The GAVI Alliance has enjoyed 10 remarkable years. It's first CEO, Tore Godal, brought people and institutions together, gave GAVI a strategic vision and inspired innovation in an area of global health that had stagnated. He did this with an emphasis on empowering partners, operating with a small secretariat and streamlined governance, spurring innovation, and focusing on results.
Since 2004 and under the leadership of Julian Lob-Levyt, the Secretariat and the Board have grown, financing has flourished, and GAVI as a "brand" has become more prominent. With his departure as CEO next week, Dr. Lob-Levyt leaves behind a large and highly visible institution that is poised to have a major impact on global health and that can continue to deliver results for millions of people in developing countries.
With Bill Gates' "Decade of Vaccines" upon us, the next GAVI CEO will take the reins at an exciting time. In the midst of this sea of possibilities, one challenge for the next CEO will be to settle on a few key priorities. Here are some suggestions:
1) Focus on results & vaccines. GAVI's ability to fundraise for vaccines is inextricably linked with achieving three key objectives related to global health: 1) accelerating new vaccine research, development, and introductions; 2) reaching all people who need vaccines, and 3) documenting that vaccines are improving people's lives.
To accomplish all three objectives, the next GAVI CEO should steer the Alliance back to its core mission of expanding access to immunization, rather than focusing broadly on strengthening health systems. Health system improvement is tremendously important for improving global health, and there is value in involving the GAVI Alliance in the effort. But for GAVI, the risk of trying to take on health system strengthening is that it sacrifices focus and diminishes performance in pursuit of its core mission without substantially adding to the health systems effort. By re-establishing a focus on immunization and results, GAVI can meet its health objectives, demonstrate its impact, and ultimately strengthen its ability to fundraise.
2) Re-empower the Alliance partners. In its early years the GAVI Alliance was almost religious in its mantra about involving its partners (WHO, UNICEF, the World Bank, developing country governments, vaccine manufacturers) in decision-making - so much so that progress was often slowed because gaining consensus among multiple Alliance partners was more cumbersome than directing a staff over whom you had direct control. As both the size of GAVI's Secretariat and the amount of funding that Alliance partners receive from GAVI have increased, this balance has shifted. Re-invigorating the key Alliance agencies will be critical for the next phase, and will require a CEO who can strategically improve ownership by Alliance partners without sacrificing speed.
3) Emphasize innovation. At the time of its inception, GAVI was one of the most innovative health partnerships the world had ever seen. Examples of its innovations included results-based financing mechanisms for increasing immunization coverage, and novel financing instruments like the International Finance Facility for Immunization (IFFIm) and the Advance Market Commitment (AMC). GAVI should continue to stimulate that "innovation pipeline" by using the Secretariat as the forum for identifying challenges and drawing in the Alliance partners for ideas to overcome them. The new CEO should make innovation a key performance indicator for executives, partner organizations, and the Alliance as a whole.
4) Prepare for the post-2015 period. By 2015, the huge disparities in child mortality that characterized the year 2000 will be gone from most of the world. GAVI and its partners will no longer be able to mobilize huge resources to address this glaring humanitarian injustice. Instead, they will need to emphasize the economic consequences of vaccine-preventable diseases and the economic benefits of vaccination. Reductions in cases and the costs they incur to the health system and individuals, increases in productivity, improved cognitive achievement, and decreased poverty will be the metrics of the period from 2015 onward. The next GAVI CEO can help the global vaccine enterprise by beginning now to prepare the Alliance for this next phase.
5) Build a popular movement for vaccines. In the early days, when donor economies were growing rapidly, GAVI's fundraising approach was spectacularly successful. Now that donor governments are tightening their belts, the lack of a popular movement of ordinary citizens to support GAVI's funding is becoming a liability. Parliamentarians just don't hear from ordinary citizens that they need to increase GAVI's funding. It should be possible to organize parents in donor countries in ways that make them a vocal constituency for maternal and child health - including increased GAVI funding - much the way the AIDS community in the USA has become a force in global health funding decisions in the US Congress. This will involve working closely with civil society, building strong alliances, and taking the message to average citizens. The work will be hard but the next phase of GAVI's work will benefit enormously from it. The next GAVI CEO should make it a priority to develop grassroots support for immunizations as a complement to its already successful media and direct fundraising efforts.