9. Saving the children

Key points

• On average globally, you are more likely to die if you are under 5 than if you are my age, 50 (Our World in Data).?But huge progress has been made. Seven million children survived in 2020 who would have died in 1990.
• There are many reasons for the progress but childhood vaccines is one of the biggest.
• Child vaccines has also been an area for major innovations in financing for development, which have helped the world recently in tackling Covid.

Millennium Development Goal 4 was to reduce the under-five mortality rate by two thirds, between 1990 and 2015. By 2015, it was reduced by over half (80% of the goal). It has been reduced by 61% by 2020, almost the MDG goal. ?The UN shows progress is slowing down.?The new Global Goal 3.2 for 2030 is to reduce under 5 mortality to 2.5%, a 73% reduction compared to 1990.?

This would still mean children in low-income countries are much more likely to die than children in high income countries, largely from preventable causes.?In the UK, four out of every 1000 children die before their 5th birthday. In Nigeria, 117 children in every 1000 die before their 5th birthday.?It was 210 in 1990, so good progress has been made but there is much more work to do. ?

There have been several reasons for the progress. Clean water reduced deaths from diarrhoea. Education for parents is linked with lower death rates of their children. Safer births have significantly reduced deaths of new-borns and mums (see next week). ?One of the biggest reasons is the expansion of basic childhood vaccines which all children in the UK would get, including for measles, mumps, rubella, flu, typhoid, polio, tetanus, diphtheria, meningitis, rotavirus and others more relevant in some countries like yellow fever and cholera.?

In 2008, after ten years working for the Department for International Development, I took what a few of my colleagues thought was the plunge to leave the civil service and join the Bill & Melinda Gates Foundation.?It was still a relatively new organisation, founded in 2000, but it was the biggest of a new wave of philanthropic foundations working on international development issues. For the next four years, I focused mainly on developing partnerships between the Gates Foundation and governments in European countries.

Eliminating preventable childhood deaths was the Gates Foundation’s top priority.?In 1997, Bill and Melinda Gates read a newspaper article about millions of children in poor countries who die from diseases, such as diarrhoea and pneumonia, that were easily prevented or treated in wealthier countries. It blew their minds. ?They said, “maybe we can do something about this.” ?In 2000, they did. They gave $750M to launch a brand-new organisation, the Global Alliance for Vaccines and Immunisation - GAVI. It brought together key UN agencies, vaccine manufacturers, and aid agencies like DFID, to vaccinate children in poor countries.?

In 2011, DFID and the Gates Foundation (my old job and my new one) hosted GAVI’s first global pledging conference, to raise $4.3Bn to roll out new vaccines against pneumococcal disease and rotavirus (a leading cause of diarrhoea) to more than 40 countries by 2015. ?The UK, led by David Cameron and Andrew Mitchell, pledged 30% of the total and Bill & Melinda Gates pledged 26%. Most of the rest would have to come from other European countries and the USA. Joe Cerrell and I led the work to raise $1.4Bn from other European countries. We didn’t have Make Poverty History to help us, but we did have support from several NGOs, including the One Campaign. ?European Heads of State and Government were keen to meet Bill Gates.?And the effectiveness of vaccines was obvious.?But we still had to use a few of those 2005 tactics, of encouraging everyone to think they’d be the odd ones out if they did not pledge substantially to GAVI.?Norway, Sweden, Netherlands, and France were the most generous European countries after the UK.?Germany was more generous in 2015 and the USA has always contributed about 10% of GAVI’s funds. ?The UK and the Gates Foundation remain the two largest funders of Global Vaccines and Immunisation by far. ?

Luckily, the UK hosted the latest (virtual) GAVI pledging conference in June 2020, just before Prime Minister Johnson shut DFID and before Chancellor Rishi Sunak slashed the aid budget in November 2020. ?So the UK remains GAVI’s biggest funder for 2021-25 and people in the UK can feel proud and sure that it is making a huge difference and saving millions of lives. GAVI estimates it has helped lower-income countries to prevent more than 15 million future deaths through its support for routine immunisation programmes and vaccination campaigns since 2000.

The UK Government and the Gates Foundation also worked together on two other major innovations in financing international development, to support vaccines and immunisation.

The International Finance Facility for Immunisation (IFFIm) was proposed by Gordon Brown in 2003, again with Shriti Vadera’s advice and urgency. ?The costs of vaccines are upfront but the benefits come over a lifetime, so a financial structure to spread the initial costs over a longer period makes a lot of sense. ?It makes even more sense if donors are increasing their ODA budgets over time, as they had promised to do in Monterrey in 2002. ?

The UK’s G8 Presidency launched the IFFIm in Gleneagles in 2005, with support from France, Italy, Spain, Sweden and Norway.?Shriti was particularly disappointed that Chancellor Schroder of Germany refused to participate in it, leading to some stand up arguments in the last hour of the Gleneagles Summit, between Shriti and me, as well as a quieter but equally stern one between Michael Jay, the German Sherpa and me. ??But we were out of time.?Germany has still never contributed to IFFIm. ?The $6Bn raised by IFFIm bonds means 100 million children have been vaccinated sooner by GAVI, saving even more lives. ?Once again, the UK has been the leading innovator and funder of this brilliant idea.

The second innovation was the Advance Market Commitment. ?The basic idea is to bring down the cost of new vaccines by promising pharmaceutical companies a minimum volume of doses that will be purchased, thus guaranteeing them the economy of scale they need to invest in research, development and manufacturing.?The Centre for Global Development promoted this idea, and it was soon picked up by DFID and the UK Treasury. ?Owen Barder being a link between all of them.

In 2007, the United Kingdom, the Gates Foundation, and Canada, Italy, Norway, and Russia (who held the G8 President in 2006)?committed $1.5Bn to launch the first Advance Market Commitment to speed up a new pneumococcus vaccine by Pfizer and GSK (one of CARE’s private sector partners). Streptococcus pneumoniae bacteria is a major cause of pneumonia and meningitis, that kill 1.6 million people every year.?The AMC could save over 5 million children’s lives by 2030. ?

In 2009, Italy hosted the G8 Summit in L’Aquila, which had just suffered an earthquake. ?As they had launched the first AMC with us, we hoped they would use their G8 Presidency to launch a second AMC for Rotavirus, which, as noted above, is a leading cause of deadly childhood diarrhoea. ?I took Bill Gates to Rome to meet the Italian Prime Minister and Finance Minister. ?Our interpreter told us afterwards that the finance minister had turned to his aide, while Bill was pressing Italy to do more for people in low-income countries, and said, “Get me out of here!”. ?His aide persuaded him to stay a bit longer, but we never persuaded Italy to launch a second AMC.?Sadly, until 2020 there had never been another AMC.?

Then, Covid happened. And all of a sudden, Advance Market Commitments seemed a good idea to rich countries, because it brings down prices for them too. ?GAVI has now raised almost $15Bn for the COVAX AMC. ?By end 2022, GAVI had shipped 1.85Bn Covid vaccine doses to 145 countries. Europe and G7 countries have secured over 10Bn doses for themselves. ?So we have still not really figured out how to share healthcare fairly in the world. (see Chart 3 in article 5 on Covid and HIV)

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