Over the last two decades the influence of new global initaives and actors has increased strongly. When it coimes to immunisation this especially applies to the Global Alliance for Vaccination and Immunisation (GAVI). This development has been a mixed blessing. On the positive side they bring increased attention and substantial and new resources leading to significant benefits for millions. Thanks to GAVI world leaders, powerful decision-makers and the public at large have become aware of the significant benefirs of vaccination. GAVI has also brought more coordinated action at the global level. It is more probblematic that this may have contributed to the weakening of the WHO. The same goes for the increased emphasis on economics as the basis for priority setting and gaining political support for health initaitves. Still, although it has come to dominate, money is not the only source of authority. Experise is another. Althoughj it is mostly exercised at the global level, it can be more easily challenged, at least where counter expertise is present.