Sania Nishtar, Gavi CEO: "If it weren't for vaccines, cemeteries would be full of children."

“I am very hopeful that the replenishment [of funds] will be a success,” said Sania Nishtar (Pakistan, 62 years old), executive director of Gavi, the Vaccine Alliance, in an interview with this newspaper in Hamburg, during the Sustainability Conference , held earlier this month. She refers to the fact that this Wednesday, June 25, the Global Summit on Health and Prosperity through Immunization will be held in Brussels, organized jointly by the European Union and the Gates Foundation, which seeks to raise at least $9 billion (€7.766 billion) to finance Gavi’s strategy for the period 2026-2030.

“I think this is a very important moment for global health leadership, and it's important that institutions like Gavi are replenished and fully funded,” adds its executive director.

The Alliance has already secured funding from various donors, including Portugal, which announced a contribution of €2.5 million , Croatia, with €1 million , and the Gates Foundation, which announced Tuesday that it will contribute $1.6 billion over the next five years. “We hope to count on Spain’s support. It has recently become a very important country for global health,” says Nishtar.

Question. The United States contributes about 13% of your budget. In March, The New York Times revealed that the organization you lead was on a list of funding cuts. Has there been any progress or clarification since then?

Answer: We haven't heard from the US administration and look forward to engaging with them. The United States is a very important country, and we've had a very good relationship in the past. We've worked very closely, including with the previous Trump administration, which supported Gavi and increased its funding. So we look forward to working with them again.

Q. In April, Gavi, UNICEF, and the World Health Organization (WHO) warned of the potential consequences of funding cuts to immunization programs. What will the impact be?

A. In response to these funding cuts , African countries in particular are increasing their commitment to domestic resource mobilization . The World Health Assembly week [held in late May in Switzerland] began with a session by the Africa Centers for Disease Control and Prevention (Africa CDC) on sustainable healthcare financing in Africa. Ghana, for example, had a funding gap due to donor withdrawals but committed to closing it, and Malawi has doubled its health spending. So countries are stepping up and taking responsibility, which is very positive.

Q. In Hamburg, there was talk about the current development aid model. Do we need a new one to ensure no one is left behind?

A. We are making profound changes to the way we work with countries, giving them more agency, more control over decision-making, and where they want to spend their money. We have published a document detailing this reform and presenting the principles on which international aid should be structured. In addition to the ideas I've just mentioned, we also emphasize the need for specific mandates and limited durations for international organizations.

Q. What examples do you know of countries in the Global South that are working to boost vaccination?

A. I recently visited Ghana, Senegal, and Sierra Leone. And last year I went to the Central African Republic, Nigeria, the Ivory Coast, and Uganda. All of these countries are leaders. I've seen it with my own eyes, and I'm only naming the ones I've been to. They take vaccination very seriously, allocating their own resources and sharing the vaccines.

If Africa has its own vaccine manufacturing capacity, it will not be dependent on doses from other parts of the world.

Q. Africa is home to 20% of the world's population, yet it produces only 0.1% of the vaccine supply. What measures should be taken to increase its production capacity and ensure it doesn't rely exclusively on external supplies?

A. During COVID-19, Africa was left behind; it didn't receive its fair share of doses; it was last in line. Learning from that, we launched the Africa Vaccine Manufacturing Accelerator (AVMA) . This is a response to the calls from African governments, heads of state, and health ministers. They want to be self-sufficient in vaccine production. They want to ensure vaccine sovereignty and that 60% of the continent's vaccine needs can be met by Africa itself by 2040.

Q. What does it consist of?

A. It's an innovative financial instrument, a subsidy mechanism for African manufacturers to make them more competitive, strengthen vaccine manufacturing on the continent, and provide an incentive for investors to invest in local production in Africa. We currently have $1.2 billion allocated for this purpose. First, if a vaccine manufacturer in Africa obtains WHO prequalification for one of the AVMA priority antigens, they are entitled to a subsidy. Subsequently, when they participate in our tenders and win, they are again entitled to a subsidy per dose. This is our contribution to the African dream of vaccine sovereignty. Of course, there are many other actors who must play their part. Governments must create an enabling environment, facilitate investment, grant tax exemptions, facilitate doing business, invest in human resources... Africa, as a continent, must also commit to purchasing from local manufacturers.

Q. You mentioned the pandemic and vaccine distribution. How can international cooperation be improved to prevent this from happening again?

A. The pandemic treaty establishes the rules of engagement ; it was negotiated by WHO member countries, and a certain level of consensus has been reached. It was approved last month, and there are still some issues that need to be resolved within the annex. So these are the rules of the game that will determine how doses will be distributed during an emergency. That said, Gavi has played an important role in creating the appropriate financial instruments. We talked about AVMA. If Africa has its own vaccine manufacturing capacity, it won't depend on doses from other parts of the world. We've also developed a First Response Fund. When an emergency occurs, we activate that fund, purchase doses as quickly as possible, and make them available to countries. With MPOX, we were able to secure doses three days after the vaccine received prequalification, and these were shipped to nine African countries.

People have questions and concerns, and it's important that we explain to them that vaccines are safe, highly regulated, rigorously tested, and save lives.

Q. The anti-vaccine movement has grown in recent years. Does this worry you?

A. In today's age of social media, conspiracy theories are unfortunately amplified. People have questions and concerns, and it's important that we explain to them that vaccines are safe , highly regulated, rigorously tested, and save lives . They are the most important and cost-effective public health tool. If it weren't for vaccines, cemeteries would be full of children. That's why I think we need to explain the truth to people to dispel misconceptions.

P. Gavi is turning 25. What are its main challenges?

A. There isn't a single program that, operating on such a large scale—we vaccinate more than half of the world's children—doesn't present challenges. But more than challenges, I see the magnitude of the opportunity. So yes, there are challenges, but the Gavi model is the right one to meet the challenges of this difficult environment.

Q. Why?

A. First, we have very low operating costs. We don't have 200 offices in different countries, or regional offices. We're adapted to a resource-constrained environment. Second, we have a co-pay model. We don't operate like a charity. Countries co-pay the cost of vaccines. They start by paying 20 cents per dose, and when the economic situation improves, their share of the co-pay increases, until they eventually stop receiving support and fully fund their vaccines. Ghana, for example, now pays 50% of the cost of vaccines. By 2030, it will pay 100% and will exit our support program. Nineteen countries have already opted out. It's exactly the kind of model needed in today's resource-constrained environment.

Q. One of the biggest challenges today is the rising number of children who haven't received any doses, the so-called "zero doses." What measures are you taking to reverse this trend?

A. We estimate that there are 14.5 million children without any doses in different parts of the world where access to vaccines is difficult. And, unfortunately, as fragility and conflict, as well as climate disasters, increase, this number is on the rise. That's why Gavi has a specific program for children without any doses. It's called the Zero Dose Immunization Program (ZIP), and it's tailored to these settings.