As Nelson Mandela himself once said: “Life or death for a young child too often depends on whether he or she is born in a country where vaccines are available or not.”
Now, 100 years since Mandela was born, equal access to vaccines for everyone is at the very heart of the mission of Gavi, the Vaccine Alliance.
Gavi was launched in 2000, birthed from a desire for every child to have access to life-saving vaccines, wherever they live.
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But still, inequality — both between different countries, and within countries themselves — is a major challenge to the goal of universal immunization.
Inequality was a central theme of Gavi’s 2016-2020 Mid-Term Review Meeting, hosted this week in Abu Dhabi by UAE Aid, to celebrate Gavi’s progress and explore the challenges and opportunities to come ahead of its 2020 replenishment.
Gavi has achieved extraordinary progress globally in its 18 years of existence. It has, for example, vaccinated over 700 million children around the world and has saved over 10 million lives.
We're here at @gavi’s 2016-2020 Mid-Term Review meeting in Abu Dhabi to celebrate the 700 million vaccines delivered over the past 18 years — and to explore the future of vaccinations around the world #HealthForAll#VaccinesWork#GotLife#GaviMTRpic.twitter.com/mmxjyjN60U— Global Citizen Impact (@GlblCtznImpact) December 10, 2018
“You can imagine the road that has been walked from 2000 to 2018,” Guillaume Grosso, Gavi's director of international business development and European strategy, told Global Citizen at the conference. “700 million children is twice the population of the United States. It’s a gigantic achievement. And that also means that we can trace how many lives have been saved, because vaccination is so transparent in terms of the impact.”
“I don’t know of any other intervention that has so much impact in people’s lives,” he continued. “So I think this is why we’re really excited. It’s not just any moment for us, it’s very special.”
“It’s also our 18th anniversary, so it’s the coming-of-age of Gavi in a sense,” he said. “And those children that were first vaccinated back in 2000 are now adults, and they’re going to be productive, and they’re going to contribute to their economies. This is going to have an impact which is amazing. So it’s really great to see all this progress.”
The Mid-Term Review meeting this week marked the halfway point for Gavi since the last replenishment, which was held in 2015 in Berlin. At the replenishment meeting, world leaders essentially gathered to make commitments and pledges of funding to put towards supporting Gavi’s work, and the goal of ensuring every child, everywhere, has access to vaccination.
But, as well as celebrating the enormous progress so far, the Mid-Term Review was also a time for exploring what the challenges are in the coming two years. It brought together voices from across all of the sectors that work as part of Gavi — which truly is an alliance, giving a platform to voices from governments, health ministries, the private sector, NGOs, and community, frontline health workers.
Today, thanks to Gavi, some 80% of children in the world’s poorest countries are immunized with basic vaccines. The challenge now, according to many stakeholders at the Mid-Term Review, is how to reach 100% of children, wherever they are born.
💉 700 MILLION children! 💉— Global Citizen Impact (@GlblCtznImpact) December 11, 2018
As @gavi CEO @GaviSeth just pointed out at #GaviMTR, that's equivalent to having immunized every living person in the Middle East & Africa born in the 18 years since Gavi's creation.
But let's not stop there.#GotLife#HealthForAll#BeTheGenerationpic.twitter.com/NmLxW4Uf2Z
Changing forces in the world are the primary challenges in this goal. We asked a lot of people at the conference what the main challenges are for the next two years, and even further in the future — and the answers were consistent: climate change, urbanisation, and fragility born of conflict.
For Dr. Seth Berkley, CEO of Gavi, the focus is now on reaching “the last child.”
“The easy stuff has been done,” he told the conference audience. “But the under-immunized now are going to be harder to reach.”
Climate change, for example, will change the spread, pace, and pattern of future diseases, he said. Meanwhile the mass movement of people that we’re already witnessing, for example in the refugee crisis, is leading to increased urbanization and the rapid growth of informal settlements.
In these informal settlements, like urban slums, people essentially don’t formally exist. They’re not formally registered, and so it’s harder than ever to track and trace people, and log the vaccinations that they have and haven’t had.
Professor Kaosar Afsana, from BRAC University in Bangladesh, spoke to the challenges of reaching children in urban slums.
“I’m going to tell you the story of a woman, a working mother,” she said. “Her name is Miriam. She came from a district with a husband and a very little daughter, about four years old. They came to the city because they lost their home, their land… All was washed away by river erosion. So they’re environmental refugees, coming to urban areas for a better life.”
“Her husband is a day labourer, and she is too," she continued. "She works in houses as a helping hand, and it means their little one is alone for long periods while they work.”
“About six months ago, she gave birth to a second child,” she said. “The little girl, who is four years old, is the primary caregiver of her little brother. Imagine the situation of Miriam. She works every day, she doesn’t have any free time during the day time. She works all seven days, and she’s completely engaged.”
“It means that little baby, her son, wasn’t vaccinated,” she said. “The reason was that the outreach centre is open during day time, and Miriam couldn’t go there. And the community frontline health workers couldn’t reach out, couldn’t find her. And she and the baby remained undetected and unvaccinated.”
Together, we’ve reached four in every five children. But, according to @ChrisJElias of @gatesfoundation:— Global Citizen Impact (@GlblCtznImpact) December 11, 2018
"The fifth child isn’t standing next to the other four, otherwise it would be easy." #HealthForAll#GaviMTW#GotLifepic.twitter.com/AYARxC0iwU
“Like Miriam’s son, there could be many children remaining unvaccinated in urban slums,” she said.
In the coming years, according to basically everyone who spoke at the conference, the key for Gavi’s future work is about adaptability and innovation, it’s about finding new systems and new ways of reaching the “unreachable.”
And frontline workers are going to be an an essential tool in this effort.
Frontline workers are the people working on the ground in countries to deliver vaccinations, working to reach all those in need of immunization, and to ensure that all those missed populations and excluded populations are brought onto the radar.
Fallone Falonne Bantu, a nurse from from the Democratic Republic of Congo, is just one of these frontline workers.
“I live in Kinshasa, where we have a lot of newborns, and people from rural areas,” she told the audience this week. “We have a lot of mothers who can’t read or write, so we do make the effort to go to markets and speak to mothers and remind them to vaccinate their children.”
“We make sure all vaccinations come through and children and babies don’t miss out,” she added. “We really put in the effort to explain to mothers the importance of vaccinations and what they’re preventing them from.”
As a soon-to-be mother herself, Bantu is all too aware of the importance of protecting her baby.
“Now I’m pregnant I must make sure my child gets all the vaccinations necessary,” she said. “But not just my child, all children. I vaccinate out of love… today when I see children and babies it really comforts me.”
We spoke to Chair of the @gavi Board @NOIweala about the link between immunization and global citizenship, at Gavi’s 2016-2020 Mid-Term Review meeting in Abu Dhabi.#GotLife#GaviMTR#VaccinesWork#HealthForAll#BeTheGenerationpic.twitter.com/hH39gUH8iJ— Global Citizen Impact (@GlblCtznImpact) December 11, 2018
But how do vaccines relate to the Sustainable Development Goals and, in turn, how do they relate to ending extreme poverty?
According to many at the Mid-Term Review, immunization actually impacts on all 17 of the Sustainable Development Goals. Goal No. 3 for health and wellbeing is the most obvious, with immunization being a major driver for good health across the world.
According to Pascal Barollier, Gavi's managing director of public engagement and digital technology, "immunization is the fastest way to health."
"Immunization is much more than just vaccines," he told Global Citizen. "It does all the things that you need to do to deliver primary healthcare in countries, and that way when you build systems to deliver vaccines, you can use those systems to do everything else for babies, and teenagers, and even people who are older in life."
"You need good delivery systems, you need education, you need training of health workers, and when we do this for immunization, we can actually do this for everything else in the primary healthcare sector in developing countries," he added. "So to me, this is how it ties to the Global Citizen idea."
But additional to health, immunization is also closely aligned with Goal No. 5 for gender equality — with girls and boys currently being immunized at equal rates around the world, to ensure equality. There are also vaccines that directly benefit girls and women, such as the rubella vaccine and the HPV vaccine (to combat cervical cancer rates).
Goal No. 10 for reduced inequalities, meanwhile, is also specifically advanced by vaccination. Thanks to universal vaccination, children of all backgrounds are given the chance for a healthier future. And further to these, immunization also contributes to the economic and welfare goals; as well as goals for partnership, with the Vaccine Alliance uniting all sectors to transform immunization progress.
For these reasons, immunization for every child is an essential path on the road to ending extreme poverty.
Throughout this year, Global Citizen has joined with the rest of the world in honoring the legacy of Nelson Mandela — and celebrating how his life’s work contributed to the global fight for equality.
Mandela envisioned a world where “no child will die from a vaccine-preventable disease.” He was a key supporter of Gavi, even taking on the role of chair of the board of the Vaccine Fund, and we remember his advocacy for children’s rights and access to life-saving vaccines.
We’re excited to join @Gavi at its 2016–2020 Mid-Term Review meeting next week, hosted by @UAEAid in Abu Dhabi.— Global Citizen Impact (@GlblCtznImpact) December 7, 2018
We’re looking forward to reviewing progress & seeing what the future holds for #vaccines! pic.twitter.com/EUz4nNClUD
This year marks 100 years since the birth of Nelson Mandela; but it also marks 100 years since the birth of the founding father of the United Arab Emirates (UAE), the late Sheikh Zayed bin Sultan Al Nahyan — making Abu Dhabi a particularly fitting host for Gavi’s Mid-Term Review.
HE Reem Al Hashimy, the UAE’s minister of state for international cooperation, represented the shared goal of the UAE and Gavi to achieve universal immunization.
“The late Sheikh Zayed bin Sultan Al Nahyan demonstrated that investing in people’s welfare, knowledge, and capabilities produces great dividends for individuals, families, and society as a whole,” she said. “This echoes Gavi’s own commitment to improving the lives of children in the world’s poorest countries.”
“It is only by working together that we can fully leverage the Alliance’s potential and ensure that everyone can benefit from life-saving vaccines, no matter where they live,” she continued.
For Al Hashimy, and more widely for the UAE: “Empowering the next generation is, from our perspective, about giving them the tools, but also the responsibility and the opportunity to shape what the future is going to look like.”
“It’s about ensuring that each individual feels that they have not just the opportunity to change, but also the responsibility to change,” she told the audience. “This is very much linked to our commitment towards the Sustainable Development Goals.”
“Empowering the next generation is about giving them the tools & responsibility and the opportunity to shape what that future is going to look like - this is linked to our SDGs commitment.”— Gavi (@gavi) December 11, 2018
- HE Reem Al Hashimy, Minister of State for International Cooperation @MOFAUAE@UAEAidpic.twitter.com/N78Mx5Y221
“They seem to be something that is very far away from where we are, sitting here in 2018,” she continued. “But that is not the reality. We will not achieve the SDGs unless we all feel the sense of urgency.”
“In a sense here, there’s no option other than to be optimistic,” she said. “We have to be, otherwise the path forward would be walking down a path of negativity and pessimism. And that’s not who we are as people.”
At the conference this week, in addition to a significant sense of celebration and achievement about the enormous impact already achieved, there was also a significant sense of the challenges that must still be overcome.
In the words of Dr. Ngozi Okonjo-Iweala, the chair of Gavi’s board: “When we have something that’s actually working, let us stand up and acknowledge it.”
“But we still have the remaining percentage of children who are not covered, those that we need to particularly pay attention to, because they are often the most vulnerable, in urban slums, in remote rural areas,” she said. “So we must not rest on our oars, we have to push even further.”
Global Citizen Prize at the Royal Albert Hall in London on Dec. 13 is the first major event in our 2020 campaign, Global Goal Live: The Possible Dream. The year-long campaign will focus on three crucial areas: the climate crisis, gender equality, and human capital — empowering people to lift themselves out of poverty through access to quality education, nutritious food, and universal health systems. Vaccinations are one of the most effective ways to ensure good health and end preventable deaths, in line with the UN’s Global Goal 3 for health and wellbeing.
Next year will be vital for global health efforts, with the UK set to continue its world-leading efforts on health by hosting a major global conference on vaccines — a replenishment moment for Gavi, the Vaccine Alliance. Gavi’s efforts over the past two decades have already seen more than 700 million children vaccinated, and 10 million lives saved as a result. You can join the movement to end extreme poverty and ensure that everyone has access to vaccines by taking action with us here.