The World Bank                                            1818 H Street N.W.        (202) 473-1000
 INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT    Washington, D.C. 20433    Cable Address: INTBAFRAD
INTERNATIONAL DEVELOPMENT ASSOCIATION                     U.S.A.                    Cable Address: INDEVAS


                                                                                   CONFORMED COPY

                                                                                             June 20, 2011


    Mr. Raeev Venkayya, MD
    Director
    Global Health Vaccine Delivery
    Bill & Melinda Gates Foundation
    1551 Eastlake Avenue East
    Seattle, WA 98102-3706

            Amendment to Trust Fund Administration Agreement between the Bill &
            Melinda Gates Foundation and the International Bank for Reconstruction
            and Development and the International Development Association concerning
            the Gates-World Bank Partnership for Enhanced Project and Policy Support
            Trust Fund (TF No. 050498; Bill & Melinda Gates Foundation Grant No.
            17388)

    Dear Mr. Venkayya:

    1.     We refer to the Administration Agreement between the Bill & Melinda Gates Foundation
    (the “Foundation�) and the International Bank for Reconstruction and Development (“IBRD�)
    and the International Development Association (“IDA�) (collectively “the Bank�) concerning the
    Gates-World Bank Partnership for Enhanced Project and Policy Support Trust Fund (TF050498)
    (the “Trust Fund’), dated June 6, 2002, as amended (the “Agreement�).

    2.    Pursuant to recent discussions between the Foundation and the Bank, the Bank proposes
    to amend paragraph 1 of the Agreement to extend the end disbursement date to September 30,
    2013. Therefore, paragraph 1 of the Agreement is hereby amended to read as follows:

            “1.      The Bill & Melina Gates Foundation (the “Foundation) is pleased to inform you
            that it has approved a grant of one million US dollars ($1,000,000) (the “Grant�) to the
            International Bank for Reconstruction and Development (“IBRD�) and the International
            Development Association (“IDA�) (collectively, the “Bank�) for the period beginning
            May 1, 2002 to September 30, 2013. The purpose of the grant is to provide a portion of
            the support required for the “Enhanced Project and Policy Support� component of the
            partnership project to strengthen global investments in health through innovative
            financing for communicable disease control (the “Project�) as described in the attached
            proposal dated March 18, 2002 (the “Proposal). It is understood that the bank will also
            use $1,000,000 of its own resources to cover costs of activities under the project.�

    3.      All other provisions of the Agreement remain in full force and effect.

    4.      The Bank will disclose this Amendment and related information on this Trust Fund in
    accordance with the World Bank Policy on Access to Information. By entering into this
    Agreement, the Foundation consents to disclosure of this Amendment and related information on
    this Trust Fund.
                                  RCA 248423.  WUI 64145  FAX (202) 477-6391
                                           -2-                              June 20, 2011



5.      Please confirm your acceptance of the foregoing, on behalf of the Foundation, by signing,
dating, and returning to us one of the enclosed originals of this Amendment. Upon receipt by the
Bank of the original of this Amendment countersigned by you, this Amendment will become
effective.

                                           Sincerely,


     INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT
             INTERNATIONAL DEVELOPMENT ASSOCIATION


                                     /s/ Cristian C. Baeza
                                            Director
                                Health, Nutrition and Population
                                 Human Development Network


CONFIRMED AND AGREED:

BILL & MELINDA GATES FOUNDATION


/s/ Raeev Venkayya
Name: Raeev Venkayya
Title:   Director, Global Health Vaccine Delivery