Three questions to Dr Sania Nishtar, Chief Executive Officer of Gavi, the Vaccine Alliance

Three questions to Dr Sania Nishtar, Chief Executive Officer of Gavi, the Vaccine Alliance

Focus 2030 : Nutrition and immunization are closely linked, as shown by a recent joint research between Gavi and the Eleanor Crook Foundation. Could you indicate why addressing both simultaneously can be considered as a potential game-changer for global health?

Dr Sania Nishtar : As minister for social protection in my home country of Pakistan, I instituted a nationwide conditional cash transfer programme called Ehsaas Nashonuma which combined health and nutrition interventions for children from poor families. Through this programme I saw firsthand the impact that could be created on the ground through taking a holistic approach to immunisation and nutrition.

Malnutrition weakens immune systems, making children more vulnerable to infections, while infectious diseases further deplete nutritional reserves, perpetuating a cycle of poor health. Addressing immunisation and nutrition together is not just an opportunity—it is a necessity.

A growing body of evidence highlights the physiological interactions between malnutrition and infectious diseases. Malnourished children are less responsive to vaccines as their immune systems struggle to mount an effective response. Conversely, immunization prevents infections that exacerbate malnutrition, such as diarrheal diseases and measles. This interplay underscores why integrating these interventions can be a game-changer in global health. By ensuring that a child is well-nourished, we are also strengthening the impact of vaccines, giving every child a better chance to survive and thrive.

There is clearly a strong link between the delivery of immunisation and nutrition programmes on the ground. Frontline health workers frequently deliver both services together, leveraging the same community platforms, supply chains, and touchpoints.

What we are looking to do now is to ensure efficient delivery of services, systematic documentation and scaling of these efforts. Gavi, with support from the Gavi Matching Fund and alongside partners such as the Eleanor Crook Foundation, the Aga Khan Foundation, the Child Nutrition Fund, and the Children’s Investment Fund Foundation, is working to build the evidence base for integrated immunisation and nutrition programmes, demonstrating the operational efficiencies, cost savings, and most importantly, the improved health outcomes this approach can bring.

By using routine immunisation visits as opportunities to screen and treat malnutrition, we can maximize every interaction a child has with the health system. Similarly, nutrition programs can serve as entry points for immunization catch-up efforts, ensuring that no child is left behind especially in the hardest to reach geographies. This integration not only optimizes resources but also strengthens primary healthcare (PHC) systems, making them more resilient and responsive to the needs of communities.

The journey to build evidence for this approach is well underway. Research commissioned by Gavi and the Eleanor Crook Foundation highlights the potential of integrated programming to enhance both vaccine efficacy and nutritional outcomes. Reports such as Results UK’s Bridging the Gap further reinforce how breaking down silos can drive impact at scale. And Gavi is co-funding alongside partners a growing portfolio of projects, pilots and models to confirm the hypothesis that co-delivery reaches more zero-dose children than if EPI services (Expanded Programme on Immunization) were delivered alone.

As we look ahead to our next strategic cycle with a focus on PHC integration, Gavi and our partners are committed to unlocking the full potential of immunisation by aligning it with complementary health interventions, particularly nutrition. Together, we can accelerate progress towards a world where every child, no matter where they are born, is protected against disease and has the foundation for a healthy future. This is not just smart programming—it is an imperative for global health equity.

Focus 2030 : Could you please detail initiatives Gavi is currently supporting that integrate the link between nutrition and immunization to improve overall health outcomes? What are the impacts observed in the field and the remaining challenges that would need to be considered?

Dr Sania Nishtar : At Gavi, we recognise that integrating immunisation and nutrition is critical to improving child health. By addressing these challenges holistically, we maximize impact. One of the funding levers which Gavi has used for integrating nutrition and immunisation has been through the Gavi Matching Fund, generously supported by the Bill & Melinda Gates Foundation (BMGF), the UK’s Foreign, Commonwealth & Development Office (FCDO), and the Government of the Netherlands. This in turn has been instrumental in attracting philanthropic funding and fostering multi-sectoral partnerships to advance health systems integrated programmes.

In Nigeria, the $2 million Nutrivax initiative, co-funded with the Eleanor Crook Foundation (ECF), is generating evidence on how nutrition services can drive vaccine demand and uptake. By identifying gaps and opportunities, we aim to optimise the way immunisation and nutrition services are delivered together.

In Indonesia, Gavi, Unilever Lifebuoy, and The Power of Nutrition have joined forces to reach over one million children under five, integrating immunisation, nutrition education, and handwashing programs with a highly innovative digital campaign bringing all three sectors under one umbrella messaging around family health.

In Ethiopia, Gavi, the Child Nutrition Fund and the Children’s Investment Fund Foundation (CIFF) have committed $30 million to reach 100,000 zero-dose children through the co-delivery of nutrition and immunisation beyond routine programming. Integration is also happening in humanitarian settings as we have witnessed through the REACH programme implemented by IRC.

Early results are promising. In Ethiopia, we have reached over 55,000 zero-dose children and are on track to reach the “100,000 target” by end of the year, particularly in pastoralist and nomadic communities, where any touchpoint, whether from social workers, self-help groups or midwives, is a moment to deliver life-saving services. However, challenges remain. Health system silos, fragmented financing, and limited joint data analysis with a child-centred approach hinders effective documentation and efficient referrals to avoid relapses and incomplete immunisation. Many frontline health workers already deliver both immunisation and nutrition services, yet these efforts require stronger data integration, policy alignment and sustained funding to be systematically integrated.

Under Gavi 6.0, our Primary Health Care (PHC) integration framework will drive co-service delivery across multiple sectors, including nutrition, based on country needs. Collaborating and joining forces with nutrition platforms is one of the levers with which Gavi is reaching the hardest to reach populations to ensure there are no missed opportunities.

By 2030 Gavi will facilitate 1.4 billion individual contact points between families and health services. This will require integrating immunisation more deeply into primary healthcare – working tirelessly alongside new and existing partners in new ways to strengthen health systems, reach more women and zero dose children in the spirit of the Lusaka Agenda.

Focus 2030 : Gavi’s next replenishment will occur on the same year as the Nutrition for Growth Summit, which will take place on March 27 and 28 in Paris. How can these two major fundraising events be connected to address both the critical issues of nutrition and immunisation, and maximize their success ?

Dr Sania Nishtar : We are attending the summit to engage with diverse partners, learn about best practices from our implementing countries, and understand the innovative approaches used by private sector and partners in tackling malnutrition. This learning process is essential for Gavi to inform its own programmes, given we all are attempted to serve the vulnerable populations, especially children, in the best and most meaningful way possible.

Gavi’s presence at the summit is also an opportunity to contribute to the conversation on how to build efficiencies and improve financing for PHC, which is crucial for achieving the global nutrition targets. By focusing on synergies between nutrition and health financing, Gavi aims to ensure that available resources are used effectively to make meaningful progress towards ending malnutrition.

The summit offers a platform for Gavi to collaborate with other commitment makers, share experiences, and jointly address barriers to integrating nutrition into health policies and programs.

This type of collaboration among global health partners is more important than ever. The interconnected challenges of malnutrition, undernutrition, and poor health demand a unified, cross- sectoral approach to address their multiple causes and impacts. The more partners can coordinate their efforts, the greater the impact they will have. By working together, Gavi and its partners can create comprehensive, sustainable solutions that ensure no child is left behind in the fight against malnutrition.

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