A New Playbook for Gavi: Advancing Equitable and Sustainable Immunization in an Evolving Global Landscape

For nearly 25 years, Gavi has delivered impact and value for money and remained one of the most successful global health initiatives. Gavi’s success has been driven by its use of three primary levers: (1) accelerating new vaccine introductions, (2) increasing equitable immunization coverage, and (3) utilizing eligibility criteria to target support to the most impactful geographies. For Gavi to be as successful going forward, its leadership and board need to reevaluate and adjust its operational model. Several imminent disruptions are exerting pressure on Gavi’s ability to deliver results across these three levers. For the upcoming 2026-2030 strategic period (known as “Gavi 6.0”), Gavi should adopt a new playbook to leverage its strengths, mitigate the impacts of disruptions associated with these levers, and enable greater agility and effectiveness in its model. We offer seven policy recommendations for Gavi’s board as it sets the course for Gavi 6.0. These include: (1) revising Gavi’s eligibility policy to better align with countries’ abilities to pay and disease burdens; (2) recalibrating the global-regional balance in vaccine manufacturing and procurement; (3) creating a mechanism across Gavi and other global health initiatives to assure integrated approaches to disease control that optimize value for money and simplify implementation for countries; (4) leveraging Gavi’s experience, including in market shaping, to accelerate innovations for immunization systems and primary health care more broadly; (5) replacing existing financing arrangements with an envelope financing approach that is driven by local priorities; (6) establishing a stand-alone subsidiary that operates in fragile and conflict-affected settings with high-risk appetite; and (7) incorporating second year of life and adolescent platform building as an explicit objective for Gavi 6.0.