TALKING POINTS INTRODUCTION

Transcription

1 TALKING POINTS INTRODUCTION I have been asked by Amina to talk about health and development and to share some of the experiences of the GAVI Alliance model that might be replicated in furtherance of other goals and sectors. In the area of global health we have had some significant successes in recent years, though unfortunately not enough at present to achieve MDGs 4, 5 and 6: For example: Fewer women are dying from childbirth: globally, a decline of 47% between 1990 and Fewer children are dying: the number of children under five who die each year has been reduced by more than 40% over the past two decades. Fewer people are contracting HIV: new HIV infections have declined by 17% globally from and for those that do contract HIV, it is no longer a death sentence due to treatment. Equally, it is in the health sector we have also seen the most progress in thinking about, and putting into practice, new ways of doing development an important part of MDG8. The GAVI Alliance has fostered some of these new approaches and I will share with you some of the innovation we have brought to the business of development. But let me start with the basics. HEALTH AND DEVELOPMENT Development is about improving people s lives. Whatever framework for development we come up with for the post-mdg era, people must be at the centre. At the end of the day, we must be able to measure our success through an indicator or indicators that help us understand the difference we have made in real people s lives and wellbeing. It is extraordinary how often this simple fact is overlooked. I was quite concerned in the zero drafts around Rio+20 how the people components were missing.

2 Whether or not one sees health as a fundamental human right, one cannot argue that there is a fundamental link between health and prosperity. Good health is critical, not just to an individual s well-being. It is a foundation for communities and nations to prosper. And ill-health, especially in developing countries, can have dire consequences for families and communities. Because low income countries pay mostly out of pocket, so for poor families, illness can have catastrophic consequences and throw them further into poverty. On a positive note, good health means greater prosperity. There is, for example: increased productivity because a healthy child can attend school, learn better, and grow stronger; and an increase in parents productive time by reducing the need to take care of a sick child. On the inter-relatedness of health with other sectors, nutrition and education for example, with a few examples: Health is an interactive goal interacting directly in an iterative fashion with nutrition and education. For example: A child who is borderline nourished, will tip into frank malnutrition if they contract an infectious disease such as measles. But also, those who are malnourished are of increased susceptibility to infections such as measles and of bad outcome to them. Prevention of rotavirus diarrhoea infections in children improves their ability to absorb the nutrients in the food they receive. Prevention of Hib disease or pneumococcal infections greatly reduces the risk of compromised brains and overall has an impact on school learning. So we need to see the benefits of good health more broadly than individual well-being. The Millennium Development Goals recognise the centrality of health to development. The MDG framework has been a powerful tool to: galvanise the global health community; raise unprecedented funds for health; encourage innovation;

3 build unlikely alliances across the public sector, private enterprise, faith based organisations and civil society organisations; and it has helped to increase access to affordable essential medicines, including vaccines, in developing countries. As I said earlier, we have seen results from investments in health, but a lot remains to be done. So looking forward, it is critical that we finish the 2015 health MDG agenda, but also look to post 2015 and assure we are well prepared for the challenges going forward. The GAVI Alliance has supported the immunisation of more than 325 million additional children and helped to prevent over 5.5 million future deaths in the world s poorest countries. Yet still today, every twenty seconds a child is dying from a vaccine preventable disease demonstrating our unfinished agenda. LESSONS FROM THE GAVI ALLIANCE MODEL While what we do is important, if we are to ensure a lasting impact, what is also important is how we do it. Let me tell you a little of the experience of the GAVI Alliance and some of the ways we have gone about our business, which may have lessons for the broader development agenda. In recent decades we have seen massive advances in the science of vaccines. But, these technological advances new and better vaccines - were not sufficiently reaching those who arguably most needed the health protection that they provide. GAVI is a public private partnership established in 2000 with an MDG inspired mission to contribute to saving children lives and protecting people s health by increasing access to immunization in poor countries. The first lesson from GAVI is the importance of inclusive and diverse partnership. Developing countries lead the vaccine uptake, integrating them into routine immunisation programmes built on stronger health systems and services. In many countries, civil society organisations are important partners in service delivery, particularly in reaching the most vulnerable groups in the population.

4 At the global level, WHO ensures the quality and safety of vaccine products through its prequalification system and UNICEF procures the vaccines demanded by countries. The GAVI Alliance brings these actors together with the vaccine manufacturers, technical research institutes and individuals with skills and commitment to the mission. The achievements of one are the achievements of all. But it is the public-private partnership that sets GAVI apart. We recognise that the market is the primary driver of economic growth and we draw on private sector expertise to inject new ways of thinking into our public health work. We are not just in the business of subsidising vaccines and ensuring more children in developing countries are given the chance of a healthy productive life. We want to change the way that the vaccine market works. So GAVI has an explicit focus on market shaping. The objective is a secure supply of more appropriate vaccines at affordable prices and to create a vaccine market more appropriate to the world we all live in. At its broadest level, by combining donor funding and aggregating developing country demand, we achieve a purchasing power that can drive new competition and reduce prices. For example, the five-in-one shot pentavalent vaccine: In 2007 we were paying an average of over $3.60 from two multinational suppliers. Last year, there were four suppliers (two based in emerging market economies) and the average price was under $2.50 a 30 per cent drop. The Advance Market Commitment pilot for pneumococcal vaccine has assured availability of a new vaccine formulated for poor countries with a 97% reduction in price and availability in developing countries within a year of its availability in the West. This mechanism also offers lessons for shaping the market associated with critical commodities beyond health. Let s move to the money. The cornerstone of smart development aid is predictable and sustainable financing. While traditional bilateral donors continue to be an important source of financial support, GAVI continually looks for innovative ways to supplement and build on this donor base. Leveraging the capital markets has been a hugely effective way of raising additional funds for the scale up of our work.

5 The International Finance Facility for Immunisation (IFFIm) increased the predictability and level of financing - key ingredients of successful development approaches by converting long-term government commitments into immediately available cash resources by issuing bonds vaccine bonds on the capital markets. For the first time in history, donors have been prepared to provide legally binding 20 year financial commitments and the power of the capital markets has been tapped for large-scale development finance. So far, IFFIm has raised over 3.5 billion dollars in vaccine bond sales. The GAVI Matching Fund is another innovative way of raising additional funds. Every Pound or dollar contributed by the private sector is matched by a Pound or dollar from the UK government and the Gates Foundation. This has already resulted in an additional US$30 m. As importantly, it has brought private sector expertise into some of our most difficult problems like how to improve the supply chain in developing countries and improve the sharing of information. Another important innovation is GAVI s policy of requiring country co-financing of vaccines, which gradually transfers responsibility for funding new vaccines to the government. More than 50 countries currently co-finance their vaccines, with their share of the costs determined by their ability to pay which adjusts as countries move towards graduation. Co-financing ensures strong country ownership and brings finance ministries into the equation. It paves the way for long-term sustainability as new vaccine costs are gradually incorporated into government health budgets. It is the power of inclusive partnerships and the injection of private sector thinking that has helped to drive GAVI s results, ambition and innovation. A relentless focus on measuring and delivering on results allows us to see how quality improvement loops to improve the implementation of the work. Non-Communicable Diseases: There have been discussions on how with the ageing of the population, we need to shift the focus to non-communicable disease. Of course, we need to focus on both: the unfinished agenda of infectious diseases and the new agenda. However, non-communicable diseases is probably a misnomer. One of our great programs has been to reduce liver cancer in many countries of the world through the use of Hepatitis B vaccine. In fact, today about 20% of all cancers are known to be caused by infections agents. Over time, with a better understanding of disease etiology, this will only increase. We will be able to prevent more and more of these expensive and debilitating diseases using advances in science such as vaccines. On our agenda

6 now is cervical cancer; one of the largest cancer killers of women in the developing world; one that can easily be prevented through vaccinations of course, today that means introducing it to adolescent girls which opens many other opportunities for health interventions in this critical age group. So where do I see the post MDG agenda. Our job will be to maximize healthy life. Each child should be able to live up to their full potential: intellectually and physically. Each young adult taught and empowered to maximize a healthy lifestyle including reproductive and sexual health. And graceful ageing with minimal morbidity and maximum functionality, will be necessary as we all go through the demographic and ageing transitions. We want to square the morbidity and mortality curve and to do so we will need to not only provide access to health and prevention services for all, but also work closely with the other sectors that are interlinked to maximize outcomes. We need healthy, productive people AND a healthy planet. And we must recognize that these goals are inextricably linked. CONCLUSION In conclusion, sustainable development is fundamentally a question of people s opportunity to influence their future, claim their rights and voice their concerns. None of this is possible if a population is coping with ill health. Working with developing countries and a wide range of partners to capitalize on each other s comparative advantages, we have produced tangible and measurable results. The MDG framework has helped to galvanise action as must what follows. We need to continue to ensure people are at the centre of a future development agenda and that health outcomes are able to be measured and that health is recognised not just as a matter of individual well-being but as a foundation of economic development and our collective prosperity. I, and my colleagues in other global health organisations, stand ready to support this process and the important work of your panel.