The 3rd GAVI Board Meeting, held in Oslo, Norway on June 13–14, 2000, opened with a strong endorsement of GAVI’s innovative role in global health. Norwegian Minister of International Development Anne Kristin Sydnes welcomed delegates and stressed Norway’s deep commitment to global vaccination as a cornerstone of international development.
She encouraged active engagement from all attendees in the forthcoming symposium, which would include remarks from Prime Minister Jens Stoltenberg. Dr. Gro Harlem Brundtland, Director-General of the World Health Organization and Chair of the GAVI Board, outlined the main objectives for the two-day session.
The meeting’s agenda was grouped around three critical themes: rapidly delivering tangible results at country level through the approval of proposals and vaccine procurement; expanding and strengthening partnerships, particularly with the polio eradication effort; and setting a path forward for long-term sustainability of immunization programs and vaccine development.
The tone of the meeting reflected a sense of urgency and opportunity, as global partners gathered to shape GAVI’s early direction in a coordinated push toward improving child health outcomes in the world’s poorest nations.
Country Proposal Process
A significant focus of the meeting was the establishment and refinement of the country proposal review process. The Board approved a framework designed to ensure fairness, responsiveness to country-specific needs, and prevention of conflicts of interest. It was agreed that representatives from eligible countries would be included on the independent review committee and that participation from Eastern and Central Europe would be actively explored. These steps aimed to ensure diversity and integrity in the evaluation of applications for GAVI support.
The Board emphasized the urgency of securing additional resources to “immunize every child,” particularly by expanding the number of trained health and immunization workers at the country level. Partner agencies, especially WHO and UNICEF, were tasked with supporting this capacity-building effort.
A fast-track timeline was adopted: countries were to submit proposals by July 1, 2000, and an independent committee would meet in Geneva from July 8–12 to conduct the first round of reviews. Additionally, the Advocacy Task Force was directed to focus its efforts on stimulating in-country engagement and ownership of immunization activities to ensure sustainability and long-term success.
GAVI and Polio Eradication Collaboration
The Board explored how GAVI’s long-term immunization goals could complement the Polio Eradication Initiative’s (PEI) time-limited objective. A strong emphasis was placed on maximizing coordination and minimizing operational conflicts.
The key actions agreed were:
- Requesting the GAVI Working Group and polio partners to jointly develop country-specific strategies
- Planning for the eventual transfer of freed-up resources (both financial and human) from polio campaigns to routine immunization programs
- Encouraging the inclusion of acute flaccid paralysis (AFP) surveillance as an indicator for monitoring immunization program quality
- Recommending that the polio and GAVI milestones be aligned, including integrating polio eradication certification into GAVI’s targets
- Acknowledging concerns from polio partners about staff being over-committed to both GAVI and polio activities
This collaboration was intended to ensure that polio eradication efforts remained fully supported while strengthening country immunization systems to sustain progress once polio campaigns were completed.
Financing and Procurement
A central focus of the 3rd GAVI Board Meeting was ensuring that financial and procurement systems were established to support rapid vaccine access for the world’s poorest countries. The Board reviewed detailed plans for vaccine purchasing, sustainable financing frameworks, and industry engagement strategies to ensure the long-term success of GAVI’s immunization goals. Discussions were structured into three major areas:
Vaccine Procurement Strategy
The GAVI Board gave strong approval to UNICEF’s proposed vaccine procurement strategy, which was tailored to meet the urgent needs of the world’s poorest countries. UNICEF emphasized an approach that would both encourage innovation and ensure supply predictability for countries most in need.
The strategy prioritized the use of combination vaccines to increase safety and reduce delivery costs. UNICEF introduced a competitive request-for-proposal model that would allow long-term purchase commitments, giving manufacturers the stability they needed to plan production and supply more effectively.
The proposed target date for vaccine acquisition was set for the end of November 2000 to meet time-sensitive global immunization needs. The Board also formally recognized the important role vaccine producers played in making donations to GAVI, adopting a formal vaccine donation policy to provide clear guidelines for these contributions. In addition, the Board debated policy challenges related to tiered pricing models in developed countries, particularly in the United States, and agreed that UNICEF would lead the implementation of vaccine procurement using funds provided through the GAVI Fund.
The Board directed the GAVI Financing Task Force to assist countries with the development of guidelines for selecting vaccines and presentations, improving demand forecasting, and addressing limited capacity technologies such as lyophilization. The overall goal was to ensure reliable supply while balancing the market realities faced by vaccine manufacturers.
Sustainable Financing
The GAVI Board reinforced that national governments must take the lead in financing and sustaining immunization programs from the earliest stages of Fund disbursement. The role of Ministries of Finance was stressed as central to developing long-term financial strategies for vaccine delivery. The World Bank, as GAVI’s financial partner, was tasked with working directly with finance ministries to establish strong country-level financial planning mechanisms.
The Board endorsed extending GAVI Fund support beyond the initial five-year period by promoting phased transitions that would encourage countries to gradually increase domestic financing and reduce reliance on external resources. The World Bank committed an initial US$1 billion in International Development Association (IDA) resources for communicable disease control, with plans to further expand support as national and regional immunization programs matured. WHO also pledged to help countries use IDA loans strategically to reinforce the capacity of health systems and enhance the cost-effectiveness of immunization services.
The discussion acknowledged the delicate balance between providing sufficient external support and avoiding long-term donor dependency. The Board strongly encouraged national ownership and accountability, while supporting countries through flexible financing tools and technical assistance.
Industry Incentives (“Pull” Mechanisms)
The Board examined ways to encourage greater industry commitment to vaccine research and development through so-called “pull” mechanisms. Two main avenues had already been adopted: strengthening routine immunization in low-income countries to stimulate market demand, and initiating long-term procurement arrangements for underused vaccines.
The Board instructed the Financing Task Force to identify further actionable steps, including evaluating constraints in current vaccine projects that could be addressed through Board action. The World Bank was specifically asked to explore how its communicable disease initiative and access to US$1 billion in IDA funding could be leveraged to drive greater private sector investment. An additional option discussed was using the R&D window of the Global Fund as a further pull mechanism.
Finally, the Board urged exploration of mechanisms that could provide market assurances to industry for future vaccines, including those for AIDS, malaria, and tuberculosis. The focus remained on aligning public and private sector efforts to accelerate the development and availability of vaccines that address pressing global health needs.
Research and Development
The GAVI Board recognized that accelerating the development of new vaccines for global health emergencies is critical to complement delivery efforts in low- and middle-income countries. The creation of a Research and Development Task Force was approved to coordinate and guide partner efforts.
The task force was designed to:
- Be co-chaired by representatives from academia, industry, and WHO
- Focus on priority diseases including HIV/AIDS, malaria, and tuberculosis
- Coordinate global partner activities to avoid duplication and increase efficiency
- Explore emerging disease areas and technologies for improved vaccine safety and delivery
- Limit membership to a small number of globally recognized experts for maximum effectiveness
- Ensure WHO oversight to prevent overlap with other expert advisory groups, particularly SAGE
- Present finalized terms of reference and membership for approval at the November 2000 Board meeting
This task force will play a key role in shaping research priorities, strengthening collaboration, and accelerating vaccine development to meet urgent public health needs in the world’s poorest regions.
Global Fund Administration and Procedures
The GAVI Board dedicated considerable time to refining the operational and financial structures of the Global Fund for Children’s Vaccines. The meeting addressed both pledges from donor countries and the internal procedures necessary to manage increased financial flows effectively and transparently.
Fund Update
Prime Minister Jens Stoltenberg of Norway announced a major five-year pledge of 1 billion kroner (approximately US$125 million) to support GAVI’s objectives, underlining Norway’s commitment to helping low-income countries strengthen their health systems. The United Kingdom committed £3 million (approximately US$5 million) to purchase vaccines for an additional 250,000 children, with the possibility of additional contributions under review by the UK Department for International Development (DFID).
The Board recognized the emerging challenge that countries with strong immunization infrastructures would be best positioned to quickly absorb new funds. There was consensus that GAVI must actively address the needs of countries with weaker systems, political instability, or conflict, to ensure equitable access to vaccines.
The first two rounds of country proposal reviews in 2000 were seen as a critical learning opportunity to fine-tune the process. The Board requested the Task Force on Country Coordination to provide a detailed assessment at the next Board meeting of the 27 countries that had not yet submitted proposals.
UNICEF Working Capital Account
UNICEF informed the Board that managing the increased resources flowing through the Fund would require an additional US$2 million per year to meet the roughly 25% increase in workload. The Board approved this request contingent upon a thorough review process, known as “due diligence,” by the GAVI Secretariat. A full report on the use and governance of these funds would be shared with UNICEF, the GAVI Board, and the Fund Board.
The Board further requested that a full operational and governance framework for the Fund and the UNICEF Working Capital Account be prepared by August. This document would clarify the relationships and responsibilities between the Fund, UNICEF, and GAVI, ensuring a fully transparent management system. A teleconference was also planned to review and finalize the proposal.
GAVI Structure and Management
As GAVI matured into a fully operational alliance, the Board addressed the need to formalize and expand its structure to ensure inclusive governance and effective decision-making. The Board approved an expansion of its composition from 13 to 16 members (15 seats plus the Chair), reflecting the growing number of partners and stakeholders involved in global immunization.
The revised structure included four renewable seats for key partners: the Bill & Melinda Gates Foundation, UNICEF, the World Bank, and WHO. Rotational seats were assigned to three OECD country governments, two developing country governments, OECD country industry (represented by Aventis Pasteur), foundations (represented by the Rockefeller Foundation), research and development (represented by the US National Institutes of Health), non-governmental organizations (represented by PATH/CVP), and a technical health institute and developing country industry (both vacant at the time). The representatives of Bhutan and Zimbabwe served in their personal capacities for the developing country government seats.
The Board also agreed to end the previous policy of allowing alternates; if a Board member could not attend a meeting, the seat would remain vacant. This change aimed to streamline decision-making and enhance accountability. Observers would continue to be welcomed under a more liberal policy to ensure openness and transparency.
Further governance refinements included the adoption of GAVI’s Guiding Principles, which outlined the roles and responsibilities of all alliance members. The document was recognized as a living framework that could be updated to reflect future decisions, especially regarding the relationship between the Global Fund and the Working Capital Account at UNICEF.
The Board commended the work of regional GAVI partner groups, such as the African regional group, which had already begun addressing localized immunization concerns. The Board also endorsed the document outlining the Operations of the GAVI Secretariat, which detailed how the Secretariat would function under the leadership of the GAVI Chair and in partnership with the Executive Director of UNICEF, as the host organization.
Closing and Next Steps
The meeting concluded with the adoption of an action-oriented roadmap for the coming months. The next GAVI Board meeting was scheduled for 19 November 2000 in the Netherlands. This would be immediately followed by the first GAVI Partners’ Meeting on 20–21 November 2000, designed to strengthen collaboration and review early results from country proposals and vaccine distribution activities. A subsequent Board meeting was planned for 20–21 June 2001.
The atmosphere at the close of the Oslo meeting reflected a strong sense of momentum and shared purpose. Delegates recognized the substantial work ahead to operationalize the many initiatives agreed upon, from vaccine procurement to the launch of the Research and Development Task Force and the full rollout of country proposal reviews. The meeting marked a turning point for GAVI, transitioning from an alliance in formation to a functioning global partnership committed to reducing vaccine-preventable child deaths worldwide.