The Gavi replenishment – a turning point for funding health multilaterals?

For more than two decades, Gavi, the Vaccine Alliance has been one of the most cost-effective investments in global health. 

But it could be at risk due to major cuts to the UK ‘aid’ budget. Immunisation is one of our most successful public health interventions; it saves up to 3 million lives worldwide each year and has led to a dramatic reduction of serious infectious diseases that were previously commonplace. 

Gavi has now vaccinated over 1.1 billion children, stopped deadly diseases from spreading around the world, and saved almost 19 million lives. It helps to strengthen health care systems, drives economic growth, and helps protect the UK from future pandemics, boosting safety and security for all. 

Yet, despite all of this – the strong and well evidenced track record, the 26-year partnership with the UK, the exciting and ambitious new strategy, the UK’s role as the co-founder, board member and leading sovereign donor – this replenishment was always going to be a challenge. 

We saw with the Global Fund to fight AIDS, Tuberculosis and Malaria’s 7th replenishment that there were significant challenges to this model of replenishment for global health institutions. Then 2025 ushered in an era of aid budgets being cut, or cancelled altogether, in some of the richest countries around the world. Not only were donors such as the UK, in a traffic jam of replenishments with International Development Association, Nutrition for Growth, Gavi, and the Global Fund all having time-bound replenishments this year, but this year has seen the biggest shocks to the internal development system in a generation. 

The loss of USAID, and American leadership more generally, has been devastating and will continue to cost lives. The political consensus in the UK, that a contribution of 0.7% of Gross National Income (GNI) to Official Development Assistance (ODA) was not just the morally right thing to do, but also in our own national self interest, has broken down, and ODA has been cut to 0.3% of GNI. 

So how have we approached this replenishment? A very welcome difference with this campaign has been the focus on demand from implementing countries. The UK’s long term support for the Lusaka Agenda, and belief that priorities of national governments are key, fits well with the fact that Gavi’s new strategy aims to be country-led and country-responsive. 

At Results UK, we have worked with our partners in ACTION Africa and the Gavi CSO constituency to ensure that the voices of affected communities are not only heard, but are at the forefront of the replenishment campaign. There have been letters to UK High Commissions from in -country civil society organisations, advocacy directly from implementing country Health Ministers to David Lammy and letters from African parliamentarians to their counterparts in the UK. 

Most recently, VillageReach and Results UK co-hosted a webinar briefing for UK MPs, where they heard directly from a Zambian MP and global health advocate, as well as the perspectives of local communities. The Hon. Dr. Christopher Kalila MP, a Zambian MP and global health advocate told MPs that “failure to fund vaccinations is to be an accomplice to murder”.

At the time of writing, we don’t know yet what the UK pledge to Gavi will be. We are also hearing messages from the FCDO that they want to change the way replenishments are done, and even the way global health institutions are structured. Many in the sector will have sympathy with these views. However, we have to do this from a position of strength and commitment to ODA, not fear of political repercussions and right-wing populism. 

As a co-founder of the modern multilateral system, the UK has a proud legacy of leading the fight against poverty and ensuring the most vulnerable have access to life-saving interventions. Recent data from Adelphi Research shows that this is also supported by the British public. 70% of the UK public believes that supporting better global access to vaccination is also good for the UK and 76% believe that protecting vulnerable children from deadly diseases improves millions of lives across the world. 

An approach to reshaping international development that is rooted in our values and genuine global partnership could be an exciting next step for the UK. 

My fear, however, is that this positive vision could instead be used to justify cuts and a further retreat from the global stage. I hope to be proven wrong.