To the Conference on Financing Vaccination for Every Child
Cape Town - 12 April 2002
Mr. President, Excellencies, Distinguished Delegates:
As you have been hearing over the past two days, the world of vaccines and immunizations cannot be taken for granted. It is a dynamic, changing area of health-and one of the most important.
Vaccination is widely recognised as one of the most powerful and cost- effective public health tools. Often immunization is a child's first - sometimes only - contact with the health system. And among all the other interventions now on offer, immunization is still one of the "best buys" in health. And, immunization can be provided even under difficult circumstances, such as in areas of conflict or where there are no health centres.
Still, every year, nearly three million young lives are lost to diseases that could be prevented by existing vaccines.
More than one quarter of the world's children is not immunized by the time they reach their first birthday. That is more than 30 million children each year who grow up without being vaccinated.
Measles alone kills nearly 800,000 children every year. There is no excuse for this, when we have a vaccine available for eleven cents. There is no excuse either for not adding on other intervetions when this is possible - vitamin A in particular.
In the 1980s, the world set the first global target to achieve universal childhood immunization - 80 per cent coverage with the six basic childhood immunizations.
Although significant progress has been made - over 20 million lives have been saved by immunizations in the last two decades - we have not achieved the goal of reaching 80 per cent of the world's children. And tremendous inequities remain in terms of access to vaccines both between and within countries.
In some countries, immunization rates are at their lowest in a decade. Coverage is now declining in sub-Saharan Africa at just over 50 percent and in 12 of the poorest countries is below 35 percent, in one coverage is as little as 6 percent.
In preparation for the UN Special Session on Children, which will convene on May 8th in New York, the Secretary-General has prepared a report assessing the achievements and "unfinished business" of the past decade. In it, he cites inadequate resources as one of the critical reasons why immunization goals have not been reached - and why immunization coverage in sub-Saharan Africa has, in fact, decreased in the decade since the World Summit for Children.
Distinguished Delegates, It is fitting that, following the Monterrey conference last month, and less than a month before the Special Session on Children, when world leaders will take stock of unfinished business and new challenges facing the world's children, that you have met here to discuss strategies to ensure adequate financing for immunization. It is clear that we cannot continue to set goals that we do not live up to.
Why has coverage decreased, and what can we learn from our experiences in the past ten years?
First, the acceleration of immunization activities in the late eighties and early nineties -although one of greatest public health achievements ever - was sometimes not planned and executed with a view to achieve sustainable results. Sustainability is essential. This is a lesson we must keep in mind as immunization now again is accelerating. Sustainable financing - the topic of this conference - is one important aspect, but not the only one. Another essential aspect is the capacity of countries to reach high coverage rates year after year. This requires an adequate number of skilled - and paid - health staff; logistics systems that deliver potent vaccines as efficiently as Coca-Cola delivers Coca Cola; health information and surveillance systems; and families and parents that know what the right choices are for themselves and their children.
Coverage has dropped in countries or regions where there is conflict. Security is a pre-condition for health workers to carry out their duties and for parents to be able to rear their children. Where conflicts do arise - the international community has a special responsibility to ensure that at least basic services are delivered.
Coverage has also dropped in several countries where health systems have been re-structured. Although change often is difficult, change also provides opportunities. It will be important for countries to continue the process of decentralisation and reform in order to reach more people and become more cost-effective.
However, it is essential that Governments take the necessary action to ensure that essential services, in particular immunization, receive enough attention during the process of transition. This includes adequate flow of resources to essential immunization functions at sub-national level, in particular better planning and monitoring at sub-national levels; outreach services in countries where a substantial part of the population does not have access to health services; and supervision and coaching of health staff.
I make in this respect a special appeal to Ministers of health and Finance present here today to ensure that that resources earmarked for immunization and health get to where they are needed.
As the Chair of the GAVI Board, I recognize that the alliance has indeed set ambitious goals. However there is no alternative if we are really serious about making a difference for all children. These goals also are reflected in the Millennium Development Goals for the year 2015, so the world community has set itself a formidable challenge.
Clearly, we need new ways of working to ensure that all children receive the vaccines they need. We cannot allow a life to be lost because a child did not receive a vaccine that costs less than elevn cents.
What must be done differently?
First, we must work together: The GAVI alliance is a good example of partnership at work. We know that no single agency, no single government can get the job done alone. We therefore need to share a common vision and agree on basic strategies. GAVI partners have done that and continue to explore new ways of working together - such as the collaboration between the private and the public sector.
Second, while strategies that work do not need to be changed, we need to explore new ways of doing things. The results-based disbursement mechanism that GAVI has adopted to support countries is one such example. The data quality audit (DQA) to validate the quality of information systems is another one. Will this work? Are these sustainable approaches? We will see - and learn - as we go.
Third, while the technical aspects of immunization programmes are usually well mastered, we need to enter into new areas that are critical for the long-term success of immunization services. Programme managers will need to acquire new skills, for example in financing.
I am glad to see that GAVI, through its financing task force, is taking the challenge head-on, with an evidence-based approach yet trying to keep simple. The Immunization Financing Options folder provides an example of new knowledge and information presented in a comprehensible way and to be used at country level.
I also look forward to see the impact of the financial sustainability plans whose preparation is a requirement for continued support from the Vaccine Fund. This process, which is starting in thirteen countries approved in the first round in May 2000, may well prove to be the litmus test for whether national governments and their partners are committed to take on the challenge of making vaccines available to all children.
UNICEF, a partner in the GAVI allaince, is committed to assist the poorest countries in this endeavour. Immunization Plus - the delivery of cost-effective vaccines and other essential interventions, in particular vitamin A - has been identified as one of five organization-wide priorities in the medium-term strategic plan approved by the UNICEF Executive Board in December 2001. In 2001, UNICEF spent more than $220m in support of immunization activities.
The agency has been supplying vaccines for the world's poorest children for nearly half a century. Last year alone, UNICEF ordered a total of $260 million dollars worth of vaccines -buying just over two billion doses. That is 40 per cent of the global supply of vaccines for children.
As you have heard, we are now facing shortages of vaccines, old ones as well as new. These shortages exist in developing as well in industrialised countries.
We need to change our way of working. Governments, bi-laterals and multi-laterals need to make long term, multi-year commitments. We will certainly not face vaccine shortages if we have planned well and made the necessary financial commitments enough in advance to ensure an uninterrupted supply of vaccines.This will require close collaboration between the public and private sectors - and genuine, shared commitments to the world's children.
The Vaccine Fund, the financial arm of GAVI, is providing an opportunity to make longer term, multi-year commitments of funding and vaccines. But it is not enough. High-level commitment by governments is critical to ensure sustained budgets for immunization. And, for those countries that cannot provide the resources that they must have, needed, the global community must come forward.
Financial sustainability has been redefined under GAVI as sustainability of the total package of resources available to countries-not only the resources available within any one country but, in the case of the poorest countries, including externally available resources as well. In some cases, the resources available are adequate, but poorly managed. Vaccines are unnecessarily wasted. Better management of what is available does not have to wait.
As a matter of utmost priority, countries, when needed with support from partners, need to develop more accurate vaccine forecasts and better track the use of vaccine. Budgets must also be made available, if possible on a multi-year basis, and not least, allocated in a timely manner.
The world cannot stand by while a child does not get a simple intervention that saves lives and reduces suffering on the huge scale that immunization does. Immunization allows millions of children to lead normal healthy lives, play, attend school and develop into adults, free from disability and disease.
As the honorable Minsiter of Finance, Trevor Manuel, said poignantly in his opening address, how can we not invest in this "overwhelmingly logical proposal" to immunise the world's children.
We may not live in a particularly logical world, but immunization is one area where we MUST use our collective common sense. The world cannot stand by while a child does not get a simple intervention that can save her life.
Distinguished Delegates, I applaud your Call to Action. Let us ensure that it is heard.