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Innovationare revealing previously unrecognized populations at risk andtherefore significantly increased the demand for the vaccine –something that usefully allows supply market stability, betterforecasting and production scale-up, with benefits to bothproducers and purchasers. The result: a marked reduction inthe size and frequency of yellow fever outbreaks in Africa inthe immediate future and increased availability of vaccinewhere most needed.IFFIm has also contributed strongly to the work on thereduction of measles deaths globally. Again on the principleof early, robust action, US$ 139 million of IFFIm supportwent to the Measles Initiative in February 2007. Nearly 240million children will have been immunized against measles insupplementary campaigns in 2007. This is a very successfulinitiative, which has already seen a reduction in globalmeasles deaths from 480 000 in 2003, to an estimated170 000 in 2010. The vaccination campaigns do more thansave lives from measles; they also provide the opportunity forinsecticide-treated nets that protect against malaria to bedistributed, and other aspects of child health to be targeted,with de-worming tablets and vitamin A supplements.In each of these areas, in protecting and fostering healthychildren, IFFIm is contributing in valuable ways to building upthe bedrock of a healthy economy.IFFIm’s origins and its special context go back to the late1990s, when G8 governments looked back at the past 50years of giving, and recognized that what was needed was amore focused purpose. This resulted in the MillenniumDevelopment Goals. At the same time, Bill & Melinda Gateswere searching for a focus for their philanthropy. One of theanswers was immunization – and a new model for moreefficient delivery. Their initial US$ 750 million dollars giftfounded that model in 2000 – the GAVI Alliance. Six yearslater, that proven concept provided the match IFFIm neededfor the prompt execution of its funds. The Gates’ “demandingdollar” in many ways was the trigger for others, like GordonBrown, then UK Chancellor of the Exchequer, to pay closeattention to how to get better value for aid and to lead theinternational support for this new funding facility.On the face of it, IFFIm investors are rational investors,responding to an impressive offer – a triple-A-rated bondoffering a good return. The bonds were priced comparably toother sovereign/supranational issuers, and the initial offer waswell over-subscribed with almost US$ 2 billion of demand.The defining difference – that which sets it apart from theothers – is IFFIm’s goal. It is not just an investment end inHealth extension worker 18-year–old Ajebush Wakalto (right)prepares to vaccinate young Brucktayet Teshome (far left, in hermother’s arms) at the local health post in Timbicho, Ethiopia. She,and 30 000 others like her in the programme, form the centrepieceof the health component of the country’s poverty reductionstrategy, bringing a range of health advice to local communitiesand providing essential basic preventive care, such asimmunization.itself. It has a greater purpose: one that allows bond investorsto give directly to the frontier of health care, one that hasinspired individuals and companies to work pro bono to bringthis idea to fruition. It makes a profound difference.The bonds were subscribed for not only by the traditionaltypes of investors such as central banks, pension funds,money managers, and insurance companies, but also, in areflection of its fundamental humanitarian purpose, byindividuals such as His Holiness Pope Benedict XVI.It is the hope and the intent of all of us who are associatedwith this new instrument that it will make the necessaryimpact. July 2007 was the mid-point in the MDG timeframe.It is generally acknowledged that progress towards the healthrelatedgoals is too slow and too little. Initiatives like theInternational Finance Facility for Immunization and the GAVIAlliance are two strong allies in the efforts to speed upprogress, confronting and offering solutions to the corechallenge of inequitable access. ❏Alan R Gillespie CBE, is Chairman of the International FinanceFacility for Immunization (IFFIm) and also Chairman of The UlsterBank Group, a subsidiary of the Royal Bank of Scotland plc.Following a 25-year career in investment banking with Citibank andGoldman Sachs & Co., he has been engaged in public service asChairman of the Northern Ireland Industrial Development Boardand as Chief Executive of the UK’s Commonwealth DevelopmentCorporation. He is a graduate of the University of Cambridge wherehe took his BA, MA and PhD degrees.References1.IFFIm’s sponsor governments include France, Italy, Norway, South Africa,Spain, Sweden and the United Kingdom. Brazil has announced itsintention to join. IFFIm issues triple-A rated bonds with a financial baseconsisting of long-term (10–20 years) legally binding commitments fromsovereign donors. The borrowings and risk are handled under prudentfinancial policies, with the World Bank acting as Treasury Manager.Goldman Sachs acted as Financial Advisor in establishing IFFIm andDeutsche Bank and Goldman Sachs lead-managed the inaugural bondissue.2.The GAVI Alliance was created in 2000 as a public-private partnershipaccelerating delivery of life-saving immunization to the world’s poorestchildren. The Alliance includes a wide range of development partners,developing country and donor governments, WHO, UNICEF, the Bill &Melinda Gates Foundation, the vaccine industry, research and technicalagencies, public health institutions, nongovernmental organizations andthe GAVI Fund (the resource and funding arm of GAVI).3.GAVI’s “country-specific” programmes include the provision ofimmunization safety equipment such as single-use syringes and disposalboxes, as well as the provision of new and underused vaccines such asthose against hepatitis B, yellow fever, rotavirus and pneumococcaldisease.4.WHO projections.098 ✜ Global Forum Update on Research for Health Volume 4
InnovationBeing healthy:the role of researchArticle by Andrew Y KituaLiving a healthy life is the ultimate common desire ofhuman beings and is what has driven individuals andcommunities to search for medicines and other healthremedies. Improvements in health research methodologieshave helped us to test beliefs, myths and theories for theirvalidity and reliability, which has led to the generation of newknowledge and in turn to new or improved tools. As a resultof better research and innovation, we have accumulated vastknowledge about the determinants of disease and ill health,prevention measures and cures of diseases. Our medicinesand health interventions are unquestionably better and saferthan they were 50 years ago. It is indeed scientific researchthat has continuously transformed or revolutionized the waywe live and has been a key determinant of the rate ofmodernization and human development.Access to and utilization of the new knowledge and theresultant new or improved tools has not been equal amongthe countries that form our global community. Becausetechnology has greatly influenced economic power, countrieswith greater technological advancement and greater researchcapacity have conspicuously better health status thancountries in transition towards acquiring technology and withweaker research capacities. There is vast heterogeneity ofhealth status today between continents, countries and evenwithin countries. Whether measured by life expectancy atbirth, infant and child mortality, maternal mortality,malnutrition, or disease patterns, the health status of acountry’s population reflects the status of its technologicaland economical advancements, which in turn reflect itscapacity to effectively access and use new knowledge andtools for human development.Risks for ill healthHealth research has greatly advanced our knowledge of riskfactors for diseases and ill health. Health risk as a measure ofthe probability that an adverse event for health will occurfollowing exposure to a certain factor has been used tomeasure the health status of individuals and communities. Itis well known that although there are no individuals orcommunities devoid of health risks, and risk factors arewidely distributed globally, there are global differentials in thelevel or position of individuals and populations on the riskscale for a particular factor 1,2,3 , along the divide of developingand developed countries.The pattern of morbidity and mortality differs remarkablyamong countries at different levels of technological andeconomic status, such that low-income countries, or leastdeveloped countries, bear higher mortality from preventableconditions, while high-income countries bear the burden ofhigher consumption and lifestyle risks 2 .Risks of dying at different age categories from birth, and thecauses of such risks, differ greatly among low-, middle- andhigh-income countries. In low-income countries, the majorityof deaths occur at very young ages, before reaching age five.Once individuals have avoided death at this level, they arealmost assured to survive the adolescent period between fiveand twenty years, where the risk of dying is lowest. With thecurrent levels of spread of HIV/AIDS, the previously most fitand productive age between 15 and 45 years has nowbecome highly risky. Mortality in this age group has increasedremarkably, bringing down previous gains in life expectancy.In contrast, the majority of deaths occur after the age of 60years in high-income countries 3 .In low- and middle-income countries, the main risk factorsfor death are: underweight, resulting mainly from malnutritionand infections; unsafe sex; unsafe water; poor sanitation andhygiene; and smoke from solid fuel 3 . Most of these areavoidable due to availability of knowledge and effective toolsto prevent them. Recent studies have shown that 87% ofmortality occurring in children below the age of five in lowandmiddle-income countries is avoidable 4 . In the samecategory of countries, 63% of males and 84% of femalesaged 5–29 years die of avoidable factors. The higherproportion of deaths among females is due to avoidablepregnancy-related and child birth-related causes. Avoidabledeaths due to communicable diseases account for 90% of allmortality in all sex and age classes, excluding middle-agedmen in whom their contribution is 80%.In high-income countries, mortality is mostly at old age.The relatively few deaths that occur in younger life areconcentrated in the neonatal period and are mainly due tocongenital malformations. Mortality risk factors are mainlytobacco use, high blood pressure, obesity and alcoholconsumption. Road traffic accidents have a significantcontribution, and this trend is also increasing in middleincomecountries 1 .The picture is reflective of the power of knowledgeownership and capacity to both generate and utilize available100 ✜ Global Forum Update on Research for Health Volume 4
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Contents096 Child immunization: acc
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IntroductionResearch contributions
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IntroductionType IType IIType IIIPr
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Introductionmaking), takes account
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Access to healthStrengthening healt
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Access to healthTraining more healt
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Access to healthimperative for acti
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Access to healthReferences1.Further
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Access to healthDeterminantsAvailab
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Access to healthThe authors are inv
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Access to healthCombining health an
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Access to health100%Availability of
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Access to healthhypothesis that an
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Access to healthMandatory clinical
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Access to healthWhile there are som
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Decision-makingReferences1.Hawes H.
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