What are the main challenges facing Gavi?
I’ll give you two. The first is equitable uptake and coverage of vaccines. We’re working in the poorest and most difficult countries in the world and we have to try to reach everybody – so an efficient supply chain is vital. The percentage of children receiving a single vaccine dose in these countries is now close to 100 percent. The problem is, they need to receive multiple doses in order to be fully immunized. For example, we estimate that 86 percent of children get their third dose of the DPT vaccine (for diphtheria, whooping cough and tetanus). Which means 14 percent aren’t receiving it.
Secondly, there are now 66 million displaced people in the world – the highest number ever – because of war, environmental disasters and other factors. We have to find ways to supply vaccines to children in emergency situations and track them to ensure they become fully immunized and so able to realize their full potential.
How difficult is it to deliver vaccines to remote areas?
Getting vaccines from a national storage point out to the regions in a refrigerated truck is usually simple in most countries that have roads. The real challenge is then delivering them to remote areas or to those children who don’t live within a short distance of a clinic. Technology helps a lot here, so we’ve created a program called INFUSE – Innovation for Uptake, Scale and Equity – to find interesting tried-and-tested logistics technologies that have the potential to improve vaccine delivery. For example, we’re working with a drone-based system in Rwanda that’s primarily designed to carry blood – but we’re talking about the possibility of it carrying vaccines and antivenom for snake bites too. We’re using geographic information systems to find off-the-grid houses so that the children who live in them can be immunized. We’re working with companies that have supply chain monitoring capabilities, and want to get our vaccines barcoded. We’re protecting vaccines with cloud-based temperature monitors; and we’re working with DHL to increase efficiencies on the systems side.
What are the potential disease outbreaks that keep you awake at night?
As an infectious disease epidemiologist, I could have a lot of nightmares – although some outbreaks need to be kept in perspective. The world went hysterical about Ebola, for example, but the truth is that Ebola is not easily spread. On the other hand, flu can spread like wildfire and, as we know, the 1918-1920 Spanish flu killed around 50 million people. We will at some point get a strain of flu that is much more deadly – and the world isn’t prepared for it. The most important thing for avoiding global outbreaks is that we control infectious diseases in their home countries with immunization.
Are you optimistic that, at some point, vaccines will be available to all?
Yes, but I’m also a realist. The world’s population is estimated to grow from 7 to 11 billion by the end of the century. We’re overcrowded and we’re urbanizing, so more epidemics are inevitable. After Ebola, the world sat up and took notice – then attention dropped. The same happened with flu and the Zika virus. The challenge is to keep the world focused on the infectious disease problem. It’s not going away. — Tony Greenway