The Gavi Investment Opportunity 2021-2025

1. The Gavi Investment Opportunity 2021-2025 by Dr Seth Berkley Chief Executive Officer Gavi, the Vaccine Alliance Prevent, Protect, Prosper

2. The world before Gavi ~10 million children died before their 5th birthday in the year 2000

3. The world before Gavi ~30 million children were under-immunised (i.e. did not receive three doses of DTP-containing vaccine) in lower-income countries in the year 2000

4. The world before Gavi were not reaching children in lower-income countries in the year 2000 powerful new vaccines

5. The launch of Gavi the Gavi Alliance was created to ensure equitable access to new vaccines in the year 2000 World Economic Forum, Davos, 2000

6. The model

7. Gavi’s model Strengthening vaccine delivery platforms Supply Demand Shaping markets Accelerating access to vaccines Market shaping Donor base Co-financing Long-term funding Sustaining immunisation and transition Pooling demand of poorest countries Powered by an Alliance of core partners

8. >100 civil society, private sector and expanded technical partners Our expanding partnerships Broader immunisation community Beyond the Alliance

9. Gavi’s work directly relates to 14 of 17 Sustainable Development Goals Gender equality Immunisation reaches girls and boys equally No poverty Health is Wealth: Every US$ 1 invested in immunisation returns US$ 54 in broader economic benefits Partnership for the Goals Immunisation progress has been transformed by public-private partnerships Decent work and economic growth Parents of immunised children can work, while healthy children grow into a productive workforce

10. Impact

11. Intra-country equity: empowering the poorest countries to scale-up new and powerful vaccines . . Hepatitis B % of countries introduced vaccines nationally Hib Before Gavi 72% 73% 2000 3%6% Low-income countriesHigh-income countries Now 87% 100% 100% 100% 2018 Low-income countriesHigh-income countries

12. Countries introducing a growing portfolio of vaccines 2001 2002 2007 2008 2010 2013 2015 20172009 20142003 2004 2005 2006 2011 2012 2016 2018 2019 PENTAVALENT HEPATITIS B YELLOW FEVER Hib MULTIVALENT MENINGITIS ORAL CHOLERA INACTIVATED POLIO HPV (CERVICAL CANCER) MEASLES 2ND DOSE PNEUMOCOCCAL ROTAVIRUS MENINGITIS A MEASLES RUBELLA JAPANESE ENCEPHALITIS EBOLA Not yet licensed TYPHOID >430 introductions and campaigns since 2000

13. Millions more children being reached with routine immunisation Numberofsurvivinginfants inGavicountries(millions) 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 10 20 30 40 50 60 70 80 2018 Source: WUENIC 2019 update

14. Global decline in under-5 mortality 2000 2017 10m deaths 5.4m deaths -46% Much steeper decline in deaths from vaccine-preventable diseases 2000 2017 2.2m deaths 0.6m deaths -70% Vaccines have helped nearly halve child mortality

15. 77 countries72 countries15 transitioned countries 57 countries57 countries + Syria Gavi supports 60% of the global birth cohortCountry engagement

16. 7% 8% 9% 10% 10% 21% 26% 36% 2016 2017 64 2011 2012 2013 201820152014 India Financing 407 Self-Financing Co-Financing36 91 116 125 241 298 Countries’ co-financing and self-financing in US$ millions Share of country co-financing and self-financing to Gavi supported routine programmes Countries stepping up to increase financing for vaccination

17. Our impact to date >760 million people immunised through routine immunisation >960 million people immunised through campaigns 13 million deaths averted

18. Our opportunity today US$ 7.4 billion We can protect at least another 300 million people with immunisation Prevent at least 7-8 million deaths With at least And generate at least US$ 80-100 billion in economic benefits

19. Global factors affecting health CLIMATE CHANGE By 2050, ~250,000 additional deaths per year from malaria, diarrhoea, malnutrition and heat stress By 2050, global population to increase by 2.3 billionPOPULATION GROWTH AND URBANISATION CONFLICT AND DISPLACEMENT >70 million people displaced worldwide 84% refugees in developing countries ~70% global population in urban settings

20. Most cervical cancer deaths are in poor countries Cervical cancer deaths, cervix uteri (per 100,000) Sources: GLOBOCAN 2018, IARC (http://gco.iarc.fr/today). World Health Organization ≥ 19.9 7.1 to 11.0 4.4 to 7.1 2.2 to 4.4 0 to 2.2 11.0 to19.9

21. We can protect tens of millions of girls by 2025 by introducing HPV vaccine National HPV programmes Sources: IVB database as at 10 October 2018, Gavi partner estimates, August 2019.

22. >500m contact points with the health system each year Expanding life course approach to vaccination: strengthening PHC platform Pregnant women RSV vaccine Gavivaccines Newborn HepB vaccine Infants 14 antigens 1-2 years 5 antigens Children Td booster Adolescents Td booster HPV vaccine (Outbreak protection vaccines) Adults Antenatal care Nutrition Postnatal care Pneumonia and diarrhea control Nutrition and growth monitoring Health education Cervical cancer control Deworming WASH

23. Strengthening and extending Primary Health Care Primary Health Care Secondary Tertiary 90% of children worldwide reached though routine immunisation Routine immunisation Children receiving the first dose of a diphtheria-tetanus-pertussis (DTP1) containing vaccine

24. Credit: Alexia Deutsch Credit: Alamy Credit: Unicef Focusing on equity: prioritising missed communities and zero dose children

25. Fostering equitable prosperity: zero dose children Two out of three zero dose children are below the poverty line US $1.90 per day poverty line

26. Spend on Health System Strengthening 20082007 2009 20122010 2011 2013 2014 2015 2016 2017 2018 >6x 92 138 34 50 44 52 119 145 172 194 226 284 HSS disbursements by calendar year US$ million

27. • Differentiated and targeted approaches to reach missed populations e.g., urban slums, conflict, migrants, remote rural • Tailored and gender responsive strategies to address immunisation barriers • Build demand and strengthen engagement with communities • Enhance collaboration – including with polio programme New approaches to reach the unreached

28. Scaling up innovation: strengthening immunisation programmes Drone delivery Thermo- stable vaccines Remote temperature monitoring Solar- powered cold chain Biometric health records New vaccine presentations INFUSE Vaccine innovations Programme innovations

29. Scaling up innovation: innovative financing The Gavi Matching Fund Advance Purchase Commitment (APC) for Ebola vaccine International Finance Facility for Immunisation (IFFIm) Advance Market Commitment (AMC) for pneumococcal vaccine

30. Replenishing IFFIm IFFIm will enter wind-down mode if not replenished 0 500 1,000 1,500 2,000 2,500 3,000 3,500 4,000 US$ million Donor contritutions Proceeds to Gavi Front-loading capacity 2012 20262018201120082006 2007 2009 2010 20242013 2014 2015 2016 2017 2019 2020 20292021 2022 2023 20302025 2027 2028

31. Dealing with outbreaks >1.3 billion people protected against outbreak preventable diseases but routine immunisation coverage gaps means outbreak risk persists 54% children receive 2nd dose measles vaccine 43% children receive yellow fever vaccine Gavi countries Gavi countries

32. Measles outbreaks reminder of risks of low routine coverage Measles resurgent globally Critical to address vaccine hesitancy demand-side issues as well as strengthen service delivery Number of reported measles cases in last 6 months, August 2019

33. Protecting the world against health insecurity: Gavi supports stockpiles to respond to outbreaks Yellow fever vaccine stockpile Measles outbreak response Meningitis vaccine stockpiles Oral cholera vaccine stockpiles Ebola vaccine response More than 140m people protected with >170m doses from Gavi-funded stockpiles and outbreak response funds since 2006

34. HEALTHY MARKETS Moderate or high levels of ‘healthy market dynamics’ Healthy market framework SUPPLY Sufficient and secure INNOVATION Suitable and quality products COST Appropriate and sustainable prices

35. Propelled by market-shaping: Gavi price <5% of developed countries HEPATITIS B PENTAVALENT HIB ROTAVIRUS PNEUMOCOCCAL INACTIVATED POLIO MEASLES RUBELLA HPV (CERVICAL CANCER) DTP Gavi price: US$ 27 Approximate USA price US$ 1,100

36. Propelled by market-shaping: continued vaccine price reductions $35 $33 $22 $22 $20 $19 $17 2010 2011 $23 20142012 20162013 2015 2017 >50% Cost of immunising a child with pentavalent, pneumococcal and rotavirus vaccines $16 2018 US$ 900 million in market-shaping savings 2021-2025

37. The ask

38. Gavi needs for 2021-2025 Board strategic investments 10 8 6 4 2 0 US$ billion Current portfolio Assured resources At least US$ 7.4 bn The ask At least US$ 9.4 bn Total need 2021-2025 At least US$ 7.5 bn The ask At least US$ 9.5 bn Total need 2016-2020 Board strategic investments Portfolio Assured resources

39. Gavi’s expenditure 2021-2025: greater efficiency and value for money Vaccine programmes US$ 5.3 bn (56%) Institutionalising post-transition support and exploring MICs US$ 0.3 bn (3%) TOTAL AT LEAST US$ 9.4 bn Investments in immunisation systems and enabling infrastructure US$ 3.3 bn (36%) Board strategic investments US$ 0.5 bn (5%) 26 6.48 0.63 3.30 1.31 4.85 3.96 6 4 2 8 0 2016–20 (ORIGINAL BERLIN FIGURES) 2016–20 (LATEST) 2021–25 (FORECASTED EXPENDITURES) Decrease in vaccines in Berlin investment case spend Decrease in vaccines in Berlin investment case spend NEW VACCINES PROGRAMMES (e.g., IPV, VIS, EBOLA) VACCINES PROGRAMMES IN BERLIN INVESTMENT CASE* • Targeted support for transitioned countries to prevent backsliding and catalyse new vaccine introductions • Explore engagement with other MICs To respond to emerging challenges and opportunities: e.g., • Scale up new approaches and innovations to reach zero-dose children • Accelerate new vaccines • Respond to changing situations of acute fragilityVaccines in the Berlin investment case included Pneumococcal, Pentavalent, Rotavirus, HPV, Yellow Fever, Measles and Rubella, Typhoid, Cholera, Meningitis A, and Japanese Encephalitis Health systems and immunisation strengthening support Technical assistance and partner support Evaluations and operating expenses 26 3.1 bn VACCINE DOSES 3.2 bn VACCINE DOSES Increase in doses

40. Gavi’s expenditure 2021-2025: value for money 97.3% spent on reaching people via immunisation programmes 2.7% spent on overheads Average over past 5 years

41. Developing country financing VACCINE COSTS US$ 5.2 bn US$ 7.1 bn US$ 8.9 bn PERCENTAGEFUNDINGSOURCE(%)PERCENTAGEFUNDINGSOURCE(%) 2011–2015 2016–2020 2021–2025 US$ 7.1 bn US$ 8.9 bn GAVI DONOR FINANCING COUNTRY FINANCING* 92% 8% 77% 23% 59% 41% US$ 5.2 bn VACCINE COSTS: *Includes co-financing, self-financing and India US$ 1.6 bn in co-financing US$ 3.6 bn in co-financing + US$ 6 bn in immunisation services US$ 432 m in co-financing GAVI DONOR FINANCING DEVELOPING COUNTRY FINANCING*

42. Greater impact 300 million more than twice the population of Japan Protect

43. Greater impact 7-8 million deaths twice the population of Yokohama Prevent

44. Greater impact US$ 80-100 billion in economic benefits to countries Prosper

45. Most complete package: ever–accelerating protection MEASLES-CONTAINING VACCINE PENTAVALENT VACCINE INACTIVATED POLIO VACCINE ROTAVIRUS VACCINE MEASLES-CONTAINING VACCINE RUBELLA-CONTAINING VACCINE PNEUMOCOCCAL VACCINE YELLOW FEVER VACCINE HUMAN PAPILLOMAVIRUS VACCINE COVERAGE BY VACCINE (%) 1st dose 1st dose 1st dose 3rd dose Last dose 2nd dose 3rd dose Last dose 0% 25% 50% 75% 100% 2017 by 2020 by 2025 Projections Current DTP3-containing vaccine coverage Aspiration to reach low- coverage and zero dose communities through new programmes, to increase access to immunisation… …lifting up the coverage ceiling, enabling coverage for all antigens to increase

46. New vaccines: premature deaths from diseases for which vaccines not yet available TB 1,183,672 HIV 954,492 Malaria 619,827 All age deaths (2017)

47. Perspective/Scale >1.1 billion Children vaccinated by routine immunisation through Gavi support since 2000 more than the population of sub-Saharan Africa

48. + ~1.5 billion estimated vaccinated through immunisation campaigns totaling the population of Africa, Europe, Japan combined Yokohama August 2019 Replenishment launch London June 2020 Pledging conference Perspective/Scale

49. Leaving no one behind by 2030 Before Gavi, we only reached 3 out 5 childrenWith Gavi’s work, we now reach 4 out of 5 childrenWith your help, we can reach every child

50. Thank you Merci Obrigado ありがとうございました ‫شكرا‬

51. 77 countries72 countries15 transitioned countries 57 countries57 countries + Syria Gavi supports 60% of the global birth cohortCountry engagement

52. Most cervical cancer deaths are in poor countries Cervical cancer deaths, cervix uteri (per 100,000) Sources: GLOBOCAN 2018, IARC (http://gco.iarc.fr/today). World Health Organization ≥ 19.9 7.1 to 11.0 4.4 to 7.1 2.2 to 4.4 0 to 2.2 11.0 to19.9

53. We can protect tens of millions of girls by 2025 by introducing HPV vaccine National HPV programmes Sources: IVB database as at 10 October 2018, Gavi partner estimates, August 2019.

54. Greater impact US$ 80-100 billion in economic benefits to countries Prosper

The Gavi Investment Opportunity 2021-2025

The Gavi Investment Opportunity 2021-2025

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