Last week’s announcement of the Minamata Convention on Mercury represents a huge step forward in international efforts to reduce the human health impacts of mercury. For GAVI what is most important about the global and legally-binding treaty is what was left out. The treaty made an exception for thiomersal, a mercury-based preservative that has been used in some vaccine manufacturing since the 1930s to prevent bacterial or fungal contamination of multi-dose vials of vaccine.
The treaty exception represents a triumph of science over the politics of fear. The anti-vaccination lobby pressed hard to have thiomersal – known as thimerosal in the US – included in the treaty despite the scientific evidence that thiomersal poses no human health risk. Indeed, banning it would have disrupted vaccination programs in many developing countries, putting millions of children at risk from vaccine-preventable illness.
The anti-vaccine lobby has been successful in raising fears and doubts about the adverse effects of vaccination and the role of thiomersal in increases in developmental disorders and autism. With parents, scientists and even initially the American Academy of Pediatrics (AAP) weighing in, the United States implemented a precautionary reduction more than a decade ago. There is now a mountain of scientific evidence refuting any link between thiomersal and autism, and AAP reversed their 1999 position that called for elimination of mercury in vaccines. GAVI and AAP share a belief that scientific evidence should guide public policy, and the evidence on thiomersal is clear. It is a safe preservative used in multi-dose vaccines, and at this time there is no replacement for it. Good science and a good global policy.
At GAVI our goal is to reach the world’s poorest children with life-saving vaccines, and while we are pressing for innovations in vaccine delivery systems, the realities of the current cold chain and storage capacities in developing nations make multi-dose vaccines containing thiomersal a necessity. Without it the number of children receiving vaccines in in 120 countries, mostly in the developing world, would plummet. The World Health Organization estimates that thiomersal-containing vaccines avert at least 1.4 million child deaths every year by protecting children from fatal diseases, such as diphtheria, tetanus, and hepatitis B (1). By using multi-dose vaccines, we can reach more children, and we can save more lives.
It is encouraging to see that the treaty negotiators used good science to inform this important global policy. We need to build public confidence in vaccine safety, and reach the 22 million children who currently lack access to vaccines. As a doctor, an epidemiologist and a father, I know that childhood vaccination is a fundamental building block of health, and it gives me confidence to see that the treaty negotiators recognised that as well.
(1) The Lancet, Volume 379, Issue 9834, Page 2328, 23 June 2012
As CEO of the GAVI Alliance, I am coming to Davos to talk about the challenges and opportunities of public-private partnerships, with an emphasis on innovative financing. The World Economic Forum Annual Meeting is the perfect place for a dialogue that brings together industry, civil society, UN agencies and countries around a shared response to the challenge of protecting children against vaccine preventable illness. In 2000, the Forum acted as midwife to the birth of GAVI and since then we have supported collaboration with a singular focus: giving children in developing countries the same protection from vaccines that children in developed countries receive.
In an increasingly complex world, we have a simple and bold vision that all children should have the opportunity to grow up healthy. The Annual Meeting 2013 theme of Dynamic Resilience challenges participants to move beyond simple solutions to strategic collaboration and new methods to create a more just and sustainable future for all.
This week, Forum participants will have the opportunity to consider global challenges, including the Millennium Development Goals. In the past, global goals have tended to be oriented around diseases as a proxy for immunization rates. I believe that the global community should now move to the idea of a “Fully Immunized Child”, which means measuring how many children have received all of the vaccines recommended by the Word Health Organization for global use that they need to keep them safe.
The pathway to a more sustainable future for all children must include access to the basic building blocks of good health, including nutrition, water and immunizations. To achieve this goal, business, governments and civil society will need to work together and find new and innovative ways to deliver vaccines equitably to all children and to measure that delivery. At GAVI, we take measurement seriously. It is the only way that we will ultimately help each country deliver on the goal of equity between and within countries.
Since 2000, in collaboration with our business, government, UN and civil society partners (many of whom are participants at the World Economic Forum), GAVI has helped to prevent more than 5.5 million deaths in the world’s poorest countries, and committed US$ 7.2 billion to new and underused vaccines and to strengthening health systems. We have added new vaccines that target the two largest killers of children – pneumonia and diarrhoea – and are now rolling out our second vaccine against HPV, which causes cervical cancer and kills 275,000 women a year. Yet, we estimate that 22 million children still lack access to vaccines, so we have our work cut out for us.
At Davos, I will be co-hosting a breakfast with Bill Gates to announce funding and partnerships made possible through the GAVI Matching Fund. The Fund is an innovative finance mechanism that matches contributions from companies, foundations, their customers, employees and business partners. The Fund also provides a setting for innovations in collaboration and the delivery of technical expertise to our shared mission of increasing access to vaccines for all children.
I have a passion and a sense of urgency about our mission because I know that vaccines offer an incredible return on investment, and that a vaccine dividend can be measured in lives improved and lives saved.
Last week GAVI convened a group of experts to examine the evidence on the value of vaccines. We knew that vaccines prevent sickness and death. But there’s also great evidence that being vaccinated helps people in many ways throughout their lives – building their health and their resilience. Children who are healthy – and have adequate nutrition – are much more likely to attend school. People who finish school, and do well, have higher earning potential in their adult lives. GAVI’s hope is that these healthy young people will enter the workforce and build the vibrant global economy of the future.
I am optimistic about the future because the evidence is clear about the economic impact of immunization. If parents don’t have to spend money on their children’s healthcare, they can use it for other purposes. If they don’t need to spend the money on health, they can spend or invest the money, which leads to economic growth in local communities and the country more broadly.
Healthy children are resilient children, and immunization is a fundamental building block for health. And the power of vaccines means that we can also target not only acute infectious diseases but also chronic infections that create chronic disease burdens that are so difficult to manage. At GAVI, we are committed to collaboration and partnership – working with business, governments, the UN and civil society to see more and more of the world’s children (and adults) fully immunized, wherever they live.
This blog post also appears on forumblog.org.
Government representatives are meeting in Geneva this week to decide whether to introduce a global ban on mercury that could include thiomersal, a mercury-based preservative that has been used in some vaccine manufacturing since the 1930s to prevent bacterial or fungal contamination of multidose vials of vaccine….
Despite the ominous connotations of mercury, the decision should, in theory, be a no-brainer: The scientific and medical consensus is that thiomersal poses no human health risk, and that rather than saving lives, a ban would put millions of the world’s poorest children at risk of deadly diseases by disrupting vaccination programs.