3 questions to Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization

Interview with Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization

Focus 2030 : The World Health Organization (WHO) is a founding member of the Alliance and a permanent member of the Gavi Board. Could you detail the implication of WHO in Gavi and more broadly the role of WHO in access to vaccines around the world ?

Dr. Tedros Adhanom Ghebreyesus : WHO plays a critical role to deliver on the Alliance’s mission to save lives and protect health by increasing equitable and sustainable use of vaccines. The Gavi strategy is based on Immunization Agenda 2030 (IA2030), the decade-long vision and goals for immunization that every country endorsed at the World Health Assembly in 2020. Across each of Gavi’s strategic goals, WHO contributes leadership and technical expertise at the global, regional and country levels. WHO is the lead technical agency in the Alliance.

WHO has played a key role in expanding access to immunization for 50 years, through the Expanded Programme on Immunization (EPI), though which every country has developed and implemented a national immunization programme with universally-recommend safe and effective vaccines. When EPI was launched in 1974, fewer than 5% of the world’s children were vaccinated. Today that number stands at 84%.

WHO’s vaccine prequalification service is the stamp of approval for safety and efficacy on which Gavi relies for the vaccines it buys. As a result, more people are reached with quality vaccines because immunization programme managers can plan, select and buy appropriate products for their national immunization schedules. But our work doesn’t stop there. Even when vaccines are prequalified, we regularly re-evaluate, test and investigate any product complaints or adverse events following immunization so that countries and communities have the confidence that vaccines are safe and effective.

WHO also establishes global immunization strategies and policies to drive national, regional and global immunization coverage and work towards eliminating or eradicating vaccine-preventable diseases. For example, in 2022, more than 14 million children did not receive a single dose of vaccine. Working together with Alliance partners under IA2030, WHO is working with our Member States to halve that number by 2030. Likewise, global disease elimination strategies developed and implemented by WHO, such as the Defeating meningitis by 2030 global road map and the Eliminate yellow fever epidemics (EYE) strategy, aim to control, eliminate and eradicate vaccine-preventable diseases.

WHO also plays an important role in research and innovation, by assessing, prioritizing and monitoring the development and licensure of high-impact vaccines and immunization delivery innovations. Our TB Vaccine Accelerator Council is one such example. The Council will facilitate the licensing and use of new TB vaccines, by aligning funders, agencies, governments and end users in identifying and overcoming barriers to TB vaccine development.

Vaccine pricing plays a huge role in supply, equitable access and decision-making at both the national and global level. Through programmes like our Market Information for Access Initiative (MI4A) we regularly analyze and report on global vaccine market dynamics in order to enhance access to vaccines, especially for countries that benefit from limited international support. Initiatives like MI4A are one area where we help countries and partners identify needs, risks and opportunities to assure sustainable vaccine supply and financing.

Focus 2030 : WHO recently released a study published in the Lancet concluding that immunization efforts over the past 50 years have saved an estimated 154 million lives. What drove this progress, according to WHO ?

Dr. Tedros Adhanom Ghebreyesus : Vaccines are among the most powerful inventions in history. According to the recent WHO-led study published in the Lancet, we found that in the past 50 years immunization was the single greatest contribution of any health intervention to ensuring babies not only see their first birthdays but continue leading healthy lives into adulthood. Thanks to vaccines, smallpox has been eradicated, polio is on the brink, and many once-feared diseases can now be easily prevented, including measles, cervical cancer, yellow fever, pneumonia and diarrhoea. And, with the recent development of vaccines against diseases like malaria, we expect millions more lives to be saved in the future.

What started as a global vision 50 years ago for vaccinating all children against diphtheria, measles, pertussis, polio, tetanus, and tuberculosis, as well as smallpox, has turned into a life-saving programme reaching beyond children to adolescents and adults.

Today, thanks to these efforts, every country has a well-established immunization programme, often with support from WHO, UNICEF, and our partners. Additionally, through a unique public-private partnership between WHO, Rotary International, the US Centers for Disease Control and Prevention, the Gates Foundation and Gavi, the Vaccine Alliance, the world stands on the brink of eradicating polio.

The creation of Gavi, the Vaccine Alliance, added another dimension to EPI’s success by providing international support to lower-income countries to enable the broader introduction of a range of new vaccines. Over the past 50 years, we have witnessed the development and introduction of new and under-utilized vaccines targeting diseases like pneumococcal infections, rotavirus, HPV, meningitis A, Japanese encephalitis and malaria – further contributing to even more lives saved in the most vulnerable parts of the world.

However, our greatest partners are health workers around the world. Vaccines do not deliver themselves. They require the dedication of trained health and care workers to reach the most remote locations, and it is through their efforts that 84% of infants globally are vaccinated, up from just 5% when we founded EPI.

Finally, innovations through EPI, such as injection safety practices, creation of the cold chain, and solar power integration in health facilities, have extended the reach and impact of immunization programmes to benefit other health programmes, including in responding to health crises.

Today, there are vaccines to protect against more than 30 life-threatening diseases. With continued partnership, research, and investment, we can save millions more lives in the next 50 years, and beyond.

Focus 2030 : The Sustainable Development Goals (SDGs), including SDG3 related to access to health, are to be met by 2030. Yet, current estimates indicate that the world is off track on the SDGs. What key interventions would be needed to accelerate progress ?

Dr. Tedros Adhanom Ghebreyesus : In the first five years of the SDG era, we saw improvements in life-expectancy and maternal, adolescent and child health, but the pandemic stalled or rolled back much of this progress. In immunization, disrupted health services during the pandemic meant an estimated 49 million children never received a single vaccine dose, resulting in outbreaks of preventable diseases, such as measles.

Despite these setbacks, the world has made some progress on the SDGs and WHO’s “Triple Billion” targets to promote, provide and protect the health of the world’s people. By 2025, an estimated 1.5 billion people are expected to be enjoying better health and well-being, meeting our target to promote health. An estimated 585 million more people will be covered by essential health services without catastrophic health spending by 2025 – a little over halfway towards our target to provide health. And, despite conflicts, outbreaks and climate-related disasters increasing, an estimated 777 million people will be better protected from health emergencies by 2025, three-quarters of the way to our target to protect health.

Yet, we know the world has dramatically changed since the adoption of the SDGs, and we are facing key mega trends including climate change, ageing, migration, evolving geopolitics, and advancing science and technology. Persistent gender inequality and discrimination, as well as threats to health in the conditions in which people are born, grow, work, live and age continue to have greater influence on health and well-being than access to health services.

There are many key interventions on promoting, providing and protecting health, including ensuring each one is aligned to country priorities and plans.

First, we need to work across sectors to address the root causes of ill health and to tackle key barriers to equity.

If health systems are not climate-resilient and climate-friendly, they will not be to provide immunization. Likewise, if health services in countries exclude populations, such as migrants and refugees, will continue to have gaps in immunization coverage.

Second, strengthening primary health care to deliver essential health services for all is critical. Today, 2 billion people face financial hardship due to out-of-pocket health spending, and half the world’s population is not fully covered by essential health services, meaning they may not have access to vaccines that can protect them throughout the life course.

Third, when families access primary health care there must be medicines, medical products and life-saving vaccines available at a price countries and people can afford. At WHO, we estimate in the next four years, at least 4.5 million lives could be saved through vaccination, however, hundreds of millions of vaccines need to be funded for low-income countries and purchased through our key partners like Gavi, the Vaccine Alliance to support these efforts.

Fourth, we continue to need research and development for new medicines, vaccines and diagnostics, and to diversify manufacturing of these new products to progress towards the SDGs and to tackle persistent challenges like malaria and tuberculosis.

Finally, the SDGs cannot be met unless we protect the world from health emergencies, including through maintaining and reinforcing country capacities for surveillance, detection and response that we built during the pandemic.

NB : The opinions expressed in this interview do not necessarily reflect the ideas of Focus 2030.