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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
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