[6] Along with Global Health Initiatives (GHIs) in general, Gavi was described as innovative, effective, and less bureaucratic than multilateral government institutions like the WHO.

[7] One author described Gavi's approach to public health as business-oriented and technology-focused, using market-oriented measures, and seeking quantifiable results.

[6][7] It contrasts with the approach typified by the Alma Ata Declaration, which focuses on the effects of political, social, and cultural systems on health.

[7] Gavi facilitates vaccinations in developing countries by working with donor governments, the World Health Organization,[8] UNICEF,[9] the World Bank,[10] the vaccine industry in both industrialised and developing countries, research and technical agencies, civil society, the Bill & Melinda Gates Foundation[11] and other private philanthropists.

[17] The UK government stated that this round of funding would mean that 300 million more children in lower-income countries are immunized for diseases including measles, polio and diphtheria by the end of 2025.

Additionally, the funding will support health systems to withstand the impact of coronavirus and maintain the infrastructure necessary to roll out a future COVID-19 vaccine on a global scale.

[18] In the period of 2016–2020, Gavi received US$9.3 billion, with over half of the total funding provided by the three largest donors: the UK, the Bill & Melinda Gates Foundation (BMGF), and the USA (see insert).

Private donors often find it easier to exert influence through public-private partnerships like Gavi than through the traditional public sector.

There is also criticism that staff at GHIs are often recruited directly from elite educational institutions, and have no experience in health care systems, especially those in poorer countries.

[4] In 2012, the first Médecins Sans Frontières (MSF) "The right shot" report criticized Gavi for focusing on funding expensive new vaccines and neglecting to give children low-cost older ones.

They criticized the pneumococcal vaccine Advance Market Commitment, arguing that GlaxoSmithKline (GSK) and Pfizer were functionally receiving a subsidy as well as a per-unit payment for supplying doses of pneumococcal vaccine, which the organization deemed "corporate welfare that is scandalously expensive to donors and taxpayers"[24] (in return, the companies committed to sell at least 30 million doses annually for ten years[14]).

MSF said that large pharmaceutical multinationals had been found to put very high markups on prices, and internationally certified vaccine could be made for about 40% less cost by smaller companies in India and China, despite patent-related obstacles.

[citation needed] They recommended that GAVI spend more money on adapted vaccines and on fostering competition, and less subsidizing large pharmaceutical companies.

Gavi said that low prices required large, stable, high-volume deals, and "careful consideration and the support of key constituencies".

[30] Bill Gates responded to MSF, saying "I think there is an organisation that's wonderful in every other respect, but every time we raise money to save poor children's lives, they put out a press release that says the price of these things should be zero".

[33] In December 2019, they reiterated this request, pointing out that the GSK/Pfizer pneumococcal vaccine often costs US$80 in middle-income countries too rich for GAVI support.

[35] They also appealed to the World Health Organization, UNICEF, and the Gates Foundation, and said that Gavi could have done more to lower vaccine prices.

Up to a quarter of Gavi's funding was dedicated to "strengthening the capacity of integrated health systems to deliver immunisation",[7][37] in practice it's been around 10%.

[7] Julian Lob-Levitt, who was Gavi's CEO between 2004 and 2010, was rumoured to have left over conflicts around his support for health system strengthening.

[7] A 2016 funding-allocation analysis of a sample of GAVI grants found that just over half the money went to purchasing drugs, equipment, supplies, and facilities (and 3% on bonuses and incentive pay[39]).

[43] The following month, Gavi announced the approval of up to $150 million to help 92 low- and middle-income countries prepare for the delivery of future COVID-19 vaccines, including technical assistance and cold chain equipment.