How Global Citizens Helped a Health Organization Deliver Millions of Life-Saving Vaccines

Author: Jackie Marchildon

GAVI/2015/Phil Moore

Kareen Awadalla has never let the nationality on her passport define the meaning of home.

Awadalla has lived in Canada since she was 2 years old and currently resides in Toronto, where she works as a freelance content specialist focusing on content that addresses social issues at home and abroad. An immigrant from Egypt, she values the importance of looking outward.

But while she was studying international development and journalism at the University of Toronto, she was at a loss for how she could help the world.

“You kind of feel hopeless in school,” Awadalla, now 31, told Global Citizen. “You just realize … how much is required to actually make an impact.”

But in 2009, Awadalla attended the North American premiere of "1.4 Billion Reasons," a presentation hosted by Global Citizen CEO Hugh Evans at the Danforth Music Hall in Toronto.

Evans gave a TED Talk-style presentation featuring parts of a documentary that focused on how to help the world’s poorest populations — 1.4 billion people around the world were living in extreme poverty at the time.

“After watching the documentary, it kind of just clicked, and Hugh Evans was there and gave us a really impactful speech,” she said. “It made me realize that we just need to feel connected to each other.”

From there, Awadalla would become one of Canada’s most engaged Global Citizens.

She had a good feeling about Global Citizen and followed its progress over the next decade, taking action and attending the first Global Citizen Festival in New York in 2012.

“I won tickets and no one could go with me, so I just booked a bus ticket to New York,” she laughed. “It was my first solo trip ever.”

Standing in the crowd on the Great Lawn in Central Park, Awadalla was overcome by the contagious energy that engulfed Global Citizens at the festival, where world leaders join musical artists on stage to announce commitments for gender equality, clean water, health, food and nutrition, and more.

“It’s crazy, the feeling that you get,” she said. “Every announcement that’s made you’re just so touched and inspired … This is all because we spoke up.”

And one particular commitment from Canada was made in 2014, thanks to Awadalla and her fellow Global Citizens speaking up — by taking action.

I. An Alliance Is Formed

In the late 1990s, global immunization efforts were beginning to stall, and a reported 30 million children living in low-income countries were unable to access vital vaccines.

Global health progress was threatened, as developing countries struggled to continue to fund immunization programs and pharmaceutical companies had little reason to invest in providing poor countries with vaccines.

That’s how Gavi, the Vaccine Alliance came to be.

Created in 2000, Gavi’s mission is to improve access to new and underused vaccines for children living in the poorest countries. It’s an international organization that works as a partnership between public and private sectors, launched thanks to an initial $750-million pledge from the Bill & Melinda Gates Foundation.

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Families gather ouside the Mnarani Dispensary in Kilifi, Kenya which serves 500 people a day.
GAVI/2014/Duncan Graham Rowe

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New vaccines against infectious diseases are coming to market at the fastest rate in history, according to Gavi.
GAVI/2014/Duncan Graham-Rowe

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Children read a pamphlet about the measles and rubella vaccine in Tanzania.
GAVI/2014/Karel Prinsloo

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Gavi 2014_4
Families gather ouside the Mnarani Dispensary in Kilifi, Kenya which serves 500 people a day.
GAVI/2014/Duncan Graham Rowe

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Tanzania implemented a program in 2014 to protect 21 million children against measles and rubella as part of a nationwide immunization campaign supported by Gavi, the Vaccine Alliance.
GAVI/2014/Karel Prinsloo

In 2014, Gavi was seeking $7.5 billion in replenishment funds for the 2016-2020 period, in which it planned on delivering life-saving vaccines to 300 million children, preventing 5 to 6 million deaths.

In order to achieve that goal, Gavi needed new funds from countries with bigger budgets — and a strong commitment from Canada was seen as essential.

That’s where Global Citizen stepped in.

Global Citizen campaigns on the United Nations Sustainable Development Goals, including Global Goal 3 for good health and well-being. When people are sick, they can’t work, earn wages, and contribute to the economy, making good health a key to ending poverty.

Immunization is considered the best way to attain good health for the world’s poorest people because it provides a safe and effective way to tackle preventable diseases and avoid unnecessary deaths. Immunization currently prevents 2 to 3 million deaths every year, according to the World Health Organization (WHO).

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Gavi plays an important role in delivering these vaccines, and Canada has supported its efforts since 2002. In fact, for the period of 2001 to 2015, Canada pledged and delivered over CAD $513 million to the organization, under both Liberal and Conservative governments, demonstrating Canada’s long-standing commitment to global health. These pledges have been made through direct contributions and also via innovative finance mechanisms.

By 2014, the country was positioned as one of the world’s top supporters of child health and Global Citizen looked to Canada to continue its support through 2020.

The Global Citizen team worked behind the scenes for a year, partnering with organizations like Results Canada, the ONE campaign, and the Bill & Melinda Gates Foundation. Global Citizen also worked with the offices of former Prime Minister Stephen Harper, former Minister of International Development and La Francophonie Christian Paradis, and former Minister of Foreign Affairs John Baird. Harper’s government had shown leadership in global health when it pushed for international commitments to the Muskoka Initiative on Maternal, Newborn and Child Health during the G8 Summit in June 2010.

II. Global Citizens Step Up — and the Government Responds

In the lead-up to Global Citizen Festival 2014, Global Citizen launched its petition calling on world leaders to increase support for Gavi ahead of its replenishment conference in January 2015.

“Every child deserves a healthy start at life. But 1 in 5 children still don't get the vaccines they need. That's wrong. Please step up your support of Gavi, the Vaccine Alliance and help immunize 300 million kids by 2020,” the petition read.

Awadalla remembers signing that petition.

“It was an obvious … thing to support,” she said. “We don’t get to choose where we’re going to be born, we don’t get to choose if the society we live in affords us access to vaccines. But the fact that they exist … to me, that means that they should be a human right, not a privilege.”

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Muna, a community health care provider, carries vaccines by rickshaw to a distribution point in Dhaka, Bangladesh.
GAVI/2015/GMB Akash

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Cooling tubs are placed on the ground at the PEV (Programme enlargi de vaccination) of the Ministry of Public Health in Kinshasa, Democratic Republic of the Congo. Gavi is involved in the provision of solar fridges that help maintain the cold chain in the Congo.
GAVI/2015/Phil Moore

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Madelein Semo, a nurse-vaccinator, carries a coolbox stocked with vaccines to go and vaccinate in a community health centre in the Ngbaka neighbourhood of Kinshasa, Democratic Republic of the Congo.
GAVI/2015/Phil Moore

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A nurse prepares a vaccine to administer to students at a health clinic in Vientiane, Laos.
GAVI/2015/Bart Verweij

By October, the petition garnered over 26,000 signatures from Global Citizens. 

The campaign was a pivotal moment for Global Citizen, according to Jonah Kanter, Canada policy and government affairs manager for Global Citizen.

“This campaign helped to further establish the Global Citizen movement in Canada,” he said.

It laid the groundwork for future commitments that Canada would deliver thanks to Global Citizen action takers, including a CAD $804-million commitment to the Global Fund to Fight AIDS, Tuberculosis, and Malaria in 2016, and a CAD $100-million pledge for the Global Polio Eradication Initiative in 2017.

At the Francophonie Summit on Nov. 28, 2014, Prime Minister Harper announced that Canada would be committing CAD $500 million to Gavi.

This commitment was made just ahead of Gavi’s 2015 replenishment conference, which was especially significant as it set the tone for expectations of other donor countries. The CAD $500-million commitment almost doubled Canada’s total prior contributions to Gavi.

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In addition, Canada committed an extra CAD $20 million during Gavi’s pledging conference in Berlin, Germany in January 2015.

And it might not have happened without Global Citizens using their voices to call on Canadian leaders. 

“In 2014, Global Citizen/GPP helped create the momentum that led to Canada’s bold announcement — a major increase in funding to help millions get vaccinated against killer diseases in the poorest countries of the world,” Guillaume Grosso, director of International Business Development & European Strategy at Gavi, told Global Citizen.

Canada’s contribution helped Gavi exceed its fundraising goal of US $7.5 billion for its current replenishment cycle, putting it on the path to vaccinate 300 million children and save 5 to 6 million lives by 2020.

Former Minister Paradis, a key figure in the government’s decision, told Global Citizen that public mobilization, including Global Citizen action takers, empowered the government to make this commitment.

“By having petitions and mobilization like you did, of course the message was well received,” he told Global Citizen. “All of this starts from what you did. Mobilization. And governments cannot do it by themselves. They don’t have the capacity, they don’t have the capabilities … This is what you did, you mobilized, and this is why I’m telling you from the bottom of my heart, thank you for doing this.”

Gavi_CaseStudy_Timeline-2.pngPhoto by Jose Luis Magana/AP

III. Lives Are Impacted

By the end of 2018, Gavi had delivered basic vaccines to about 80% of children in the world’s poorest countries. Since its inception in 2000, Gavi has reached over 760 million children with vaccines, and saved more than 13 million lives from devastating and potentially fatal infectious diseases, including diseases like polio, measles, rotavirus, pneumococcal disease, human papillomavirus, and more. All of this was made possible thanks to global commitments to the organization.

Canada’s commitment — along with commitments from countries like Australia, Germany, Norway, the UK, and the US — is being used to support on-the-ground health programs. For example, Kenya AIDS NGOs Consortium (KANCO) is a membership-based organization in Kenya that focuses on health advocacy and also implements health programs, with operations in Eastern Africa.

With support from Gavi, including improved delivery of health services in Nairobi’s informal settlements, KANCO ran an outreach program in Nairobi in early August this year with community health volunteers. They visited two areas with low immunization coverage in the informal settlements of Nairobi.

Over two days, in the early mornings, the health volunteers visited the community by first going door to door. Then, community members were encouraged to visit the centers where workers provided health education and administered vaccines. Local leaders spoke to the community, as well.

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“This is a very important population when it comes to immunization, and also [for] monitoring their growth,” Dr. Lucina Koyio, health county director in Nairobi County, told Global Citizen. “It is very important that we make sure we come to the communities to reach our children.”.

Without these outreach programs, these populations might not ever have access to vaccines.

Koyio specifically highlights the importance of reaching the children under 5 years old in the region. Not only does this ensure they are vaccinated against preventable diseases, but it also allows health workers to screen them for diseases like tuberculosis, and monitor their growth and overall health. They can also check in on their mothers and provide them with additional information.

Five days ahead of the official outreach days, when the teams are set up in facilities like schools, health volunteers go door to door to educate the community on the importance of vaccination.

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Vaccine campaign launch at a school in Rakhine, Myanmar.
GAVI/2017

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A child is carried by a relative into the cholera treatment center in Banadir hospital in Mogadishu, Somalia. She contracted cholera after drinking from a borehole near her home on the outskirts of Mogadishu.
GAVI/2017/Karel Prinsloo

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Families arrive at a health center to receive the measles-rubella vaccine in Dedza, Malawi.
GAVI/2017/Karel Prinsloo

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Vaccine campaign launch at a school in Naypyitaw, Myanmar.
GAVI/2017

“Back when we didn’t have community health workers, diseases were spreading all over like flu,” community health worker Susan Wanjiru Sharambu told Global Citizen. “When these vaccines were introduced to prevent these diseases, we [started to] direct the children to the health centers, reducing the cases significantly.”

Wanjiru Sharambu explained that services like this are important because there are no health centers nearby, so it can be challenging to deliver health services as people complain about the distances they must travel to access health care, not necessarily seeing the value in the effort.

But on the day she spoke with Global Citizen, crowds had gathered at the makeshift center. This allowed workers such as herself to speak to the community, dispel myths around vaccines, and help assess the overall health of a vulnerable population.

These efforts are meant to carry out community social mobilization to get to the unreached children in some of Nairobi’s most vulnerable districts.

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Mildred Ondisa, a young mother from the area, visited the center during an outreach day to vaccinate her child.

“I have seen the effects that are brought by not taking a baby to be vaccinated,” Ondisa told Global Citizen. “They become paralyzed and are not healthy and are hard to take care of.”

Ondisa wants to prevent her child from becoming ill from vaccine-preventable diseases like measles and polio, as well as illnesses like tuberculosis — and to keep her child in good health overall.

“I was vaccinated when I was a baby, that’s why I’m healthy,” she said.

IV. The Work Continues

As of Dec. 31, 2018, Canada had successfully paid three installments of its total CAD $520-million 2016-2020 commitment, amounting to CAD $320 million helping to fund vaccine outreach initiatives like the one in Nairobi. There are two more installments due, in 2019 and 2020.

Gavi funding for 2016 to 2020 will ensure that 300 million children will be immunized in total — 127 million had been vaccinated by the end of 2018. These vaccinations will ultimately save up to 6 million lives, Gavi estimates.

But 2019 is coming to an end and Gavi’s next replenishment conference is now less than a year away.

In June 2020, the UK will host the next Gavi replenishment conference, calling on world leaders to commit new funding to build on the progress made to date — and we need Canada to continue to support this initiative.

Related Stories Aug. 30, 2019 This Initiative Has Saved 13 Million Lives. With New Funding, It Could Save Millions More.

“Canada's proven through its historic 10-year ‘Thrive’ commitment to women and girls' health announced in June that it will continue to be a global health champion for years to come,” Kanter said. “The government has rightly emphasized the critical issue of sexual and reproductive health and rights, but we need Global Citizens to help us also emphasize that vaccines are a crucial part of a child's development — and the development of vulnerable communities and countries as a whole.”

Next year’s event will seek to raise funds for the 2021-2015 period, and will be a critical moment that will determine if we can achieve Global Goal 3 by 2030. 

Since 2014, Gavi has managed to do great things with its funding. But the core message remains the same: The world needs to invest in vaccines, in order to achieve not only Global Goal 3 on good health and well-being for all, but almost all of the Global Goals. Immunization has a direct impact on reducing poverty. Vaccinated, healthy children can go to school and grow up to become productive adults, and parents can work instead of caring for sick children. Healthy children grow into a productive workforce and become strong contributors to the economy.

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Under both Conservative and Liberal leadership, Canada has remained committed to global health efforts. As the country heads into an election period this fall, the call for funding for Gavi will continue to be just as important as ever.

Conservative Member of Parliament Mike Lake has worked with Global Citizen to raise awareness around the importance of vaccines, having attended events and penning an op-ed for the National Post during World Immunization Week. He supports the important commitment made by the Conservative government in 2014, and hopes for similar commitments in the coming year.

“I’m hopeful that regardless of the outcome [of the election], Canada will renew our strong support for both Gavi and the Global Polio Eradication Initiative over the next year,” Lake told Global Citizen. “Because in this campaign, we’re all on the same side.”

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The cumulative effects of population growth and displacement, climate change, increasing fragility, and recurrent disease outbreaks are threatening to reverse the progress the world has seen over the last two decades. This is not the time for complacency, but for renewed commitment to help countries to continue to prevent diseases, to protect their communities, and to prosper.

Support from countries and Global Citizens around the world is necessary if Gavi is going to reach its funding goal, and if the world is going to reach its global health targets by 2030.

“We all need to take responsibility to call on the decision makers to pledge that kind of commitment, to make [vaccines] accessible,” Awadalla said.

And the way to do that is to raise your voice.

“I believe that … collective action inspires collective impact,” she explained. “And I learned that from Global Citizen.”