 |
Fifth GAVI Board Meeting, 21-22 June 2001, London, England
Speech
From the Department for International Development Fifth GAVI Board
Meeting: Global Alliance for Vaccines and Immunisation – 21 June 2001
Clare Short, MP, Secretary of State for International Development
I want to
make some remarks about GAVI and the remarkable lessons it teaches, and
some of the lessons it teaches us about the proposed Global Health Fund.
I am optimistic that we can get that right, but there are dangers that
we do not get it right. If we build on what we have learned from GAVI,
and we are all determined to do that, we are more likely to get it right.
I. Poverty
and Ill-Health
It was in Lancaster House in London where we had that conference a
couple of years ago, looking at the interaction between poverty and
ill-health. We have all understood that human beings want healthcare and
good health systems in order to have a better life. There was a
prevailing presumption that countries needed to develop, and that as
they got more resources they could afford better healthcare for their
people. This was a shift in analysis that we all clarified for ourselves
at the London conference, with the massive interaction between being
trapped in poverty and ill-health. If you do not do something to provide
people with better healthcare, they will not escape. As you know, the
figures show clearly that the poor of the world struggle and work hard,
harder than any of us. They often lift themselves up by their own
efforts, but ill-health constantly throws them back: either the
ill-health of the breadwinner, or of a child. Then a family will borrow
and mortgage itself in order to get drugs or treatment. It is often very
bad treatment, poor and inappropriate drugs, which throws the whole
family back into poverty. Of course, good healthcare is good for people,
but we have to do more to provide it and enable people to climb up and
improve their lives and develop the economies of their country. It is
not something that comes afterwards; it has got to come at the beginning
to enable people to move forward. That was the thing that we really
clarified at that conference. It is very important that we remember it
clearly.
In an
ancient place like this, such as the UK is littered with, it is good to
remember history. When you read about the industrial revolution in this
country, it began in the city that I come from and represent part of in
the House of Commons, Birmingham, with the squalor and poverty, the
child labour, the disease, all the things you can read about that
inspired Dickens, and lots of anger. For a fifth of humanity, those are
the conditions that still prevail in their lives. After all the wealth
that has been generated, and technology and knowledge that we have, one
in five of humanity is still living in conditions of poverty. As we have
more knowledge, capital and technology, it is more unforgivable that it
continues. Humanity has a capacity now that if we could put our
resources together and have enough determination and united will, we
could see over the next 20 or 30 years systematic improvement in poverty
reduction, and the removal of that condition of abject poverty from the
human condition, just as it has been removed from a country like this
where it used to prevail.
II. Progress
in Development
For too long
in development we have been satisfied with one-off initiatives, gestures
and doing some good. To make the systematic progress that is required,
we have to be always looking to get all our initiatives to scale, to
reach all and to be sustainable. This is a bigger challenge than some of
the old efforts just do some good and have some good projects that we
might fund here and there in the world. This requires us to collaborate
in the international system in a way in which we have not before.
Different countries, agencies and UN agencies have all gone out to do a
bit of good here and there to the best they could. If we really mean to
reach everyone in the world and get interventions that are sustainable,
to get to scale and reach everybody, we have to group our resources in a
way that we have not previously. It is a challenge to new ways of
working. In all our government systems, in the international system and
in the UN system, we see all the bureaucratic petty jealousies that mean
we are less effective in our operations than we could be. It is our duty
to be effective in order to give all those 1.2 billion of our fellow
citizens some decent opportunities in life. My view on countries like my
own, and public opinion, and the willingness to provide increased levels
of ODA, is that we will win increasingly public support for these
efforts as what we achieve is more effective and as people see that we
know what we are doing, that we are spending the money well, that we are
bringing about sustainable change and so on.
III.
Responsibility
We carried out a survey after we formed our government just over four
years ago in the UK. We won the election on a commitment to increase our
work on development and our spending on development assistance. We then
tried to get a baseline survey of public opinion to make sure we brought
it with us. We asked the British public what they thought about aid, and
they said it was a complete waste of time and money, and it all goes
into corruption – a shocking, worrying result. However, we went on and
said, ‘what do you think of these international development targets and
the commitment to getting every child in the world into primary
education, reducing infant, child and maternal mortality, and giving
people access to reproductive healthcare?’ They said, ‘excellent; do
it.’ That was really important learning for us: that is was not a lack
of generosity of heart, it was not that people did not want to see their
fellow human beings across the world having a decent chance in life, but
that they had become cynical about the old procedures, and they wanted
some new clarity and determination about achievement and objectives.
This is the challenge of these times: we have more capacity, knowledge
and capital technology that we have ever had, can we rise to it and
collaborate to make all our systems more effective? Can we achieve more
to keep our public opinions with us, moving the world forward in a way
that is the most noble and morally important thing for humanity to do?
If we fail, the catastrophes that are going to come and bite everyone,
wherever they live, are going to be terribly serious for humanity in a
30-year timescale.
We have a
fantastic opportunity and an enormous responsibility. Making progress in
healthcare for the poor of the world is key to giving them the chance to
develop their lives and gain the benefits of learning, knowledge, and
technology that globalisation is making available in greater abundance
for the world.
IV. GAVI’s Role
In this effort to have a step change in the way we work and the way we
collaborate in our ambition and effectiveness, GAVI is a very optimistic
new baby. It shows all the signs of a new way of working: much more
flexible, lighter in its bureaucracy, inclusive, willing to be open and
learn, not being bureaucratic and slow and ponderous, using resources
effectively, seeking to work in partnership and bring people together,
and not having prima donna issues. This is all enormously important. It
is important the GAVI goes on and builds on that and does better, and
that we learn from the best of GAVI in the launch of this proposed
Global Health Fund. I want to make a few remarks about the interface
between the two, and the lessons we can learn.
GAVI has led
the way in a willingness to work with a diversity of partners, public,
private, multilateral and NGO; an aspiration and reality of swiftness of
action; the openness to suggestions and new ideas; a responsiveness to
the concerns of partners and agencies in developing countries rather
than the arrogance that can sometimes come from the centre; and a
willingness to be flexible in response. These things are admirable, and
you are all to be congratulated. They need to be held onto, as often new
organisations are flexible and then we all get sclerotic as we go on.
GAVI is
good, but must never be complacent, and some of these qualities must be
maintained and driven forward. On the Vaccine Fund, of course, it is my
view that we could have, after the UNGASS that is coming up on HIV/AIDS
and the G7, a fund for commodities and organisations to get better
treatment of HIV/AIDS, malaria and TB. This could leverage further
improvements in the way that GAVI has trailed. On the other hand, we
could have a series of bureaucratic conflicts, the thing collapses and
we do not really get it. We must make sure we get the good outcome, and
that we do not have people trying to play games in order to make
announcements.
V. Resources
International development is full of ponderous conferences, with lots
of bureaucratic preparation, the launch of funds that are a gesture for
the media – and then we move on. For example, not that long ago we had
the conference in Dakar delivering the 2015 target to have every single
child in the world in primary education. There was big pressure for a
fund. The next year there might be a pressure for a health fund, the
next year it is a forest fund, and the next a desert fund. Everyone
pretends it is new money, but really it is the same old ODA, and it is a
shrinking pile. Someone sets up these bureaucratic funds and there is a
great dance of international meetings. Little bits of good are done, but
it is not real, sustainable change country by country.
We have to
make sure we have proposals for a fund here that can leverage the kind
of change that is needed to bring in better drugs, encourage research,
get the commodities and encourage countries to put in place the basic
healthcare systems and delivery mechanisms that are absolutely key.
Otherwise, it does not matter how cheap the drugs are, the bulk of the
poor will not receive them. We have to make sure that both GAVI
continues in that spirit, and that the new Health Fund is structured in
that kind of way. The structure and governance needs to be inclusive but
light and non-bureaucratic, the secretariat light and effective, both
for GAVI and the new Global Health Fund. We have to always be looking
for sustainability.
We know that
ODA and very generous donations like that of the Gates Foundation – and
I was just thinking, that if one of the most successful businessmen in
the world is willing to support an initiative it must be good; I was
thinking ‘yes, and if his father agrees it must be even better,’ as the
person who gave birth to the man. I think it is a delight that not only
the funding is there, but your personal engagement and commitment, and
what you said about the kind of satisfaction of working in areas of this
kind of importance, and some of the idealism you meet, is very nice to
hear.
The big
additional resources that in the end have to be there to get scale and
sustainability are out of the economies, revenue systems and improved
organisation of the countries themselves. The ODA and the other
donations are leverage to build up the systems. You can only get
sustainability if countries can be helped to have the expertise to grow
their economy and get the efficiency into their health departments and
the training of their own people. This means you really have got
sustainability, and that the economy itself can continue to provide a
decent service for their people. This is what we are always looking for,
so if GAVI and the Global Health Fund can help to leverage that kind of
change, that is wonderful, but unless we have leveraged that kind of
change everywhere, we have not got sustainability or scale, and we are
not reaching everyone. Those are very big objectives and we must hold
onto them.
VI. Markets
Clearly, GAVI has taught some very important lessons about commodity
markets and price. We all know that there is a real problem in the
world’s pharmaceutical industry, which is overwhelmingly in private
hands with some of the best brains in science in the world. It is driven
largely by where the markets are. Even in a country like India, where a
third of the poor of the world live and which now has a very large
pharmaceutical industry, only 10% of its research is done for the
diseases of poverty. The poor do not generate a market, and therefore
cannot buy products without some intervention.
Clearly, in
these globalising times we need to look at the world and see what the
public sector can bring. We need to get some sort of order and structure
into our global arrangement, and to use the science, technology and
capacity of the private sector to make the kind of partnerships and
interventions that make sure the drugs are delivered to the poor of the
world, and the research is being done. GAVI is trailing big enough
orders that begin to make the pharmaceutical companies of all kinds
bring down the price and bring reliability of supply. They see that the
orders are going to be there and hopefully, as we go on, leverage the
research that is not being done to produce the products that the poor of
the world need to have better health. That is the promise we have here,
and it is fantastically important. If we can build on what GAVI has
achieved in this direction and go onto drugs on a bigger scale for
malaria, TB, HIV and so on by the way we structure the Vaccine Fund,
that will be a very big prize. We are starting to get a world then that
looks at the needs of its people and its capacity, public and private
sectors together, to deliver an outcome for everybody. We are on the
brink of being able to think in that way, of managing the whole world
and its people in a way that in the past we have not been able to do. We
must build on that.
VII.
Additionality and Partnership
I have made
the point that everybody pretends these new initiatives are additional
funds, but whenever ODA is being committed, i t is
not additional. The money would have gone into some other ODA spending,
unless we can get enough effectiveness into the system that our public
will vote for growing budgets – and I do believe these things are
linked. Every time we set up a new initiative, it is a duty not just
that it funds itself, but that it brings improved performance into the
whole system. Then we have real additionality, and the improved capacity
of developing countries themselves that I have always talked about.
This is why
the spirit of partnership is so crucial. Partnership is not just a good
word, although it is a good word, describing the fundamental equality
and mutual respect you need to share knowledge and do good development
work. It is no good experts from countries with much more capacity,
training and skilled human resources rushing in and telling developing
countries what to do. They also have to be able to listen well enough to
where the blockages and problems are and share the knowledge and
investment, training and skills that enable the partner country to take
on that knowledge and apply it.
This spirit
of partnership is absolutely crucial to effectiveness. I am told that
GAVI has to watch for this, as there is such efficiency in the
organisation, and such enthusiasm, there is a danger that the patience
to listen and learn back, and hear from the partners what the blockages
are and why something did not work disappears. There is always a danger
there that we do not listen and we do not get it completely right.
VIII. Outputs
We must measure performance, and be clearer about outputs. I have no
doubt about that. The whole world of development since the Second World
War has been obsessed with inputs and how much was spent, with far too
little stress on what was being achieved, measuring progress, learning
from success and from failure and adjusting what we do, too much gesture
spending and people boasting about what they are spending, rather than
what they are achieving.
We must –
and GAVI is – make sure that the new Global Fund looks to an
output-based system. We must be careful that the targets do not make us
have numerical incentives, and that we do not only supply to those who
are easiest to reach. We need outputs, but of course the poorest and the
people living in the most remote communities and the people with the
greatest difficulties are going to be more difficult to reach. If we
just go with numerical targets and do not somehow take account of that
it could distort what we do. I say this as someone who is dedicated to
getting the international system to work on output-driven targets, so it
is a mea culpa too, and we all must keep both these things in mind:
reach the people with the greatest difficulties, but also measure our
progress and success, and learn from errors and success.
IX.
Challenges
The is the biggest challenge of all is that we need global efforts,
where we come together in partnership and create a new energy and a new
enthusiasm, but we have to leverage the building of basic healthcare
systems that reaches everybody in a sustainable way, in the poorest
countries where they do not exist at the moment. We know that in the
poorest countries, the poor are spending more on their healthcare –
often more than much better off people – totally ineffectively on poor
treatments and bad drugs. They are spending enormous proportions of
their very low income on very poor quality healthcare. If we could only
break through this, we could get an enormous improvement and use some of
the resources that they are already putting in.
It is easier
to talk and think about this than to do it in practice. I know GAVI has
in its structure – and we have to get it into the Global Health Fund –
the back up and technical capacity to help countries deliver not just
the immunisation systematically, which is the beginning of looking for
system-wide improvements, but also to build basic healthcare systems
that can provide all the things that people need. If we can get the two
structures working side by side, leveraging that sort of roll forward of
improvement, that really will be a very important opportunity. It is
there on the tips of our fingers, if we can get both these things right.
X. Conclusion
I am
delighted to be joining the GAVI board for the reasons I gave last night
and this morning: you have been pioneers. There is something very
creative and important going on here. GAVI is also new and pioneering
and we have to make sure that spirit is maintained, all its ambitions
are delivered, that we get the same spirit into the Global Health Fund
and the collaboration between the two, and that we do not waste and
duplicate resources. I commit my department and the UK government, as a
member of the Board, to do its very best to ensure that GAVI never
ceases to be a learning organisation, and that the lessons from GAVI are
widely shared for the benefits of all. We are planning a multiyear
donation, but I have to manage my money properly, and I am not,
unfortunately, announcing it this morning. We will, I promise.
|
|