With your health experience in over 25 countries around the world, you have a uniquely informed view of global health trends. What is top of mind for you and what keeps you up at night?
Science and technology have the potential to solve so many of our problems. However, focusing R&D on the needs of the poor has been a challenge. A severe influenza pandemic, for example, has the potential to kill tens of millions of people. We were lucky that last year's pandemic ended up being relatively mild, for virtually no one in the developing world was vaccinated given the antiquated vaccine production methods and the difficulties in scaling up vaccine production. We need better technologies as well as technologies appropriate for use in developing countries. Given the global financial crisis, it is important to make sure there are adequate finances to create new prevention tools and get new technologies and existing interventions to those who need them most. Finally, it is essential that developing countries prioritise and finance the most cost-effective of these interventions.
You are sometimes described as the first pioneer of public-private partnerships in global health. What are the key ingredients of a successful public-private partnership (PDP)?
Public-private product development partnerships have been successful at expanding the pipeline of new drugs and vaccine candidates for a range of diseases affecting the developing world. The success of these partnerships is a result of fostering a strong link between government, academia, and private sector expertise to achieve a not-for-profit mission. These partnerships are based on mutual respect for what each side brings to the table and an understanding of the different cultures they operate within. The challenge is to embrace appropriate risk, provide adequate incentives, and keep innovation going; there is always a danger as an effort gets mature that it can get risk-adverse and bureaucratic.
Why GAVI? What most excites you about GAVI's role in global health?
Vaccines are one of the most amazing technologies in public health. They have probably done more to improve health than any other medical intervention. GAVI has the ability to impact vaccine production and use, bringing these amazing tools to some of the world's most disadvantaged people and by doing so, changing the future course of disease distribution globally.
You've led the charge for an HIV/AIDS vaccine. What else inspires you about the roll out of new vaccines and the field of immunisation at large?
My wife is a sophisticated physician who trained at one of the best teaching hospitals in New York. She has never seen a case of measles, whooping cough or tetanus. In fact, the anti-vaccine movement is only able to get traction because people in rich countries don't remember what the world was like before immunisation. Yet tragically, this is not the situation in the developing world. A visit to a refugee camp during a measles outbreak would convince anyone, even the worst skeptic, of the power and necessity of these preventive public health tools. We need to see to it that all children in the world have a future without these diseases. We can save millions of lives and avoid countless misery if all of the vaccines available today were made available universally as well as the ones we will have in the future.
What are the key ingredients to ensuring that immunisation rates remain high (or accelerate) in developing countries?
Immunisation must be a priority at all levels in a country, from the president to those living in the community. We need to redouble the effort to reach stigmatised, isolated and impoverished groups. It is often said that how people treat their least advantaged defines what type of society they live in; equity becomes an important metric. To get new vaccines out, we not only need political commitment, but also adequate finance, good health systems, appropriate health staffing and reasonable pricing.
Why are civil society organisations (CSOs) important to ensuring equity in health? How can global health players better work with CSOs to increase equity?
Governments should be responsible for the health of all their citizens. But we know that governments may be limited in their reach. Sometimes that is due to their capacity to implement health programmes. But often it represents differences in the way they serve various sectors of their populations. When this occurs, CSOs provide significant value because they can reach out and engage in these under-served and often stigmatised communities where they have a base and function so well. Integrating CSOs into the work and planning of global players helps to increase equity and coordinate a response. But we also have to recognise that to be sustainable and to reach every child, woman and man - no matter who they are or where they live - we need to move beyond ad hoc mechanisms and work with CSOs to build sustainable health systems that serve all communities.
What role does the vaccine industry have in increasing access to affordable vaccines for low-income countries?
Continuing innovation to develop new products and improve old ones is critical. Companies using technology to make vaccines more accessible - such as increasing shelf life, simplifying delivery, improving dosing, etc. - is also important. But we have to do a better job of assuring that vaccines are available in the wealthy and developing countries simultaneously. And that means high volume production early in the product life-cycle leading to a reduction in the cost of goods. This requires a very strong partnership between companies, purchasers and generic manufacturers.
What's been your most important lesson in life?
My motto for life is: Live like you are going to die tomorrow; learn like you are going to live forever!
What do you enjoy doing when not leading the global charge on HIV/AIDS and equal access to immunisation?
I love to sail, fly, cycle, ride horses, cook. I am peripatetic.
What does success in immunisation in 2015 look like to you?
I would take the question out further, to the end of the decade. By 2020, we should have polio eradicated, measles eliminated, neonatal tetanus and rubella controlled, and general immunisation coverage well over 90% (so-called "universal coverage") - not just across countries but within countries. New vaccines being introduced now such as rotavirus and pneumococcal will be included in this universal coverage. There will also be new vaccines for malaria, AIDS and tuberculosis either entering the market or in late-stage efficacy trials. Success would also mean that developing countries will be able to pay for a substantial percentage of the cost of their vaccines and make a significant investment in immunisation as a percentage of their health expenditures.