Learning from the Success of Global Immunization
Reflections on the CSIS "Conference on the Strategic Power of Vaccines" Event
With the Gates Foundation’s effort to turn the next ten years into a global “Decade of Vaccines,” vaccines have taken center stage at a number of high level policy events. On Friday, the Center for Strategic and International Studies (CSIS) hosted the “Conference on the Strategic Power of Vaccines” which brought together top leaders such as Dr. Anthony Fauci of the National Institute for Allergies and Infectious Diseases (NIAID), Dr. Orin Levine of the International Vaccine Access Center at Johns Hopkins, Dr. Helen Evans of the GAVI Alliance and many others to discuss strategies for encouraging the further adoption of existing vaccines and the development of new ones. Vaccines are a tried and tested global health intervention that prevent disease and avert future treatment costs. The GAVI Alliance has been a major international force for raising and channeling resources to increase vaccine coverage worldwide and has likely contributed to the global decline in under-five mortality. GAVI’s accomplishments are lauded at nearly every major global health event, and Friday’s conference was no exception.
As the Decade of Vaccines moves forward and experts devise new strategies to improve coverage, it is worth taking a look back and identifying lessons from the global vaccine movement that can be applied to other forms of disease control. As global aid budgets tighten, it may be useful to learn from an area of global health that already has achieved broad based political support. The speakers at CSIS raised a number of interesting points.
Before GAVI, the vaccine market in developing countries was unreliable. GAVI rationalized the global market by harmonizing both supply and demand. USAID Administrator, Dr. Raj Shah, noted that GAVI was the first entity to calculate credible demand forecasts for vaccines, enabling the private sector to plan ahead and scale-up manufacturing capacity as necessary. He explained that GAVI didn’t just look at need, since the need for vaccines doesn’t always match actual public procurement, but real expected demand. Sometimes, volumes can be even greater than expected if countries opt to run “catch-up” campaigns for adults when introducing a new vaccine. Regina Rabinovich of the Gates Foundation reinforced that at the minimum industry must have a good sense of the volume of product needed in order to assess existing manufacturing capacity. Modeling and aggregating demand in developing countries for other types of needed health technologies, such as diagnostics, might similarly help the private sector participate in the these markets.
Speakers also emphasized the importance of separating support for vaccines from politics to the extent possible. Director of the National Center for Immunization and Respiratory Diseases at the CDC, Dr. Anne Schucat emphasized that to overcome vaccine hesitancy and to earn public trust, people must associate vaccines with enduring technical experts, not changing faces of a political party. If there is an adverse event associated with vaccination, she said, then the president should not go on television to temper fears—the head of the NIH or the CDC should. This could be important for other health products as well, especially technologies under-going late stage trials, and is certainly relevant for other countries. Sometimes people in developing countries fear that new health products intended for low-income countries are inferior or dangerous. High-level technical experts within those countries should take on at least part of the responsibility to address those suspicions.
Staying above politics still requires working with local leaders and building broad based support. Vaccines require the cooperation of local leadership who can create the enabling environment for events like immunization days. Markus Geisser from the International Committee of the Red Cross (ICRC) argued that if you can create a sense of shared value, then local leaders may be willing to help ensure that an important health service is delivered. In keeping with the ICRC’s practice of working with both sides of an armed conflict to achieve humanitarian aims, the ICRC has worked with the Taliban and other opposition leaders in Afghanistan to facilitate days of peace where the ICRC and public health personnel can immunize children in conflict areas. This is no small feat, but it shows that even in the grimmest circumstances, people are willing to prioritize what is important to them, like the health of their children. Health systems often crumble in the presence of conflict. Using neutral intermediaries to work between opposing groups could create entry points for other preventative health services as well (distribution of bed nets, nutritional supplements, diarrheal treatments, etc.). In general, this principle of elevating healthcare to a politically neutral status and building trust with the community aligns with Dr. Schucat’s advice of keeping health technologies above the political fray.
Finally, Dr. Fauci of NIAID pointed out that vaccines cannot be viewed in isolation. They are one piece of larger control efforts. He considered the case of HIV/AIDS where the development of a vaccine should continue to be a top public priority, but in the meantime, the epidemic’s trajectory should be countered with existing prevention and treatment options. Advocacy for one particular technology should not shut out complementary approaches to effective disease control.
These are just a few of the ideas that emerged at Friday’s event, but they are important to keep them in mind. As the various Decade of Vaccine working groups charge ahead and test new approaches for improving vaccine coverage, we should keep our eyes open to how we can use the lessons learned to create a similar track record of success for other global health technologies.