AMC Institutional Arrangements

1. AMC Institutional Arrangements

2. Donor governments stated 3 primary objectives to guide the review of possible institutional arrangements to support an AMC Objectives of Institutional Arrangements • Locate AMC within an existing institution – no separate entity should be established • Ideally have single institution act as an intermediary between multiple donors and multiple firms • But different functions of an AMC should be efficiently and effectively supported

3. The first step in the review was to identify how the functions of an AMC evolved over time AMC Functions • Establishment of AMC • Initial set-up of arrangement to support and implement the AMC. • Support negotiations by and between donors, firms and host institution while finalizing financial and legal frameworks. • Interim Monitoring • Monitor progress toward the AMC goals. Support countries to be prepared when AMC product available. • Activation • Trigger the AMC once product becomes available and is vetted by experts (IAC). • Implementation • Efficient and timely management to assess national demand, procure and deliver vaccines, and collect country co-pays. • On-going monitoring and reporting • Maintain credibility of AMC and transparency of results

4. Given the defined functions, the following characteristics for the institutional supporters were identified Ideal Institutional Characteristics • Institutional credibility with donors, firms and recipient countries • Financial capacity to negotiate and implement complex agreements with donors and industry. • Operational efficiency to manage programmatic implementation, provide technical support and link the AMC to country demand

5. An independent review was conducted of different possible hosts Institutions considered to host the AMC • Bill & Melinda Gates Foundation • Global Fund for AIDS, TB and malaria • UNICEF • WHO • GAVI • World Bank

6. Four entities did not have the appropriate mandate to support the AMC Institutions considered to host the AMC • Bill & Melinda Gates Foundation: Inconsistent with mandate • Global Fund: Inconsistent with mandate • UNICEF: Unable to house secretariat given UN audit rules and procedures but supportive and willing to provide specific services • WHO: Unable to oversee full range of functions given UN specialized agency role but supportive and willing to provide specific services • GAVI: Entirely consistent with mandate and well positioned to provide programmatic functions of AMC, including housing Secretariat • World Bank: Well positioned to provide financial functions of AMC, but does not have specialized remit to efficiently provide programmatic services.

7. The optimal arrangement for AMCs would draw on the capacity and experience of both GAVI and the World Bank Optimal arrangement • GAVI provide the programmatic functions and host the AMC Secretariat • World Bank provide financial and fiduciary functions for the AMC • Two institutions coordinate AMC negotiations and divide reporting responsibilities

8. GAVI has the mandate to coordinate and direct immunization and vaccine support GAVI • Founded in 1999 as an alliance of public and private partners working to accelerate access and use of vaccines in the poorest countries. • In immunization and vaccine arena, GAVI has demonstrated its ability to manage innovation, coordinate partners, efficiently manage operational activities and monitor and report on progress • GAVI has credibility with: • Donors to efficiently use resources to support government immunization programs • Countries to provide predictable funding and coordinate technical support as demanded by governments • Vaccine firms to improve demand forecasts and strengthen immunization markets

9. The World Bank would complement GAVI’s programmatic capacity, drawing on its financial and fiduciary experience World Bank • Bank, as trustee and administrator for $9 billion in trust funds from donor sources, has extensive fiduciary experience and capacity to manage multi-donor guarantees and arrangements, manage and disburse funds as required and to negotiate and sign complex contractsThe World Bank would complement GAVI by drawing on its experience to manage the financial and fiduciary functions of the AMC. • Negotiate and hold donor commitments • Manage funds • Sign contracts drawing on funds • Translate commitments into cash as needed to pay firms