GAVI works to establish country-level immunization programs. Countries with gross national income per capita of less than $1,000 in 2003 are eligible for GAVI support. Currently, 72 countries are eligible. Funds are allocated based on a countrys needs, with countries with lower existing immunization rates receiving greater funding. Countries can use GAVI funding to purchase vaccines or vaccine safety equipment. The funding can also be used to strengthen health systems to deliver the immunizations.
GAVI has developed several mechanisms for funding the alliance and supporting its goals. One of its primary goals was to ensure long-term, predictable financing. GAVI also recognized that there can be advantages to frontloading aid, particularly health aidan area with important economies of scale. To facilitate predictable aid that could be optimally allocated across time, the U.K. proposed establishing the IFFIm to support GAVI. The IFFIm, established in 2006, asked donor countries to make 10- to 20-year, legally binding aid commitments. Currently, France, Italy, Norway, South Africa, Spain, Sweden, and the U.K. have made commitments to the IFFIm. On the basis of these commitments, the IFFIm issues AAA bonds in the international capital markets. The inaugural bond issue, in 2006, raised $1 billion.
GAVI has also implemented a creative financing mechanism to provide market incentives for vaccine development. Developing a vaccine requires substantial research and development investments. There is a concern that the private sector under-invests in research and development of vaccines for developing countries because the potential for profit is unknown. Through Advance Market Commitments (AMC), donors commit money to guarantee the price and market for future vaccines. In the early years after a vaccines development, GAVI promises to pay an inflated AMC price for the vaccines to compensate companies for their initial investment. As part of the AMC, vaccine manufacturers make binding commitments to supply the vaccine at sustainable prices after the initial AMC period ends. An independent advisory group decides which diseases to target and how to structure the financial incentives. The AMC program is currently being piloted for the introduction of pneumococcal vaccine. Canada, Italy, Norway, Russia, and the Bill & Melinda Gates Foundation pledged $1.5 billion to fund this initial AMC.
In addition to generating additional funding, GAVI seeks to ensure the sustainability of its immunization efforts by requiring recipient countries to co-fund the efforts. Starting in 2007, GAVI asked recipient countries to start co-financing when they introduce a new vaccine and to co-finance existing vaccines after the first five years of GAVI funding. The co-financing requirements are determined by the income of the recipient countries, but the concept of co-financing ensures that there is the country-level support of the vaccination program that is necessary for long-term sustainability.