The Global Alliance for Vaccines and Immunization (GAVI) has in many ways been remarkably successful in revitalizing the international coalition of institutions and organizations concerned with getting vaccines to the children of the poorest countries. Many have seen this high-profile venture in public-private cooperation as a model for other groups concerned with more effectively helping to solve health problems in the developing world. We examined major flaws in the GAVI and argue that in fact the alliance does not represent a new paradigm for international public health. However, the experience of the GAVI may suggest an alternative, and more effective, way to conceptualize future global initiatives.