Is today's world better or worse than in the past? We feel the progress of science and technology, the convenience of life, but also the alienation of technology, the fragmentation of values, the increasing proportion of people no longer have to worry about food and clothing (but 1 in 10 people in the world still live in extreme poverty!), it seems more difficult to achieve happiness and joy.
We can continue to debate this question until we start thinking about how many children will not live to be 15 years old, one of the greatest tragedies facing human society. The world is much better today than it used to be: by the end of the 19th century, half of the world's children would die before they reached adulthood. Today, that figure is 4.4 percent. This means that in the past 100 years, countless families have no longer had to bear the most heart-wrenching loss in the world, and their children have not had to die prematurely to experience and create the beauty of the world.
Most of this "miracle" life-saving achievement needs to be attributed to an inconspicuous "small object" - the development and popularization of vaccines.
Eradicate a disease, there is only one time
Smallpox, one of the most deadly infectious diseases in history, was an estimated 300 million deaths worldwide in the 20th century alone. They could be anyone's children, friends, who, despite being loved by those around them, are living in pain: covered in rashes, confused and frightened, not understanding why this is happening to them and not knowing what they can do about it. Before the advent of vaccines, nothing could be done for them: humanity was not strong enough to have enough knowledge to fight back against an invisible "monster". From the Peloponnesian War to the American Civil War, the smallpox virus has killed more soldiers and civilians than any weapon or army during its time of existence.
The trumpet of mankind to fight back against smallpox began to sound in 1796. Dr. Edward Jenner invented the liquid from the blisters on the skin of a girl who was suffering from cowpox and administered it to an 8-year-old boy – the first vaccine in history was born. Then, thanks to the sustained efforts of scientists, doctors, politicians, and social workers, in 1980, the World Health Organization announced that the smallpox virus had been eradicated for the first time. This disease, which once killed 500 million people around the world, has become history through the long-term efforts of human beings across the world.
However, it took us nearly 200 years from the birth of the smallpox vaccine to the complete eradication of smallpox. During this time, thousands of people died every day from smallpox.
This "delay" is not a special case.
The challenges are similar when it comes to eliminating other infectious diseases that threaten children's lives. The development of a vaccine is only the first step in a long march to save lives, and the more important work is the popularization of vaccines, that is, mass vaccination. Most people will only be safe if the vast majority of the world's population is vaccinated. In order to form such herd immunity, vaccination rates need to reach at least a minimum, which varies from disease to disease, but generally does not fall below 70%.
In other words, the real difficulty in eradicating smallpox, or other similar infectious diseases, is how to overcome the constraints of distance, health care, wealth disparity, conflict and insecurity, and lack of funds on a global scale, so that all those who need them can be vaccinated in a timely manner.
This is often highly dependent on governments to implement free and mandatory childhood immunization programmes. However, for less developed countries with a high lack of economic strength, transportation and medical infrastructure, this task is too daunting.
Smallpox can be eradicated, even after 200 years, and it is still commendable. After all, to date, we have never eliminated a second human infectious disease. Vaccines against viruses such as hepatitis B, measles, diphtheria, and polio (polio) have long been available, but these diseases are still killing tens of thousands of children every year decades later.
The turnaround occurred at the turn of the century. At that time, the global inequitable distribution of vaccines was at its peak, with some 30 million children without access to life-saving vaccines.
On the demand side, they live in more than 80 of the world's poorest countries, and these governments lack the financial resources to procure vaccines, provide the cold chain needed to transport them, and train the nurses and epidemic prevention personnel needed to administer them. In a country where even basic water and electricity are not guaranteed, it is unthinkable to find all the children and vaccinate them (even several times).
On the supply side, vaccine companies have little incentive to expand their capacity because low-income countries cannot afford to pay, resulting in insufficient vaccine supply, and sometimes companies are unprofitable to invest in developing vaccines for diseases that are prevalent in these least developed countries. As a result, the only reasonable business model for companies is low production capacity and high prices, which makes the price of vaccines that really need to be widely available remain high.
Focus on fair innovation, reverse the impossible
This dilemma has stung Gates, the world's richest man, who is just beginning to think about how to do philanthropy. In 2000, he donated $750 million to join forces with the World Health Organization, UNICEF, and the World Bank to form a new nonprofit, Gavi, the Vaccine Alliance. Gavi's mission is simple: to make life-saving vaccines equally accessible to all people around the world, no matter where he was born or where he lives.
Since declaring war on the issue of "inequitable vaccine distribution" more than two decades ago, Gavi has promoted immunization programs in dozens of countries, helped more than 1 billion children in underdeveloped countries access routine immunization, averted 17.3 million child deaths, and created more than $220 billion in socioeconomic value.
Behind Gavi's success is a series of imaginative and groundbreaking innovations that have made such a big impact on such difficult issues. In Gavi's view, the core of the tragedy of global vaccine inequity is the failure of the vaccine market and the mismatch between supply and demand. Philanthropy can catalyze big changes by innovating market mechanisms.
Since each of the 80 countries has a weak ability to pay, the first step is for Gavi to consolidate the vaccine demand in the poorest countries and create economies of scale, thus providing companies with a predictable and large demand for vaccines to stimulate vaccine development and supply. In other words, companies no longer have to face uncertain, weak demand in a single market, but can negotiate with only one reputable buyer with large purchase volumes, dilute costs, and accept the "high capacity, low price" model.
In addition to expanding production capacity, Gavi's Advance Market Commitments (AMCs) can also provide companies with a binding purchase contract during the R&D phase, incentivizing companies to accelerate the R&D process and reduce their innovation risks. Rapid development of vaccines that are critical to the lives of children in low-income countries, such as the Streptococcus pneumoniae vaccine and the Ebola vaccine, has benefited from this mechanism. The man behind the fastest vaccine in human history – the coronavirus vaccine – is also behind the AMC.
Having greatly motivated the business, Gavi did not let it go and surrendered to "capital".
Since Gavi procures vaccines on behalf of dozens of countries, it is a buyer with strong bargaining power, which means it can significantly drive down the price of vaccines. The price drops have been staggering at times: at Gavi, the total purchase price of seven routine immunization vaccines has dropped from around $1,000 to around $27. This has greatly eased the extremely tight pressure on public health budgets in less developed countries.
Not only that, through communication with the United Nations and the World Health Organization, Gavi has set up a "graduation" mechanism, proposing that when the recipient country exceeds the World Bank's low-income country level for three consecutive years, Gavi will reduce the percentage of vaccine aid payment (about 15%) year by year, until this country "graduates" from Gavi funding and transforms into a country that can fully pay for the procurement of vaccines by itself. Such a mechanism could reduce the health burden of recipient countries at an early stage and reverse the over-reliance on international aid that prevails in less developed countries at a later stage.
What's more, goodwill sometimes spirals: in 2010, China "graduated" from Gavi's hepatitis B vaccine aid program, and in 2015 officially became a donor to Gavi. To date, China has donated $25 million to support Gavi in bringing life-saving vaccines to children around the world. With the continuous development of the economy and society, more Gavi "recipient countries" will be turned into "donor countries" in the future, and continue to inject strength into the cause of global health equity.
In addition to market problems, Gavi will also use its own resource advantages to incubate various technological innovations to help recipient countries solve the problem of vaccine delivery and delivery. From refrigerators that can refrigerate vaccines for a month without plugging in, to drones that can quickly deliver vaccines over mountains and mountains, the wisdom of human society is unmatched in the determination and passion to save lives – and as long as we remain mindful of the enormous needs of those most neglected, change is still possible.
Protection, every life is equally important
Even today, the global child mortality rate has fallen to 4.4 per cent, which means that millions of children still die every year from vaccine-preventable diseases, the vast majority of them vulnerable children from underdeveloped regions who are unvaccinated.
The world has always been unfair – the country with the highest child mortality rate in the world is Niger in West Africa, where about 14% of children die prematurely. In the European Union, the region with the lowest child mortality rate in the world, the proportion is 0.47 per cent.
This huge chasm shows us that the world is better today than it was in the past, but it is still far from perfect, and that if critical life-saving tools like vaccines are developed, produced, and distributed more equitably, millions of children each year who should be alive can actually live and create a better future.
In the success story of the Gavi model, we can not only see why "fairness" is closely related to the lives of millions of people, but also deeply feel:
"The death of one person is a tragedy, and the death of a million people (by no means a number) is a million tragedy. ”
In such an era of anxiety and loss, we can all do more to realize that behind every sad and tragic number is a fresh life, and to pursue more impactful and altruistic efforts to reach more people.
Resources:
1. https://www.gavi.org/vaccineswork/how-many-lives-do-vaccines-save
2. https://futureoflife.org/future-of-life-award-2020/
3. https://scholar.harvard.edu/files/manela/files/pox-chinese.pdf
4. https://ourworldindata.org/much-better-awful-can-be-better
5. https://blog.jaibot.com/500-million-but-not-a-single-one-more/
6. https://www.gavi.org/investing-gavi/funding/donor-profiles/china
7. https://www.gavi.org/our-impact/evaluation-studies/gavi-government-china-hepatitis-b
Author: Li Zhilin
Co-founder & CEO of CharityBox, he leads the team to find the best donation opportunities in China and explore the science and philosophy behind philanthropy and philanthropy. He graduated from the University of Hong Kong with a degree in Political Science and Economics and is a big fan of indie rock.