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By Eileen Palmer
GENEVA - Commemorating this year’s World Immunization Week between 24 and 30 April, WSSCC interviewed Ms Anuradha Gupta, Deputy Chief Executive Officer, Gavi, The Vaccine Alliance. In describing Gavi’s mission, to save children’s lives and protect people’s health by increasing equitable use of vaccines in lower-income countries, Ms Gupta underscores the vital contribution of sanitation and hygiene in securing public health and well-being for all.
WSSCC: Gavi, The Vaccine Alliance, has saved lives by immunizing 760 million children and averting 13 million deaths. In your opinion, what are the main drivers of this success?
Ms Anuradha Gupta, Deputy CEO of Gavi, the Vaccine Alliance: Gavi has been stupendously successful. And I would attribute this success to the unique alliance that we are. We are a public-private partnership bringing together an array of diverse partners and stakeholders. We leverage the competitive advantage of each of our alliance partners to ensure that the whole is greater than the sum of its parts. That has given us the ability to continuously innovate and implement vaccine programs at scale. Our partnership with governments has meant strong country ownership, to expand access to new life saving vaccines through national programs driving impact on a phenomenal scale.
Because of our bias towards smart approaches, we managed to aggregate and pool demand for vaccines from nearly 70 countries. These are the lowest income countries in the world, accounting for 60 percent of the global cohort, which means that we have the volume to achieve economies of scale, competition and low prices. Our vaccine demand forecasting, predictable financing and very transparent procurement mechanisms allow us to cut down vaccine prices and secure incredible savings. For example, Gavi has secured a price of less than $2 per dose of Rota vaccine that costs over $100 in many rich markets. Likewise, Gavi price for one dose of HPV vaccine is $ 4.50, compared with 120 dollars per dose prevalent in industrialized countries. We have thus been able to make each Gavi dollar go very far and achieved more with less.
Lastly, our unique selling proposition is our focus on equity. When Gavi was set up in 2000, there were more than 10 million children dying every year, largely because of preventable causes and mostly in poor countries. Gavi embraced this whole mission of supporting 73 poorest countries of the world, where a large number of child deaths were concentrated.
At least 25 percent of these child deaths would be prevented with the right vaccines, and while these vaccines were becoming available in rich countries, poor countries did not have the purchasing ability to get those vaccines. That is why our work began with this huge focus on promoting equitable access to new and life-saving vaccines. Over time our focus has moved from equity between countries to equity within countries. We have had phenomenal success because we were able to excite countries about the value of vaccines, and now the coverage of most of the vaccines that we support is higher in Gavi-supported countries than the non-eligible Gavi countries.
WSSCC: Gavi has stated that due to the current COVID-19 pandemic, major vaccination campaigns, including Polio, Measles, Cholera, and Meningitis, will be postponed. This puts millions of children at risk of these deadly and debilitating infectious diseases. What steps is Gavi taking to minimize this disruption?
Ms Gupta: COVID-19 is an unprecedented crisis. It’s rapidly become a health, social, and economic crisis. In Gavi-supported countries though, the trajectory of the impact of the pandemic is looking different. It is unfolding at a relatively slow pace, which, in my opinion, has given countries a window of opportunity to prepare themselves better to respond to this crisis. But as countries start to prepare, we have seen redeployment of the health workforce, lockdowns and physical distancing measures being imposed in many Gavi-supported countries.
We have also seen fear among communities to bring children for immunization services. As a result, two things have happened: One is that the new vaccine introductions that were scheduled to happen in many countries and preventive campaigns have been suspended because they are no longer possible. In addition, we have seen that most countries are struggling to maintain fixed-site immunization services because of hesitation on the part of caregivers and fears among the health workforce impacting service utilization.
There is a substantial disruption of immunization services. And we are extremely worried about this trend because this means that besides COVID-19 infections and its impact, there is a risk of increased mortality if children, particularly in poor households, do not receive life-saving vaccines on time.
Additionally, there is the risk of disease outbreaks. We have already seen that in DRC, there are fresh Ebola cases. There is a yellow fever outbreak that has claimed lives in Ethiopia. There is a meningitis outbreak in Ghana, and we suspect we will see many more polio and measles outbreaks happening in countries. So, what we are trying to do is to make sure that countries’ strategic preparedness and response plans focus on maintaining a set of essential health services, of which immunization is one.
There is new guidance that has been done on how immunization can be conducted and delivered in the midst of lockdowns and physical distancing measures. We are proactively working with countries to make sure that something as essential as immunization is not disrupted.
WSSCC: what role do you think the sanitation and hygiene sector should be playing right now?
Ms Gupta: Hygiene and sanitation are going to be critical to an effective response because they hold the key to people’s health in the face of this crisis. Emphasizing the importance of water, hygiene and sanitation has never been more important. This is also the time for us to appreciate the fact that while we are advising people to frequently wash their hands, there are some poor communities that do not have access to drinking water or any kind of water for washing or for their needs. A longer-term plan of action is needed to ensure that poor communities have access to water, sanitation and hygiene. These investments are critical to ensuring good health and well-being.
We need all of us to collectively start to prioritize attention and investments in essential life-saving services such as sanitation, hygiene, and water because, in the face of a pandemic, you suddenly cannot provide for these services if they do not pre-exist.
WSSCC: Currently, you are providing advice to WSSCC through its Advisory Group, as we evolve into the Sanitation and Hygiene Fund. Why do you think the world needs this Fund and what is your message to our potential donors. Why should they invest now?
Ms Gupta: Health and well-being is something that should be accorded priority. If we are to look at this holistically, then sanitation is a critical prerequisite. I have worked in India on these issues a lot, and I know that in cases where we were able to take care of sanitation and eliminate open defecation, there were rich dividends in terms of improved public health outcomes. These investments unlock unprecedented gains. It is sad that countries tend to focus more on treating illnesses and diseases, but that comes too late in the day. We need to take a health-promoting approach. Prevention is better than cure so it is important to avert illnesses and that is where sanitation and hygiene play such an important role.
By eliminating open defecation, you can unlock not only the virtuous cycle of health and well-being but also promote dignity, security and empowerment of girls and women. Again, the focus on menstrual health and hygiene is important because I have personally seen how girls drop out of school when they do not have access to sanitary napkins, or when there are no toilets at school.
I worked in the education sector in India, and I was horrified to see the rates of dropouts, particularly among girls, because there were simply no toilets in schools. When a girl started to menstruate, she found it very shameful because millions of girls did not have access to sanitary pads and were either using a used cloth or unhygienic materials such as
ash, which created so many health challenges, including reproductive health-related infections.
Development needs a very holistic understanding and focus, and clearly, investments in sanitation and hygiene are foundational because if we don’t do that, then we are not taking a preventive and promotive approach to health and well-being but only belatedly trying to resort to reactive approaches including exaggerated attention to treatment in hospitals.