The first Board meeting of the Global Alliance for Vaccines and Immunization (GAVI) took place on 28 October 1999, at UNICEF House in New York. The meeting marked the official launch of a coordinated international response to address childhood immunization gaps around the world. Ms. Carol Bellamy, Executive Director of UNICEF, welcomed participants and observers to this historic event.
The session was chaired by Dr. Gro Harlem Brundtland, Director General of the World Health Organization (WHO). In her remarks, Dr. Brundtland described vaccines and immunization as essential tools for breaking the vicious cycle of poor health and poverty. She outlined the priorities for GAVI and reinforced the critical role that coordinated global action would play in saving millions of children’s lives from preventable diseases.
Key Challenges Identified by the Board
During the first GAVI Board meeting, Dr. Gro Harlem Brundtland and the Board members outlined the most pressing obstacles that GAVI would address to improve global childhood immunization. These challenges reflected the critical gaps between rich and poor countries and the need for urgent innovation and partnership.
The key challenges identified were:
- Improving immunization coverage globally, particularly in low-income countries where vaccination rates remained stagnant despite successes in polio eradication campaigns.
- Reducing the vaccine gap between children in wealthy nations and those in the poorest countries. At the time, children in the US had access to 11 vaccines compared to only 6 vaccines available in countries like Malawi.
- Finding sustainable ways to stimulate research and development for vaccines against diseases primarily affecting poor populations, such as HIV and malaria, for which no substantial markets existed in industrialized countries.
- Developing new financing tools and partnership models to overcome the lack of commercial incentive for manufacturers to invest in vaccines for neglected diseases.
- Promoting the urgency of filling these gaps, recognizing that failure to act would prolong cycles of disease and poverty for vulnerable populations.
Establishment of the Global Fund for Children’s Vaccines
To help address these monumental challenges, the Board approved the establishment of the Global Fund for Children’s Vaccines. The Fund was created as an essential financing instrument to support GAVI’s mission and operations. A landmark contribution of $750 million over five years from the Bill and Melinda Gates Foundation allowed the Fund to become operational.
The Fund was intended to catalyze support for vaccine procurement, strengthen immunization systems, and promote access to newer vaccines and safe injection equipment for the world’s poorest countries. The Board approved a structure whereby the Fund would complement national efforts, working in conjunction with national immunization plans and supporting countries through guidelines established by GAVI.
The first sub-account of the Fund was dedicated specifically to the procurement of newer vaccines and safe injection supplies, with clear operational rules outlined in the official documentation. Proposals from national governments, with the endorsement of their National Inter-Agency Coordinating Committees, would be required to access the Fund’s resources.
Vaccine Procurement Strategy
The GAVI Board set out a clear and ambitious strategy to guide the procurement of vaccines for the world’s poorest countries. The approach was designed to balance three critical priorities: affordability, supply security, and private sector engagement in research and development.
The strategy included:
- Securing vaccine prices that were affordable for governments of low-income countries.
- Ensuring adequate investment by manufacturers to meet global vaccine demand.
- Creating incentives for the private sector to invest in R&D for vaccines addressing diseases prevalent in developing countries.
- Acknowledging that different markets would require different price levels, with the poorest country segment always receiving the lowest effective price.
- Committing to a process of open, competitive tendering through UNICEF’s Supply Division to achieve the best pricing for eligible countries.
- Exploring the use of a competitive negotiation mechanism with producers of new vaccines to accelerate access for poor countries.
- Expressing gratitude to the pharmaceutical industry for its efforts to reduce vaccine prices and expand availability.
GAVI Launch Event Details
The official launch of the Global Alliance for Vaccines and Immunization (GAVI) was scheduled to take place at the prestigious World Economic Forum in Davos, Switzerland, on 31 January 2000. This event was chosen as the platform to bring GAVI’s vision and mission to the attention of the world’s most influential political leaders, business executives, global health experts, and philanthropists.
The Davos launch would mark the transition from conceptual planning to active implementation of GAVI’s programs and the Global Fund for Children’s Vaccines. The program was designed to showcase GAVI as a groundbreaking example of public-private collaboration aimed at solving one of the world’s most pressing health challenges: immunization inequity.
Key components of the launch included:
- A panel presentation featuring key GAVI Board members and leaders of major partner organizations, outlining the alliance’s strategic goals, operational structure, and early priorities.
- A press conference immediately following the panel, intended to raise public awareness, build momentum for fundraising, and inspire additional international partners and donors to support the initiative.
- Engaging both the public health community and private industry stakeholders to foster broad commitment and accountability toward GAVI’s shared objectives.
The event was positioned to serve as both a milestone announcement and a call to action for the global health community.
Board Meeting Dates
To maintain momentum and ensure early accountability, the GAVI Board agreed to an immediate calendar of follow-up meetings. These meetings were designed to provide structured decision-making opportunities and assess the early implementation of GAVI programs and the Global Fund for Children’s Vaccines.
The next scheduled meeting was set for 31 January 2000 at Davos, Switzerland, to take place in the morning, ahead of the formal launch event. This meeting would focus on final preparations for country proposal submissions, initial operational steps, and launch logistics.
The following Board meeting was scheduled for 13 and 14 June 2000 at WHO Headquarters in Geneva, Switzerland. This gathering would represent GAVI’s first major post-launch checkpoint. Key agenda items included:
- Reviewing and approving initial country proposals for funding and vaccine procurement.
- Evaluating early field experiences and lessons from initial advocacy efforts.
- Formulating adjustments to operational guidelines and funding strategies based on early feedback from partners and countries.
The regular cadence of Board meetings was intended to build a strong culture of accountability, transparency, and responsiveness from the outset of GAVI’s work.
Acknowledgements
At the conclusion of the first GAVI Board meeting, the Board formally recognized the outstanding contributions of two individuals whose work had provided essential guidance and structure to the alliance’s early efforts.
Dr. Mark Kane was commended for his critical role in developing the founding principles and strategic framework of both GAVI and the Global Fund for Children’s Vaccines. His presentations at the meeting provided clear direction for the alliance’s operational path forward.
Mr. Piers Whitehead of Mercer Management Consulting was acknowledged for his insightful analysis and detailed discussion paper on public sector vaccine procurement strategies. His recommendations provided valuable considerations for how GAVI could structure procurement relationships with vaccine manufacturers and ensure the best outcomes for low-income countries.
Their technical documents, overheads, and supporting materials were officially included in the meeting record as Annexes 3.1 to 3.3 to guide GAVI’s future planning.
Annex 1: Dr. Gro Harlem Brundtland’s Introduction Speech
Dr. Gro Harlem Brundtland, Director-General of the World Health Organization and Chair of the GAVI Board, delivered a compelling opening address that set the tone for the alliance’s mission. She welcomed the diverse group of international partners, emphasizing that their collective commitment to children’s health was what would drive meaningful change.
Dr. Brundtland made a clear call for urgency, describing the meeting as a unique opportunity to break the cycle of poverty and poor health that plagued vulnerable populations. She stressed the need for GAVI to rethink traditional approaches and build new models for financing, partnerships, and vaccine distribution that addressed the realities of the 21st century.
She also identified the three primary global immunization gaps that GAVI would work to close:
- Coverage stagnation for the six traditional vaccines in low-income countries, especially sub-Saharan Africa.
- Slow introduction of newer vaccines, such as those for Haemophilus influenzae type B and Hepatitis B, resulting in a widening vaccine gap between rich and poor nations.
- Lack of research and development for vaccines that targeted diseases mainly affecting low-income countries, like malaria and HIV.
Dr. Brundtland ended her speech by highlighting the importance of country ownership, private-public partnerships, and innovation, while also acknowledging the groundbreaking $750 million commitment from the Bill and Melinda Gates Foundation. She called upon all partners to translate their shared goals into immediate, actionable plans.
Annex 2: Principles of the Global Fund for Children’s Vaccines
The following section outlines the design, objectives, eligibility criteria, review process, sustainability approach, and operational timeline for the Global Fund for Children’s Vaccines as approved by the GAVI Board.
Purpose of the Fund
The first priority for GAVI was to create a dedicated funding mechanism to support countries unable to afford newer vaccines or safe delivery technologies. The Global Fund for Children’s Vaccines was launched to fulfill this purpose.
The GAVI Board established the Global Fund for Children’s Vaccines as a cornerstone of its strategy to expand access to life-saving vaccines in the world’s poorest countries. The Fund was never intended to operate in isolation, but as a critical tool to complement national health budgets, bilateral and multilateral aid, concessional loans, and other development funds.
The primary mission of the Fund is to address inequities by making newer vaccines and safe injection equipment available to countries that lack the purchasing power to acquire them independently. It also encourages governments to assume leadership in developing sustainable, long-term immunization plans.
The Fund was structured around three sub-accounts: procurement of new vaccines and safe injection equipment; supporting vaccine delivery infrastructure and access; and promoting research and development for vaccines targeted at diseases with limited commercial markets, such as malaria and HIV. The first sub-account was prioritized for immediate rollout, with the others scheduled for future development.
First Sub-Account: Procurement of Vaccines and Safe Injection Equipment
The first operational window of the Fund focused on immediate support for vaccine procurement and safe delivery supplies. Countries applying for support were expected to meet clear guidelines and work through national coordinating bodies.
This first sub-account provided funding for:
- Hepatitis B vaccine
- Haemophilus influenzae type B (Hib) vaccine
- Yellow Fever vaccine (for routine immunization only)
- Auto-disable syringes and safe disposal containers
Only governments of eligible countries could submit proposals, and these had to be endorsed by their National Inter-Agency Coordinating Committees. Exceptions were permitted only for emergency public health situations.
Country Eligibility Criteria
To ensure the most equitable use of limited resources, the GAVI Board applied strict eligibility rules to determine which countries could access the Fund. Two core criteria were used: countries had to have a Gross National Product (GNP) per capita of USD 1,000 or less and a national population below 150 million.
The combination of financial need and manageable program scale allowed the Fund to focus on countries that lacked the capacity to negotiate favorable pricing or manage large-scale vaccine delivery independently. A detailed list of eligible countries was provided in Appendix I, including birth cohort sizes and DTP3 coverage rates.
Countries like China, India, and Indonesia were not eligible under these thresholds due to their population size, but the GAVI Board committed to work with them through separate engagement strategies and technical partnerships to expand immunization coverage.
Proposal Review Criteria
The GAVI Board developed clear, consistent guidelines to evaluate funding proposals from eligible countries. The first priority was the documented burden of vaccine-preventable diseases, with epidemiological data guiding resource allocation.
Second, countries had to show proof of functional immunization systems by reporting DTP3 coverage rates of at least 50% to WHO and UNICEF. Countries falling below this threshold would receive extra review and potential capacity-building assistance.
Third, applicants were required to have an active National Inter-Agency Coordinating Committee overseeing immunization planning and coordination. Fourth, a multi-year immunization plan had to accompany the application, detailing both national and partner resource commitments and financial sustainability goals.
Finally, countries needed a credible plan for financing traditional EPI vaccines from national resources, with the Fund supporting only the gap for newer vaccines. This rigorous process ensured funding reached countries ready to deliver results.
The Global Fund was envisioned as a temporary catalyst rather than a permanent financing mechanism. Countries receiving assistance were expected to progressively assume full financial responsibility for their immunization programs as their economies and infrastructure improved.
The GAVI Board endorsed a phased withdrawal strategy based on each country’s readiness and demonstrated ability to fund and manage their programs independently. Countries were encouraged to explore multiple financing streams, including increased national budget allocations, concessional development loans, and bilateral aid from donor governments.
A new opportunity identified was debt relief for Highly Indebted Poor Countries, which could free up fiscal space for health investments, including immunization. The goal of this strategy was to build sustainable national programs that would thrive beyond the period of direct GAVI support.
Timeline for Fund Implementation
Key dates for the first operational phase:
June 2000: GAVI Board reviewed recommendations and authorized the first disbursements from the Fund.
November 1999: Country priming and advocacy began.
January 2000: Official GAVI launch at Davos; first materials distributed to eligible countries.
March to May 2000: Field test countries submitted proposals; final proposals from all eligible countries accepted.
Appendices to Annex 2: Supporting Data and Models
The following appendices provide essential data tables and planning models that guided the creation and early operations of the Global Fund for Children’s Vaccines.
Appendix I: Eligible Countries Data
The following table presents a sample of countries eligible for GAVI funding based on the agreed criteria: Gross National Product (GNP) per capita of USD 1,000 or less, and a population under 150 million. The table also includes estimates of annual birth cohorts and DTP3 vaccination coverage rates from 1997 and 1998, as used by the GAVI Board to guide early funding decisions.
| Country | GNP per Capita (USD) | Birth Cohort (Thousands) | DTP3 Coverage 1997 (%) | DTP3 Coverage 1998 (%) |
|---|---|---|---|---|
| Somalia | N/A | 469 | N/A | 24 |
| Myanmar | N/A | 939 | 90 | 87 |
| Ethiopia | 100 | 2,606 | 63 | 57 |
| Congo (Dem. Rep.) | 110 | 2,228 | 18 | 18 |
| Malawi | 200 | 486 | 95 | 96 |
| Nigeria | 300 | 4,056 | 45 | 21 |
| Vietnam | 330 | 1,729 | 95 | 94 |
| Bangladesh | 350 | 3,403 | 98 | 78 |
| Sri Lanka | 810 | 326 | 97 | 94 |
| Albania | 810 | 65 | 99 | 96 |
Note: This table presents a representative sample. The full list of 68 eligible countries was maintained by GAVI.
Appendix II: Vaccine Funding Needs Projection (2000–2010)
GAVI projected vaccine funding needs to help guide partner resource mobilization and long-term sustainability planning. Estimated funding requirements were divided between existing EPI vaccines and additional new vaccines as they were introduced.
| Year | Baseline Vaccine Costs (USD Millions) | Additional New Vaccines (USD Millions) | Total Projected Funding (USD Millions) |
|---|---|---|---|
| 2000 | 500 | 200 | 700 |
| 2002 | 500 | 400 | 900 |
| 2005 | 500 | 800 | 1,300 |
| 2008 | 500 | 1,200 | 1,700 |
| 2010 | 500 | 1,500 | 2,000 |
These figures provided a framework for understanding the dramatic growth in required vaccine financing over time, emphasizing the importance of sustained international commitment.
Appendix III: Structure of the Global Fund for Children’s Vaccines
This appendix describes the governance and operational structure of the Fund. The design was intended to maximize transparency, protect donor resources, and ensure alignment with GAVI’s mission.
The Fund was overseen by an independent Fund Board, composed of representatives from key donor governments, foundations, international agencies, and technical experts. Major contributors included the Bill and Melinda Gates Foundation, bilateral government donors, UNICEF National Committees, multinational corporations, and private philanthropic organizations.
All contributions were deposited in a Working Capital Account managed by UNICEF. Disbursements were made only upon approval from the GAVI Board based on recommendations from the GAVI Working Group.
The Fund was structured with three sub-accounts:
- Procurement of vaccines and safe injection equipment
- Support for vaccine delivery infrastructure (planned for later implementation)
- Support for research and development of vaccines for neglected diseases (also for future phases)
This structure gave GAVI the flexibility and accountability needed to manage global contributions effectively and support long-term immunization scale-up.
Annex 3: Presentations on GAVI and Vaccine Procurement Strategies
As part of the first GAVI Board meeting, two key expert presentations were delivered to help shape the operational and financing strategies for the alliance and the Global Fund for Children’s Vaccines. Dr. Mark Kane and Mr. Piers Whitehead provided foundational recommendations on alliance principles and procurement approaches to ensure both rapid impact and long-term sustainability.
Dr. Mark Kane’s Presentation
Dr. Mark Kane outlined the conceptual framework for how GAVI and the Global Fund would work together to overcome barriers to vaccine access in low-income countries. He stressed that GAVI’s support should be based on nationally developed multi-year immunization plans, giving countries ownership and leadership in setting their priorities.
He further recommended that partner agencies align their activities around country plans and deliver their support in coordinated, predictable ways. Dr. Kane highlighted the need for sustained donor funding commitments to match country needs and avoid disruptions in immunization programs. His roadmap emphasized collaboration between governments, global agencies, and donors to create a strong, stable foundation for expanding childhood vaccination.
Mr. Piers Whitehead’s Presentations
Mr. Piers Whitehead of Mercer Management Consulting delivered two presentations focused on public sector procurement strategies and market dynamics. In the first, he outlined procurement models that could deliver the lowest possible vaccine prices without compromising product quality or supplier relationships.
He advised GAVI to:
- Use public sector approaches to maintain bargaining power and secure discounts.
- Explore tiered pricing systems, where wealthier countries pay market rates while poorer countries receive deeply discounted vaccines.
- Transition from short-term tender-based procurement toward longer-term contracts, which offer manufacturers stable demand in exchange for lower prices.
In his second presentation, Mr. Whitehead examined real-world market examples. He pointed to the dramatic drop in recombinant Hepatitis B vaccine prices after its early adoption in high-income countries. The price reduction was achieved through global scale-up and aggressive introduction campaigns. He urged GAVI to consider such market behavior and timing when shaping its vaccine procurement plans, to drive affordability for the poorest nations.