Partners' Forum Blog

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Running blog from the ground, covering all aspects of the 2012 Partners' Forum

Voices from the Forum

The 5th GAVI Alliance Partners’ Forum said goodbye to Dar es Salaam on Friday. As 650 ministers, academics, activists and scientists  from over 50 countries head for home, here’s what the leading voices in global immunisation were saying about the Forum’s four themes: Rise, Innovation, Sustainability and Equity. 

“Eradication of vaccine preventable diseases is the ultimate equity – no one has to suffer from the disease anymore.”
Alan Hinman, CSO representative, GAVI Board 

“Vaccines are integral to preventing child deaths. The immunisation programme in Tanzania has been a model for all of Africa.”
Alfonso Lennhardt, US Ambassador to Tanzania 

“We need to build human capital to create sustainable growth.”
Babatunde Osotimehin, Executive Director, UNFPA 

“Working with GAVI long term demand forecast for Yellow Fever allowed us to make $30m investment in increasing capacity.”
Chris Viehbacher, CEO Sanofi 

“The challenge is that the fifth child isn’t standing next to the other four.”
Chris Elias, President of the Global Development Program, BMGF 

“GAVI is the toughest buyer we deal with, when the price is fixed for GAVI you can be assured that there is nothing extra left.”
Christophe Weber, GSK Vaccine CEO 

“Too many girls are robbed of their future by [cervical] cancer.  I am personally committed to do what it takes to ensure that girls have access to HPV vaccines.” 
HE Christine Kaseba, First Lady of Zambia

“Honourable health workers – you are the heroes of immunisation.”
Dagfinn Høybråten, chair of the GAVI Alliance Board 

“The fifth child doesn’t exist for governments as they are not registered.”
Flavia Bustreo, ADG, Family Women & Children’s Health, WHO 

“Immunisation needs equity, just as much as equity needs immunisation.”
Geeta Rao Gupta, Deputy Executive Director, Programmes

“[To reach the fifth child] …we need a sense of urgency as if it were your mother, your sister, your child.”
Mrs Graça Machel

“GAVI has empowered us to introduce new vaccines that would otherwise not be affordable.”
President of Tanzania, HE Jakaya Kikwete 

“This is an Alliance that’s at the cutting edge of science, technology and innovation.”
Richard Sezibera, Secretary General, East African Community 

“Although we know that vaccines are cost effective, it will be a challenge for us to convince our government to increase significantly the budget for immunisation.”
Sabine Ntakarutimana, Minister of Health, Burundi 

“During very active conflict and fighting in Afghanistan, one of the few live saving services provided to children was immunisation.”
Suraya Dalil, Minister of Health, Afghanistan and GAVI Alliance Board member 

“The GAVI Alliance very much defines the state of the art in health partnerships and development cooperation, so just keep going.”
Ursula Muller, Director General BMZ, Germany 


The new new vaccines: what vaccines could be coming your way in the next 5-7 years?

GAVI never stands still. As the Alliance continues to rollout pneumococcal and rotavirus vaccine around the world, work has already started on identifying potential new vaccines, yet to reach the market, that could save lives in developing countries.  

A special session on Friday looked at the status of R&D and clinical trials into vaccines against HIV, tuberculosis, malaria and cholera – four diseases that each have huge potential to improve public health and reduce morbidity and mortality in developing countries.

HIV: Margaret McGlynn, President and CEO of the International AIDS Vaccine Institute (IAVI) reported that although an HIV vaccine is probably too early for the next GAVI Vaccine Investment Strategy, it remains “the only way to truly end an epidemic” that results in 7,000 new HIV new infections daily around the world.

Tuberculosis: AERAS, a non-profit organisation dedicated to the development of effective tuberculosis (TB) vaccines reported that there are 13 vaccine candidates in clinical trials for a vaccine against

Malaria: the PATH Malaria Vaccine Initiative reported that the ground-breaking phase three clinical trial conducted at 11 sites across seven countries in Africa on the potential malaria vaccine RTS,S  have shown more than 50% efficacy in five-17 month old babies. However, efficacy is lower in younger ages and may vary across some regions due to variations in transmission rates.

Cholera: the International Centre for Diarrhoeal Disease Research, Bangladesh provided an update on the largest-ever feasibility study for the Shanchol vaccine, in the context of recent cholera epidemics in Haiti and Zimbabwe. 

“The development of an oral cholera vaccine stockpile was extremely positive, especially with the potential of further GAVI funding to help use these vaccines in countries where they are desperately needed,“ said Firdausi Qadri, Director, icddr,b.

The session concluded with an overview of the 2013 Vaccine Investment Strategy process which GAVI is leading, detailing key steps and types of criteria anticipated to be used in prioritising future vaccines for the Alliance’s investments.

"GAVI’s new vaccine investment strategy will look at new and underused vaccines, which will be made available within the next five years, to ensure that countries and donors alike get the best value for money,” said Nina Schwalbe, Managing Director of Policy and Performance at GAVI.

“We now have new data such as updated DALY estimates that we can include this time. Comprehensive analyses coupled with our consultation process will ensure we bring concrete recommendations to the GAVI Board for decision in December 2013.


Why Hans Rosling likes GAVI

Professor Hans Rosling is a doctor and a professor of international health at the Karolinska Institute in Sweden. This morning, he showed how GAVI’s mission to increase access to immunisation fits into a new way of looking at global poverty and population trends.  

Using his trademark computerised graphs and information diagrams, with circles that swarm, swell and shrink like bacteria under a microscope, Dr Rosling this morning demonstrated that the eligibility criteria for GAVI support is unique in recognising a new world order no longer divided along traditional lines between developing and developed countries. 

“I like GAVI because it is intellectually easier to understand why the line (for eligibility) is here,”said Dr Rosling, pointing to one of his trademark graphs. 

Drawing on data-visualisation software developed by his Gapminder Foundation, Dr Rosling held his audience spellbound as he plotted country by country economic and public-health data onto two axes: child mortality rates against average national income.

The graph showed that 50 years ago, the world was split into two categories with much of Africa and Asia registering low income and high infant mortality. On average, Africa’s poorest families had six children, of which only four survived.

Updating his graph over time, Dr Rosling demonstrated how once poor countries have shifted closer to their richer ‘western’ counterparts. In 2011, places such as Ghana and Tanzania recorded relatively low infant mortality and higher income with the likes of Somalia and Afghanistan at the other “extreme end of the spectrum”. 

Superimposing the average national income figure of US$ 1,500 that is the cut-off point for GAVI support on to the graph, it was clear that countries above the line corresponded to the high infant mortality rates traditionally associated with developing countries.

“How did GAVI become clever to have this line at US$ 1500,” asked Dr Rosling. “Most of what you still call the developing world is already here (low infant mortality). Sub-Saharan Africa have come in late, but they have moved a lot although there is lots of internal diversity.”

In contrast, OECD’s definition of poverty (US$ 12,000) suggests that more than half the world require aid, even when they have relatively low child mortality with two child families and are not eligible for GAVI support. 

For Dr Rosling, the correlation between his graphics and GAVI’s eligibility criteria represents confirmation that it no longer makes sense to consider the world as divided between developing and developed countries. The majority of people are living in the middle—although the distance from the very poorest to very richest is wider than ever.

“I suggest a new term for the developing world, more intellectually relevant, I suggest we call it ‘the world’,” said Dr Rosling, tongue firmly in cheek. “It’s a problem dividing the world in two groups. It’s like when you drive and you have a rearview mirror and a windscreen. It’s important to use the rearview mirror, but don’t look back all the time. We must be fact-based.

“Almost all (countries with high) child deaths are above the GAVI line. They die because they come from big families, with lots of children. It is interlinked,” he said, “the most common criticism of immunisation is that if you provide life-saving vaccines, you will destroy the planet with population growth. It is untrue. The best route to small families is to make children survive. “ 

Statistics bear out Dr Rosling’s conviction that there is a linear relationship between money and child mortality. The poorest countries clearly stood out on their own onthe graph with an average family size of six and the fastest population growth. 

“This is a sign that we have not completed the job. What we need is that this last group should join the rest,” he said.

Dr Rosling left an audience clearly mesmerised with his solid stats and colourful graphics with an intriguing question. “We need to apply your system throughout the world, not just to immunisation,” he said, “Do we need a global alliance for family planning, can your mechanisms be reproduced in oncology?”


Graça Machel-Nelson Mandela dialogue series

CNN international’s anchor Zain Verjee hosted the inaugural Graça Machel-Nelson Mandela dialogue series at the Partners’ Forum on Thursday.  The series aims to engage powerful advocates in support of GAVI’s mission to bring vaccines wherever they are needed most. The first participants were: 

  • Graça Machel herself, Member of the UN Secretary-General’s High-Level Panel on the Post 2015 Development Agenda and a former GAVI Alliance Board Chair
  • GAVI Alliance CEO Seth Berkley
  • Babatunde Osotimehin, Executive Director, UNFPA,
  • Richard Sezibera, Secretary General of the East African Community

Zain Verjee: what are the keys to the success of GAVI and immunisation? 


Graça Machel: “all those people who are sitting in this room. With a very small intervention, immunisation, you give the mother the chance to immunise her child. You can see the difference it makes to both the mother and child.”

Seth Berkley: “we have a clear mission and everybody round the table is focused on that mission, we also have these amazing tools, the power of vaccines that everyone understands. People in developing countries know about vaccine-preventable diseases. They know who dies from diarrhea. That’s a problem in the West, where people have got complacent. They say it’s ok not to be immunized. That’s why we have these huge outbreaks.”

Richard Sezibera: "during the liberation struggle, we had to vaccinate our own families against meningitis and when we did, the joy of the children being vaccinated in a conflict zone was a big motivator for me.”

Babatunde Osotimehin: “one key to success is political will. The fact that governments are there to provide resources.”

Zain: how do you ensure sustainability? 

Babatunde: “developing country governments have to make difficult choices. You cannot get value for money if you spend five percent of your budget on health. If you don’t invest in education, you’re not going anywhere.”

Richard: “some in the north say we should not use our tax dollars to support health in the developing world. That is the wrong debate. The bedrock to health crosses the globe. If one part of the world is full of disease, it will spread and affect everyone else.”

Graça: “it is up to us to make health and education our priority. We should not give the impression that we put all our hopes on the international community. We must take responsibility and stand strongly on our own feet.“

Zain: do we have the supply chain capacity to roll out modern vaccines like pneumococcal and rotavirus? 

Seth: “health care workers are miracle workers. Here in Tanzania, 42 percent of health posts are filled yet the country has 92 percent immunization coverage – and they are still trying to reach the unreached. They really are heroic.”

Babatunde: “there is one sector that we do not use effectively. The private sector does supply chain management better than anyone now. A bottle of Coca Cola goes anywhere.”

Seth: “we’re doing it. We are working with Coca Cola in Ghana to look at supply mechanisms, to get private sector companies to bring their technology to the great challenges we face.“

Richard: “maybe with new technologies, we could leapfrog over the challenges of terrain, geography and lack of trained personnel. We will not train enough personnel to cover our needs in Africa in the short time, but with technology we can offer 1st class healthcare with a modest increase of workers. Mobile phones for example, could democratise health care by monitoring maternal mortality and training health workers.”

Zain: please give me final thought on GAVI and the future 

Babatunde: “I came here to solidify my relationship with Seth so we can provide human papillomavirus vaccines to girls in the developing world, to save the lives of women from cervical cancer.”

Graça: “if you have a health worker, even if she is not very well trained, she can assist and improve community lives but in 21st century we cannot still sit and live with populations who are still living in the 17th and 18th century. … We shouldn’t meet again in the next Partners’ Forum without asking what has fundamentally changed in the way we work. There must be a sense of urgency in what we do. It’s not business as usual.”


Graça Machel on why she became an advocate for women and children

Interviewed by CNN anchor Zain Verjee at the Partners’ Forum, Graça Machel (Member of the UN Secretary-General’s High-Level Panel on the Post-2015 Development Agenda and a former GAVI Alliance Board Chair)provided a rare insight into why she is such a powerful advocate for women’s and children’s rights. More of the session itself later. 

“I’m not an outstanding advocate. I am a simple African woman who from my early twenties, was exposed on a daily basis to seeing women in pain, deprivation, in some cases, death. Why does this have to be like this, I asked? What are the reasons?”

“I was Minister of Education when the conflict started in Mozambique. (Before the war) … I had been all over the country, mobilising mothers and teachers and children to realise that education is a powerful way to change their lives. Then the war erupts. In those days there was no fax, no email, so each day, I could go into my office and find out the information: I would hear that this school was attacked, that teacher was killed, this child was abducted. The world I was fighting to build was being destroyed.”

“This experience taught me a huge empathy for women and children. It’s not a theoretical academic thing. These children would not have the chance to use a platform like I could to bring international attention to what is happening. Then the UN took me to Bosnia, Cambodia, Rwanda, Colombia and in these countries I would find the same thing: women and children in refugee camps, starving and unfortunately, it is still going on. So, when people ask why do you carry on its because the face of injustice or the pain of conflict is always that of a child.” 

“Children in displaced person camps had seen terrible atrocities. I asked myself how do I talk to this child to make them a child again. We asked UNICEF in Maputo to arrange for help from Brazil to come and train teachers (on Saturdays and Sundays) to be psychologists. How do I help this child to learn again, to smile again, to dance before he or she can again absorb a curriculum? How do I make this child self-confident or even listen to the teacher. “


Zambian First Lady and MTV Africa star join forces against cervical cancer

Two charismatic African women, from different generations and representing different audiences, joined forces at the Partners’ Forum on Thursday to emphasise the importance of raising awareness about a life-saving vaccine against cervical cancer.   

Her Excellency Christine Kaseba capitalises on her position as the First Lady of Zambia, a qualified doctor and a member of the Forum of African 1st Ladies to advocate for women’s health, nationally and across Africa.

Vanessa Mdee, the 22-year-old Tanzanian presenter of a weekly show on MTV Africa writes an awareness blog for her fans and tweets on women’s issues.

Both were speaking from the same platform at the Forum to underline the importance of communication, traditional and modern, in ensuring African girls have access to a vaccine that will protect them from a cancer that claims 275,000 women’s lives every year, most of them in developing countries.

The human papillomavirus (HPV) vaccine can protect against 70 percent of cervical cases and, since last year, GAVI is offering support to developing countries to introduce the vaccine into their routine immunisation programmes.

Uganda and Rwanda are already approved for funding subject to clarification, while 15 other countries are awaiting a final decision on their applications However, some groups in African society are suspicious of the HPV vaccine.

The vaccine should be administered before sexuality, in the nine to 13 age group. Mothers are suspicious that administering the vaccine raises sexual awareness at an early age and encourages girls to be sexually active –even though official data suggests this is not the case.

“This is especially true among religious groups,” said Kaseba, “our Government has developed a communications strategy that is not selling HPV as a defence against sexually transmitted diseases but a way to stop a particularly deadly form of cancer.

“Because many girls top going to school at the age of five, our information campaign reaches out to Churches where it’s easy to find groups of girls on a Sunday, as well as village chiefs who tend to know what is going on in their neighbourhood,” she said. “We also go to marketplaces as we know that girls tend to go with their parents to buy food.

Vanessa, who first learnt about the HPV vaccine when she lost her grandmother to cervical cancer, believes advocacy is neglecting the very people it is designed to help – and uses social media to get her message across

“Sometimes young girls and women have minds of their own,” she said, “these women can make the choices now so we should talk to them. Use the people that I can hear in blogs and on twitter to convey the information. Lets speak to the girls.”

“When I tweeted my friends about the death of my grandmother, I was amazed how many people didn’t know about HPV. So I said, I’m going to talk to the people I hang out with, to help ensure there is a cervical cancer generation that we can detect and cure.


Bringing immunisation together under the baobab tree

With the Partners’ Forum now officially up and running in Dar, Dr Seth Berkley delivered a visionary speech this morning touching on GAVI’s past, present and future. Here are some key excerpts.

PAST

About the Baobab tree, the Forum’s symbol: “the baobab tree has a special significance in Africa. It’s revered. People gather under its branches to discuss important issues and talk to their ancestors. This Forum is a time for us to come together and discuss. We should start with our founders and the question is how are we doing. I think we are living up to their vision. As of 2014, every single GAVI country will be using the DTP3 vaccine. It is a routine vaccine and that is what we are trying to do.”

PRESENT

Rollout of pneumococcal vaccine: it‘s an extraordinary story that this vaccine (pneumococcal) was made available in developing countries about a year and a half after it became available in high-income countries. The ultimate goal would be simultaneous introduction in north and south. That’s what we want.  Never again will a company have a life-saving vaccine and ask ‘when’ will it reach a developing country. The question should only be ‘how’.

On the heroic efforts of health workers in developing countries: health workers do whatever it takes to get the vaccines out there … camels, donkeys .. It’s heroic. It’s getting the vaccine into her hands so she can vaccinate and it’s going to lead to healthy children in school.”

FUTURE

The fully immunised child: WHO recommends that every child has 11 antigens: BCG, DTP3 (diphtheria-tetanus-pertussis), measles, polio, hepatitis B, Haemophilus influenzae type b, pneumococcal, rotavirus, rubella and human papillomavirus. 

So should we be looking at DTP3 or the fully immunised child as an indicator of immunisation coverage? What we want is every child, everywhere protected by the full number of antigens. Conceptually, this is where we want to go. If we want to do this, current estimates predict that by 2030, only 50 percent of children will be fully immunised. This is not good enough; we need to reset our aspirations.

Technology: we also need to use technology. Every village household has one cell phone in it and often two or more. Why is it that we are not looking at vaccine stock using GPS, so a flashing red light on an interactive map tells us immediately there is a stock problem in a local health clinic. This is not far fetched. This is what is happening in most of the world for supply chains.  We just haven’t used it in immunisation.

Inconsistency in immunisation data: can we measure immunisation rates? Our numbers really aren’t very tight. We’re shooting in the dark against a target, because we don’t have the tools to really allow us to understand what is happening. This is a critical goal going forward.

Flowering of our effort: when we think about the field of immunisation, we’re back to the (baobab) tree. We need to bring together all the critical parts of immunisation, to become part of routine immunisation. Something extraordinary will happen, we will see the flowering of this effort, and we will see something extraordinary happen.


Reaching the unreached in Tanzania

Fantastic video was played at a packed first plenary session this morning showing why Tanzania’s immunisation coverage rate has reached 92% but also highlighting the difficulties of reaching the remaining eight percent in a vast landscape stretching across more than one million square kilometers. 


Value of vaccine video

Watch this brilliant new GAVI animation showing how the true impact of vaccines stretches far beyond a simple injection. Not only do they save lives, they make them too, It was shown for the first-time this morning during Seth Berkley’s speech.


GAVI Partners’ Forum challenged to “walk the talk”

The Princess of Africa, singer Yvonne Chaka-Chaka, stole the show at the opening ceremony of the GAVI Partners’ Forum this evening, challenging the President of the United Republic of Tanzania H.E. Jakaya Mrisho Kikwete to “walk the talk” to achieve universal immunisation coverage for all the world’s children.

In a tongue in cheek moment that broke with the script, the UNICEF & Rollback Malaria Ambassador asked Tanzania’s President, his Health Minister Dr. Hussein Ali Mwinyi and the 650 participants at the Forum to promise to commit donor money to accelerate immunisation of all children.

“It’s not just Forums that will save lives, it’s universal immunisation coverage that is needed. Let’s walk the talk. Let’s do it for the sake of the children,” she said.

From the Tanzanian children’s choir and the House of Talent performing arts centre for youth to many of the speeches, children took centre stage at the ceremony, which was held in the grounds of the President’s State House and set in motion the December 5-7 event.

GAVI Board Chair Dagfinn Hoybraten told a touching story of his six-year-old grand-daughter telling him that “children may live” should be the focus of his new book. “That’s what this meeting is all about,” said Mr Hoybraten.

GAVI CEO Dr Seth Berkley thanked the Government of Tanzania for hosting what will be the 5th Partners’ Forum, describing the Alliance as “stronger than ever”.

“We have proved that vaccines can deliver, now it’s up to us to make sure we deliver them,” he told an audience that represented all the organisations and countries GAVI works with.

Tanzania’s President highlighted GAVI’s role in helping his country increase immunisation coverage  to 92 percent in 2011 through support for hepatitis B (2002) and Haemophilius influenzae type b (2007) vaccine, welcoming Thursday’s dual launch of pneumococcal and rotavirus vaccines. These two vaccines will protect children from the primary causes of pneumonia and deadly diarrhoea.

“Preparations for early next year have been completed and I am confident we can score further points in reducing under-five mortality. GAVI has empowered us to introduce new vaccines that would otherwise not be affordable,” said the President.


Welcome messages from Bill Clinton, Melinda Gates, Jim Kim, Tony Lake

Watch the video messages that some of GAVI’s most important partners sent to the Partners’ Forum opening ceremony to celebrate the start of the three day event.


More than ONE winner in annual Africa award

The stage couldn’t have been more apt for today’s announcement of the winner of ONE’s Africa award, which honours outstanding advocacy efforts by Africans to help advance the Millennium Development Goals.

To the resounding beat of African drums and a backdrop of one of Africa’s most famous ports, Future Generation a Cameroonian non-governmental organisation was recognised for its efforts to ensure those living with HIV/AIDS have the right to treatment.

“When we found out we were going to win this award, we were filled with doubt,” said Positive-Generation Executive Director Fogue Foguito.

“All we could do was panic! But we also thought about the long way we had to go to attain zero infection when it comes to HIV/AIDS.”

As part of their innovative tactics, Future Generation place ‘sentinels’ in local communities to help give a voice to the large numbers of Africans who are HIV positive, yet have no access to television or radio to understand their rights to quality health care.

GAVI Board Chair Dagfinn Hoybraten took time out from the GAVI Board meeting to congratulate Future Generation. “The fact that this year’s winner focuses on innovative advocacy for health makes this an even more special occasion,” he said, “Innovation is what GAVI is all about – from technological innovations in vaccines and vaccine delivery, to GAVI’s public-private business model.”

The ONE award, which celebrates innovative Africa-led, Africa-driven advocacy efforts, attracted 250 applications. Here’s a rollcall of some of the impressive runners-up to this year’s award

  • Supporting Orphans & Vulnerable for Better Health, Education and Nutrition (SOVHEN), Uganda-based organisation who noticed that teenage girls would often not go to school because they could not afford sanitary towels. To help, SOVHEN have developed a sanitary pad that is affordable and created from sustainable and bio-degradable materials. The discarded banana stem, when pressed and processed, provided an absorbent fiber that when placed into sheaths of special paper and shaped, could provide the solution to help keep girls in schools.
  • Rural Health Advocacy Project (RHAP) which works out of Johannesburg for the rights of South African’s rural citizens to access affordable, quality healthcare in their home districts. RHAP ensures that all health policies are ‘rural-proofed’ rather than biased toward the very specific needs of urban communities.
  • The Muliru Farmers’ Conservation Group (SOVHEN), who work with local communities in Kenya to grow a medicinal plant. This provides both an income but also helps preserve the country’s ancient rain forests.
  • Friends of the Global Fund Africa (Friends Africa), an indigenous non-profit organisation in Nigeria which mobilises political and economic supporters as well as civil society in the fight to eradicate tuberculosis, HIV/AIDS and malaria.

CNN.com feature: Braving lions to deliver Maasai nomads’ vaccines

Arusha, Tanzania (CNN) – In most doctors’ waiting rooms, it’s the nurse who calls the mother and child for their vaccination. In Tanzania’s Arusha National Park, nurse Neema Baynet has to go out and find her patients.

With the Maasai tribes constantly on the move searching for water and fresh pasture for their cattle, Baynet can spend up to five days traveling 100 km searching the savannah for remote communities for whom her mobile immunization clinics are the only protection against deadly disease….

Read the full story on the CNN.com website 


All Together Now – Civil Society Delivers on Immunisation

One of the first events of the GAVI Alliance Partners’ Forum was “All Together Now: Civil Society and GAVI Partners RISE-up in Cooperation”, a standing room only event. Hosted by the GAVI CSO Constituency, the packed CSO Forum reflected strong civil society commitment to push forward the goal of reaching every child with immunisation, and the civil society drive to strengthen health systems and integrated approaches to child health. 

There was a strong presence of faith-based organisations, which are becoming a major force within the GAVI CSO Constituency. The Forum Panel covered the significant role that CSO organisations play in policy recommendations, coordination and service delivery.

South African singer and humanitarian activist Yvonne Chaka Chaka addressed the CSO participants during the session, noting the power of CSOs and encouraging them to strengthen their work in immunising children: “We must work together to build healthy communities – healthy men, healthy women, healthy babies, healthy children. When we have healthy communities, we can have healthy economic development. People are our greatest asset – let’s invest in them and their health.”

Here’s a snapshot of what some of the participants at the CSO Forum had to say:

Anne Lise Ryel, Secretary-General of the Norwegian Cancer Society 

“This is the first time I have participated in a GAVI event, and of course I am here because of GAVI’s role in getting HPV vaccines to children in the developing world. My organisation is a member of the Union Internationale Contre le Cancer; we have advocated – successfully – for HPV vaccines to be given routinely to girls in Norway and we are advocating for access to HPV vaccines for girls in developing countries. This is an important opportunity to make connections with other organisations around the world so that we can find ways of strengthening our voices.” 

Crickett Nicovich, RESULTS, US 

“RESULTS is always looking for new advocacy partners in building support for advocacy around the world. This is an important opportunity for us to find even more ways to spread the word.” 

Cecilia Senno, Hope for Future Generations and Executive Member of the Coalition of Health NGOs, Ghana 

“This is an important networking opportunity to learn from other people doing similar work, to learn about approaches that we may be able to integrate into our work and to share with others the innovative approaches that we have developed. This is a capacity-building opportunity and I am happy to have the opportunity to strengthen the work that we do. In Africa we should strive to have the capacity to help ourselves – that should be our approach.” 

Maria Matsinhe, Manager, Expanded Programme on Immunisation, Ministry of Health, Mozambique 

“In my country, we the EPI do not have a strong link with CSOs – we are working with just a couple – but CSOs have such a crucial capacity to reach people that we cannot reach and to do the things we do not have the capacity to do. I came to this Forum to learn more about how CSOs work on a programmatic level in delivering immunisation; they can really play a very important role.” 

Dr. Adinoyi Ben Adeiza, IFRC, Nairobi 

“I came here to learn from the experiences of others – how they are able to carry out immunisation in their countries, especially the role they play in bridging the gap between governments and communities, providing social mobilisation at the community level and in helping with the MNCH continuum of care; at IFRC we encourage our national societies to focus on these areas.” 

Dr. Samuel Mwenda, Christian Health Association of Kenya 

“I represent a national association of faith-ased organisations working in health service delivery. Services to children are key, in particular preventive services – and immunisation is a key preventive intervention. I am here to share the perspective of FBOs and our contribution to results, sustainability and equity in immunisation. FBOs are key players in service delivery; we have a wide range of health facilities, training programmes and a long term commitment to providing health service delivery. We provide immunisation through our networks of health facilities and we are also very strong in reaching hard to reach children with immunisation outreach services.” 

Filimona Bisrat, Director, CORE Group Polio Project, Ethiopia 

“This is a great forum to bring together CSOs; it’s an opportunity for us to learn from other organisations’ experiences, to learn about innovation and developments in immunisation and about what GAVI is doing. It’s a great opportunity to learn about new approaches and to meet other people who share the same goals.” 

Dr. Sharmin Zahan, BRAC, Bangladesh 

“GAVI’s CSO Constituency is very strong and well-established. I can see how it has strengthened during the years since the last Partners’ Forum in Hanoi in 2009. We have achieved a lot in strengthening and refocusing our role. We have a lot of recognition from GAVI but we still need to work to increase our recognition on the ground for the work we do. CSOs bring valuable experience and information to the table, but sometimes on the ground individuals working for them do not feel empowered to speak up, so an opportunity to be even more effective is lost. This Forum is an opportunity for us to exchange information about the challenges we face and to reinforce and strengthen each other.” 


Doctors dream of a better future at Dar hospital

I was given a stark reminder of what the GAVI Alliance is all about during a visit to Sinza public hospital on Tuesday – an impressively well-equipped, and recently redeveloped, hospital that provides health care to half-a-million people in Dar es Salaam.

The rows of wooden benches at Sinza’s outpatient department are lined with more than 50 mothers, most clutching sickly babies to their chest as they wait to see Dr Bandiot Masange. Every 10 minutes the newly installed PA system calls another patient into Dr Masange’s surgery, including one-and-a-half year-old Amina Husna. Like so many other children here, Amina is suffering from a respiratory tract infection and her mother is given an envelope of paracetamol tablets.

It’s the rainy season in Tanzania, when the sweltering heat and humidity make children vulnerable to this kind of infection. If not treated quickly like Amina, some of these children will contract pneumonia, a disease ranked as the biggest killer of under-fives in Tanzania. Some 15% of children aged less than five fall victim to pneumonia.

Dr. Gunini Patrick Kamba, the District Medical Officer, who is showing me round the hospital, estimates that, with time, the number of pneumonia cases will drop by 40 percent thanks to the pneumococcal vaccine that will become part of Tanzania’s routine immunisation programme at a special launch event in Dar on Thursday.  Pneumococcal vaccine will protect Tanzania’s youngest generations from the primary cause of pneumonia – pneumococcal bacteria.

For only the second occasion in developing countries, Tanzania is introducing two new vaccines at the same time. From tomorrow, rotavirus vaccine, which helps spare children from the main cause of severe, often fatal, diarrhoea, will also be part of the regular immunisation card. Diarrhoea accounts for another six to seven percent of child mortality across in Tanzania. “Children are the same the world over,” says Dr. Kamba, “leave them alone for two minutes and they will touch anything.” In the poor, unhygienic housing conditions of Dar’s slums, that can have deadly consequences.

The rows of people - mainly mums, but also some dads - waiting patiently outside the immunisation clinic at Sinsa suggest parents will not be slow to bring their children for the new life-protecting vaccines. Electrician Shadrack Satidinga says he has taken the day off work so he can bring his nine-month-old son Leonard for his third dose of the five-in-one pentavalent vaccine. He recommends that more Tanzanian fathers follow his example. Zamuozoni Ramadsani has brought her fourth child for a final dose of penta. She tells me that all her other children have been immunised against “the deadly diseases that claim our babies’ lives.”

Sinza’s high level of service attracts outpatients from far beyond the six Dar wards it is supposed to serve. Sister Salina tells me that mothers frequently by pass Tanzania’s local health clinics and travel 40 km, usually on public transport, to have their baby treated at the modern hospital.  In 2012, the hospital administered BCG to 5,941 children, a staggering 212% of its original target. It’s not just limited to vaccines. Some 2000 pregnant women attend the antenatal clinic every month. With an average 22-30 babies delivered daily here, the maternity ward is packed with mothers sleeping on the floor, their mats and pushed between regular beds.

The hospital is a victim of its own success, with its reputation of excellence travelling far beyond the official catchment area. According to Dr Kamba, the ministry of health is trying to strengthen the referral system to ensure patients have to go to their local health clinic before receiving treatment at Sinza and also offer more outreach services. But, he emphasises, the hospital never turns any patients away.

Of course, the best way to avoid overcrowding is preventing the type of infection which afflicts poor Amina, and Dr Kamba is quick to point to the long-term impact of Thursday’s introduction of pneumococcal and rotavirus vaccines on the long queues in his outpatient ward.   Maybe in five years, he says, “we won’t have this problem, all these cases will stop.”


GAVI adopts a tailored approach

Introducing greater flexibility will enable GAVI to respond to short-term and long-term challenges faced by countries 

A new country-by-country approach will give GAVI more flexibility to work with fragile states by providing tailored support to those eligible countries that most need it. The new framework was approved this week by the Board at the GAVI Alliance Partners’ Forum in Dar es Salaam and enables GAVI to deal with countries on an individual basis with greater transparency. 

The new policy comes in recognition of the limitations that can be faced by a handful of the 57 GAVI-eligible and 16 graduating countries in accessing and leveraging GAVI support. For example, some of these may experience short term man-made or natural emergencies, circumstances that warrant a one-off, time-limited, flexible approach. Other underperforming or fragile countries may however experience more long term, protracted immunisation and non-immunisation challenges, where it may be more appropriate to adopt a country tailored approach. As of August 2012 under the new policy ten countries would qualify for this kind of long term response. 

“With the country-by-country approach, GAVI will be better able to respond to the challenges that countries face to access GAVI support and strengthen their immunisation systems. The country tailored approaches will help us to adjust our support in a way that is more relevant to the country context and the specific challenges they face,” said Aurélia Nguyen, Director of Policy for the GAVI Alliance. 

GAVI already has a number tools in place designed to be used in such exceptional circumstances. However the new framework will introduce new mechanisms along with greater transparency ensuring that policy is applied fairly between countries. “This policy and its framework gives us a transparent tool for identifying the eligible countries that will receive intensified support from the GAVI Alliance, and it also gives us guidance on giving flexibility to countries who experience emergency situations,” said Aurélia Nguyen. 

The inclusion criteria for this country-by-country approach have been created following extensive consultation with country stakeholders through bilateral meetings at the government and regional levels, and through meetings with civil society organisations. A technical consultation group was also established  made up of immunisations experts and experts working in fragile states including those from the United Nations Office for Coordination of Humanitarian Affairs (UN OCHA), the Organisation for Economic Cooperation and Development (OECD) and the UK’s Department for International Development (DFID).


Countdown to the Partners’ Forum

Less than a week to go now until the 2012 GAVI Partners’ Forum officially kicks off. Most delegates will be arriving in the early part of next week and I’ll be on the ground to report on all the interesting goings on. Follow this blog on the GAVI website to stay up to date with the many interesting sessions, press events and field trips.

Watch this space!

 

5 -> 16

From 5 to 16 vaccine manufacturers supplying Gavi – more than half based in Africa, Asia and Latin America.

2001: 5 vaccine manufacturers producing prequalified, appropriate Gavi vaccines – 1 based in Africa;
2016: 16 vaccine manufacturers producing prequalified, appropriate Gavi vaccines – 9 based in Africa, Asia and Latin America.

Gavi 2017

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