In the run up to the official launch of Gavi’s African Vaccine Manufacturing Accelerator (AVMA) on June 20 in Paris, Janeen Madan Keller, deputy director of global health policy, at Center for Global Development, explains to Viveka Roychowdhury how Gavi must reform its operational model, why Gavi must plan beyond the 10-year horizon of AVMA and how India can help advance global cooperation on more distributed manufacturing of vaccines and other medical countermeasures
Gavi has a new CEO from March this year and is also setting its agenda for its next strategic period, 2026–2030 and beyond. Your organisation, The Center for Global Development believes that Gavi needs a new playbook to remain fit for purpose. What are some of the areas for reform in Gavi 6.0?
2024 is an important year for Gavi: it recently welcomed a new CEO, Dr Sania Nishtar; the board just approved its next strategy, known as “Gavi 6.0”; and it will soon kick-off a campaign to raise several billion dollars from donors to roll-out the new strategy. Gavi must seize this opportunity and reform its operational model to remain fit-for-purpose, respond to country priorities, and continue to deliver impact in a changing global landscape.
First, Gavi must rethink which countries receive support for immunisation as a growing number of countries, including large middle-income countries, are facing economic headwinds and stagnating vaccination rates in the post-COVID era.
Second, Gavi needs to address how it delivers vaccines in humanitarian and conflict settings, including by collaborating with new and different partners such as humanitarian NGOs. Effectively delivering immunisation in these settings has been a challenge thus far but will be critical to achieving Gavi’s mission going forward.
Third, Gavi should play a bigger role in scaling innovations to address barriers to vaccine delivery and help build critical infrastructure needed for public health. Gavi can support dedicated resources to partner countries to help scale proven innovations for immunisation systems, including technologies such as digital immunisation records that India has long championed. Efforts should also build on exemplars, including India’s experience nationally scaling real-time monitoring of cold chain equipment and vaccine supplies that help prevent vaccine stock-outs and reduce vaccine wastage.
What is the scope of Gavi’s African Vaccine Manufacturing Accelerator or AVMA, which is being officially launched on June 20 in Paris?
Gavi’s $1 billion African Vaccine Manufacturing Accelerator is a new financial mechanism to help diversify vaccine manufacturing, developed in collaboration with the Africa Centres for Disease Control and Prevention. This is a timely commitment, building on one of the lessons learned from COVID-19: regionally diversified production of vaccines and other health products is essential for sufficient supply and equitable global access during a pandemic.
The overall goal is important, yet ambitious: to build a sustainable African vaccine manufacturing base that can also contribute to improved pandemic response capacity and supply resilience. AVMA will provide payments to manufacturers meeting certain criteria and milestones providing a financial kickstart to “pull” African-made vaccines to market.
What are the challenges of building up Africa’s vaccine manufacturing capacity?
The main challenge is creating the broader enabling ecosystem that is essential to support a nascent manufacturing industry and help it overcome barriers to market entry. Bottlenecks in the regulatory system, for example—which ensures vaccines pass quality, safety, and efficacy checks—pose a significant challenge across the African continent.
Some of these dynamics in the broader ecosystem are admittedly outside of Gavi’s direct control. Still, as AVMA gets off the ground, Gavi needs to think carefully about where and how it can work with other partners to address these bottlenecks and build an effective enabling environment to support more diversified manufacturing, while also protecting a healthy and sustainable global market for vaccines.
Looking ahead, India can also help advance global cooperation on more distributed manufacturing of vaccines and other medical countermeasures via mutually beneficial approaches, such as technology transfer, to advance health priorities at home and abroad.
If the 10-year timeframe is not realistic to build sustainable manufacturing capacity on the continents, what are the solutions?
While creating a time-limited mechanism is understandable, Gavi needs to think more long term. Realistically speaking, the time required to make significant progress on some of the stated goals of establishing a sustainable African vaccine manufacturing base may exceed the proposed time frame. This is especially the case given production complexities and current gaps in manufacturing capabilities on the African continent. So, while AVMA is an important contribution, it is also just the start. Learning and adjusting during the early years of AVMA will be essential, Gavi must also keep in mind the longer-term sustainability, beyond the 10-year horizon.
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