Five things Gavi should address as it implements its new 5-year strategy

In the ever-evolving global health security architecture, Gavi, the Vaccine Alliance , stands out as a cornerstone organisation. Established in 2000, Gavi unites public and private sectors to enhance global immunisation efforts, focusing on equitable and sustainable vaccine access in lower-income countries. Its innovative approach combines funding for new vaccines, support for national immunisation programs, and market-shaping strategies to lower vaccine costs and mitigate risks for manufacturers.

MOPAN recently assessed Gavi’s performance from 2017 to early 2024. Since its inception, Gavi has showcased the ability to adapt to unforeseen challenges while remaining steadfast in its mission to improve vaccination coverage, equity and sustainability. This adaptability was particularly evident in the assessment period, where Gavi not only launched transformative organisational strategies, but also responded with agility to the Covid-19 pandemic.

The MOPAN assessment highlights Gavi’s strong organisational effectiveness - all 12 MOPAN KPIs are rated satisfactory - affirming its fitness for purpose and value for money.

However, progress in 5 specific areas was more limited, indicating the need for more focused action:

1. Putting beneficiaries first: strengthening Gavi’s accountability

Gavi draws its strength from its unique Alliance model, which builds on its key partners – WHO, UNICEF, the Bill and Melinda Gates Foundation and the World Bank – but also includes donors, research agencies, vaccine manufacturers, and crucially, governments and civil society of implementing countries. Gavi’s governance structure includes this broad mix of stakeholders that influence decision-making. While independent Board members provide an important counterbalance, ensuring accountability remains a work in progress. Partner institutions that receive Gavi funding also play a role in governance, raising further questions about the potential for blurred lines.

Gavi’s partnership model complicates accountability to the populations it aims to serve. The organisation has committed to inclusivity and evidence-based decision-making but lacks clarity in defining its main beneficiaries and applying accountability in practice through its operations, for example through direct representation or robust feedback loops. To truly fulfill its mission, Gavi needs to clarify roles and responsibilities among Alliance members and partners, and, most importantly, integrate mechanisms to ensure accountability to beneficiaries.

2. Ensuring a holistic approach: better integrating cross-cutting issues

Clear strategies have allowed Gavi to adapt to evolving global health needs, including the pandemic, while being increasingly ambitious in its overall mission goals. But those strategies have not sufficiently integrated cross-cutting issues such as gender, climate change and environmental sustainability.

While Gavi has adopted a Gender Policy and incorporated gender-sensitive approaches into program design, challenges persist in mainstreaming gender across strategic objectives and translating policy into action. For instance, compliance with gender-related recommendations is not mandatory for funding approval.

Despite recognising climate change's impact on health and vaccine supply chains, these issues are yet to become core strategic objectives. Similarly, no indicators exist to measure progress on

environmental sustainability. However, Gavi’s forthcoming Strategy 6.0 (2026–2030) signals a more robust focus on these areas.

3. From data to impact: consolidating learning practices

Gavi strategies and programmes are supported by strong evidence. Gavi has made significant progress in embedding a learning culture across its operations, particularly through its monitoring, evaluation, and learning (MEL) functions. The shift to a decentralised results-based management (RBM) approach has promoted a focus on evidence-based decision-making and learning.

However, bridging the gap between centralised and decentralised evaluations by improving oversight, ensuring methodological rigor, and providing adequate resources for MEL activities at all levels is key. Efforts should be made to enhance systems for sharing lessons learned, refining country-level data collection, and leveraging Alliance partner data to make it more actionable. Equally important is ensuring that Gavi’s evaluative functions remain grounded in the needs of its beneficiaries. Strengthening beneficiary representation in MEL processes and applying lessons consistently across operations will ensure that Gavi can leverage evidence and lessons learned to improve programming effectiveness.

4. Improving efficiency: streamlining and simplifying funding mechanisms

Although Gavi has no in-country presence, its strong partnership model enables alignment with country health systems and partners, thereby ensuring sustainability. However, in-country partners often operate in fragile, resource-constrained environments and face challenges such as limited technical expertise and management capacity.

These difficulties are compounded by the complexity of Gavi’s funding mechanisms, which include five primary funding types and six additional categories. The cumbersome application process creates inefficiencies, delaying program implementation and straining partners.

Gavi’s Operational Excellence (OE) Agenda and EVOLVE initiative, which aim to simplify funding applications, streamline grant-making, and transition to results-based budgeting, are still in the early stages. To adapt to evolving needs, the Secretariat will also have to address staff competencies, burnout, and attrition.

5. Protecting impact: strengthening risk management and safeguarding

Gavi’s organisational strength and solid results support a solid value for money proposition, which should be protected against risks. While Gavi has made notable strides in improving its risk management framework—updating its Risk Appetite Statement and increasing staff capacity—gaps persist in identifying and addressing key risks, particularly safeguarding vulnerabilities such as sexual exploitation, abuse, and harassment (SEAH).

Currently, Gavi lacks standardised risk analyses during grant applications and program design, leading to reactive rather than proactive risk management. Furthermore, oversight mechanisms for risk escalation to the Board are unclear, making it harder to address risks systematically and proactively.

Gavi’s reliance on partner organisations and direct funding to governments, particularly in fragile and conflict-affected settings, heightens the risks associated with political instability, financial

mismanagement, and safeguarding violations. A more systematic approach to risk identification and mitigation that includes well-defined responsibilities and targeted strategies would help maintain trust going forward.

Strategy 6.0 is not just an operational roadmap; it is a critical opportunity for Gavi to reaffirm its commitment to immunisation equity, contribute to global health security, and leave a legacy of impact as part of the global effort to build healthier, more resilient communities. As Gavi embarks on its implementation, increasing needs and the fiscal realities of declining development assistance for health and heightened competition funding create a challenging environment to navigate. Addressing the five areas identified by the MOPAN assessment will help reinforce trust and cement Gavi’s invaluable place in the global health architecture.

We invite you to read our full assessment of Gavi, the Vaccine Alliance, available on the MOPAN website. This report is part of MOPAN’s series of assessments and knowledge work across global health organisations, contributing to a more coherent and effective multilateral system and cross-cutting lessons for global health governance.