Presentation from Gavi CEO Dr Seth Berkley during the replenishment launch at the Seventh Tokyo International Conference on African Development (TICAD) in Yokohama, co-hosted by the Japanese government.

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