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Laying the foundation for global health:

A panel session to launch GAVI at the World Economic Forum meeting in Davos, 31 January 2000

The organizers of the World Economic Forum meeting in Davos developed a special panel session, "Laying the foundation for global health: the GAVI Initiative" in which the following questions were posed: How can business play a role in immunization? Who will bear the cost of not acting now? Can market incentives spur research into, and action against, diseases which predominantly affect developing countries?

The GAVI session has been featured prominently by the WEF organizers - on the WEF website, during press meetings and a press conference held in Geneva prior to Davos, and during other panel sessions in Davos.

The chair of the GAVI Board of Directors, Gro Harlem Brundtland, Director-General of the World Health Organization, opened the session. Also on the panel were, in speaking order: William H. Gates III, Founder of the Bill and Melinda Gates Foundation; Joaquim Alberto Chissano, President of Mozambique; Carol Bellamy, Executive Director of the United Nations Children’s Fund (UNICEF); Raymond V. Gilmartin, Chairman, President and CEO of Merck and Co.; and James D. Wolfensohn, President of the World Bank.

Summary of remarks by Dr Brundtland:
The fact that 1.3 billion people around the world live on less than one dollar a day is bad for business; in a globalized world, one region’s poverty is another region’s opportunity loss. More than anything, poverty means bad health, and bad health means low productivity. Malaria costs at least one percent of GDP in many African countries through lost productivity. HIV/AIDS is devastating whole economies. Tuberculosis drives millions of families deeper into poverty every year through medical expenses and lost income.

We can turn this around. Improved health means improved productivity. It can be very simple. The most cost-effective health intervention of them all is childhood immunization. For only US $17 per child, we can provide lifetime protection against the six historical scourges - polio, diphtheria, tuberculosis, pertussis, measles and tetanus.

The Global Alliance for Vaccines and Immunization has been formed to kick-start a campaign to increase vaccination coverage. GAVI is a true partnership between public and private sectors. It is one based on enlightened self-interest, but it is also one that recognizes the moral responsibility we all have for a world where all children receive a basic chance of survival and health.

Summary of remarks by Mr Gates:
Millions of lives have been saved by the massive efforts to increase immunization in the 1980s. But millions of lives are still being lost because the vaccines that we in the industrialized countries take for granted are not yet available in many of the poorer countries. Typically it has taken 15-20 years from the time a new vaccine is available in the United States and other industrialized countries before it becomes more broadly available. After speaking with scientists and undertaking my own research, it has become clear that it is more important to help the world secure basic health rights than to ensure that every person had access to the Internet.

The critical need to get today’s vaccines out to more children, and developing new vaccines for diseases such as AIDS, malaria and tuberculosis has had very little visibility until now. There hasn’t been the will to take this to the next level. That is why it is so gratifying to see this issue raised in a number of sessions at the World Economic Forum, including this session. Also gratifying is the commitment from President Clinton to ask Congress to provide GAVI with $50 million for the Global Children’s Vaccine Fund.

We need cooperation from many groups - governments in the developed world, governments in which vaccine coverage is low, and the pharmaceutical industry - in order to make this happen. We are just getting the critical mass, and GAVI is galvanizing people to say, yes, we can do better. It is a privilege to be a part of something that is going to have a positive impact on the world’s children.

Summary of remarks by Mr Chissano:
My country was in war for 16 years during which time the population was spread, with many refugees moving into neighboring countries. As a result, we had a very large period of time when we could not immunize children and adults alike. During this time, new health threats were spreading, such as AIDS. AIDS is such a problem because we have no cure, but in fact it is malaria that is killing more people in our country than any other disease. In addition to these two diseases, there are other major health threats, such as tuberculosis.

The problem is that we don’t have the means. We had to rebuild all that was destroyed by war, including health and education facilities. These two are very important for vaccination programs. The issue of vaccination cannot be seen in isolation. It needs to be seen within the context of all health problems. Resources are so meagre, that we need to establish the balance between preventive medicine, and treatments.

Another very important aspect to increasing immunization rates is the development of research capacity in the countries. Research cannot only be conducted in the United States, or Japan and then brought to Mozambique, or Liberia. The international community, bilateral donors, and the private sector need to help establish research centres and pharmaceutical production facilities close to the people who need the vaccines. In this regard, the transfer of technology will be very important. A new ministry of science and technology has been formed, with the aim of bringing us closer to the technology.

Summary of remarks by Ms Bellamy:
As Mr Gates mentioned, in the late 1980s there was huge push for universal vaccination, driven largely by WHO, UNICEF and Rotary International. These efforts were very successful; by 1990 global immunization coverages had reached nearly 80% coverage of all the world’s children. But we still are seeing millions of children dying unnecessarily. We have the technology - the vaccines, the safe injection materials - to reduce disease and death among all the world’s children. What we need is to work together, to mobilize political will and the financing necessary to bring this about.

GAVI brings together the very important different actors into a broad-based strong alliance, with a strong commitment for financing. But even with the commitment from the Gates Foundation and President Clinton, we know that we will need more. In fact, that is a reason why we have come here to the World Economic Forum to speak with you.

The success of the Children’s Challenge will depend on a commitment by private and public sector leaders to support the right of every child to vaccination. The same resolve that markets products in poor rural villages, and sends television programming into the most remote corners of the world, can surely overcome all the usually cited barriers to universal immunization. The use of mass media has been crucial to the success of immunization programmes so far but we’ve got to explore all possible means from wind-up radios to hand-held cameras.

Summary of remarks by Mr Gilmartin:
GAVI can serve as a model for corporate and public cooperation. Merck is committed to developing new vaccines; we do not have scientific discoveries sitting on the shelves for lack of a market. The development of new vaccines is high on Merck’s agenda; Merck is making exciting advances on the creation of an AIDS vaccine. At the same time, however, there needs to be more emphasis on developing better healthcare systems in all countries. The kind of cooperation that GAVI represents will be essential for improving access to better health care and medicines and vaccines more accessible.

Merck’s experience with Mectizan, a medicine that prevents a disease called river blindness, shows that even the simplest pharmaceutical intervention faces tremendous challenges in delivery. Even after Merck decided to donate the medicine free of cost, it took years of collaboration with international partners and developing countries to develop the protocols necessary to deliver the medicine to those who need it. Today, we are seeing the fruit of that collaboration, with millions of people receiving Mectizan every year.

Building infrastructure, improving delivery systems, political will, and sustained commitment to financing can have a tremendous impact on public health in develop. Indeed, by improving health infrastructure, this initiative may further stimulate vaccine research and development. But the success of any sustainable health program starts with the political will and commitment from local governments.

Summary of remarks by Mr Wolfensohn:
Health has emerged as the central issue in a country’s development. In a survey conducted by the World Bank among 60 000 people living in poverty, it was found that health is the single largest contributor to poverty, and the single most vulnerable aspect. Health lending is such a good investment because of the direct links between health and poverty, and immunization is one of the most cost-effective health interventions.

Increased child survival has been shown to slow down the rate of population growth, as well as increasing school enrollment; education rates are a key determinant of national productivity. In addition, immunization can reduce production losses caused by worker illness; permit use of natural resources inaccessible due to disease e.g. malarious zones of land and safeguard the gains in life expectancy resulting from years of development efforts.

The World Bank is making a strong commitment to reducing poverty through improving health, by increasing health lending and leveraging our influence with finance ministers to raising the priority of health in the broader development context and ensuring a strong focus on the poor. We will also strive to correct the market failure resulting in under-investment in priority new products.

Videocast of the launch of the GAVI Children’s Challenge at the World Economic Forum, 31 January 2000 (recorded for later viewing; you will need the Realplayer from Real Networks).



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