The United Nations Sustainable Development Goals were created as a roadmap for the world to follow in order to succesfully end extreme poverty by 2030. While many of the goals are somewhat related, it is Global Goal 3 on good health and well-being for all that is the easiest to connect to the others, as good health is needed in order to achieve most of the other goals.

So when Gavi, the Vaccine Alliance was created in 2000, it planned to bring together public and private sectors under the shared goal of increasing access to new and underused vaccines for children living in the world’s poorest countries. And it's been quite successful — Gavi has immunized over 760 million children and saved more than 13 million lives, working all over the world, including in hard-to-reach areas in countries like Yemen, Syria, and North Korea.

But in order to continue its vital work towards the achievement of Global Goal 3, Gavi needs funding commitments from countries across the globe.

Ahead of Gavi's next replenishment conference, which will take place in June 2020 in London, Global Citizen sat down with Gavi's CEO Seth Berkley during the World Health Summit in Berlin to talk vaccine hesitancy, the Global Goals, and gender equality.

The number of people in Germany — and in other parts of the world — who are skeptical about vaccines is rising. What do you want to tell those people?

We live in a world where people are becoming more nationalist and not multi-nationalist. People need to understand that we are all connected. Diseases don’t respect borders, mosquitoes don’t respect borders. These are moving all the time. And the young generation wants to travel – they want to be connected with the world. But this is a risk for basically everyone, everywhere, if we don’t take vaccinations seriously.

And what would you tell parents who are concerned about vaccinating their kids? 

Kids are made to play on the ground. The immune system is like a muscle — the more you exercise it, the stronger it gets. Kids are made to crawl on the ground and eat stuff, that’s what they should be doing. Our immune system is able to handle thousands of pathogens. 

Beside that, vaccines are the most cost-effective prevention. For every dollar you invest in vaccines, you get $54 in return. There is nothing like that in health. So if you look at it this way, you should invest in vaccines — and you have to educate parents about the importance of vaccines.

Vaccine hesitancy seems to be one of the greatest challenges in health in developed countries. How is the situation in developing countries?

There are obviously places where you don’t get vaccines. But in most places in the world, vaccines are available. So this is not the issue. The challenge is that not everybody is taking them. Therefore, it is crucial that people understand the value of vaccines. 

In general, stigma against vaccines hasn’t been a huge problem in poor countries because they see the diseases, they see people dying. This just became an issue recently when social media became more widely used and people spread rumors — that is what we have seen in Nigeria and India, for instance. This is really problematic. This is why we — and the health workers — have to talk to the village elders and religious leaders, because the communities have trust in them. 

Which families and areas are the hardest to reach?

We have seen great progress over the last 20 years. But we weren’t able to reach all children everywhere… we call them zero dose or underimmunized children. 

Two-thirds of these children live below the poverty line. If you don’t get vaccinated, you are more likely to get sick, if you get sick there is no treatment, if an epidemic starts, there are usually no health workers available — so these are really the hotspots. These children often live in urban slums in big cities and it’s difficult to track them and their families and to provide vaccines in these areas. 

The same is true for migrants and refugees, children in war zones, and also some religious minorities. These kids are hard to reach, and that’s why we need to focus on them.

Some countries do better than others when it comes to immunization coverage rates. What is the reason for this? 

Funnily enough, you would think immunization coverage is in general higher in developed countries than in developing countries, which is not true. Rwanda, for instance, has the highest immunization coverage when it comes to the human papillomavirus (HPV) vaccine, that protects from cervical cancer. This might be a special case, but it clearly shows what it is possible in developing countries if politicians make vaccines and health care a priority.

Many health care issues are interlinked with gender. Is this also true when it comes to vaccines?

Absolutely. Sometimes it’s about really practical things. In some areas, clinics are only open during the day when the mothers have to work. If there are night-time clinics, you often have to worry about their — the mothers — safety. So we are working on [ways to make sure] women will be comfortable enough to go there. The situations differ from one region to another. That’s why Gavi encourages the countries to do more research around this. We provide money to do surveys, interventions and trainings, and experimenting with new options to reduce and eventually overcome the barriers. 

What kind of commitment would you like to see from the German government?

In the wake of the Ebola outbreak in West Africa in 2015, the German federal government has significantly strengthened its commitment to the Vaccine Alliance during its G7 presidency. Germany hosted Gavi's successful financing conference in January 2015 and chancellor Merkel pledged 600 million euros for our work 2016-2020.

Great to meet @GlblCtznDe’s Jana Sepehr & @ONEDeutschland Youth Ambassador Amina Hikari Fall to discuss civil society’s role in making #vaccineswork Looking forward to further strengthing our partnership. pic.twitter.com/LkRZxTI2Bf

— Seth Berkley (@GaviSeth) October 29, 2019

By the end of 2018, we have supported countries to vaccinate 760 million more children and thus protect 13 million lives in the long term.  Our goal is now to vaccinate another 300 million children in developing countries between 2021 and 2025, saving 8 million lives. To deliver on this plan will require at least US $ 7.4 billion, in addition to the US $2 billion we expect to have already available, and we have called on donors to back these ambitions.

We hope that Germany will continue to champion global health and strengthen its commitment to the Vaccine Alliance in the coming period. In concrete terms, we hope that Germany will increase its support to 700 million euros.

Why are vaccinations so important in the context of achieving the Global Goals by 2030? 

Immunization plays a critical role in achieving the third goal, global health and well-being, but also all the other Global Goals. You obviously cannot have a strong economy if you are not healthy. You cannot end extreme poverty if you are not healthy. The social sectors, food, health education, security are all interlinked — and health is one of the most important. And when you think about efficient investments in health, prevention is much better than treatment.

If you have a rational system, you get vaccines out to a 100% of the population, and you prevent many diseases. But of course, the system is not rational and people value treatment more than prevention. So they use their next dollar to buy medicine and spend it on treatment. That’s why education is everything.