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|  Executive
Speeches
CLOSING STATEMENT BY CAROL BELLAMY
EXECUTIVE DIRECTOR OF THE UNITED NATIONS CHILDREN'S
FUND
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.
Thank you.
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