Politics & Policy Processes of Global Health Partnerships: The Case of Gavi, the Vaccine Alliance

At the 2008 Sir Mark Oliphant Conference on Vaccine and Immunotherapy Technologies, former GAVI Executive Secretary Julian Lob-Levyt described the organisation as “a new type of international entity…we are a pilot for new ways of doing development business”. Lauded since its inception in July 1999 as a 21st Century model for international development, GAVI emerged at a unique critical juncture in time. It also formed part of a more generalised and substantive shift from international to global health cooperation and the way that global health issues are addressed. For some, the proliferation of new organisational forms like GAVI appeared to promise a break with the past, renouncing the overly political bureaucratic processes of UN agencies while ushering in a new era of evidence, performance, and public-private partnerships. A shift in players, paradigms, and the political dynamics of global health has been taking place, with GAVI representative of this shift.

The aim of this PhD study was to identify and analyse the processes that shaped GAVI's organisational structure and strategic policy direction at its emergence and later across key phases as it evolved. A qualitative case-study design was applied, which combined in-depth semi-structured interviews and documentary review. Analysis involved coding and categorising themes to identify and describe: key actors and coalitions; the organisational structures shaping and shaped by their actions; and policy issues as they evolved over time.

Drawing on concepts from field and policy theories for discussion of findings, the thesis analyses GAVI as a strategic action field; occupied by incumbent and challenger coalitions organised around shared policy priorities; with coalitions acting to translate their policy priorities into organisational practice. While saving children’s lives was a shared goal, findings detail the frequently conflictual and political nature of GAVI policy processes and coalition priorities. Findings link changes in GAVI strategic policy direction and organisational reforms to the strategic behaviour of actors; the influence they exerted over key internal governance units; and adjustments in relations between (and gradually within) influential policy coalitions over time. In so doing, this thesis provides a comprehensive account of GAVI from a health policy perspective, and advances knowledge on how policy processes work more generally by setting out a new way to analyse old questions regarding who influences whom and how.