Video from charleston and other stops on the tour, visit cspan. Org citiestour. Youre watching American History tv. All weekend, every weekend, on cspan3. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] what a continuous process of reworking the transition policy. Of the Seen Movement institution into a more concentrated discussion around the role in advancing Health Security, and promoting stockpiles and advancing hpv vaccine. At immunization across the lifespan. Institution has been graded at various points with very high marks in terms of gender equity, transparency and accountability. Its ability to shape markets effectively in order to bring prices to within affordable levels but also to expand the pool of producers which has more than tripled in the course of the tenure. The notice states remains very strong, and congratulations that last week the administration on the 10th of this month announced a pledge of 1. 16 billion for the threeyear time fy 2320 three. That comes up to 290 Million Dollars per year which is a significant increase if you look back over the earlier years. Andgn of the high regard the strength of rotation across gavi and landscape for the work that it does. It has become a Strong Partner with others within the global universe. It moved onto the campus in geneva. We see strong alignment with the global fund, with global polio eradication initiative. These are just the high marks sethe are delighted that has chosen to take time out of a very frenetic schedule to come and be with us this afternoon to help kick this off. And when to invite him to come forward and do his presentation. Please join me in welcoming him. [applause] you for thatthank level introduction. Thank you all for coming to hear this presentation. Were together at the Munich Security Conference just a week ago when we had the chance to discuss some of the things were talking about today which is becoming more relevant given the news that we have in front of us. I will try to touch on that and i suspect we will have a chance to talk about it later on at the panel. You have heard that gavi is 20 years old. This picture on the top is the original panel. You see a much younger bill gates. It is a different leaders in the multilateral institutions there. The question when it started was, is this going to succeed . There had been a childrens Vaccine Initiative which failed miserably before this. It was an experience experiment that we have to agree was a successful experiment. Since gavi began, we can immunize more than 760 million additional children read the number that people dont know is close to one billion additional children have been reached by campaigns. We have supported 50 to 60 of we global board birth have expanded the vaccines now to cover a whole range of diseases. Thisnk we can see that private Public Partnership is working. More importantly than the numbers of process indicators, in development of course we use how the mortality as one of the key indicators. We can see during this time, this is still 2017, if you carry this out until now, a 50 reduction in child mortality. It is really extraordinary. If you ask the question what components of that are vaccines . You can see a 70 reduction in vaccine presentable preventable mortalities. We know that we can get the vaccines out and it really works. If we look at this over a timeline, what you can see is the improvements that have occurred in being able to reach people. , top, ucb birth cohort growing. It is growing slowly because we are talking about a more global number. Africa and increase over this time. You can see the number of immunize, we have gone up 22 dpt3entage points for bpt because it is working to deliver 1, 2 and three doses. Into the number of immunize going down then zero does, the number of children that have not had any contact with a routine immunization system. This will become a much more important indicator for us Going Forward and i will come back to it. White was gavi set up originally . The idea was an equity agenda. Re were new and popular powerful Vaccines Available for they were not reaching the people who needed them the most. You see hepatitis b in green. This is not only a virus but the main cause of liver cancer. You can see in high income the blue is influenza type b, you can see where we are today. More developing countries have access to these then developed countries. This is a dramatic change in equity. The poorest countries have had such good access, the rich countries have access and sometimes someones of the middle do not. That is something that we as an alliance are discussing about what role he can play. We can play. We started getting with 77 countries before we got formal programs about sustainability. You can see china is the big one. It was specific around hepatitis 365,000 deathsd per year from liver cancer because they have 10 of the population infected and we were able to show that you could get vaccines to the population and today, less than 1 are infected and those deaths are going away. We started with 77. We then went down with a formal policy of transitions down to 72. This is where the 60 of the Global Corporate comes from. We had 15 countries transition out of gavi. I will show you how that works in a second. Now that7 countries are gavi eligible that are left behind. I show syria because it was the only time gavi ever included a country that was not included for economic reasons. It was included because of the situation there and tragically, two years after it was included for fragility region reasons, it became gavi eligible because of the Economic Disaster of the years of warfare. 57 countries plus syria. Here is the eligibility policy. The way it works, it is a pure economic policy. 1630, you are no longer gavi eligible trade if youre below that, you are eligible so we dont choose countries aced on politics we do. T purely based on economics we start off with the poorest countries paying a little bit. . 20 per dose. As they move into the preparatory transition, they increase their expenditure 50 per year until they cross the threshold. Then, they have five years to take on the full cost of their vaccines. Our pharmaceutical partners have made sure there is no shock after this. They have allowed countries to keep gavi prices for five to 10 years afterwards hurried now, we are at the process of having graduates, how do we make sure that there is a smooth landing . The good news is, the 15 countries who have transitioned are all continuing to finance their vaccines and we expect 10 more countries to transition during this time. What does this mean . This means that countries are putting more and more of their finances on costeffective interventions like vaccines. You can see her the cofinancing that is going up over time. Dramatic increase now, 36 of the financing is going to this and in the next time it will go higher than that. Thing that is about vaccines that i like to tell people is a little dirty secret. Vaccines are great tools but they dont deliver themselves. What we need to do is figure out how do we make sure that we have Vaccines Available . One of the things we do is try to innovate in making Vaccines Available. We do that often working with the private sector. Here are some examples of the innovations that have been done. Everything from better vaccines to drone deliveries, temperature monitoring, ecological solar powered chains, Digital Health records. This is a process to try to bring private sector into the effort to deliver these vaccines better. Which is going to be absolutely critical as we move into the next phase of leave no one behind. Stevee already heard from that we are doing more on outbreaks. It has been an evolution of happy. Gavi. So far 1. 3 Million People have been protected against preventable diseases. You can see big gaps. Second dose of measles and another vaccine, we need to make sure we get these out ahead of time and not just wait until outbreaks. I think measles is an example of a disease, it is a cheap vaccine it has been around more than 50 years, we know there is a global resurgence of measles. There are issues around Vaccine Hesitancy in the west but we are also seeing problems in the south with fragile countries, countries that have disturbances created if you look at drc, more people have died there of measles and ebola so far. As an example of why we have to make sure we are paying attention to the routine systems. Tragically in europe, 47 of 53 countries now have measles. Vaccine that is this effective and cheap, this is something the world has to Pay Attention to. Going back to the Global Health security, we managed to finance the stockpiles that are used globally. For yellow fever, meningitis, cholera and ebola vaccine. We have had a good track record. It more than 100 40 Million People have been protected with more than 170 million doses since we started the program. We have become much more systematic in doing this. Unicef, the supply division which does the procurement of vaccines, we have worked to make sure there is adequate supply of vaccines in case of emergencies hurried i think in fact, the ebola situation is the alliance operating at its best. When the african outbreak occurred, people realized everyone was piling in with your technologies woman thought it was a global outbreak. Who was going to pay for this . How can companies scale it up and sustain it . The board made a decision because we had innovative financing mechanisms we could do this. We announced we could put up to 390 million available to create a marketplace for ebola vaccines and distribute those. We did an advanced purchase commitment for any company very at merck stepped forward. Part of that agreement was both to make sure that the regulatory systems were moved forward, that merck would submit an application to who they would also move forward to regulatory approval. Also important that they would keep 300,000 doses available just in case there was another outbreak in the interim time before a licensed product. Think of this for that because there have been three outbreaks, as you know. Two of which were rapidly controlled and another outbreak in which the vaccine has been remarkable. We vaccinated more than 280,000 people in that and it has kept it at bay traded captive from spinning out of control. The challenges in governance has been the outbreak has continued hurried today, we have a licensed product and license not only in the west, the ema and fda but also for african countries have licensed it. We are working with merck to create half a million does global stockpile so this will not be a problem again in the future. Steve mentioned the importance of working on polio. We have been working with the polio group for a long time. Where we really stepped up is when they decided to announce a polio vaccine. That was the most rapid scale up of a vaccine in history. We tried to do it in more than 70 countries over the course of a year and a half. That is that has now occurred. It was independently financed in the past. The last two years, the gavi board agreed to step up and pay for it given the outbreaks that are occurring in the regular program to free up some funds. Assuming we have a successful replenishment, the gavi board has agreed to pay for ipv. One of the importance and this is to lift up the routine average but also to move from pet the valence a hexavalent vaccine. Those are supposed to be ready in this next. In thed it would be alliance to move forward to a better product. This looks at pricing which is an important issue. As we purchased vaccines for 60 of the population, what that means is we are able to negotiate better prices. That is very important to shift the mindset from low volume, high cost to highvolume, lowcost. Not just for true industrial country manufacturers but as steve mentioned, we brought a lot of new new manufacturers. Five to 17 we have gone from five manufacturers to 17 and that means we have a healthy vaccine market. You can see today, they are not exactly an old apple comparison so we dont use the same vaccines in the u. S. But approximate u. S. Price around 1100 for the vaccines the who recommends and you can see the gavi price being 27. To give you an idea of the power of market shaping. That is critical of countries are going to dust lets talk about where we are pivoting to. New strategy goals and you can see on the top, leaving no one behind with immunization. This is really the kind of big change that is occurring because you will see in a second, at one point when gavi started, a little more than half of the worlds kids were getting vaccines but today, were up to 90 received at least one dose of a routine vaccine. How do with you that you theres a lot of things affecting us right now. We have talked relation growth and organization. By 2050see an increase of 2. 3 billion people of which 70 of the global address global population will be in urban settings. Numbereeing the largest of displaced people in history most of which are in developing countries. Were seeing dramatic shifts in climate which is causing movement of people with also affects the way they are. These are more macro things but they expect affect the strategies we need to take. Going to the concept of zero importanthey very concept. If you look at where we started in 2000, there were close to 30,000 on immunized children. We have read the reduced that i have. If you ask the question who has not had any contact with routine immunization, that has gone from 18. 9 million down to 10. 4 million. Those zero dust children are the criminal pivotal priority where moving to. From the neck weak point of view, two thirds of those children, those families are below the poverty line. From an equity point of view, this is critical. Iny are often today not just an isolated or rural area but in urban slums, refugee camp. People moving because of climate change. That is why we have to change our strategies. If you reach zero dust children, they are the families that have no access to any health intervention. If you are missing vaccines, you are missing everything. This becomes the platform for primary health care or universal Health Coverage as you move forward. Finally, we need to think of this as a Global Health security. We are lucky coronavirus occurred in china where they have a Good Public Health system. You can make critiques if you want about some aspects but china was able to jump on it quickly. They had the tools. They were able to work on it. That was not true in 2014 when ebola appeared in africa. For three months, we were unable to note it was ebola. Thats why it spread so widely and it turned into such an explosive epidemic. If we want the world to be safe, we have to have no communities left out. We have to think about this just as a Development Issue and equity issue and also a Global Health security issue. The other thing is, if you get sick when youre in one of those communities because you dont have any Health Interventions, you are more likely to die or have side effects. For all of those reasons, zero dose are a good priority. Where are they . 75 in 13 large and fragile countries reacted we are going to get very granular. We are going to come up with a metric on reaching zero dust children create it we will try to take away about but we will also have a metric on how those children get incorporated into a help system. That is really going to be the critical metric because what we would like to do is build a resilient help system for everybody. Health system for everybody. We have to be more differentiated and targeted. We have to go subnational. There is a reason why communities are being reached. How do we reach them . We have to tailor responses and Pay Attention to it gender issues. Many of the barriers have a gender component. We have to focus on demand. We will have to deal with the hesitancy issues that are beginning to spread. We have to think about this not just in a Traditional Alliance that has worked so well of unicef, the gates foundation, the who. How do we bring in the humanitarian players who have not been involved that might have a specific role to play. Lastly, we changed in vaccination. It used to be just about children. Someone said years ago that Public Health is like a sinking ship. Women and children than everyone else comes last. That is not true and what we are trying to do is build a life course platform across all of the different vaccines. This is going to be important again for all of the concepts we talked about. You can see here, some of the advantages of working across a platform. You can work with different groups and with other interventions to try to have integrated approaches. This is ay that particularly good place to do it because the we have more than half a billion contact points with the Health System each year as a part of immunization. In terms of again going to scale this is a great way to look at it. Let me finish by talking about the replenishment and resource needs. In berlin, we ended up asking for them 7. 5 billion. We agreed that the replenishment would be less than that. We also ended up absorbing the big ask on polio. We have squeezed our Health Systems funding more than we like. The board has said we are looking for at least 7. 4 billion. We see that as 7. 4 as a minimum for being able to do this. If we have more finance, we can use that for the equity zero dose and differentiated approach to hss agenda. What is interesting is that you begin to see the changes that have occurred with countries self financing. Heres the resource chair, 71 donor financed. Now 54 . I will show a slight about the market shaping savings in the second. Have 8 of the funding coming from countries. Ins going to be a full 41 21 to 25. That number which is 3. 6 billion, if you add in the cost of paying for the Health Systems which is another 6 billi