Dagfinn Høybråten

Dagfinn Høybråten
Board Chair of the GAVI Alliance

Thursday

26 April

2012

Why immunisation is an act of immeasurable love

I had the chance to help protect a life today, the life of a little girl named Madeleine Isaac.

My part was brief and ceremonial, squeezing out two drops of polio vaccine. Madeleine made a funny face and then sat up from her mother’s lap and smiled.

The part played by Madeleine’s mother was immeasurable. Those two drops of vaccine will protect her little girl for life and help ensure that their nation – Haiti – remains polio-free.

The mother’s effort to bring Madeleine to the Palais Municipal de Delmas to be vaccinated, amid the cacophony of traffic and people in the heat of Port-au-Prince, was remarkable. It was, as our partner PAHO describes for its broader immunisation campaign, “an act of love for you, me and everyone.”

That also is why the ceremony itself also was important. It marked the launch of World Immunization Week (WIW) and the tenth anniversary of Vaccination Week in the Americas. WIW builds on nine years of ever-growing Vaccination Week regional campaigns that have led to the vaccination of more than 365 million people.

This has been led by the Pan American Health Organization/World Health Organization (PAHO/WHO), and strongly supported by other key GAVI partners, such as UNICEF. This year, more than 180 countries are participating in WIW, including 45 countries and territories in the Americas, where 44 million people are expected to be immunised.

I was in Haiti to represent GAVI’s participation in WIW, which began on Saturday with the intensification of a vaccination campaign against measles, rubella and polio by Haiti’s Ministry of Health.

That is how I came to cross paths with Madeleine, whose mother had brought her to the ceremonial kickoff because it included a free immunisation clinic. It provided a tangible symbol of Haiti’s remarkable leap in public health just two years after its devastating earthquake.

And Haiti is going further. In late spring, it also will roll out pentavalent vaccine in partnership with GAVI to help protect its children from five other deadly diseases.

As a former minister of health for Norway, I salute Haiti’s leaders for making child health a top-priority. Their commitment to routine immunisation services will create a backbone that supports the rest of society as Haiti rebuilds.

GAVI has been a partner with Haiti for more than 10 years, helping to bolster its immunization services. In addition to pentavalent vaccine, GAVI has approved Haiti’s plan to provide vaccines against the two leading causes of child deaths worldwide: pneumonia and rotavirus.

It is an honour that GAVI can play a role in Haiti’s rebirth. When I see the faces of children such as Madeleine, I see the future of Haiti and appreciate the lasting difference that immunisation makes.

I know that it was through a mother’s act of love that my path crossed that of Madeleine. GAVI’s mission is to multiple that act of love millions of times over.

Dagfinn Høybråten
Board Chair of the GAVI Alliance

Wednesday

21 March

2012

Hope for the hard to reach

I met her in Kabul. Suraya Dalil had just been approved by the Afghan Parliament as the new Minister of Public Health. As of January this year she is also a GAVI board member. She has been serving the hard to reach people in hard to reach areas throughout her medical career, not only in her own country, but also through UNICEF in such places as Somalia. One out of three female members in her government she carries one of the toughest posts in the whole cabinet.

They are really hard to reach, many of Afghanistan’s children. This poor and mountainous country, so tired of war and conflict, is working every day to give all their young inhabitants a basic health package. Between 15 and 25 percent of the population has no access to immunization services. Two thirds of the vaccination is carried out through outreach and mobile services. However, DPT3 Coverage has been increasing substantially over the last ten years thanks to a close partnership with civil society organisations and funding from GAVI among others.

Now Dr.Dalil has set out on a journey to build a health system that can better ensure basic coverage to all. There are huge communications challenges and human resource shortages in the country.  One of her main strategies is building the skills of health workers such as midwives and other Public Health officers. The cold chain so critical to an efficient immunization system needs to be strengthened.

Minister Dalil has a rough road ahead. There is certainly hope. Recent survey data indicate that the record high child mortality rates have dropped substantially the last few years. But there is much more to do. The plan is to introduce pneumococcal vaccine in 2013 and rotavirus vaccine in 2014/15. - We are working hard to fulfil the conditions that will make this happen, the minister told me.

Afghanistan is in a phase of transition. As the Afghans resume more and more responsibility for their own security, they will still need strong support and cooperation to build services to their people. The civil society organisations will have a key role to play in areas like public health. Other partners should also stand ready to support the plans developed by Dr. Dalil and her team.

I am certainly looking forward to work with our new GAVI Board member as she is taking on the huge task of reaching every Afghan mother and child with basic public health interventions. Her voice on behalf of partner countries will help to enable GAVI reach the overall goal of granting every child access to basic vaccines.

Dagfinn Høybråten
Board Chair of the GAVI Alliance

Friday

27 Jan

2012

The Perfect Match

The immunisation of children is an investment with guaranteed results: child survival. And once you know that the investment will double if put toward such a principled cause, how could you not contribute?

Leaders from the business world and civil society were presented with this compelling case at a breakfast meeting in Davos this week. It was a joy for me as Chair of the GAVI Alliance to moderate the event. 

Davos is site of the World Economic Forum, a beautiful place framed by a bleak economic environment. The 2012 WEF annual meeting is devoted to finding bold ideas, personal courage and new models to reshape the global economy and improve rather than cap human potential. That’s also what the GAVI Alliance was demonstrating at the breakfast meeting. 

GAVI, in fact, was launched in January 2000 at WEF in Davos. Twelve years later, the bold ideas and courage that formed our Alliance has become a dynamic success story. It stands as a light in a rather dark state of the world. 

Its newest programme is the GAVI Matching Fund. Through it at our breakfast, Bill Gates and British International Development Secretary Andrew Mitchell offered the Matching Fund as a perfect investment for the leaders around the board room table: for every pound given to this GAVI programme by organisations and businesses in the United Kingdom, the British Government will give another. 

For every dollar that is given by similar enterprises in other parts of the world, the Bill & Melinda Gates Foundation will give the same. 

Thus, at the breakfast meeting in Davos, the GAVI Matching Fund attracted another US$ 9 million to immunise the children of the world, bringing the total to US$ 38 million dollars in just a handful of months.

From the world of organ transplant, we know that a “perfect match” means that an organ is perfectly compatible for the recipient, saving life in a highly sustainable way. This is also the case with GAVI, an alliance that is pooling the demand for vaccines from lower income countries in order to deliver them in a secure, low-cost way. 

In the case of the Matching Fund, GAVI now is matching the best experience and knowledge from the private and public sectors to develop an innovative financial solution. GAVI is matching those around the boardroom those who can make a sustainable difference in global immunisation. And this leads to the most important match of all: the vaccine and the child, protecting life, enhancing healthy populations and building nations.

For me, this is a perfect match. It saves life in the most sustainable way. That is why I went to Davos. That is why I devote much of my time to the GAVI mission.

Dagfinn Høybråten
Board Chair of the GAVI Alliance

Tuesday

15 Nov

2011

Pushing back the boundaries of public health in Bangladesh

As I chair the GAVI Alliance Board meeting in Bangladesh and discuss decisions that will shape the future of immunisation in the developing world, it will be important to remember health worker Rabbi Aztor who I met on a field trip earlier this week.

It is people like Rabbi who fulfill the GAVI mission every single day: delivering vaccines through a weekly ‘Vaccination Day’ held in the living room of her home at Bara Goan, a village set 55km south of Dhaka amid the tributaries of the Padma river.

I watched as mothers waited patiently for Rabbi to register the weight, height and health of their newborn babies.  Her measurements complete, she pulls life-saving vaccines out of a cold box.

This morning it is 10-week-old Fatema’s turn. Like children across the world, she cries as Rabbi drops rotavirus vaccine into her mouth and administers a second dose of pentavalent vaccine.  Her mother Maksuda Aketer, aged 41, looks on calmly: she has already seen Rabbi deliver the same vaccines to her two elder daughters and knows this simple five-minute act will offer life-long protection against the biggest child killers in Bangladesh: diarrhoea and pneumonia.

Immunisation sessions like these are held once a week at Rabbi’s house. In between, the health worker makes daily calls on the community’s young babies to check on progress and ensure mothers do not forget immunisation schedules.

Rabbi says that during the monsoon season, when Bangladesh’s rivers can flow four metres above their normal depth and local homes become small islands perched on raised embankments, Rabbi uses a small paddleboat to reach her patients.
Rabbi works for the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), the medical centre based at nearby Matlab, whose pioneering research has laid the foundations for Bangladesh’s routine immunisation rates to reach an astonishing 95% of infants.

Forty years ago, icddr,b successfully piloted the concept of Bangladeshi health workers deliberately selected from the local community to ensure they have the trust and respect of their neighbours. Today 46,000 trained health workers underpin the nation’s maternal and child health programme.

This is just one example of iccdr,b pushing back the boundaries of public health in developing countries.

The centre’s medical and demographic surveillance programme has been running for almost 50 years: the longest running in the developing world.

Ever since a group of scientists conducted research on a cholera vaccine in the early 1960s, based on a boat in the Padma River, icddr,b has monitored the health and welfare of some 220,000 people – from cradle to grave.

Three generations of local villagers have grown used to icddr’s surveys, with studies ranging from the impact of new vaccines against influenza and pneumococcal disease to the reasons why drowning is the number one cause of death among young children in Bangladesh.

The rotavirus vaccines that Rabbi is administering are part of an impact assessment study funded by GAVI.

Round the corner from Rabbi’s house, I watch as another villager uses a handheld PDA to input data about the health of a newborn child; the information is fed via satellite into a giant database back at iccdr,b’s centre in Matlab.

Later in the day, I am taken by motor launch down the Padma, navigating fishing boats and brightly coloured water hyacinths, to Matlab to see the result of this research: a library of yellowing folders and a state of the art database that contains information about four generations of Bangladeshis.

Scientists from international medical schools around the world, such as the London School of Tropical Medicine in London and the Johns Hopkins University regularly consult the medical equivalent of an oracle.

Matlab runs its own hospital, and as I meet the staff and patients I am reminded of the need of the vaccines that Rabbi administered to Fatema earlier in the day.

On one side of the hospital’s courtyard, I visit a ward for newborn babies suffering from diarrhoea – the doctor explains that it is approaching the peak season for diarrhoea cases in Bangladesh and most of the beds are already taken-up.

On the other side, a 17-day-old baby in the neonatal clinic wheezes gently and snuggles deeper into the comfort of her mother’s arms – she has contracted pneumonia. Thanks to Matlab’s amazing medical care and antibiotics, she will survive.

Diarrhoea and pneumonia – Bangladesh’s (and the developing world’s) number one killers of infants. Both are vaccine-preventable diseases: rotavirus vaccine for diarrhoea, pneumococcal vaccine for pneumonia.

Bangladesh has applied for GAVI funding for the introduction of these vaccines, with pneumococcal vaccine support set for approval in 2012.

As we focus on points of order and policy decisions at the GAVI Board this week, we should keep in mind what it is all about: health workers like Rabbi who need GAVI support to continue to do their job on the frontline of immunisation.

Dagfinn Høybråten
Board Chair of the GAVI Alliance

Thursday

29 Sept

2011

Every woman, every child in Manyara, Tanzania

While world leaders recently gathered at the United Nations in New York to discuss how to reach every woman and every child with lifesaving health care, mothers and their children gathered at a remote health post in Tanzania’s Manyara region to receive vaccinations, prenatal care and anti-retroviral therapy against HIV/AIDS.

This is just one of the approximately 30 of such health posts in the region that is served by the  Haydom Lutheran Hospital located about 300 kilometers from Arusha in northern Tanzania.  Every month a dedicated band of health workers travel over bumpy roads and in single engine planes to reach far-flung communities with life-saving assistance. While leaders were discussing how to reach” the hard to reach,” these health workers were on the ground actually doing just that.

The hospital, which was originally set up by a Norwegian civil society organisation and is now run by a local church group, was all a bustle on the sunny afternoon of my arrival. There, as at the health post, large groups of mothers with their children were lining up for registration, vaccination, check-ups and medication, some shading their babies from the hot sun and swatting away the ever-present flies.

Maternal and child health is a priority for Tanzania. And mothers are responding.  Since 2008, vaccine coverage has gradually improved. Routine immunisation for babies has increased from 83% in 2007 to 91% in 2010. And the government has plans to soon provide new life-saving vaccines against rotavirus and pneumococcal, the two main causes of severe diarrhoea and pneumonia, respectively.

I spoke to one of the pregnant women waiting in the registration line. She is expecting her second child. And thanks to a free ambulance service, she will be able to give birth at the clinic under the supervision of a trained midwife.  In-hospital deliveries have doubled over the last three years due to these free services. Last year there were more than 5,000 deliveries at this hospital and only six maternal deaths – much lower than in years past.

Three days prior to my visit, a young mother died on her way to the hospital. She had not used the ambulance service.  Back at the hospital, I held her baby in my arms – he managed to survive. Strong and lively, he will be taken care of in a special ward for a few months until his extended family is able to take care of him.

Here in Manyara, as in other areas of sub-Saharan Africa, the critical role of civil society organisations is evident, and the efforts of local health workers are making a difference in the lives of every woman and child – every day.

This blog post is also featured on the Bill & Melinda Gates Foundation website.