Women and Girls Hub: First, tell us a little bit about the global landscape for vaccinations today. How many kids are in need of vaccinations in the developing world?
Ngozi Okonjo-Iweala: Through Gavi, the Vaccine Alliance, we’ve immunized 500 million children and that has saved an estimated 7 million lives. We know that by 2020, we need to catch about 300 million more. Many of these will be the hardest to reach. These are the issues of access and equity in vaccines; we have to work really hard [to confront them]. Children in remote, rural areas are most affected, but we hope to reach them by 2020.
Women and Girls Hub: How much of this is due to a lack of education – in particular, mothers not knowing what they need to give their babies?
Ngozi Okonjo-Iweala: All studies have shown that when mothers are educated, when girls are educated, the chances of their children getting immunized and getting healthier rises significantly. So education is very, very important. Cultural norms that do not prevent women from taking their children to be vaccinated are very important. Even uneducated mothers, when they know about vaccines, will try, but sometimes they are prevented. I would say both cutting down those barriers that prevent women from accessing, as well as trying to educate them – both are important.
Women and Girls Hub: Gavi aims to marry the private and public sectors in order to increase the rate of vaccination. Tell us a little bit about what the approach entails.
Ngozi Okonjo-Iweala: Gavi is a unique and interesting public-private partnership. It’s an alliance that brings together countries that are donors and foundations such as Bill and Melinda Gates’. It brings together pharmaceutical companies. It brings together international organizations like UNICEF, the World Bank, WHO, etc. Including civil society to create an atmosphere in which it can work with some of these partners to reduce the cost of delivering vaccines to the poorest people.
For instance, you can have a vaccine, maybe like the HPV vaccine for girls that may even cost up to $100 a dose in developed countries. But by the time Gavi gets in and works with these companies, on what we call market making, it can bring the cost down significantly to something like $13 to $15. With further work and partnership with the companies and guaranteeing them a market, and volumes that they will need, it can even come down to something like $4 or $5. This is one way of working that brings these partners together to deliver these medicines and vaccines at low cost.
Women and Girls Hub: Are vaccines a women’s issue?
Ngozi Okonjo-Iweala: I don’t think it’s particularly a women’s issue, but I think that if you put women at the center of it, you’re likely to get better results for children. This is one of the reasons why it’s important to educate women because they’ll make sure their children are vaccinated and even educate the men so that they don’t prevent women from taking their children to access this. Also, we need to educate governments about the cost savings from supporting vaccination and immunization.
Lastly, there is also an important point I want to make. Vaccines are a private benefit to individuals and to families, a benefit to governments, but they’re also a global benefit. Vaccinations do the global public good in the sense that it matters to you in your country a thousand miles away that children somewhere else are vaccinated, because with pandemic outbreaks, anyone flying from one place to the other can carry that disease.
Women and Girls Hub: how has your experience as Nigeria’s finance minister helped you in this new role?
One of the things that Gavi is pushing to do is precisely to be able to explain to finance ministers, prime ministers and presidents what the benefits of immunization are. If it wasn’t clear before, let’s explain it in dollars and cents, in rates of return. One dollar spent on immunization saves you $16 in averted cost. They need somebody who can speak the same language to be able to help deliver this message.
Second, countries now have to assume more of the costs of their vaccination programs. Many countries are exiting the low-income class, getting into lower middle and middle income. Gavi’s rules are that they assume more of the cost of vaccinating their children. Again, we have to educate the finance ministers to get this into their budgets. This is one of the ways where my experience and training is helping.