Today in London the UK is hosting an international conference that aims to raise £2.3 billion ($3.7 billion) for vaccination programmes worldwide through the Global Alliance for Vaccines and Immunisation (GAVI). David Cameron is co-chairing the event with Bill Gates, and has spoken passionately about Britain’s global and moral responsibility to address the millions of preventable deaths of children around the world. The UK has been GAVI’s biggest national donor (outstripping even the US) and plans to increase its commitment even further. All this despite domestic criticism that Westminster is wasting money on overseas development while we are in economic crisis here at home.
As we have blogged before, GAVI is a major global alliance pulling together the World Bank, several major governments (including the UK and USA) and private companies and foundations (including the massive Gates Foundation) with the aim of getting vaccinations against major diseases of childhood to the poorest nations. As a public health strategy, vaccination is a good bet – low cost for high impact. In Uganda it is estimated that 75% of the disease burden is preventable, and this is broadly true in many developing nations. If major killers such as pertussis, measles, meningitis, rotaviral diarrhoea, etc. can be prevented through relatively low cost vaccination campaigns, the impact could be massive, helping many of the poorest nations back on track to the achieve the Millennium Development Goals. And we have seen it happen before, with the elimination of small pox and virtual elimination of poliomyelitis through massive vaccination campaigns. And long term research into HIV and malaria vaccines could widen the impact of two of the biggest killers in the developing world.
However, as we mentioned before, GAVI is not without its critics. Firstly that it does not use its huge purchasing power to get better deals on vaccines from pharmaceutical companies. This means that its campaigns are far more costly than they could be, while drug companies make considerable profits. Furthermore, several of those companies have a seat on GAVI’s board, raising questions about conflicts of interest.
Then on the ground onhealthy lipitor there are real questions about how it operates – it requires national governments to cover a substantial part of the cost of instituting a mass vaccination programme. This means that many of the poorest nations cannot get involved. And in fragile or unstable states there is no chance of GAVI instituting a programme. As a result many of the most poor and vulnerable cannot benefit from vaccinations on a big scale.
Furthermore, vaccination programmes only work where there is some infrastructure in place. This includes health workers, clinics and vaccination stations in remote areas as well as cities, cold chains to ensure vaccines are still viable when they get to the point of use, etc. And vaccination does not work on children who are too malnourished or too ill to have a competent immune response. Vaccination is not quite the simple ‘magic bullet’ it at first seems. Without addressing these more complex issues, GAVI cannot succeed in its long term aim of getting effective vaccines to all the world’s children.
But does this mean we should give up on GAVI? It needs reform for certain, it needs to flex its muscle with the drug companies more (and indeed, has begun to do so), and it needs to explore new models of working on the ground. But it has achieved 288 million vaccinations worldwide, saving millions of lives and improving the overall health and wellbeing of tens of millions. It may be the best option we have for eliminating serious childhood diseases from the developing world. And David Cameron is to be applauded for making this a priority for the British Government. Leave aside arguments about how aid can bolster our image abroad and put us in better standing with poor nations, so fostering our long term economic and security objectives. It is fundamentally the right thing to do.
We just need to use our clout as a major donor to push for reform to ensure GAVI can deliver on its high minded ideals.