Positive phase 3 clinical trial results for a TB vaccine would be momentous, but they would not be the end of the long and arduous journey to vaccine implementation. Financing, procuring, and implementing a new TB vaccine at the scale required to ensure equitable access will be a major challenge. But it is a challenge we must meet if we are to capitalise on the potential of new TB vaccines, save millions of lives, and turn the tide against one of humanity’s oldest scourges. Since 2000, Gavi, the Vaccine Alliance, has vaccinated more than 1 billion children in low-income countries and prevented more than 17 million deaths. This chapter draws on Gavi’s experience of broadening access to vaccines in low-income countries to shed light on some of the challenges ahead as we plot a path towards the successful implementation of a future TB vaccine.