Dear HAI:

I am very pleased that HAI's interests now include vaccines. I have been involved with immunization programmes in Africa and Asia since 1980, and, before then, Smallpox. The HAI-Lights March 2001 article by Anita Hardon, "Immunisation for All?" well describes the misleading and continuing international agenda for immunization, which is time limited initiatives like GAVI promoting technology and donor funding as the only solution for improving health and survival in the poor countries.

Another question to ask about GAVI is, how does this time limited funding contribute to promoting better programme management and sustainability of immunisation services? Incredibly, the global agenda for health gets narrower each decade. First UCI, which down graded PHC to only immunization; then polio eradication, which established a vertical initiative within a vertical programme; and now GAVI, which promotes only selected vaccines, supplies of which are not yet guaranteed to accommodate all countries needs, as well as GAVI's funds. While at least with UCI one knew with whom to communicate (UNICEF), and there were staff in country (UNICEF Project Officers) to help direct the effort, GAVI offers no efficient communication network or structure for immunisation programme managers and MOH's to make inquiries, for effective monitoring on the use of the funds, or for technical support.

While working on one recent assignment, I found that no one on the country's coordinating committee for immunization, including WHO and UNICEF representatives, had a clear understanding of GAVI or the process for obtaining funds. No one in the MOH or the coordinating committee knew who would fund the Hepatitis B and HIB vaccines after 4 or 5 years when the GAVI funding supposedly ends. I would guess that they all hope that GAVI funds will continue for another 5 years.

With corporate donors now directing the agenda for immunization services, we should ask them: Can you establish a solid business when the product is completely dependent on an external, time limited investment, and when the business strategy is designed without asking those in the business, in this case the MOH's, what is needed? Is it wise to begin marketing new products when the marketing and management systems are not yet sufficient to optimize profits on the original products?

Mark Weeks

McLean, Virginia USA

3 April 2001

[The author currently works with John Snow Inc. (JSI) on a USAID funded project, BASICS, based in Washington DC, as a technical officer for immunization. His views and comments to HAI, were prepared during his own time.]