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Board Chair of the GAVI Alliance
Cervical cancer is a scourge of women the world over, but particularly so in the poorest parts of the world, where it kills nearly a quarter of a million women every year, or roughly one every two minutes. From Mombasa to Mumbai women who have been infected with the human papillomavirus (HPV) could be developing life-threatening cervical cancer and are unaware or unable to do anything about it.
Every year an estimated 275,000 women lose their lives to cervical cancer. More than 85% of those who die from the disease live in developing countries where access to screening and treatment is limited – and often non-existent – so they simply do not receive the treatment they require.
But this is about to change.
From this week, the GAVI Alliance, a public-private partnership that supports vaccination in developing countries, will help countries to introduce the HPV vaccine. By 2020, we estimate that countries will have immunised more than 30 million girls in 40 countries against this silent killer.
Making HPV vaccine available to girls in developing countries marks a huge step for GAVI too. For the first time we will help countries offer vaccination to girls of school age. Previously GAVI’s routine immunisation support has been focused on protecting babies from the major killers of children under five, such as pneumococcal disease and rotavirus diarrhoea.
Our second major challenge was to secure agreements with vaccine manufacturers to enable us to purchase HPV vaccines at prices that are both affordable for GAVI and sustainable for countries once their economies grow beyond the threshold for GAVI support. When we made our decision to include HPV in our portfolio at the GAVI Board meeting in Dhaka in November 2011, we did it on the condition that affordable prices would be accessible. As chair of the GAVI board I was delighted when GAVI’s CEO, Dr Seth Berkley, was able to report to me that he had secured a record low price for HPV vaccine of $4.50 per dose.
The whole case of HPV not only shows that the GAVI model makes sense when it comes to market innovation, but it is also a compelling case for equity: most of the disease burden is in the poorest countries yet most of the vaccine has so far been used in the richest countries. Just three years ago the need for HPV vaccine in the developing world existed, but no vaccination programs did. But now thanks to GAVI’s model, that need is being filled.
This week, Kenya became the first country to introduce HPV vaccines with GAVI funding as part of a demonstration project, where countries are given the opportunity to explore ways to deliver HPV vaccines and to make informed decisions if they then choose to apply for national introduction. We expect Ghana, Lao PDR, Madagascar, Malawi, Niger, Sierra Leone and United Republic of Tanzania to follow suit over the next year. From 2014, a further set of countries will begin national HPV vaccine introductions giving, extending the reach of this life-saving vaccination.
Prevention is usually better than treatment. This is never more true than when the opportunity to prevent comes in the form of a simple vaccination while the diagnosis and treatment is, in many cases, simply not accessible.
It fills me with pride to know that the GAVI Alliance is at the forefront of ensuring that women in developing countries have access to the same vaccines as their counterparts in the industrialised world.
Dagfinn Høybråten vaccinating a child in Haiti during World Immunization Week,2012
World Immunization Week, which is being celebrated around the globe this week, is an important opportunity to highlight the power of immunisation in protecting children against life-threatening diseases, including rotavirus diarrhoea and pneumococcal disease, two of the leading child killers.
It is impressive and encouraging to see how governments, development partners, international organisations, manufacturers, health experts and civil society are all uniting around one important goal – universal immunisation coverage. Every child, everywhere deserves a healthy start in life. There is no reason why children in poor countries should die from vaccine-preventable diseases in the 21st century.
Although vaccines are widely available in high-income countries, the unacceptable reality is that 22 million children under five in developing countries are missing out on basic vaccines. For this reason, the GAVI Alliance is committed to working closely with countries to reach the hard to reach with vaccines – including children in remote areas and marginalised populations, and improve communities’ understanding about the health benefits of immunisation.
The good news is that, this week alone, four countries – Haiti, Somalia, Uganda and Zambia - will introduce new vaccines with GAVI support.
Over the past year, Haiti has really stepped up to the plate in making immunisation a priority after the devastations caused by the earthquake that hit its capital, Port au Prince, in January 2010.
This time last year during World Immunization Week, I was in Haiti representing GAVI at a vaccination campaign against measles, rubella and polio organized by Haiti’s Ministry of Health. It is inspiring to see that one year on the country has made great strides in rolling out the pentavalent vaccine and is now introducing the rotavirus vaccine, protecting infants from the leading cause of severe diarrhoea, which is often fatal for children under five. To date, GAVI has supported 14 countries to introduce the rotavirus vaccine and plans to reach five million children with the vaccine.
During World Immunization Week this year, political leaders and global health experts will gather in Abu Dhabi for the Global Vaccine Summit to celebrate immunisation successes, including the unrelenting efforts of the polio eradication partners over the past few years. This global push around polio eradication underscores the true power of immunisation – the idea that diseases can be literally wiped off the face of the earth.
GAVI is committed to supporting the polio “endgame” by strengthening routine immunisation services. These services are essential to complete eradication and ensure that countries remain polio free. Investing in routine immunisation programmes will not only help us deliver the full package of vaccines to children, but eradicate polio once and for all.
I am delighted to see that President Barroso and Commissioner Piebalgs of the European Commission will take part in the Summit, demonstrating the EC’s strong commitment to support immunisation. I was very pleased to meet with Bono and Commissioner Piebalgs last year in October and to discuss with the Commissioner the power of immunisation.
Scaling up immunisation programmes in poor countries would not be possible without continued support from GAVI’s generous donors, including 10 European Union member states and the European Institutions. Since 2003, the European Institutions have committed EUR 82.5 million to support GAVI’s mission of ensuring that children of the African, Caribbean and Pacific (ACP) Group receive the basic package of vaccines, including EUR 10 million for pneumococcal vaccines in ACP countries, pledged in June 2011.
We are grateful that most of GAVI’s donors provide long-term predictable funding, thereby ensuring that routine immunisation programmes are sustained with a reliable supply of quality, low-cost vaccines.
World Immunization Week is a chance to celebrate global achievements in vaccination, but also an opportunity to acknowledge how much we still need to do.
This blog post is also featured on Euractiv.
Dagfinn Høybråten with Bill Gates at the World Economic Forum 2013
There’s a growing and welcome awareness that the world’s biggest health challenges have profound economic implications as well.
Illnesses such as pneumonia, measles and meningitis take an enormous personal toll on people in the world’s poorest countries. I’ve seen this firsthand in hospitals and rural clinics from Tanzania to Haiti.
There’s also a growing awareness that one of the strongest ways to prevent this is through vaccines, which have proven to be one of the most cost-effective tools in global health.
This is important information for the private sector, with global business leaders gathering this week at the World Economic Forum in Davos. Global health is a key topic there because companies recognise that their competitiveness and the health of communities where they do business are mutually dependent.
Vaccines are one of the most cost-effective health investments around. The cost of vaccines used to fully protect a child against the most dangerous diseases is less than US$ 25 in GAVI countries.
And delivering vaccines provides an enormous and proven value well beyond healthcare. Healthier children – spurred by immunisation – attend school more frequently and longer, and learn more while they are there. As adults, they will have longer, healthier and more productive lives than those who weren’t vaccinated as children.
My organisation, the GAVI Alliance, was launched at the World Economic Forum in 2000 as a public-private partnership devoted to a mission of saving children’s lives and protecting people’s health by increasing access to immunisation in poor countries. Ever since then – with strong support from governments – GAVI has worked with a variety of partners, including many in the private sector. They want to be part of something transformative.
That is why many have joined the GAVI Matching Fund, where every dollar they contribute to GAVI is matched by either the Bill & Melinda Gates Foundation or the UK Government. These companies also are providing core business skills to help GAVI overcome roadblocks and provide visibility to the cause of immunisation.
For instance, LDS Charities – the volunteer-driven relief and development arm of The Church of Jesus Christ of Latter-day Saints – arranged 1.5 million text messages to be sent during GAVI’s historic double rollout of vaccines in Ghana last April.
Or consider Vodafone, one of the world’s largest mobile communications companies, which is helping health ministries in GAVI-supported countries in sub-Saharan Africa use mobile technology solutions to improve their immunisation programmes.
And Comic Relief, the popular UK charity, has partnered with GAVI to significantly raise awareness of the need for vaccines in the developing world. Last April, it featured immunisation as part of its annual appeal in the UK, which was viewed by millions and has helped raise US$ 24 million for GAVI.
Each of the three is making a major announcement at the World Economic Forum about the Matching Fund, bringing the total amount raised under the 18-month-old initiative to US$ 78 million, demonstrating how the private sector has become a key driver of the very innovation required to tackle the world’s biggest global health challenges.
How do we immunise an additional quarter billion children by 2015, to which GAVI has committed? With private sector partnerships, these accomplishments and many others are within our reach.
Dagfinn Hoybraten, Chair of the GAVI Board with a mother and child awaiting vaccination. Shambarai, Tanzania, December 2012. Copyright: GAVI Alliance 2012/Robert Beechey
After an hour’s drive on dusty, bumpy roads out of Arusha, Tanzania we arrived in Shambarai village. I was asked to address a group of parents, mostly mothers and a few fathers, who had brought their young children to be vaccinated and were gathered under a tree. Some of the parents had walked more than 20 kilometres to receive basic vaccinations for their children.
This week Tanzania will take an important step to protect its children against two of the biggest child killers – pneumonia and severe diarrhoea – by introducing pneumococcal and rotavirus vaccines.
I will never forget the look on the parents’ faces when I told them this news. They know instinctively and sometimes from painful experience that these diseases too often claim the lives of children before they reach their fifth birthdays. The parents were relieved to be able to protect their children against these illnesses.
My trip to Shambarai was a field visit in connection with the GAVI Alliance Partner’s Forum. More than 600 of our allies are gathered in Dar es Salaam to consider the progress we have made together and how we can build on it in the coming years.
The United Republic of Tanzania has much to be proud of. In 1999, 147 out of every 1000 children died before their fifth birthday. That figure was down to 67 in 2011, and Tanzania is on the track to reach the Millennium Development Goal on child mortality: a reduction of the under-five mortality rate by two thirds between 1990 and 2015.
Monday I witnessed the partnership that has brought us here at work. I was part of a GAVI delegation that visited several different vaccination sites near Arusha. We visited a district level health centre, a regional health centre and took part in the vaccination outreach in Shambarai.
The district representative of WHO told us how they have worked with the local authorities and other partners to prepare for pneumococcal and rotavirus vaccine introductions by training health workers, expanding the cold chain and raising awareness of the effort through advocacy.
To help spread the word about the importance of vaccinating children, the health workers in turn worked with local government leaders and civil society organisations as well as religious leaders in the community. And they did well, scoring above the targets set for immunisation coverage in the community.
At the Usa River Health Centre, I had the privilege of giving little Barack two drops of polio vaccine. Thinking of how close we are to wiping out polio, and the continued financial commitment and political will needed to finish the job, was a moving reminder of the power of partnership to save lives.
Dagfinn Høybråten, Chair of the GAVI Board, at the Usa River Health Centre, Arusha, Tanzania, December 2012. Copyright: GAVI Alliance 2012/Robert Beechey
As I was writing my new book, my six-year-old grand daughter asked me what I was up to. I am writing my book, I said. What is it on? She asked. On what grandpa thinks is most important. Do you know what grandpa thinks is most important? That the children may live, she replied with a big smile.
She is so right, and that is also the common goal behind the efforts of the partners working together in the GAVI Alliance: That the children may live.
What would it take to protect a child against five diseases with a single vaccine in a country like Haiti, which is still rebuilding after the devastating 2010 earthquake? Or to bring vaccines against pneumonia and diarrhoea, two of the biggest killers of children in developing countries, to places such as Pakistan and Yemen? Or to target Africa’s 'meningitis belt' by reaching 100 million people less than two years into a mass vaccination campaign?
It takes partnership, and the belief that by working together those of us who are passionate about saving lives and improving health can accomplish much more than we could on our own. Since 2000, GAVI has been able to save more than 5.5 million lives and will work to save an additional four million by 2015. This is possible by working as an alliance whose partners include UNICEF, the World Health Organization, the World Bank, the Bill & Melinda Gates Foundation, governments and pharmaceutical companies in the developed and developing worlds, research institutes, and civil society and advocacy organisations such as ONE.org and many others.
Later this week, more than 600 global health leaders will come together in Dar es Salaam for the GAVI Alliance Partners’ Forum. The United Republic of Tanzania is the perfect place for this three-day event, which will include a dual introduction of pneumococcal and rotavirus vaccines and discussions aimed at advancing access to vaccines and immunisation. In 2010 pneumonia accounted for 15% of child mortality in Tanzania, according to the International Vaccine Access Center at Johns Hopkins Bloomberg School of Public Health. And yet, according to 2011 estimates from WHO and UNICEF, Tanzania’s vaccine coverage rate against key causes of child pneumonia meet or exceed targets that if adopted worldwide could prevent two-thirds of child pneumonia deaths.
GAVI’s mission underscores the themes of the Partners’ Forum, which are Results, Innovation, Sustainability and Equity (RISE). Those who are unable to join us in Tanzania can follow the conversation on the GAVI website, where we’ll be streaming some of the sessions, and on Twitter at #GAVIpartners.
The results of our work lie not only in the number of lives saved or lives we hope to save but in the fact that an additional 370 million children in the world’s poorest countries now have an opportunity to grow up healthy and contribute to their communities.
Innovation is at the heart of what makes vaccines one of the most cost-effective ways to save lives. GAVI uses several funding mechanisms to raise funds in international capital markets and stimulate the development and supply of vaccines to make them affordable for developing countries. By using these tools to shape vaccine markets and lower costs, countries are able to sustain their commitment to providing immunisation after they graduate from GAVI support.
Even the world’s poorest countries take pride in contributing to the cost of their vaccines. This reinforces the fact that they are equal partners in this effort. Equity drives a central goal of our work to dramatically reduce the amount of time it takes for vaccines to reach poorer countries after they’re introduced in wealthier countries. Just 20 years ago, this would not have seemed possible.
I’m excited to leave Tanzania after several days of discussion and debate further inspired by what can be achieved when we come together in partnership.
This blog post also appears on the Global Poverty Project website, on Shotatlife.org and on defeatdd.org.
GAVI Board Chair Dagfinn Høybråten talks to Myanmar midwife Daw Zin Mar Lwin at the launch of the pentavalent vaccine. Copyright: GAVI Alliance 2012/Phil Davey
Myanmar made news this week but not for reasons you might expect. The scene at the little health center in Thagaya in Yedashe township is an unmistakable sign of progress as the country emerges from decades of social and political isolation. For the first time, with support from the GAVI Alliance, a pentavalent vaccine was introduced that will defend children against five potentially fatal diseases. Over the next six months, more than half a million children in Myanmar will be protected from diphtheria, pertussis, tetanus, hepatitis B (hepB), and Haemophilus influenzae type b (Hib).
Some mothers cradled their babies while others bounced them on their laps as senior midwives and younger health workers lined up to administer the vaccine, which will be available to all children under the age of 1. Babies and young children are at particular risk for hepB, a viral disease that can cause liver cancer later in life. Hib can cause meningitis and pneumonia, a largely preventable disease that is the leading killer of children under five worldwide. The new vaccines were officially launched during a ceremony in the capital Nay Pyi Taw the day before.
Along with the pentavalent vaccine, Myanmar also rolled out the measles second dose vaccine as part of the routine immunisation schedule. The country plans to reach 1.1 million children over the next year, giving them protection against a virus that kills hundreds of people a day.
GAVI is a public-private partnership that reduces the price of vaccines in order to make them more readily available to people in developing countries. Introducing the pentavalent and measles second dose vaccines simultaneously will help GAVI and our alliance partners to immunise nearly an additional quarter billion children by 2015.
But providing the vaccines themselves is only part of the story.
Countries must have strong health systems—including well-trained health workers and proper storage facilities—in order to get the vaccines to people who need them most. A grant to aid the vaccine introductions in Myanmar funds upgrades to the cold chain system that’s vital for keeping the vaccines at the correct temperature so they remain effective.
As officials in Myanmar know, there’s no room for error in this part of the process. Earlier this year, they faced weaknesses in the cold chain system that could have compromised the pentavalent vaccine introduction. In just eight months, the officials made some necessary, and impressive, adjustments.
In the heart of the city of Yangon, health workers proudly showed us how they keep the temperature regulated at the central cold storage site. This is just one of the links in a chain that includes the refrigerator at the local health clinic, and the portable coolers taken to the hardest-to-reach areas by health workers on bicycle or on foot. These workers are dedicated to doing their part to ensure that people in their country can lead healthy and productive lives.
Myanmar has shown that even nations facing significant challenges can build a more secure and stable future by investing in vaccines and immunisation.
As world leaders gather this week at the General Assembly in New York, I'm encouraged by the focus on children's health alongside other pressing global issues.
These discussions come in the wake of UNICEF's latest report on declines in child mortality around the world.
There's much good news to celebrate in these figures. The number of children who die before they reach their fifth birthday has dropped from 12 million in 1990 to 6.9 million in 2011. Widespread progress has been made with steady gains in all regions over the past 20 years.
In June, the governments of the United States, India and Ethiopia along with UNICEF launched a renewed global commitment to child survival at a meeting in Washington. Since then, more than 110 governments, almost 300 faith leaders and 174 civil society organisations have pledged to renew their efforts to reduce child mortality. I continued to be inspired by new partnerships and reinvigorated partnerships forged out of that meeting to ensure that children everywhere can lead healthy and productive lives.
Partnerships are key to ending preventable child deaths and the GAVI Alliance (Global Alliance for Vaccines and Immunisation) operates under the belief that working together as an alliance ensures greater results and more lives saved than any of our partners can achieve alone.
UNICEF is a critical partner to GAVI as the world's biggest purchaser and supplier of vaccines for developing countries. UNICEF's country offices also help plan and implement immunisation programs supported by GAVI.
The declines in child mortality highlighted in the UNICEF report are due in part to dramatic increases in routine immunisation against the leading killers of children under 5, pneumonia caused by pneumococcal disease and diarrhea caused by rotavirus. According to the World Health Organization, 1.2 million children died of pneumonia alone in 2011.
Today, more than two dozen countries have introduced pneumococcal and rotavirus vaccines with GAVI's support. But that's not enough.
On average, about 19,000 children still die every day. These deaths are largely preventable and expanding access to vaccines and immunisation can play a major role. Vaccines are the great equalizer. Making them available in developing countries shortly after they're offered in developed countries has an impact far beyond health.
This year alone, GAVI has introduced vaccines in the Democratic People's Republic of Korea, Yemen and Rwanda. We're currently planning to introduce pneumococcal vaccine in Pakistan. Children in countries that are often isolated are receiving the same protection against life-threatening illnesses as their peers in other parts of the world.
By working together to save lives and improve the health of all children no matter where they live, we can create a world where equity is within our reach.
This blog post also appears on the Huffington Post.
Next week in Washington I'll join hundreds of leaders--from world governments, the private sector, and faith-based organizations--to launch the Child Survival Call to Action, a long-term, focused effort to save children's lives.
Secretary of State Hillary Clinton, USAID Administrator Rajiv Shah, and other leaders will join the health ministers of India and Ethiopia in leading the two-day high-level meeting.
The gathering will also focus on improving maternal health-an effort supported by a recent partnership pledge between the U.S. and Norway and announced by Secretary Clinton in Oslo last week.
As vice president of the Norwegian Parliament, I'm proud of the longstanding collaboration between our countries to save lives and improve people's health around the world.
I also chair the board of the Global Alliance for Vaccines and Immunisation (GAVI), a public-private partnership that works with governments in the developing world, vaccine producers, and others to expand access to vaccines and immunization.
The support of donor countries, including the U.S. and Norway, is also vital to GAVI's work and has helped avert 5.5 million deaths since GAVI was founded in 2000. At a conference in London last June-where Administrator Shah proposed the Call to Action-donors pledged critical new support to GAVI.
As a result, new vaccines have been introduced in more than a dozen countries since then. Pneumonia caused by pneumococcal disease and diarrhea caused by rotavirus are two of the biggest killers of children. Almost 50 countries will introduce the pneumococcal and rotavirus vaccines by 2015. This will allow us to deliver on the promise made to donors to reach as many people in the developing world as possible with vaccines. Working with partners including UNICEF, the World Health Organization and the World Bank, our goal is to vaccinate an additional quarter billion children in the next four years. Countries are also key partners as GAVI support is not a handout. Countries that apply for and receive GAVI funding must also pay a portion of the costs to provide new vaccines.
The urgency behind this effort, and the Call to Action, is driven by a sobering fact: 7.6 million children around the world die each year and countless children in developing countries don't live to their fifth birthday. A staggering 1.7 million children mostly in developing countries die each year from diseases that can be prevented by vaccines.
The conference has an ambitious goal of ending preventable child deaths within a generation. This goal is indeed achievable. But this will require a new level of collaboration, additional resources and increased accountability. We should be driven by our goal to end a massive tragedy that is now entirely preventable.
Vaccines play a critical role in achieving this goal. Expanded use of vaccines and additional cost-effective interventions could reduce child mortality by about 5 million lives per year. Thanks to worldwide support and the commitment in countries, there's been tremendous success in reducing child mortality over the last 10 to 15 years.
Immunization has been a major driver of this progress, saving more than 3 million lives per year. In the past decade, coverage rates have increased more than 10 percent, even in the poorest countries. Given the availability of vaccines and mechanisms like GAVI to ensure that vaccines reach the poor, the ethical and moral imperative becomes even greater.
Immunization is a matter of justice. New vaccines are being rolled out against two of the biggest killers of children, pneumonia and diarrhea. By ensuring greater equity we can address the once shameful delay of 15 years or more between when vaccines were used in wealthier countries versus poorer ones. For the first time in history, these life-saving tools are available in the developing world soon after they're introduced in the developed world.
I passionately believe that vaccines should reach children wherever they live.
I've been in public life for more than 30 years and count myself fortunate to have served as Norway's former health minister and to have led a national party.
But the children whose lives are changed by the efforts of organizations like GAVI and many others doing important work in child survival do not have a voice in the political process. They can't vote, they can't write letters to their Congressional representatives, they can't make campaign contributions. These children need advocates who can speak for them and for their concerns. Let's use the child survival meeting in Washington to create a dramatically different future for millions of children around the world.
This blog post also appears on The Hill's Congress Blog.
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.
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.
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.
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.
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.
© GAVI Alliance 2013
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