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Science in society – politics, development and social justice.

The Trouble With GAVI…

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Bill Gates, a champion of the GAVI Alliance. Ben Fisher/GAVI Alliance

GAVI – the Global Alliance for Vaccines and Immunisation – or GAVI Alliance as it is now tautological branding would have us call it, has had a rather happy September thus far. The 11 year-old Public Private Partnership on Friday 16th of the month proudly declared Burundi will become the tenth African country to roll out the new pneumoccal vaccine. GAVI said more than 16,000 children die of pneumococcal diseases including bacterial pneumonia in Burundi every year, almost all of which would been prevented by the vaccine.

Five days later, on 21 September, praise was rained down on the Alliance by two rather grande fromages of the aid world. That is Andrew Mitchell the UK’s secretary of state for international development, the chief of the Department for International Development (DFID), and Raj Shah, head of the United States Agency for International Development (USAID), the world’s single biggest development donor. They said GAVI is a “game changer” in a meeting at the UN General Assembly in New York.

Less than a week had passed before they were popping up in the news once again with their jolly announcement that it would be funding the introduction of rotavirus vaccine in 16 more countries and the pneumococcal vaccine in 18 more countries. Rotavirus is the leading cause of severe diarrhoea in children under five in Africa. it is a significant cause of death across the world. According to the World Health Organisation, in 2004 527,000 children who had yet to reach their fifth birthday died from a rotavirus infection. The vaccine would have made these deaths preventable.

The British government and Bill Gates together gave over $2bn to GAVI in the summer of 2011. Ben Fisher/GAVI Alliance

GAVI can do these things thanks to the generosity of the people of the developed world and the Bill and Melinda Gates Foundation. You may recall this summer gone in a very snazzy hotel in the City of London David Cameron pledged approaching a billion pounds, more than a billion in dollars, to GAVI. Bill Gates, in his slightly hunched up and earnest fashion, pledged a billion freshly pressed greenbacks.

GAVI has pulled in these kinds of sums, attracts the kinds of remarks made by Mitchell and Shah (who should open a tobacconist if this international development gig doesn’t work out), because the principle of the Alliance is beyond reproach. It takes the money it is pledged together and pays UNICEF to buy and ship million upon million of childhood vaccinations to developing countries. These recipients, or partner countries as they are called, contribute a portion of the moneys thus gaining some degree of ownership over the whole enterprise.

Once at their destination the vaccines are trucked about the country and injected into various bits of children. there they stimulate immunity in the child and protect them from a plethora of pathogens, diseases that burden developing countries with sick and dead kiddies.

GAVI is extremely pleased with this wheeze for two very important reasons. Firstly, thanks to the trials that these vaccines are subjected to before market, GAVI can estimate to what would seem to be a reasonable degree of accuracy how likely a dose of the vaccine is to protect a child. With a set price for the vaccine, GAVI can happily proclaim that spending X billion dollars will protect Y million children from disease and prevent Z million deaths.

Secondly, vaccines as a medical commodity are not that attractive for theft and black market sale. Many kinds of vaccine have to be kept at a refrigeration-cold temperature, they are not currative and they can require a degree of training to administer – injections are harder to give than a tablet. This means GAVI funds and resources are less likely to be misappropriated and misused, this is a problem that bedevils malaria drug distribution programmes.

A vaccine dose is prepared to go into an Ethiopian child. Pete Lewis/DFID

These factors mean that GAVI provides a cost-benefit figure – money in equals lives out – a boon in terms of value for money. These factors also mean donors can be confident their taxpayers’ money will not be siphoned off into Switzerland by a psychotic central African potentate while his emaciated people cough they pneumonic coughs, choking in the refuse and waste of slum living, before snuffing it.

This is the trouble with GAVI. Vaccines are important but they are by no means the be all and end all. The work that GAVI does is laudable and many children will live when before they would have died.

However, development is difficult. It takes time. It is not about merely saving lives so that they may grow up to help boost their beleaguered countries economy. It is about helping a country build the institutions to be able to provide the kind of society the people of the developed countries in the north are used to. Vaccinations alone is too easy, it is something of a cop-out. It is sold to the taxpayer much in the same way that NGOs that sponsor children sell their wares. This is health system strengthening, donors  providing financial assistance to a partner country the complements what the partner country spends on healthcare. The donated funds go to strengthening where they are most needed, not where the donor country is willing to spend them.


Written by nascenthack

September 27, 2011 at 8:20 pm

Posted in Development, Disease

Tagged with , , , , ,

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