Introduction

The United States (US) is reportedly set to terminate its funding for Gavi, the Vaccine Alliance,^[a] the international organisation that carries out immunisation programmes in the world’s least developed countries.^[1] It had pledged US$2.6 billion between 2026 and 2030, around 13 percent of Gavi’s budget for these five years, but may now, according to recent news reports, provide nothing at all.^[2] Immunisation is a pillar of public health intervention, essential to protecting communities from debilitating diseases. Vaccines, particularly as part of childhood immunisation programmes, form a cost-effective and sustainable strategy to reduce the global disease burden.^[3] Immunisation initiatives, spanning vaccine research, financing, supply chain management, and implementation, have prevented 154 million deaths globally since 1974.^[4] Vaccine coverage protects populations from heavy medical expenditure, especially burdensome for low- and middle-income countries (LMICs); it also protects unvaccinated individuals within a community through ‘herd immunity’.^[b] Immunisation forms an essential strategy to address the third of the United Nations Sustainable Development Goals—Good Health and Well-being—and sets the path towards universal health coverage. Notably, coordinated global vaccination efforts have almost completely eradicated the polio virus. The measles vaccine alone averted 23 million deaths between 2010 and 2018, while the development of vaccines against malaria and Ebola have drastically improved health outcomes.^[5]

Although the Gavi funding cut has not yet been officially communicated at the time of writing, the move is imminent, as it forms part of US President Donald Trump’s ongoing termination of most of the United States Agency for International Development’s (USAID) contracts. If it happens, it could lead to over a million additional children dying in the next five years.^[6] For people in LMICs, medical expenditure is mostly out-of-pocket, with little state support—thus, vaccines offer not only health security but also economic security since vaccinations prevent the onset of particular diseases and the associated costs of their cure.^[7] Maintaining immunisation programmes is all the more essential because populations remain susceptible to infectious disease outbreaks, which are being exacerbated by climate change, conflict, and displacement. Further, diminishing public memory of the debilitating impact of diseases and mistrust around vaccines has given rise to vaccine hesitancy, particularly in high-income countries (HICs).

Gavi apart, other global vaccination programmes are also under fire. The US has already withdrawn from the World Health Organization (WHO), which will also affect vaccine research and immunisation activities. The near-closure of USAID threatens vital research into HIV and malaria vaccines. Under newly proposed cuts to the US National Institutes of Health (NIH),^[c] the vaccine platform using mRNA^[d] technology is also likely to be scrapped.^[8] Research studies being conducted by the NIH were critical to addressing priority pathogens like Covid-19, and remain crucial for addressing cancers.

This brief provides a brief account of Gavi’s mandate, its co-financing model, and immunisation activities. It appraises the current upheaval in global health as it awaits the US’s likely funding withdrawal and its consequent impact on vaccine-preventable diseases, on the global ability to address the malaria burden, and on the African Union’s domestic vaccine manufacturing endeavour. Finally, it provides insights for Gavi and a roadmap for India to secure its position as a global health security provider.

The Gavi Story

Gavi, the Vaccine Alliance, was formed in 2000 to address the immunisation challenges of children in LMICs.^[9] Seeking to encourage vaccine manufacturers to lower prices for developing countries, Gavi’s founding partners—WHO, the United Nations Children’s Fund (UNICEF), the World Bank, and the Gates Foundation—formed a public-private partnership (PPP). To promote national ownership of immunisation activities, the model encompasses a co-financing component provided by the recipient country. A 2020 study estimated that Gavi brought substantial economic benefit to all stakeholders in the long run—that for every US dollar invested in Gavi, a yield of US$54 was obtained.^[10]

Gavi’s main aim^[e] is to reduce the number of ‘zero-dose’ children,^[f] or those who do not have access to routine immunisation services.^[11] Sustaining immunisation programmes and ensuring equitable access to vaccines through health market access form the other pillars of Gavi’s strategy. Its efforts have reduced the burden of vaccine-preventable diseases and communicable illnesses, promoting equitable vaccine access for all, including women and children—thus, forming a critical and cost-effective public health intervention.^[12] Gavi is also one of the agencies that developed the Global Action Plan for Healthy Lives and Well-being for All (SDG3 GAP), which accelerates programmes seeking to address health-related SDGs. It is aligned with the Immunisation Agenda 2030 as well, aimed at “leaving no one behind.”^[13] The initiative is endorsed by the World Health Assembly and aims to save over 50 million lives by 2030.

Gavi provides funding for immunisation programmes in countries whose gross national income (GNI) per capita falls below the World Bank’s low-income country threshold. Between 2000 and 2020, it vaccinated over 1 billion children.^[14] At present, the World Bank defines low-income countries as those whose GNI per capita is less than or equal to US$1,820. Gavi spans vaccines across 20 infectious diseases, which include those preventing diphtheria, tetanus, whooping cough, Ebola, cholera and yellow fever, as well as the human papillomavirus (HPV), which guards against viral infection-induced cancer.^[15]

Since it was launched, Gavi has provided US$23 billion^[g] for immunisation activities.^[16] Apart from the US, top donors include the Gates Foundation and the United Kingdom (UK).^[17] Multi-year pledges^[h] are committed by donors. In the case of the US, funds are allocated by Congress through a legislative mechanism on an annual basis.^[i] Annual contributions by the US have steadily increased from US$175 million in FY 2014 to US$300 million in FY 2024.^[18] Separately, in 2021, the US contributed US$4 billion for emergency Covid-19 vaccine procurement under the Covid-19 Vaccines Global Access (COVAX), a Gavi-led global collaborative effort.

Until now, Gavi had enjoyed bipartisan support in the US. Indeed, even during Trump’s first presidency (2016-20), the US pledged a total of US$1.16 billion over the four years to Gavi.^[19] However, contributions to Gavi are made under USAID’s Global Health account, and USAID itself is almost scrapped. Of the US$2.6-billion pledged by the US between 2026 and 2030, around US$1.7 billion has yet to be paid out. According to Sania Nishtar, Gavi’s Chief Executive Officer, even the US$300 million already approved by Congress for 2025 has not been received.^[20]

Cost-Cutting Immunisation

Gavi has estimated that it needs US$9 billion to fulfil its goals for the next replenishment cycle (2026-2030).^[21] The European Union (EU) and the Gates Foundation will co-host this year’s pledging summit, where Gavi will seek investors. Global health financing is already in dire straits, not only with the recent termination of 83 percent of USAID contracts, including programmes on HIV/AIDS, tuberculosis, malaria, and maternal and child health, but also with the UK announcing that it will reduce development assistance from 0.5 percent of its GDP to 0.3 percent, as funds have to be diverted for aid in the ongoing conflict in Ukraine.^[22] The Gates Foundation pledged US$1.8 billion for 2021-2025, but whether the foundation or any other entity can bridge the funding deficit for the next cycle remains uncertain.^[23] The EU (with its member states) was Gavi’s largest contributor in 2021–2025, contributing €6.5 billion (US$7.41 billion).^[24] Most recently, the EU pledged €260 million (US$297 million) for Gavi’s 2026-2027.

Operationally, slashed Gavi contributions are likely to reduce the number of vaccine programmes and supply of vaccines, diminishing the resilience of health systems.^[25] In 2024, 54 countries were eligible for Gavi support, spanning primarily Africa, South Asia, and Southeast Asia.

Under the co-financing programme, nations pay and procure for a proportion of vaccines introduced through Gavi support. Nations progress from an initial self-financing stage, when their governments are required to fund a flat amount—typically 20 cents—per dose of all vaccines, while the rest is paid for by Gavi. As a country’s GNI increases, it enters the preparatory transition stage where the national contribution has to rise by 15 percent per year, while Gavi support diminishes in the same proportion. Upon passing the eligibility threshold (i.e., GNI per capita), the country enters into an accelerated transition stage, where the co-financing component of the nation increases by 15 percent for one year and then increases steeply over the next four years. A country fully self-finances its vaccine costs by the time Gavi support ceases. To ensure that the transition from Gavi support is sustainable, vaccine manufacturers often make commitments to maintain vaccines at the same costs for a certain period of time.

Figure 1 illustrates Gavi’s latest co-financing model. Of the 54 countries that are eligible for Gavi-support, 26 are at the initial self-financing stage, which includes Afghanistan, Democratic Republic of the Congo, and Uganda; 17 are in the preparatory transition stage, including Myanmar, Nepal, and Pakistan; and 11 are in the accelerated transition stage, including Bangladesh, Kenya, and Nigeria. Of the countries Gavi began funding, 19 (including India) have transitioned to fully self-financing—i.e., they can no longer access fresh financial support, but can obtain previously approved Gavi support. Indonesia is Gavi’s most recent former Gavi-implementing country to become a donor and has contributed US$30 million for its 2026–2030 effort.^[26]

Figure 1. Gavi’s Most Recent Co-Financing Model Illustrating the Transition Stages

Source: The Gavi Alliance^[27]

Impact on Global Health Security

Global health security is achieved by strengthening national immunisation programmes, ensuring equitable access to vaccines, addressing vaccine hesitancy, and promoting vaccine manufacturing. Disruptions and delays in routine childhood immunisation programmes will trigger the resurgence of vaccine-preventable infectious diseases such as measles, whooping cough, and rotavirus-induced diarrhoea, which are potentially life-threatening.^[28] The Covid-19 pandemic disrupted routine healthcare in over 100 countries and triggered various outbreaks, including that of yellow fever, diphtheria, polio, and cholera.^[29] Factors such as climate change, altered disease-causing vector distribution patterns, anthropogenic activities, conflict, and displacement will exacerbate the global burden of infectious diseases, including the numbers of diseases with epidemic or pandemic potential.

High-income countries (HICs) face a very different kind of problem—that of vaccine hesitancy, which has grown due to mistrust in vaccine safety and misinformation over its efficacy. Vaccine hesitancy is said to be mainly responsible for the 50-percent rise in measles outbreaks between 2020-2021 and 2022-2023 in these countries.^[30] However, vaccine hesitancy in HICs, coupled with disruptions in routine vaccinations in the Gavi-supported ones due to the forthcoming funding crunch, will reduce global herd immunity and lead to more outbreaks of vaccine-preventable diseases. Further, buffer stockpiles of vaccines maintained for public health emergencies will be affected, as the global health security response relies on Gavi’s ability to mobilise vaccines.^[31] As recently as in April 2025, for instance, Nigeria faced a meningitis outbreak, and it was Gavi which funded the rollout of 1 million meningococcal vaccines to control it.^[32] Since 2009, the global stockpile of meningococcal vaccines has been accessed over 50 times by 16 countries.

Gavi is also actively involved with the global ‘Zero by 30’ plan to eliminate rabies by 2030, using the rabies vaccine as a post-exposure prophylaxis (PEP) on those bitten by unvaccinated canines.^[33] Almost all human rabies deaths occur in Africa and Asia, primarily affecting poor and marginalised sections. It is Gavi which ensures equitable and affordable access to PEP, which will surely be impacted if its funding is reduced.

The rollout of new malaria vaccines in Africa will likely be affected too. Africa accounts for 94 percent of global malaria cases, which kill nearly 500,000 children under the age of five each year.^[34] Along with WHO and other partners, Gavi co-financed the introduction of two new vaccines—the R21/Matrix-M vaccine^[j] and the RTS,S vaccine^[k]—in several African countries.^[35] Disruptions and delays in their supply will further deepen the malaria burden. Gavi has also launched the African Vaccine Manufacturing Accelerator (AVMA), a programme intended to help meet the African Union’s goal of producing at least 60 percent of vaccines it needs within the continent by 2040.^[36] If US funding stops, it will likely affect this initiative as well, as its operationalisation is expected to cost around US$1 billion over the next decade.^[37] Unexpected outbreaks of cholera and mpox (formerly known as monkey pox) in several African countries in the last three years once again exposed the continent’s dependence on HICs for its vaccines. Indeed, vaccines were in such short supply globally during the cholera resurgence that WHO advised countries to donate at least a single dose of the oral cholera vaccine, if they could not manage the optimal two doses.^[38] The crisis will be exacerbated once Gavi’s funding is slashed.

Impact on India

India is a critical partner to Gavi, supplying 60 percent of its vaccines.^[39] Initially, Gavi provided India with US$1.7 billion in funding over two decades to enhance national immunisation programmes covering hepatitis B, inactivated^[l] poliovirus vaccine, and measles-Rubella; in turn, from 2014, India became the first implementing nation to donate to Gavi.^[40] During the pandemic, India partnered with Gavi to introduce the Electronic Vaccine Intelligence Network (eVIN) to monitor vaccine supply chains, and the Serum Institute of India (SII), in an agreement with Gavi and the Gates Foundation, manufactured Covid-19 vaccine doses as part of COVAX.

Although India became a fully self-financing country in 2022, it continues to receive health system strengthening support from Gavi. While it is too early to speculate about the impact the proposed US funding cut will have on India, there is a chance it may affect the agreements Indian vaccine manufacturers have signed with Gavi. SII, for instance, recently entered into an agreement with UNICEF and Gavi to supply 10 million doses of pneumococcal conjugate vaccine (PCV) (which prevents pneumonia) to Gavi-supported countries each year for the next decade; whether the deal will actually materialise is now open to question.^[41]

The cut may also impact immunisation strengthening initiatives in India as India receives Gavi support for targeted health system strengthening initiatives designed to ensure optimal and sustained vaccine coverage. India’s rollout of PCV into its national childhood immunisation schedule, for instance, still relies on a Gavi procurement agreement.^[42] In 2022, India pledged US$15 million to Gavi (for the 2021–2025 phase) and entered into a three-year partnership with it, through which it raised US$250 million in funding to introduce HPV vaccines and typhoid conjugate vaccines into its routine immunisation schedule.^[43]

Geopolitical Implications

Geopolitical Implications

If the US disengages from Gavi, China’s presence in the global vaccine market is likely to grow.^[44] China already supplies vaccines to several countries in Africa, Latin America, South Asia, Central Asia, and the Western Pacific, and is thus well poised to fill the void.^[45] It has been estimated that 11 countries^[m] that are currently in accelerated transition phase or in line to becoming self-financing are likely to face the brunt of the US fund cut. These countries are also members of China’s Belt and Road Initiative (BRI) and have already received US$1 billion as health assistance from China, indicating the latter’s intent to promote health activities to advance its strategic interests and expand its spheres of influence. China’s biotechnology sector is also rapidly growing with considerable investments in research and development (R&D) and in vaccine manufacturing.

India, as the world’s largest vaccine producer, with a similarly cutting-edge biotechnology industry, will undoubtedly vie for influence in this space too. Clearly, the global health ecosystem faces a power vacuum that will likely be replaced by a multipolar governance system with more opportunities for emerging economies to exert their influence.

Where to Next?

The US is disinclined to lead global health efforts, but this should not hamper investments by other countries or private donors. While Gavi tries to raise alternative funds, the path to self-reliance in immunisation must be cognisant of criticalities. Partnerships under PPP models like Gavi have played a pivotal role in advancing global health. There remain concerns, however, about the legitimacy, transparency, and accountability of these finance models; new ways must be found to strengthen contractual obligations and voluntary commitments.^[46] Systematic monitoring, evaluation, and documentation of Gavi’s programmes, its decision-making process, its defined measures of ‘success,’ and its impact on resource allocation and vaccine equity will demonstrate the significance of its operations and draw investments from existing and potential donors.^[47] In this context, insights from its COVAX partnership should be applied to its future approaches.

Lessons from COVAX

In policy circles, Gavi came into the limelight most notably during the Covid-19 pandemic (2020-2022), when it facilitated access to Covid-19 vaccines through COVAX,^[n] a novel global health partnership where it handled the procurement, coordination, and distribution of Covid-19 vaccines. COVAX delivered 2 billion doses to 146 countries.^[48] Though the COVAX programme ceased in 2023, 92 countries remain eligible for Covid-19 vaccines through Gavi.^[49] COVAX demonstrated innovation in vaccine distribution during a time of crisis and the power of technology transfer in vaccine manufacturing. It was COVAX which enabled AstraZeneca to enter into a licensing and technology transfer agreement with SII, allowing the latter to manufacture the COVISHIELD vaccine^[o] and distribute it widely.^[50]

However, COVAX has received its share of criticism too.^[51] It was premised on a vaccine donation system comprising donor countries and vaccine manufacturers. It had aimed to procure vaccines for at least 20 percent of the population of participating nations but this level was not attained.^[52] Some donor countries displayed vaccine nationalism, preferring to vaccinate their domestic populations first, while some donated only to countries within their sphere of geopolitical influence. Moreover, SII had to renege on a US$300-million prepaid agreement with Gavi to boost manufacturing under COVAX’s advance manufacturing commitment (AMC).^[53] In April 2021, as India faced a deadly second Covid-19 wave, the vaccine was subjected to national export bans, due to which some doses intended for COVAX AMC countries were diverted to addressing India’s needs. The COVAX experience also demonstrated that scaling up of R&D to vaccine production needs resilient health systems in LMICs—from laboratories and primary healthcare centres to adequate physical infrastructure that can store vaccines in bulk under specific conditions.^[54]

Lessons from the India Experience 

India’s role in helping Gavi contribute to global health security should not go unnoticed; 60 percent of Gavi’s vaccines are supplied by India. Development of innovative technologies against Covid-19, such as Zydus Cadila’s needle-free vaccine and Gennova Biosciences mRNA vaccine (that does not require ultra-low refrigeration), are other notable breakthroughs achieved by India.^[55]

Accordingly, India’s experience in vaccine manufacturing offers several insights.^[56] It shows that domestic manufacturing requires a strong bioscience environment, commitment to developing a strong workforce, strategic investments by the private sector, and a steady and sustainable market.^[57] Vaccine manufacturing is at odds with the ‘fail-fast’ approach that is typically adopted in the tech industry, where initiatives that do not immediately deliver favourable outcomes are terminated.^[58] Further, for PPPs to succeed, there needs to be clarity beforehand of the incentives required to expand vaccine manufacturing across geographies; R&D should also be promoted in a country- or region-specific manner.^[59] India’s efforts to eradicate polio, for instance, were reinforced through its own national effort, highlighting the need for immunisation programmes to form an integral part of health systems.^[60] The experience shows that targeted investments aimed at sustaining immunisation programmes in countries that are transitioning from the Gavi-supported stage to self-sufficiency will be beneficial.^[61]

Immunisation is the bedrock of health security and global partnerships remain a sustainable path to prioritise global health. India’s experience puts it in a position where it can lead global health security efforts. Investments in India’s vaccine ecosystem, through policies such as Bio-E3^[p] and Bio-RIDE^[q], can strengthen its endeavours and address the ongoing strife in global health.^[62] Cross-collaboration with regional partners, be it bilaterally or through the Indo-Pacific Health Security network, or through Quad^[r] or BRICS^[s] under PPP models like Gavi, will contribute to addressing the vulnerabilities of LMICs.^[63] The power vacuum left by the US can be filled by regional initiatives that centre on local capacity-building and strengthening health systems.

Conclusion

Immunisation is a critical component of public health and essential for disease eradication. The US has signalled that it no longer wants to lead global health efforts, and as a result, the future of several global health activities is in jeopardy. Vaccine manufacturing and health system strengthening through immunisation are urgently needed as they cater to global health security. In an interconnected world, Gavi needs to address the issues that hamper countries’ paths to self-reliance and implement measures that will promote strategic investments.

The US’s disengagement from global health is an opportunity for India to secure its role as a global health security provider by taking active measures to strengthen its vaccine manufacturing ecosystem. Strategic investments will foster regional partnerships and strengthen the bioscience ecosystem making immunisation efforts resilient enough to withstand the funding void created by the US’s new approach.

Endnotes

^[a] Formerly known as the Global Alliance for Vaccination and Immunisation, but currently referred to only by its acronym, Gavi.

^[b] ‘Herd immunity’ is an indirect form of immunity against infectious diseases that arises within a population. When sufficient numbers within a population are immunised (either naturally or through vaccination), the chance of transmission of a particular disease reduces and herd immunity is attained.

^[c] The NIH is the world’s largest public funder of biomedical research.

^[d] mRNA vaccine technology—a cutting-edge vaccine technology—refers to the use of mRNA or messenger ribonucleic acid for the development of vaccines.

^[e]The current strategy is referred to as Gavi 5.0 and is Gavi’s strategy for the period between 2021 and 2025.

^[f] This strategy is premised on the notion of ‘leaving no one behind with immunisation.’ (See: https://www.gavi.org/our-alliance/strategy/phase-5-2021-2025).

^[g]Excluding funding for COVAX.

^[h]Pledges are multiyear commitments made by donors.

^[i]The US Congress Appropriations Committee determines the extent of funding an authorised programme receives (See: https://www.congress.gov/crs-product/R47106).

^[j] The R21/Matrix M vaccine was developed by the Serum Institute of India and Oxford University and received WHO recommendation as an effective malaria vaccine in October 2023.

^[k] The RTS,S vaccine was developed by GlaxoSmithKline, Bharat Biotech and the Programme for Appropriate Technology (PATH) and was recommended by WHO in October 2021.

^[l] An “inactivated” vaccine is one where the viruses in it have been rendered incapable of causing the disease.

^[m] Bangladesh, Congo, Côte d'Ivoire, Djibouti, Ghana, Kenya, Lao People’s Democratic Republic, Nigeria, Papua New Guinea, Sao Tome and Principe, and Solomon Islands.

^[n]COVAX was a partnership between CEPI (Coalition for Epidemic Preparedness Innovations), Gavi, WHO, and UNICEF that was launched in 2020 and ended in 2023.

^[o] The vaccine is also known as AstraZeneca (AZ)-Oxford vaccine.

^[p] Bio-E3 policy: Biotechnology for Economy, Environment and Employment.

^[q]Bio-RIDE policy: Biotechnology Research Innovation and Entrepreneurship Development .

^[r] Quad is a diplomatic partnership between India, Australia, Japan and the US.

^[s] BRICS is a multi-government organization comprising 10 countries, the acronym derived from the first five countries which began it – Brazil, Russia, India, China and South Africa.

^[1]Stephanie Nolan, “U.S. to End Vaccine Funds for Poor Countries,” The New York Times, March 26, 2025, https://www.nytimes.com/2025/03/26/health/usaid-cuts-gavi-bird-flu.html

^[2] Global Health Policy, “The USAID List of Terminated Global Health Awards – What Does it Tell Us?,” KFF, https://www.kff.org/policy-watch/the-usaid-list-of-terminated-global-health-awards-what-does-it-tell-us/; Adam Taylor and Immanuel Martinez, “Trump Cuts to USAID Halt Funding for Global Vaccinations,” The Washington Post, March 26, 2025, https://www.washingtonpost.com/world/2025/03/26/usaid-cuts-gavi-vaccines-trump/

^[3]Sachiko Ozawa et al., “Cost-Effectiveness and Economic Benefit of Vaccines in Low- and Middle- Income Countries: A Systematic Review,” Vaccine 17, no. 31 (1) (2012), https://pubmed.ncbi.nlm.nih.gov/23142307/

^[4]Andrew J Shattock et al., “Contribution of Vaccination to Improved Survival and Health: Modelling 50 Years of the Expanded Programme on Immunisation,” The Lancet 403, no. 10441 (2024), https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00850-X/fulltext

^[5] Minal K Patel, “Progress Toward Regional Measles Elimination — Worldwide, 2000–2018,”Morbidity and Mortality Weekly Report 68 (2019), https://doi.org/10.15585/mmwr.mm6848a1

^[6] Dorcas Wangria, “One Million Children Could Die If US Cuts Funding,” BBC, March 27, 2025, https://www.bbc.com/news/articles/cwyd505vzlwo

^[7]Arindam Nandi and Anita Shet, “Why Vaccines Matter: Understanding the Broader Health, Economic, and Child Development Benefits of Routine Vaccination,” Human Vaccines and Immunotherapeutics 24, no. 16 (8) (2020), https://pmc.ncbi.nlm.nih.gov/articles/PMC7482790/#cit0003

^[8]Carla Bleiker, “Crucial mRNA Vaccine Research at Risk in the US,” DW News, April 21, 2025,

 https://www.dw.com/en/crucial-mrna-vaccine-research-at-risk-in-the-us/a-71989604

^[9]The Gavi Alliance,”Eligibility,” https://www.gavi.org/types-support/sustainability/eligibility

^[10]Sim So Yoon et al., “Return On Investment from Immunization Against 10 Pathogens In 94 Low- And Middle-Income Countries, 2011-30,” Health Affairs (Project Hope) 39, no. 8 (2020): 1343–53, https://doi.org/10.1377/hlthaff.2020.00103

^[11]The Global Health Observatory, “Number of Zero-dose Children,” World Health Organization, https://www.who.int/data/gho/indicator-metadata-registry/imr-details/7792

^[12]The United Nations, “Ensure Healthy Lives And Promote Well-Being For All At All Ages,” https://sdgs.un.org/goals/goal3#targets_and_indicators

^[13]World Health Organization, “Explaining The Immunisation Agenda 2030,” https://www.who.int/teams/immunization-vaccines-and-biologicals/strategies/ia2030/explaining-the-immunization-agenda-2030

^[14] The Gavi Alliance, “Annual Progress Report 2023,” 2023, https://www.gavi.org/sites/default/files/programmes-impact/our-impact/apr/Gavi-Progress-Report-2023.pdf and The Gavi Alliance, “Eligibility,” https://www.gavi.org/types-support/sustainability/eligibility

^[15] The Gavi Alliance, “Annual Progress Report 2023”

^[16] The Gavi Alliance, “Annual Progress Report 2023,”

^[17]Immunisation Economics, “US Government Intends to End Financial Support for Gavi, Threatening Flagship Vaccine Programs,” https://immunizationeconomics.org/recent-activity/2025/4/1/us-government-intends-to-end-financial-support-for-gavi-the-vaccine-alliance/

^[18] Global Health Policy, “The U.S. Government and Gavi, the Vaccine Alliance,” KFF, https://www.kff.org/global-health-policy/fact-sheet/the-u-s-government-gavi-the-vaccine-alliance/

^[19] The Gavi Alliance, “United States Endorses Gavi with Recommendation of US$ 1.16 Billion, Four-Year Commitment,” https://www.gavi.org/news/media-room/united-states-endorses-gavi-recommendation-us-116-billion-four-year-commitment

^[20] Wangria, “One Million Children Could Die If US Cuts Funding”

^[21] Wangria, “One Million Children Could Die If US Cuts Funding”

^[22] Centre for Global Development, “The USAID Cuts: Little Signs of Mercy For ‘Life-Saving’ Health Programs,” Centre for Global Development, https://www.cgdev.org/blog/usaid-cuts-little-sign-mercy-life-saving-health-programs; Peter Walker, “Dismay As UK Poised To Cut Funding For Global Vaccination Group Gavi,” The Guardian, February 10, 2025, https://www.theguardian.com/society/2025/feb/10/dismay-as-uk-poised-to-cut-funding-for-global-vaccination-group-gavi; Kat Lay, “This Will Cost Lives: Cuts To UK Aid Budget Condemned As ‘Betrayal’ By International Aid Groups,” The Guardian, March 2, 2025, https://www.theguardian.com/global-development/2025/mar/02/this-will-cost-lives-cuts-to-uk-aid-budget-condemned-as-betrayal-by-international-development-groups

^[23] Fran Kritz, “Gavi, The Vaccine Alliance, Has Its Billion Dollar Grant Cut by Trump Administration,” NPR, March 28, 2025, https://www.npr.org/sections/goats-and-soda/2025/03/28/g-s1-56881/vaccines-gavi-usaid-rubio

^[24]European Commission, “Joint press release by the European Commission and the European Council on the European Union and the Bill & Melinda Gates Foundation co-hosting Gavi High Level Pledging Summit,” https://ec.europa.eu/commission/presscorner/detail/en/ip_24_6187

^[25] Think Global Health, “US Retreat From Gavi Cedes Influence From China’s Vaccine Suppliers,” https://www.thinkglobalhealth.org/article/us-retreat-gavi-cedes-influence-chinas-vaccine-suppliers

^[26]The Gavi Alliance, “Indonesia pledges US$ 30 million to support global immunisation efforts through Gavi,”

https://www.gavi.org/news/media-room/indonesia-pledges-us-30-million-dollars-support-global-immunisation-efforts-through-gavi

^[27] The Gavi Alliance, “Eligibility,” https://www.gavi.org/types-support/sustainability/eligibility

^[28] David M Higgins and Sean T. O’Leary, “A World Without Measles and Rubella: Addressing the Challenge of Vaccine Hesitancy,” Vaccines 12, no. 6: 694 (2024), https://doi.org/10.3390/vaccines12060694

^[29] World Health Organization, “Immunisation Coverage,” https://www.who.int/news-room/fact-sheets/detail/immunization-coverage

^[30] World Health Organization, “Message by The Director of Department of Immunisation, Vaccines and Biologicals at WHO – May 2023,” https://www.who.int/news/item/24-05-2023-message-by-the-director-of-the-department-of-immunization--vaccines-and-biologicals-at-who---may-2023

^[31]Alice Park, “This Is About Children’s Lives: Gavi’s CEO Makes The Case For Funding The Global Vaccine Alliance,” Time, April 2, 2025, https://time.com/7273414/gavi-vaccine-alliance-sania-nishtar-ceo-funding/

^[32]The Gavi Alliance, “Gavi-Funded Meningococcal Vaccines Arrive in Nigeria To Aid Outbreak Response,” https://www.gavi.org/news/media-room/gavi-funded-meningococcal-vaccines-arrive-nigeria-aid-outbreak-response

^[33]World Health Organization, “Gavi To Boost Access To Life-Saving Human Rabies Vaccines In Over 50 Countries: Gavi, WHO, UAR,”  https://www.who.int/news/item/13-06-2024-gavi-to-boost-access-to-life-saving-rabies-vaccines-human-in-over-50-countries-gavi-who-and-uar

^[34] World Health Organization, “Malaria,” https://www.who.int/news-room/fact-sheets/detail/malaria

^[35]The Gavi Alliance, “Routine Malaria Vaccinations,” https://www.gavi.org/news-resources/media-room/communication-toolkits/routine-malaria-vaccinations; Oommen C Kurian, “India's Pharmaceutical Manufacturing Power: A Decisive Force in Africa’s Battle Against Malaria,” Observer Research Foundation, July 13, 2023, https://www.orfonline.org/expert-speak/indias-pharmaceutical-manufacturing-power

^[36] The Gavi Alliance, “The African Vaccine Manufacturing Accelerator: What Is It? And Why Is It Important?,” https://www.gavi.org/vaccineswork/african-vaccine-manufacturing-accelerator-what-and-why-important

^[37]Devex, “Devex Checkup: Why Gavi Needs Nearly $12B Over The Next 5 Years,” https://www.devex.com/news/devex-checkup-why-gavi-needs-nearly-12b-over-the-next-5-years-107798

^[38] Health Policy Watch News, “Mpox and Cholera Outbreaks Underscore Importance of Gavi’s Africa’s Vaccine Initiative – But Can It Ensure Equity?,” https://healthpolicy-watch.news/mpox-and-cholera-outbreaks-underscore-importance-of-gavis-african-vaccine-initiative-but-can-it-ensure-equity/

^[39]Shireen Bhan, “India’s Leadership Vital For Global Pandemic Preparedness, Says Gavi Chair Barroso,” CNBCTV-18, March 5, 2025, https://www.cnbctv18.com/india/healthcare/gavi-india-pandemic-preparedness-vaccine-manufacturing-jose-manuel-barroso-19569243.htm

^[40]The Gavi Alliance, “Gavi and Government of India Establish New Partnership to Protect Millions of Children by 2026,” https://www.gavi.org/news/media-room/gavi-and-government-india-establish-new-partnership-protect-millions-children-2026

^[41]United Nations Children’s Fund, “Pneumonia vaccine price drops dramatically for lower-income countries thanks to the Gavi pneumococcal Advance Market Commitment,” https://www.unicef.org/turkiye/en/press-releases/pneumonia-vaccine-price-drops-dramatically-lower-income-countries-thanks-gavi

^[42]The Gavi Alliance, “India completes national introduction of pneumococcal conjugate vaccine,” https://www.gavi.org/news/media-room/india-completes-national-introduction-pneumococcal-conjugate-vaccine

^[43]The Gavi Alliance, “India,” https://www.gavi.org/investing-gavi/funding/donor-profiles/india; The Gavi Alliance, “Gavi and Government of India Establish New Partnership To Protect Millions of Children By 2026”

^[44] Think Global Health, “US Retreat from Gavi Cedes Influence from China’s Vaccine Suppliers”

^[45]Liu, Liangtao, Yongli Huang, and Jiyong Jin, “China’s Vaccine Diplomacy and Its Implications for Global Health Governance,” Healthcare 10, no. 7 (2022): 1276, https://doi.org/10.3390/healthcare10071276

^[46]Antoine de Bengy Puyvallée et al., “Global Health Partnerships for a Post-2030 Agenda,” The Lancet 405, no 10477 (2025), https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02816-2/fulltext

^[47] Charnele Nunes, Martin McKee, and Natasha Howard, “The Role of Global Health Partnerships in Vaccine Equity: A Scoping Review,” PLOS Global Public Health 4, no. 2 (2024): e0002834, https://doi.org/10.1371/journal.pgph.0002834; Gian Gandhi, “Charting the Evolution of Approaches Employed by the Global Alliance for Vaccines and Immunizations (GAVI) to Address Inequities in Access to Immunization: A Systematic Qualitative Review of GAVI Policies, Strategies and Resource Allocation Mechanisms through an Equity Lens (1999–2014),” BMC Public Health 15, no. 1 (2015): 1198, https://doi.org/10.1186/s12889-015-2521-8

^[48]World Health Organization, “Covid-19 Vaccinations Shift To Regular Immunisations As COVAX Draws To A Close,” https://www.who.int/news/item/19-12-2023-covid-19-vaccinations-shift-to-regular-immunization-as-covax-draws-to-a-close

^[49] Timothy Jesudason, “COVAX Officially Closes,” The Lancet Infectious Diseases 24, no. 4 (April 2024): e223, https://doi.org/10.1016/S1473-3099(24)00133-6

^[50] Matthew Cooper et al., “Final Report: COVAX Facility and AMC Formative Review and Baseline Study,” Itad, 2023, https://www.gavi.org/sites/default/files/programmes-impact/our-impact/Final-Report_COVAX-Facility-and-COVAX-AMC-Formative-Review-and-Baseline-Study.pdf

^[51] Cooper et al., “Final Report: COVAX Facility and AMC Formative Review and Baseline Study”

^[52] Antoine De Bengy Puyvallée and Katerini Tagmatarchi Storeng, “COVAX, Vaccine Donations and the Politics of Global Vaccine Inequity,” Globalization and Health 18, no. 1 (December 2022): 26, https://doi.org/10.1186/s12992-022-00801-z

^[53] Cooper et al., “Final Report: COVAX Facility and AMC Formative Review and Baseline Study”

^[54] Nitya Mohan Khemka, “Accelerating Global Health: Pathways To Health Equity For The G20,” Observer Research Foundation, September 2023, https://www.orfonline.org/research/accelerating-global-health-pathways-to-health-equity-for-the-g20; Anjali Pushkaran, Vijay Kumar Chattu, and Prakash Narayanan, “COVAX and COVID‐19 Vaccine Inequity: A Case Study of G‐20 and African Union,” Public Health Challenges 3, no. 2 (June 2024): e185, https://doi.org/10.1002/puh2.185

^[55] Sheriff M Kaunain, “Explained: Needle-free System To Administer Zydus Cadila’s ZyCoV-D Vaccine,” Indian Express, August 25, 2021, https://indianexpress.com/article/explained/explained-zydus-cadilas-needle-free-system-to-administer-zycov-d-7467011/; Anuradha Mascarenas, “India’s First mRNA Covid Vaccine Is A Gamechanger, Can Be Stored In Medical Refrigerator,” Indian Express, June 13, 2022, https://indianexpress.com/article/lifestyle/health/indias-first-mrna-covid-vaccine-is-a-gamechanger-can-be-stored-in-medical-refrigerator-7967796/; Think Global Health, “Insights From India On Expanding Global Vaccine Production,” https://www.thinkglobalhealth.org/article/insights-india-expanding-global-vaccine-production

^[56]Shereen Bhan, “India’s Leadership Vital For Global Pandemic Preparedness, Says Gavi Chair Barroso,” CNBCTV-18, March 5, 2025, https://www.cnbctv18.com/india/healthcare/gavi-india-pandemic-preparedness-vaccine-manufacturing-jose-manuel-barroso-19569243.htm

^[57]Think Global Health, “Insights from India On Expanding Global Vaccine Production”

^[58] Nora Draper, “Fail Fast: The Value of Studying Unsuccessful Technology Companies,” Media Industries Journal 4, no. 1 (2017), https://doi.org/https://doi.org/10.3998/mij.15031809.0004.101

^[59]Nunes, McKee, and Howard, “The Role of Global Health Partnerships in Vaccine Equity: A Scoping Review”

^[60]Ikponmwosa Jude Ogieuhi et al., “Global Partnerships in Combating Tropical Diseases: Assessing the Impact of a U.S. Withdrawal from the WHO,” Trop Med Health 53, no 36 (2025), https://doi.org/10.1186/s41182-025-00722-8

^[61] Tania Cernuschi, Stephanie Gaglione, and Fiammetta Bozzani, “Challenges to Sustainable Immunization Systems in Gavi Transitioning Countries.” Vaccine 36, no. 45 (2018): 6858–66, https://doi.org/10.1016/j.vaccine.2018.06.012

^[62] Lakshmy Ramakrishnan, “Mpox Outbreak – Why It’s The Right Time To Initiate Vaccine Production Under BioE3 and Bio-RIDE,” Observer Research Foundation, December 2024, https://www.orfonline.org/research/mpox-outbreak-why-it-s-the-right-time-to-initiate-vaccine-production-under-bioe3-and-bio-ride

^[63] Australiasian Medical Publishing Company, “Global Health Leaders Urge Australia To Stand Up To the USA,” Australiasian Medical Publishing Company, https://insightplus.mja.com.au/2025/13/global-health-leaders-urge-australia-to-stand-up-to-the-usa/

• Healthcare
• India
• USA and Canada
• China health diplomacy
• Global health security
• Health system strengthening
• India’s vaccine leadership
• International Development contracts
• PPP arrangement
• Public private partnership
• USAID Contract
• USAID cuts
• Vaccine-preventable diseases

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