Gavi, the Vaccine Alliance, supplies vaccines to nearly half of the world’s children. For decades, governments, institutions, and private groups around the world have provided the funding it needs to buy, stockpile and distribute vaccines at reduced cost for lower and middle-resource countries.
But leaked documents, first reported by the New York Times, reveal that the Trump Administration has created lists of funding projects it plans to stop supporting, including Gavi.
[time-brightcove not-tgx=”true”]Dr. Sania Nishtar, Gavi’s CEO, talked with TIME about what that could mean for the health of the world.
This interview has been condensed and edited for clarity.
Have you received any formal notice from the U.S. government about cutting funding?
We have enjoyed bipartisan support in Congress for the last 24 years, ever since Gavi was created. That includes support during the last Trump Administration. We were gearing up to have a discussion with them on how to operationalize the budget. About 10 days ago, Congress approved the continuity bill, and funding Gavi was part of that bill. My colleagues and I were exploring ways of having a discussion with them on how to operationalize that budget. This list, this news—we are really concerned to hear it.
If the U.S. government does stop its funding of Gavi, what will happen?
This is about children’s lives. This is about potentially a million children dying if funding is withdrawn. It’s about compromising global health security if the funding is withdrawn.
The U.S. underwrites about 13% to 14% of our budget. If that budget is cut, that translates to 75 million children not getting vaccinated. And that, in turn, means more than a million lives will not be saved. That’s just one dimension of the fallout.
The other dimension is entirely different, and relates to global security. Gavi vaccines are a pillar in the global health security response. Whenever there is a public health emergency, and whenever there is a question of needing to mobilize vaccines, we maintain stockpiles of vaccines for Ebola, cholera, and meningitis. Going into 2026, we will be maintaining vaccine stockpiles for mpox as well. Whenever there is an outbreak or an emergency, we mobilize the stockpile.
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The U.S. does not just bring dollars to the table. They are important technical partners for the entire global health system, and for Gavi. Last year, for example, when the mpox emergency happened, we invoked the emergency response fund. This is a fund created after I joined Gavi—a special $500 million fund whose purpose is to make money available as soon as a health emergency strikes. We set it in place after learnings from COVID-19, because during the pandemic, the money was not available on day one to invest in vaccines.
Last year, with this fund, within three days of the WHO approving a vaccine for mpox, we were able to ship the vaccines to the African countries who needed them to contain the outbreaks there. That was possible because we worked closely with the U.S. government, which wanted to donate the vaccines from its stockpile. We worked closely to coordinate moving the stockpile. So the U.S. is a very important partner in the response system that the world has established to respond to emerging infections. And we really want the system to work and to [continue to] work closely with them.
Are you looking at alternative sources of funding?
We have 44 sovereign and private entities and foundations. We are reaching out to them, of course, and they are watching. We are widening our donor base. Some countries that were recipients of Gavi assistance are now becoming donors—Indonesia is a case in point. But a 14% contribution in the budget is significant. It is difficult for other donors to bridge that gap.
Public health leaders have talked about how the U.S.’ diminished role in global health will open the door for China to become a leader in health. Would China be a possibility for becoming a donor to Gavi?
We speak to all countries of the world. Currently, China is not a major contributor to Gavi.
Could they be?
Potentially all countries of the world could be donors. We work very apolitically. We are in the business of saving lives. We are in the business of very impartially moving stockpiles to any country of the world when they are needed. We are really looking forward to working with this [U.S.] government and bringing to bear the importance of the need to continue supporting Gavi.
What would you tell the Trump Administration about why it’s so important to continue funding Gavi?
I might talk to them about three things. Firstly, I would explain to them that this is about saving children’s lives. Vaccination is one of the public-health miracles. It’s one of the most important public-health interventions ever created on this planet. I would explain what the implications of their pullout is—one million children dying in countries of world with whom they plan to have foreign policy relationships, 40 of which are in Africa.
Secondly, with humility, I would explain to them that a world without Gavi is a more dangerous world. Because we know that infectious diseases know no borders. The capabilities established by Gavi are unique. No other international body can put money on the table on day zero for financing facilities to order vaccines and mobilize stockpiles. If we are taken out of the equation, there is no way to nip Ebola in the bud in Africa, there is no way to stop mpox from getting on a plane and arriving on your shores.
Number three perhaps is not well understood. Gavi is not a charity. We are a multilateral organization. We transition toward country sustainability.
When we start supporting countries by introducing vaccines, countries start paying a certain percentage of that vaccine. When a country’s economic situation improves, its share of their copayment increases. Ultimately, they take over the entire payment for vaccines themselves. Gavi supports [such] “exits.” Since our creation, of the 78 countries we originally supported, 19 have exited from our support. Indonesia exited and has now become a donor. India exited, and it’s highly likely they will become a donor in 2026. African countries have exited. We create a path toward sustainability. We create a path toward country transition so a country owns its public health agenda.
Last year, countries paid just over $200 million in copayments toward vaccines. Going forward in 2026, countries will be paying 50% of their vaccines. We say we want to run ourselves out of business. That model of development is unique to Gavi.
We don’t have 200 offices in field. I would explain to them that we are exactly the organization you should be working with to demonstrate to the world how an organization that is results-oriented with low operational costs, with an established path for countries to transition and become self-sustaining, is an example.
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This Administration is questioning across the board why U.S. taxpayers should be supporting programs that primarily benefit other countries, and Gavi might fit into that. How do you respond?
Even if you take the lives of children out of the equation—which I think is the most heartless thing anyone could say, but still, let’s take that out of the equation—there are two other reasons why it’s important to support Gavi. One is global health security. Taking us out of the equation would water down and compromise the world’s ability to fight disease, and would be tantamount to compromising yourselves.
Secondly, there is a very important business equation here, because Gavi spent more on vaccines supplied by U.S. companies than any other country in the world. Gavi funded the procurement of $4 billion lifesaving vaccines from U.S. companies from 2012-2023. And that excludes COVID-19 [vaccines]. They actually get back from GAVI more than what they give us. If [the U.S.’] funding decreases, we will buy less vaccines and serve less countries. Their pharma industries also take a hit.
How is Gavi trying to avoid such shortfalls in the future and rely less on donors like the U.S.?
This is another learning from COVID-19. Last year, we put in place an instrument called the African Vaccine Manufacturing Accelerator. We put in $1.2 billion for financing that is meant to catalyze sustainable commercial vaccine development on the African continent. It’s an important part of the equation for African nations to be truly sovereign when it comes to vaccine manufacturing. If a vaccine manufacturer on the continent gets WHO prequalification or WHO approval for one of its vaccines, we will give them a milestone payment. It’s an incentive for local investors so that they know there is a light at the end of the tunnel, and if they invest, they have the potential for gaining back their money and making profits going forward.
source https://time.com/7273414/gavi-vaccine-alliance-sania-nishtar-ceo-funding/
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