs in vaccine delivery and advocacy. 

• Improved sustainability through increased domestic resource mobilization. 

The consultation on Gavi’s funding policy review highlighted key learnings related to MMR follow-up campaigns: 

1. Guardrails are Critical for Funding Security 

   • A dedicated funding guardrail was introduced to ensure that sufficient resources are allocated to MMR follow-up campaigns. 

   • This prevents underfunding and ensures predictable support for outbreak prevention. 

2. Timing and Predictability Improve Planning 

   • MMR campaigns need to be conducted at regular intervals based on WHO guidelines to close immunity gaps.

   • Gavi aims to align funding timelines with country planning cycles to prevent delays in implementation.

3. Balancing Flexibility and Overspending 
   • The guardrail ensures that minimum funding is available for MMR, but also sets an upper limit to prevent excessive spending that could divert resources from other immunization efforts.
4. Integration with Routine Immunization is Key 

   • There is an increasing push to integrate MMR campaigns with routine immunization programs to enhance efficiency and reduce costs.

   • Gavi encourages countries to co-deliver other essential vaccines where possible.

5. Tailored Support for Fragile and High-Risk Countries 

   • A 10% funding multiplier was introduced for fragile states, recognizing the extra challenges they face in executing successful campaigns.

   • Countries with weak immunization systems require longer-term technical and financial support to sustain MMR coverage.

These learnings will shape future MMR funding strategies to ensure sustainability, improve efficiency, and maintain high coverage levels. 

During the consultation, several key concerns and questions were raised by stakeholders. Below are the main discussion points and how Gavi responded: 

1. Civil Society Organizations (CSOs) and Fund Allocation

Question: How will Gavi ensure the 10% allocation for CSOs in the consolidated grant is effectively enforced? 

Gavi’s Response: 

• Most countries already meet or exceed the 10% allocation, but advocacy efforts will continue for those that do not. 

• Gavi will provide guidelines and monitoring mechanisms to track CSO involvement. 

• The funding guidelines (to be released in October 2025) will clarify how funds should be distributed. 

2. Technical Assistance and Country-Level Support

Question: Will technical assistance have a separate allocation, or will countries determine how much to use for technical support? 

Gavi’s Response: 

• Technical assistance will be integrated into the consolidated cash grant, giving countries flexibility in allocation. 

• There will be no separate guardrail, but coordinated planning will ensure alignment with country needs. 

3. Co-Financing Policy and Financial Burden on Countries

Question: How will Gavi support countries struggling with rising co-financing obligations, especially those facing economic challenges? 

Gavi’s Response: 

• New co-financing caps (80% for preparatory transition countries and 35% for new vaccine introductions) will ease financial burdens. 

• Fragile states will benefit from multi-year waivers instead of annual renewals. 

4. Eligibility and Transition Policy Adjustments

Question: Could the increase in the eligibility threshold ($2,300 GNI per capita) be revised if replenishment funding is insufficient?  

Gavi’s Response: 

• While the threshold increase is currently board-approved, it could be revisited depending on financial realities post-replenishment. 

5. Health Systems Strengthening and Immunization Sustainability

Question: How will Gavi ensure that the consolidated single cash grant remains flexible? 

Gavi’s Response: 

• Countries will have more flexibility in fund allocation while maintaining critical investments through established guardrails. 

• A new monitoring system will track the impact of health system strengthening activities. 

6. Risk of Policy Adjustments Due to Replenishment Uncertainty

Question: Could some of the policy shifts be postponed, reversed, or eliminated if Gavi’s replenishment is lower than expected? 

Gavi’s Response: 

• While all Board-approved policy changes are intended for implementation, adjustments may be required based on the available budget.