In 2000, more than 10 million children under the age of 5 died.
In the two decades since, that number has been almost halved to 5.3 million, a testament to the value of public-health programs.
Much of the progress is attributable to the expansion of childhood immunization programs, which have sharply reduced deaths from common infectious diseases such as measles, diphtheria and whooping cough.
At the turn of the millennium, only 70 per cent of the world’s children were getting basic immunizations. Despite the braying of anti-vaxxers, that number has increased to 86 per cent.
The improvement has been even more marked in the developing world, where the childhood immunization rate has jumped to 81 per cent from 59 per cent.
Much of the credit goes to Gavi, The Vaccine Alliance, a public-private partnership that is responsible for vaccinating more than half the world’s children but is virtually unknown to the general public.
Gavi was launched 20 years ago at the World Economic Forum in Davos. The Bill and Melinda Gates Foundation got the ball rolling with a whopping US$750-million donation. Canada was an early, enthusiastic supporter.
Wealthy countries and charitable organizations have long supported public-health programs in the developing world, with middling success.
What Gavi did differently was to move away from the long-established model of providing sporadic handouts to poor countries. Instead, it set out to reshape the market so vaccines would be affordable for even the poorest countries to purchase themselves.
Gavi guarantees purchases in advance and provides subsidies that, in turn, incentivize manufacturers to lower their prices in return for large-scale, long-term contracts.
The result is that a basket of basic childhood vaccines, which costs approximately $1,100 in the United States, can be purchased for as little as $28 in a low-income country.
When Gavi began, fewer than 7 per cent of vaccination programs were funded by developing countries themselves; now it’s 36 per cent.
Two decades ago, there were five vaccine manufacturers. Today, there are 17, and most of the new ones are in the developing world.
Gavi has also created stockpiles of drugs to combat outbreaks of yellow fever, cholera and Ebola, which are available to any country.
“Ultimately, our greatest success has been creating viable markets in developing countries,” says Seth Berkley, chief executive of Gavi.
In 2018, 66 million children were vaccinated in Gavi-supported initiatives. That’s important for the individual children, but also for the health systems of countries more broadly.
As Mr. Berkley is fond of saying: “Vaccines don’t deliver themselves.” Getting vaccines into the arms of children requires supply chains, infrastructure, transport and health workers, and all of those help bolster health systems writ large.
As more and more countries become self-sufficient – in recent years, 16 countries have created self-financing vaccination programs – Gavi is shifting its focus to the so-called “zero-dose children,” the 10.4 million children who receive no vaccination.
Traditionally, these children were seen as unreachable because they live in the most remote parts of the world. But it has become clear over time that the zero-dose children are actually concentrated in conflict zones and urban slums, and they can be vectors for the rapid spread of disease.
A striking example is in the Democratic Republic of the Congo, where a measles outbreak has killed 6,000 children, and has been overshadowed by an Ebola outbreak that has killed 2,200.
“Zero doses of vaccines usually means zero of many other things,” Mr. Berkley says.
Ultimately, that’s why immunization matters. A child who avoids deadly and debilitating childhood illnesses is a healthier child, one who can get an education and become a productive adult.
A study conducted by researchers at Johns Hopkins University found that every US$1 spent on vaccines in developing countries produces an economic return of US$54.
But you have to invest money in public-health programs to get those returns.
When Gavi was founded in 2000, global alliances and collaboration were very much in vogue. The impulse today is for countries to retreat into nationalism and reject globalism.
As Gavi seeks US$7.4-billion in replenishment funds to do its work over the next five years, the global solidarity of both public and private donors will be tested.
Hopefully, in the era of Brexiting and wall-building, there will be a recognition that, as the frightening new coronavirus reminds us vividly, infectious diseases know no borders that, as the well-worn public-health mantra goes: “An outbreak anywhere is a threat everywhere.”
Keep your Opinions sharp and informed. Get the Opinion newsletter. Sign up today.