GAVI is the third largest multilateral in the health sector. It has a single-purpose mandate, to increase access to immunization in poor countries. The World Bank is a founding partner to GAVI and remains a major partner, particularly at a financial level by supporting operations of two major innovative financial mechanisms on its behalf. By design, GAVI itself does not have a presence at the country level and relies heavily on its partners, WHO and UNICEF, for planning and implementing country activities.

While the Bank's financial engagement on behalf of GAVI has been transformative, this review identifies opportunities for stronger Bank engagement in immunization activities at the country level, in GAVI's governance, and in broader immunization policy discussions:

Financial engagement. The Bank's most significant contribution is a key role in the establishment and management of two innovative financing mechanisms (IFFIm and AMC) that have contributed one-third of GAVI's financial resources from 2000 to 2010. In both cases the Bank worked with partners to translate a conceptual innovation into a viable financial pilot mechanism. Operationalizing these instruments required the Bank to assume financial risk, develop new systems, and make a long-term commitment. The Bank assumed a direct balance sheet risk on behalf of AMC and used its excellent credit rating to place IFFIm "vaccine" bonds. The Bank's financial relationship with GAVI and IFFIm has been highly competent and professional. It deserves widespread appreciation and recognition. 

Engagement at country level. The relationship with GAVI has been collegial and constructive in countries where there is engagement, but in many countries the Bank is not substantially involved in immunization. This review concludes that the status quo leaves organizational synergies untapped, and that stronger Bank involvement, drawing on its strengths in sustainable funding for immunization, addressing inequities in access to immunization, investments in health systems strengthening, and donor coordination in health could help achieve greater development results.
Governance. The mandates and priorities of the Bank and GAVI were mutually relevant and compatible at GAVI's inception but the engagement diminished during a period from around 2008 until recently. This disengagement by the Bank can be traced to differences in alignment between the Bank's broader development objectives and GAVI's focused approach on accelerating introduction of new and sometimes costly vaccines in low-income countries, and the changing influence of the founding partners and growing autonomy of the GAVI Secretariat after GAVI's 2008 governance reform.