- Iceland has given €1 million to Malawi’s immunisation programme through GAVI
- Norway has helped Poland develop a vaccination website
- Denmark backed Lithuania’s vaccination programme in the early 1990s
- Finland has offered public health support to Estonia
- The UK helped Albania develop immunisation and disease surveillance systems
- Canada provides support for vaccination in Ukraine
In the early 1990s, several formerly communist European countries were in crisis. The Soviet Union had collapsed, the Berlin Wall had fallen and a new era was dawning. Within 15 years, several of these nations would join an expanded European Union.
However, change is never easy. In the early post-Soviet years between 1990 and 1995, some countries saw declines in GDP as large as 40% – significantly worse than the 27% decline suffered by the US during the Great Depression of the early 1930s. Public spending on health, education and infrastructure was cut, threatening important initiatives – including immunization programmes.
This could have unravelled entire preventative health systems as funding for medical emergencies and acute illnesses was, perhaps understandably, prioritised. For scientists and doctors, this was a potential catastrophe. Childhood vaccination rates were generally high in post-Soviet states but – as recent outbreaks illustrate – a few years of low vaccine uptake can open the door to diseases once thought to be on the verge elimination.
However, health professionals and researchers, as well as politicians and civil society, had links with European neighbours. The case for helping a neighbour’s health system, particularly in disease prevention, was a strong one.
Professor Vytautas Usonis, Head of the Children’s Diseases Clinic at Vilnius University in Lithuania, recalls how near neighbours stepped in to bridge the gaps as countries struggled through a deep economic crisis. ‘Denmark supported our immunization programme in the early 1990s,’ he told a workshop hosted by the Coalition for Life-Course Immunisation at the Excellence in Paediatrics conference in Prague. ‘This is still greatly appreciated. Other countries developed similar arrangements at that time.’
The Danish-Lithuania solidarity story is not unique. Finland worked with Estonia as it modernised its public health system. Norway continues to partner with Poland, funding the Szczepienia website through a grant to the Polish National Institute of Public Health – the site (like Vaccines Today) is a member of the WHO Vaccine Safety Net network of websites.
This Norway-Poland collaboration and support also helped the Polish institute to launch a communication campaign aimed at health professionals, use Facebook to react to vaccine safety signals, and fund research comparing the two countries’ vaccination programmes.
Community immunity
Some of this local solidarity may be explained by the fact that contagious disease outbreaks tend to travel across borders. An epidemic in one corner of Europe can quickly spill over into other countries – especially in an era of accessible air travel.
Measles spreads rapidly when vaccination rates are low, so a collapse in vaccination rates is a community concern.
However, vaccine programme solidarity is about more than protecting your own house by investing in the local neighbourhood. Many of the most striking examples of solidarity are between countries thousands of miles apart.
On a global level, GAVI has helped to formalise support for immunisation on a grand scale. Created in 2000, is brings together public and private sectors with the shared goal of creating equal access to vaccines in the world’s poorest countries. (See more about GAVI’s stunning results)
One of the most remarkable examples this year was the announcement that Iceland had pledged US$1 million over three years to protect children in Malawi from some of the world’s deadliest diseases. To put that in context, Malawi has 18 million people – Iceland has just 300,000.
However, as the two countries are at different stages of development, the people of Iceland have made a history gesture that will help to continue progress in Malawi where immunisation coverage has increased from just 64% in 2002 to 88% in 2018. Under-five mortality has dropped by almost two thirds over the same period.
‘With Gavi’s support Malawi has made incredible progress over the past 18 years: now almost nine in every ten children receive basic vaccines,’ said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. ‘Iceland’s help will now be crucial to help us reach that tenth child, as well as continue to expand access to newer vaccines, including major killers of women like cervical cancer as well as the two largest killers of children: pneumonia and diarrhoea.’
Guðlaugur Þór Þórðarson, Iceland´s Minister for Foreign Affairs, said his country had developed strong links with the people of Malawi over several decades. ‘For 30 years Iceland has provided support to Malawi, including in the area of public health. The new agreement with Gavi is in line with the special focus we have placed on reducing maternal and child mortality, contributing to the remarkable drop in infant mortality in Malawi.’
Technical support
Many developed countries have signed up to twinning projects with developing countries, supporting the implementation of international health regulations as well as basic immunisation programmes. Norway, for example, supports Moldova and Palestine. The German government supports the central Asian countries including Tadjikistan and Uzbekistan. The UK and France also support several African countries with which they have historical links.
The Ukraine has received financial and technical assistance from EU countries and support for its polio vaccine programme from Canada. Russia has helped several of its neighbours to tackled measles and rubella elimination.
It doesn’t end there. The WHO supports collaboration between National Immunization Technical Advisory Groups (NITAGs), including twinning initiatives that foster exchanges of expertise. The International Association of Immunization Managers (IAIM), hosted by the Sabin Vaccine Institute with support from the Bill & Melinda Gates Foundation, supports training and networking for key staff working in vaccination programmes.
All of this tells us that vaccination programmes matter. Even countries in a state of political crisis or at low levels of development prioritise immunisation. And, whether with the support of neighbours or well-developed countries further afield, immunisation systems are widely considered too important to fail.
