My attendance last week at events surrounding the 69th meeting of the UN General Assembly highlighted for me the need for a global commitment to innovating health systems, particularly those in the developing world.
In particular, the UN special session on the Ebola crisis – which has severely impacted several partner countries of Gavi, the Vaccine Alliance – stressed the magnitude of health systems in combating infectious disease outbreaks. When there is a strong health infrastructure with sufficient power, clean water, nursing care, nutritious food and space to keep patients in isolation when necessary, outbreaks can be managed quickly and effectively. Without such an infrastructure, millions of people are in danger.
When there is a strong health infrastructure with sufficient power, clean water, nursing care, nutritious food and space to keep patients in isolation when necessary, outbreaks can be managed quickly and effectively.
Gavi has invested more than US$ 50 million to strengthen health systems for people in countries affected by the outbreak, but the unfilled needs remain enormous. Gavi stands ready to respond to their requests to reprogramme funding to help them respond to the outbreak.
A number of Vaccine Alliance partners are deeply engaged in the response to Ebola, and Gavi - with its expertise in shaping vaccine markets, track record in rapidly scaling up access to vaccines, and experience in innovative financing - is examining how it can work with them to help accelerate the availability of an Ebola vaccine.
But for now, the Ebola crisis is having a destructive effect on health systems, with resources stretched to the limit. How do we get from here to there? Innovation in the way we provide health care in the developing world already is giving us a head start, but much more needs to be done. For example:
* New vaccines: This is the most visible form of innovation. Gavi, for example, has been instrumental in helping introduce into routine use new vaccines against the two largest killers of children under age 5: pneumonia and deadly diarrhoea. The pneumococcal vaccine, for example, is projected to avert 1.5 million deaths by 2020. In the case of Ebola, manufacturers, research institutions and global health institutions are now dramatically accelerating efforts to create and approve such a vaccine.
* Medical devices: The creation of a new vaccine does not mean that it can quickly be used, especially in countries with poor infrastructures. Vaccines must be kept within a narrow temperature range, making them difficult to transport in remote, hot areas with spotty transportation. I have seen time and again remarkable efforts to ensure children have these vaccines – people walking miles, through rivers and over mountains, with cold boxes on their backs. We can do better. The Bill & Melinda Gates Foundation, for instance, is helping fund a portable cooler that can keep vaccines cool, without power, for up to 90 days.
* Medical applications: Even the successful delivery of vaccines to remote areas is not enough. Parents need to know when to bring in their children to be immunised, health workers need to know that there are sufficient stocks, and the entire system is dependent on having accurate, up-to-date health records. Gavi is working with the private sector to test whether mobile health technology used in remote areas can increase immunisation coverage, reduce drop-out rates and improve vaccine stock management.
* Medical technology: In the case of diseases for which there is no vaccine – not just Ebola, but also HIV, for example – there are other innovations that are helping reduce their spread. The Clinton Health Access Initiative (CHAI), for example, is working with UNICEF, supported by UNITAID, to accelerate the scale up of HIV point-of-care diagnostics in developing countries. They are using a portable machine that has dramatically increased antiretroviral therapy initiation compared with conventional approaches – another example of using innovation to save lives.
Some global health challenges can seem insurmountable. Innovations are the key to changing the system for the better. The global community needs to encourage more initiatives like these, including Gavi’s work to improve vaccine implementation and strengthen health systems. They are examples that I hope will inspire us to do more.