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The GAVI children's challenge

Statement by Carol Bellamy, Executive Director of the United Nations Children's Fund on the launch of the GAVI children's challenge

Davos, Switzerland, 31 January 2000

Dr. Brundtland, President Chissano, Mr. Wolfensohn, Mr. Gates, Mr. Gilmartin, Ladies and Gentlemen:

We are here today to proclaim a renewed crusade against an old and implacable enemy -- the scourge of preventable disease.

Presently, immunization efforts in developing countries are aimed at six garden-variety diseases, including diphtheria, tuberculosis, pertussis, measles, and tetanus.

The sixth, polio, once struck thousands of children a day. But now, thanks to a global effort, this number is down to just 30 a day -- and the complete eradication of polio is within sight.

Yet the other five diseases continue to kill over 1.6 million unimmunized children each and every year, the overwhelming majority of them in the world's poorest and most strife-torn regions.

This means that every minute, somewhere in the world, three children die of these vaccine-preventable diseases.

Ladies and gentlemen, these are needless deaths. They are needless because the vaccines necessary to prevent the six most common childhood diseases have been available for many years at remarkably low cost -- and we know exactly how they can be delivered to all young children.

But the yearly deaths of these 1.6 million children -- and the incalculable loss of human potential they represent -- are more than needless.

They are economically ruinous -- and, on the most fundamental human level, they are legally, morally and ethically unacceptable.

They are unacceptable, ladies and gentlemen, not only because these deaths are within our means to prevent, but because the children of the world -- especially those suffering the effects of grinding poverty and economic crisis and armed strife -- have a right to a better future, beginning with the right to survival.

Ladies and gentlemen, that includes every child's right to be immunized against the major diseases that can be easily prevented.

Over the last decade, 191 countries -- virtually the entire community of nations -- have affirmed their responsibility to uphold and protect children's rights to survival, to protection, and to full development and participation.

This global commitment is why the Convention on the Rights of the Child is the most embraced and celebrated human rights instrument in history.

Indeed, the movement that gave the world the Child Rights Convention has helped bring about the greatest advances in child immunization ever achieved -- successes literally unimaginable two decades ago, when just 5 per cent of infants in developing countries were immunized against the six major vaccine-preventable diseases.

The drive for Universal Child Immunization (UCI) that UNICEF, WHO and other international partners began in 1986 elevated global immunization rates for the six diseases to 80 percent by the early 1990s.

It was a stunning achievement, made possible by the dedication and hard work of many organizations and many individuals, who tackled such seemingly insoluble problems as how to immunize children in countries without adequate health facilities; how to keep heat-sensitive vaccines cool in countries without refrigeration equipment or electricity -- and how to promote universal immunization amid widespread illiteracy.

Ladies and gentlemen, UNICEF and its partners are here today because we have a historic opportunity to go further, and make the most effective vaccines against preventable disease available to every single child.

Vaccines for the six diseases were introduced to most developing countries more than two decades ago.

Since then, new and more effective vaccines have been available in the industrialized world, including vaccines against Hepatitis B, a major cause of liver cancer, which kills mothers and fathers in the very prime of their lives -- and Hib, a major cause of meningitis and pneumonia deaths in children in developing countries.

Ladies and gentlemen, if we could reach all children in the developing world with the Hepatitis B and Hib vaccines, along with the other six, we could prevent an additional 1.3 million deaths per year, bringing the total number of deaths prevented to some 3 million a year. That is six young lives saved every minute.

Indeed, the near-eradication of polio demonstrates that it is possible to reach virtually all children -- and this effort offers some powerful pointers for the future.

In 118 countries, National Immunization Days have been carried out -- events in which the whole of civil society, not just health workers, have been mobilised around joint action to improve child health.

The results have been dramatic. In many of the poorest countries, where only 40 per cent or less of children have been immunized against measles, over 98 per cent of children have been reached through National Immunization Days with polio vaccine.

Ideally, child immunization is best provided as part of a strong routine child health service -- and this should be the goal of every country. But in many of the poorest countries of the world, a fully functioning health system may be years away -- and so alternative ways of reaching children with effective immunization services, supported by the whole community, must be supported today.

But despite such measures, some of the most impoverished countries of sub-Saharan Africa and South Asia have struggled to maintain immunization at the same levels that were achieved in the last decade.

Indeed, there have been serious setbacks in some regions, triggered by such disasters as armed conflict, the shrinking economies of many sub-Saharan African countries, the HIV/AIDS pandemic's effects on health workers and health systems, and decentralization so rapid that the critical central functions necessary to ensure good immunization programmes have faltered.

The result is that, today, at the gateway of the 21st Century, there are scores of countries where immunization rates against the six diseases have fallen off to less than 50 per cent -- which translates into some 30 million unprotected children.

Ladies and gentlemen, this situation need not be.

For immunizing all children is a goal that we can achieve -- and achieve at very modest cost. And now is the most opportune moment to act -- and to re-generate the global momentum that helped make past successes possible.

We must act now because we have innovative new tools that will make easier to immunize all children, including the hardest to reach.

For example, the vaccine-vial monitor, which changes colour when a vaccine vial has been exposed to damaging heat, can markedly reduce the cost of refrigeration equipment, and allow vaccines to be used with confidence in remote locales.

We have auto-disposable syringes, which reduce the need for cumbersome sterilisation equipment and make immunization injections safer.

And we have new and improved vaccines, including those that can immunize children against five diseases at once.

Moreover, the additional vaccines now under development could save the lives of up to 8 million additional children a year in coming years, hopefully from malaria and even HIV/AIDS.

We must act now because we have a "backlog" of newer vaccines that have already been used effectively in the industrialised world, but which have not yet been introduced into routine immunization programmes in developing countries because they have always been considered too expensive.

We need to demonstrate that ways can be found to make these highly effective vaccines available to children who need them -- and to stimulate the research and development community, as well as the pharmaceutical industry, to put additional efforts into developing additional new vaccines, including those that will offer protection against malaria and HIV/AIDS.

We must act now because we now have a much better understanding that immunization is one of a range of highly effective, low-cost health interventions that can dramatically reduce child deaths in countries that still have high mortality rates among young children.

This includes the fact that nutritional status is as important as immunization in reducing child deaths and disability -- and that, indeed, the benefits of immunization are optimised when children are well nourished.

We must act now because we have a range of exciting new communications tools -- including the Internet, the potential of global digital satellite radio broadcasts, and low-cost video cameras and recorders, to name just a few -- innovations that can help in promoting and expanding immunization services.

And we must act now because the world is coming to understand more clearly than ever that investing in immunization and other measures to promote child survival and development is at once a human rights imperative -- and a powerful weapon against poverty and underdevelopment.

That is why we have come together in the Global Alliance for Vaccines and Immunizations (GAVI), a coalition dedicated to ensuing that all the world's children are immunized, using every effective vaccine available.

GAVI is a coalition of business leaders, philanthropic foundations, development banks and national governments, including the Rockefeller Foundation, the International Federation of Pharmaceutical Manufacturers Associations, and developing and donor country governments -- as well as WHO, the pre-eminent health agency, which has had a long and productive partnership with UNICEF; the World Bank, which is the largest official development assistance funder in health; and UNICEF, which is specifically mandated to advocate for the protection of children's rights, to help meet their basic needs as well as to develop to their full potential.

UNICEF is deeply committed to this alliance -- and we are grateful to Bill and Melinda Gates for the moral vision that led them to establish the Global Fund for Children's Vaccines, which will, for the first time, enable the poorest children in the poorest countries of the world to start to benefit from the exciting new vaccines that are becoming available.

In that connection, we applaud the initiative of the Government of the United States of America, which was introduced by President Clinton last week.

UNICEF spends $100 million annually to support government efforts to immunize children in 161 developing countries -- and to boost efforts this year, UNICEF is making an additional $10 million available to support countries that are in special need of help.

However, even more financial support is needed if the full potential of immunization is to benefit all children.

UNICEF sincerely hopes that other major donors will step forward with additional funds -- and join with us in striving to reach the ambitious but feasible goals that the members of the GAVI Alliance have established.

Fatima Saide is just one of the people we can help. She is a 38-year-old mother of six who lives in a remote village in the Kilombero district of the East African nation of Tanzania.

As a child, she was never vaccinated, and nearly died in a measles outbreak that killed 20 other villagers -- two of them her siblings.

Today, thanks to the tireless efforts of Tanzanian health care workers, who regularly trek for hours to reach families in outlying villages like Fatima's, she understands why vaccinating her own children is a priority -- one that compares with her daily workload of farming, cooking, cleaning, and fetching water and firewood.

Not long ago, Fatima had to walk for four hours to get her youngest child vaccinated. Now it is only a one-hour walk to the nearest community health clinic -- and all of Fatima's children have been immunized against measles and other illnesses.

But they are chronically afflicted with malaria -- a disease that nearly killed her 4-year-old just a few weeks ago. And Fatima is terrified by the threat of AIDS, which recently killed her cousin and the cousin's husband. They left eight young children behind.

Ladies and gentlemen, helping the Fatimas of the world is what the Children's Challenge is all about -- and that is the challenge that we bring to Davos today.

Thank you.