By Gunter Nooke
BERLIN, Jul 10 2015 (IPS)

When the three-day conference on Financing for Development begins on Jul. 13 in Addis Ababa, the competitors in this year’s Tour de France will have reached the mountains. They will have already experienced a few spills and will still have many kilometres to go.

A similar situation is facing us with the many important conferences taking place in this important, watershed year for development.

Günter Nooke. Credit: Bundesregierung/Bergmann

The journey began with a successful and financially productive pledging conference organised by Gavi, the global vaccine alliance, in Berlin in January, and it is set to end in December with the conclusion in Paris of a climate agreement that is binding under international law.

In between, we had a G7 Summit at Schloss Elmau in Bavaria in June that will surely remain in our memories for a long time. For one thing, this was probably the first summit where so many guests were invited to attend for such a long time and where development issues were so prominent on the agenda.

Heads of government from Nigeria, Senegal, Ethiopia, Liberia, Tunisia and Iraq were joined by the heads of international organisations such as the United Nations, World Bank, International Monetary Fund (IMF), World Trade Organisation (WTO), International Labour Organisation (ILO), Organisation for Economic Cooperation and Development (OECD) and U.N. Environment Programme (UNEP).

As announced by German Chancellor Angela Merkel in Brussels back in 2014, it was a true development outreach focusing on Africa for all that security issues also played a major role.

For the first time ever the heads of state and government of the G7 countries agreed to strive for a carbon-free world by the end of the century. Merkel, Germany’s environment minister at Kyoto in 1997 and the climate chancellor of Heiligendamm in 2007, has once again succeeded in convincing others to join forces in forging ahead with regard to an important issue.“If the countries of Europe and Africa could agree that those who use up more of the permitted volume for storing CO2 in the atmosphere than others should pay more into the climate fund, then we would have taken a huge step forward. And those whose CO2 emissions are lower … should enjoy a comparatively greater benefit from this climate money"

So far what we mostly have are words. Germany is the only industrialised country to have significantly increased its Official Development Assistance (ODA) in 2015.Germany stands by the 0.7 percent target, but is unwilling to commit to a rigid timetable with fixed increments for increasing ODA.

Of course, ODA remains important but there are other sources for financing development. Above all it is about how efficiently the money is spent and whether the burden is fairly shared. That should also be the most important leitmotif for the Financing for Development conference in Addis Ababa.

It will scarcely be possible to get binding financial commitments from everyone in Addis. It would also be a great shame if developing countries were to call for more money from the industrialised countries and donors and the “accused”, having been put on the spot, were to respond by pointing the finger at the poor performances of the developing countries when it comes to governance, legal certainty, human rights and an independent judiciary.

Instead of confrontation it would be better if efforts were made in Addis, as they were in Elmau, to continue laying the ground for working together on a basis of mutual trust, with concrete topics and fields of cooperation being named.

Before the December climate conference in Paris, there will be the General Assembly week in New York with all the heads of state and government, a meeting that is especially important this year.

This will be the occasion for agreeing on new goals for sustainable development, on a new pact on the world’s future with concrete goals (Sustainable Development Goals – SDGs), with targets for both developing and industrialised countries.

The intention is that all countries should each make their own contribution. The SDGs are to be universally applicable, but with shared yet differentiated responsibilities for achieving them jointly.

The success of the Elmau summit was the outcome of a rare harmony between language and substance. The Group of Seven is not just a group formed by the world’s strongest industrialised countries. Following the exclusion of Russia, it has once more become evident how much we need a partnership of countries that really want to build a community of values.

The situation at the United Nations, where 193 nations are represented by their national governments, is different.

Surely, in this critical situation and in the interests of Germans and Europeans, it behoves us to work towards a special trust-based partnership between Africa and Europe. The only way for the countries of Europe and of Africa to develop in peace is by working together as good neighbours.

If we take this partnership a bit further in Addis and in New York, then we will also be successful in Paris and will reach a binding climate agreement. And then we will no longer be able to get away with being vague about the numbers, we will have to share out the CO₂ savings among us and, from 2020 onwards, find the 100 billion dollars for the Green Climate Fund.

If the countries of Europe and Africa could agree that those who use up more of the permitted volume for storing CO₂ in the atmosphere than others should pay more into the climate fund, then we would have taken a huge step forward. And those whose CO₂ emissions are lower than the average level or the maximum level per head according to the dictates of sustainability should enjoy a comparatively greater benefit from this climate money.

This arrangement would be good for everyone in Europe and in Africa. Germany, the strong export nation with emissions levels of about nine tonnes a head, would have to pay a lot of money and countries like Burkina Faso or Malawi would receive a lot. And a country like Nigeria would also finally have an incentive to put an end to gas flaring once and for all.

There are many mountains and cliffs to overcome before reaching Paris, not just for the participants in the Tour de France. However, it is important that we know the route. Otherwise we may find that there are only two parties sitting at the table together in Paris and talking about what they – the United States and China – consider acceptable.

Europe and Africa would be out of the running. This other way is not the route that will lead us to our goal.

Edited by Phil Harris    

The views expressed in this article are those of the author and do not necessarily represent the views of, and should not be attributed to, IPS – Inter Press Service. 

Excerpt:

“In situations where there is a higher mortality and morbidity, people very often still see on a day to day basis the impact of vaccination.” Jos Vandelaer, UNICEF. Credit: Adil Siddiqi/IPS

By Lyndal Rowlands
UNITED NATIONS, Feb 5 2015 (IPS)

Measles remains one of the leading causes of death for young children worldwide, even though a safe vaccine is available.

Most of the 145,700 people who died from measles in 2013 were children under the age of five, according to the World Health Organization (WHO)."These kids face a double whammy, in that if they don’t get immunised and they fall sick their chance of getting treatment is also lower than an average kid.” -- Jos Vandelaer of UNICEF

However, immunisation has also saved many children from death and serious illness. The WHO estimates that 15.6 million deaths were prevented between 2000 and 2013, because of increased access to the measles vaccination.

Jos Vandelaer, prinicipal advisor on immunisations for UNICEF, the United Nations children’s agency, told IPS that the children most at risk of missing out on vaccinations are among the world’s most vulnerable and disadvantaged, including children from minority backgrounds and displaced or refugee children in temporary accommodation.

“These are the very same kids who also don’t have access to health care, to clean water, to hygiene, to school, and so on,” he said.

“So these kids face a double whammy, in that if they don’t get immunised and they fall sick their chance of getting treatment is also lower than an average kid.”

In light of the recent outbreak of measles in the United States, Vandelaer spoke to IPS about some of the differences in communicating the importance of vaccination in developed and developing countries.

“In situations where there is a higher mortality and morbidity, people very often still see on a day to day basis the impact of vaccination. If you still have a lot of measles around, people will understand that vaccinating the child will protect the child,” Vandelaer  explained.

“That is probably less visible in situations where you have higher coverage and the diseases are less prevalent. People start to see less of the benefit of immunisation, because they don’t see the disease anymore,” he said.

“What we start seeing, as has also been in the press here in the United States, or in some European countries, these are often the people who are higher educated who are having objections against immunisations, it is not a matter of not being informed, but it is a matter of being misinformed,” he said.

Vaccines protect the group not just individuals

Vandelaer also spoke about the importance of herd immunity.

Within any society there are always a small number of people who cannot be immunised, including the very young and children with compromised immune systems from cancer or other illnesses. These children rely on what is called herd immunity to protect them from vaccine-preventable illnesses.

As Vandelaer explained, “If you get above a certain threshold with immunisation, you protect a large number of kids, and if you do that and you manage to be above that threshold, you have enough children protected to make life for the virus difficult enough to find the few kids who are not protected.

“A virus will hop from one person to the next, but if a person is protected the virus can’t go any further. If you have enough of these people who are protected and the virus is hopping around and it hops onto a protected person, it can’t go any further,” he said

“When there are very few un-immunised children they are actually protected by the children around them. That is why it is important to vaccinate, not just to protect individuals, but also to protect the group.”

Elder explained that governments voice their concerns about the high prices of vaccines at the World Health Assembly every year.

Governments of the world’s poorest countries can access vaccines through the GAVI Vaccine Alliance, of which UNICEF is a member. These governments are required only to make a small copayment, and GAVI covers the rest of the cost, through donated funds.

However many of the world’s poorest people now live in middle-income countries, and their governments usually purchase vaccines directly from manufacturers, in a market shrouded in secrecy.

While compiling their latest report, MSF Access contacted governments and vaccine producing companies to ask for information about how much vaccines cost.

Elder said that none of the vaccine producing multinational corporations MSF Access contacted provided any data on how much they charged for vaccines and that they actually “[took] great lengths to conceal whatever price information possible”.

The companies did all tell MSF Access that they used a tiered pricing structure, so theoretically this should mean poorer countries pay less than richer countries to access vaccines.

Elder explained that one of the reasons MSF Access believes that vaccine prices should be made publicly available is because the data they did receive from governments did not necessarily reflect the tiered pricing structure that the vaccine manufacturers claim to use.

“When you actually look at the [limited] data, and look at the prices governments are paying vis-à-vis their economic level there isn’t this classic line,” Elder explained.

Another issue effecting vaccine supply is having a healthy market, preferably without monopoly or duopoly situations. MSF Access report that there is currently only one manufacturer (Serum Institute of India) who produce 80 percent of the supply of the measles vaccine and who are also the only WHO prequalified manufacturer of the MR vaccine (the combined measles and rubella vaccine).

This has actually resulted in a price increase for the MR vaccination, which the WHO now recommends as part of the basic vaccination package, and places a worryingly heavy reliance on a single manufacturer.

While UNICEF and the United States government both publish what they pay for vaccines, they are rare exceptions. Elder says that greater transparency is needed across the board so that taxpayers from the donor countries who support GAVI and middle income countries who buy their vaccines directly, know how much vaccines are costing their governments.

Edited by Kitty Stapp

By Anna Shen
NEW YORK, Sep 3 2013 (IPS)

Africa and Pakistan are now battling outbreaks of polio, threatening the extraordinary progress the world has made in fighting the almost-extinct disease. In the Horn of Africa, there are now 121 reported polio cases. Last year, there were 223 worldwide.

Siddharth Chatterjee has served as the chief diplomat, head of strategic partnerships and international relations at the International Federation of the Red Cross and Red Crescent Societies, the world’s largest humanitarian network, since June 2011.

Photo Courtesy of Siddharth Chatterjee.

In his previous work with UNICEF, Chatterjee was on the front lines of polio eradication campaigns in South Sudan, Darfur and Somalia, and remains passionate about the eradication of polio and the advancement of child rights.

Excerpts from his conversation with Anna Shen follow.

Q: Considering all the attention given to fighting polio, what are the causes of these outbreaks now?

A: When the Global Polio Eradication Initiative (GPEI) was launched in 1988, the poliovirus was in 125 countries, paralysing or killing 1,000 people a day. Today, polio cases have been reduced by 99 percent with only 223 cases reported worldwide in 2012.

The GPEI Independent Monitoring Board recently remarked that, ‘Poliovirus has been knocked down but it is certainly not knocked out.’

Outbreaks happen when large populations of children are not immunised. This can happen for a couple of reasons, including operational quality of campaigns, but most often because insecurity, like the recent violence in Pakistan, or mobile populations make children inaccessible.

Ultimately, to stop this outbreak, we need to hammer the virus continuously with vaccines and repeated rounds of immunisation, and find ways of accessing the hard to reach and insecure areas.

Q: What is the biggest obstacle to the eradication of polio and how do you overcome it?

A: Myths and misinformation, high illiteracy, extreme poverty, weak health systems, insecurity and poor infrastructure represent real challenges to vaccination efforts and the overall expansion of access to health care.

I saw this firsthand in 2005 when I was working with UNICEF in Somalia. After two years without a case, polio returned and paralysed 228 children. Herculean efforts were made to ramp up social mobilisation, intensive and wide-scale response activities, overcoming huge security and logistical challenges and massive funding helped in stopping the spread.

Through the Somali Red Crescent we were able to access some of the most insecure areas.

Government leadership, trusted national institutions, social mobilisation, engagement and negotiating with all parties is key to any successful campaign. This was my experience in Darfur too. In insecure areas we have to talk to everyone, each party regardless of their political or ideological position is a stakeholder and we have to get everyone aligned around one central theme-children and their wellbeing.

Q: Why is the focus on polio alone, and what is the international community doing to stop other vaccine-preventable diseases?

A: The world has made an enormous amount of progress against a whole range of vaccine-preventable diseases over the past few years. The GAVI Alliance – a public-private partnership focused on increasing access to vaccines in low-income countries – has contributed to the immunisation of more than 370 million children since 2000. Dr. Seth Berkley, the CEO of GAVI, is leading the charge to ensure a quarter of a billion children are vaccinated by 2015.

The greatest legacy of the polio eradication movement might very well be the foundation for stronger health systems it creates along the way. The polio programme is already finding and reaching previously inaccessible children with the polio vaccine and combining these efforts with other health care resources.

We’re building a system that can increase access not only to vaccines, but to other medicines, bed nets for malaria prevention, clean water, access to proper sanitation, hygiene promotion, improved nutrition, reproductive health services, etc.

Q: Has the international community done enough?

A: The international community has been awesome, and frankly without their support we would not have got this far in our fight against polio.

At the end of April 2013, I was at the Global Vaccine Summit in Abu Dhabi. Leaders attending this meeting signaled their confidence in GPEI’s Strategic Plan. Together, they committed four billion dollars, close to three quarters of the plan’s 5.5-billion-dollar cost over the next six years.

Led by Mr. Bill Gates, chairman of the Bill and Melinda Gates Foundation, and the Crown Prince of Abu Dhabi, along with Rotary International, UK, U.S., Australia, and EU among others, joined to renew their commitment to end polio forever. We saw new partners like the Islamic Development Bank join the fight against polio.

Q: What is the end game that will complete polio eradication and how can the IFRC help?

A: After decades of foreign aid, national investments and philanthropic giving that has produced an impressive record of results, we need a decisive win.

The GPEI’s Polio Eradication and Endgame Strategic Plan 2013–2018, launched earlier this year, sets out a clear framework to not only interrupt the transmission of wild poliovirus, but to introduce a dose of inactivated polio vaccine – or IPV – into routine immunisation programmes globally to simultaneously eliminate the risk vaccine-derived poliovirus.

IFRC reach spans the global to the local. With 187 National Societies, and nearly 100 million staff, volunteers and members, I believe every child can be reached by the Red Cross Red Crescent National Societies. Our volunteers speak the language, live in these communities, engage with community leaders. Our National Societies are trusted at the grassroots, everywhere.

Q: The GPEI Update of Partners’ Report describes you as one of the global influentials and you have been writing a lot about polio eradication. What about this issue compels you the most?

A: I have seen distraught mothers crying inconsolably after their children contracted polio. Many were paralysed and many died. It is really heartbreaking. I have also seen many young people who survived were crippled for life, helpless and their lives a living hell.

And for me, it’s personal: I survived polio and I was very lucky. In fact, many thousands of children in India contracted polio in the not-so-distant past and were forced into lives of infirmity and despondency because of poverty, ignorance, and poor access to health services.

I would certainly want to see this disease eradicated forever. This would be the greatest gift we can give to all children in the world.

Excerpt:

Anuary Saidi, who suffers from viral diarrhoea, with his mother Mariam. Credit: Kristin Palitza/IPS

By Kristin Palitza
DAR ES SALAAM, Dec 13 2012 (IPS)

Half asleep, Anuary lies exhausted on his bed in Amana Hospital in Dar es Salaam, Tanzania’s capital. His mother, Mariam Saidi, sits on the edge of his mattress, staring blankly out of the window. Every now and then, she turns to wipe her 18-month-old son’s forehead.

When she brought Anuary to the hospital the day before, he had a high fever, was suffering from viral diarrhoea, was severely dehydrated and had lost consciousness by the time he was admitted. The doctors saved his life, but he faces a slow discovery.

“Viral diarrhoea and respiratory infections are very common in children here,” hospital director Dr. Meshack Schimwela tells IPS. “Both illnesses are leading causes of death of children under the age of five in Tanzania.”

Anuary’s hospitalisation puts Saidi, a single mother who works as a hairdresser in the slum of Buguruni on the outskirts of Dar es Salaam, under severe economic strain. Each day that she spends next to her son’s bed is a day that she does not earn any money.

Already, she struggles to make ends meet with her meagre salary of four dollars a day, which, she says, affords her only one meal a day. “God knows how we will cope,” the 21-year-old tells IPS. “It’s very difficult.”

Anuary’s illness could have been easily prevented had he been immunised against the Rotavirus, which causes severe diarrhoea, commonly known as “stomach flu”. But the vaccine is currently not available through the public health system in this East African nation.

The situation is similar in many other countries on the continent. About 20 percent of Africa’s children – or every fifth child – are not immunised, according to the international children’s charity Save the Children.

“It’s always the poorest children who don’t get access to vaccination services,” says Kirsten Mathieson, health policy and research officer at Save the Children. “Much more needs to be done to reach the ‘fifth child’.”

In Tanzania, at least, this may soon change. Through co-financing from the GAVI Alliance – a global public-private partnership for vaccines and immunisation that negotiates lower vaccine prices for the world’s poorest countries – the government will be able to integrate Rotavirus as well as pneumococcal vaccines into its routine public immunisation programme from January 2013.

“Children in developing countries have an 18 percent higher chance of dying before their fifth birthday (than those living in developed countries). Vaccination could make a big difference,” GAVI deputy chief executive officer Helen Evans tells IPS.

Dr. Mtagi Kibatala, acting chief paediatrician at Amana Hospital, agrees: “A lot of the children in our paediatric wards would not be here had they access to Rotavirus and pneumococcal vaccines.”

Vaccinating all of the children in this country of over 885,000 square kilometres, almost four times the size of the United Kingdom, will take time. Reaching nomadic families and those living in remote rural areas or on small islands will be especially tough, Kibatala tells IPS. She expects it will take “at least a year” to see an improvement in child health and a decrease in mortality rates.

Another hurdle is Tanzania’s severe health worker shortage. About 40 percent of positions in the country’s public health facilities are vacant, according to the Ministry of Health. Without sufficient personnel, it will be difficult to provide health care to every child, Schimwela says.

The impact vaccines can have on children’s health “is very clear”, explains Schimwela. Tanzania has seen a steady decline in child mortality since it started offering vaccines through its public health system that protect against polio, tetanus, tuberculosis and diphtheria.

As a result, mortality of children under the age of five decreased from 155 per 1,000 live births in 1990 to 76 per 1,000 live births in 2010, according to the United Nations Children’s Fund.

Although the introduction of the Rotavirus vaccine will come too late for Anuary – children have to be younger than 15 weeks for it to be effective – thousands of Tanzania’s children will not only be able to lead healthier, but also happier, lives.

One of those children will be six-week-old Rosemary Julius.

Her mother, Janet Julius, patiently sits on a blue plastic chair in front of the Buguruni health clinic, fanning herself against the stifling December heat, Rosemary snug on her lap.

Rosemary is one of seven infants who were chosen by the clinic staff to receive dual Rotavirus and pneumococcal immunisation. Although the vaccines will officially only be available from next month, the health department decided to immunise a small group of babies in celebration of the launch of the new vaccines.

Julius, a 22-year-old housewife who was told about this opportunity during a post-natal check-up, says she is extremely happy that Rosemary will now be protected against pneumonia and viral diarrhoea. She tells IPS: “I have seen babies get very sick and die. The vaccine will help my child to grow up well.”

A child grimaces as he receives a measles vaccination at a school in Charsarda District in Pakistan's northwestern Khyber-Pakhtunkhwa Province in 2010. Credit: UN Photo/UNICEF/ZAK

By Lindsey Walker
UNITED NATIONS, Oct 9 2012 (IPS)

Pakistan, where some 126,000 children under five years old die from pneumonia every year, launched a new pneumococcal vaccine Tuesday, making it the first South Asian country to do so.

Pneumonia is the most common killer of children under five, and 99 percent of these deaths occur in developing countries, according to the World Health Organization (WHO).

Some 1.4 million children under the age of five die each year of pneumonia – more than child deaths by HIV/AIDS, tuburculosis, and malaria combined. And 550,000 of these deaths occur in South Asia alone, according to the United Nations children’s agency UNICEF.

The Global Alliance for Vaccines and Immunisation (GAVI), of which UNICEF and WHO are members, will bear 95 percent of the immunisation costs in order to bring the pneumococcal vaccine into Pakistan’s Expanded Progamme on Immunisation (EPI).

The EPI already includes several vaccinations, including those against polio, meningitis, and childhood tuberculosis, but has until now lacked the badly needed pneumococcal vaccine due to its considerable expense.

In an interview with IPS, Dr. Seth Berkley, CEO of the GAVI Alliance, said, “Historically, the delay between a vaccine being made available in the West and its availability in the east is 10, 15, (or possibly) 20 years.”

Pneumococcal, a vaccine that has been in existence for many years, is only recently conjugated into an inoculation safe for infants.

“When it came out of the West it was expensive,” Berkley said, “and the reason is that it is actually a collection of 10 or 13 vaccines (depending on which of the two products that are being used now) and it was a very complex, difficult to manufacture vaccine.”

The developing world was introduced to the vaccine only one and a half years after its introduction to the Western world, closing the usual gap by at least a decade. This is due to GAVI’s innovative Advance Market Commitment (AMC), an initiative that offered incentive to the vaccine manufacturers to produce large quantities of the pneumococcal at lower costs.

“AMC basically put out a programme to encourage manufacturers to make a vaccine that would contain the appropriate strains for the developing world,” said Berkley, “as well as having a better price point. That was the big innovation that occurred.”

AMC raised 1.5 billion dollars and offered a top up to the companies for the vaccines produced until the money ran dry. In this way, the price of each dose was reduced a staggering 90 percent from the price of each dose originally sold in the West.

In most countries, the poorest and most deprived children are likely to die before their fifth birthday.

“Coverage of key prevention should be higher among these children,” said UNICEF in a report published in early June of this year, “but too often the opposite occurs.”

In developing countries such as Pakistan, air and water pollution, overcrowding, and most importantly, lack of access to medical facilities all contribute to the enormous death toll by treatable and preventable illnesses.

The GAVI Alliance has called for “equity approach”. The concept is to treat children under the age of five in the lowest 20 percent of the economy in the same way as the top 20 percent of households are treated.

“Our long-term goal is to get it (the vaccination) to every child possible, especially because we know that the children who are stigmatised or who are in the poorer districts not only have higher incidence of disease because of living conditions, but also have less access to treatment,” Berkley told IPS.

He explained the strategy to accomplish this is to continue working with governments, NGOs and others to distribute the vaccine as widely as possible, despite the challenge of Pakistan’s wide gap between the rich and poor districts.

“It’s unlikely that the coverage in those places are as good as the places that have easy access,” said Berkley, “but on the other hand we don’t ignore them either. We try to do everything we can to get vaccines to them.”

GAVI’s financial support in the developing world comes in two parts: the financial backing to provide the vaccines themselves and the training needed to administer them, and the funding to improve the actual health system of the country in order to increase the functioning of the immunisation programmes.

Berkley explained that, in order for this these programmes to sustain themselves, there must be a visible price drop of vaccination costs, and the countries getting support from GAVI must begin to increase their payments as the economy improves.

Pakistan, for example, currently pays 20 cents per dose. Over time, as the economy begins to support itself, it will increase its payment to the full 3.50 dollars per dose, unless the price per dose has dropped by that time, as GAVI hopes and expects. AMC has already established that the price of each dose will not increase from 3.50 dollars.

“Above all, we must not lose sight of the heavy infant and child mortality burden facing Pakistan’s families,” said Dr. Guido Sabatinelli, WHO representative in Pakistan. “The introduction of the pneumococcal vaccine represents an important milestone in the fight to reduce this burden.”