4.2 PANDEMICS
It’s time to leap to a new global health architecture
Sania Nishtar, chief executive officer, Gavi, the Vaccine Alliance
S ome of the topics on today’s health agendas may seem familiar, but the tone and tenor of the debate are different from those in years past. That difference reflects a simple but sobering fact: day by day, the foundations of global health are shifting beneath our feet. Collectively, as stakeholders in global health, we face a moment of reckoning. Our global health architecture has helped us eradicate smallpox, halve childhood mortality and deliver so many other health gains. But the way this architecture has grown over the past decade – unplanned, often in response to crises – has given rise to fragmentation, duplication and, at times, unhealthy competition. Amidst new geopolitical realities and an unprecedented retrenchment in funding, what had become perennial conversations about how to reform our global health architecture – in ways that allow us to protect and build on the gains secured to date – have taken on an urgent and existential quality. All this comes at a time of unprecedented and growing fragility in countries that are at the sharp end of escalating and intertwined threats to health: conflict, climate change, and the increasing and dynamic threat posed by infectious diseases, including pandemic threats. This is the reality that confronts us all today. That same reality that confronted me in 2024, when I took the helm at Gavi, the Vaccine Alliance. It was clear to me then, as it is clear to all of us now, that for Gavi to succeed in its next five-year period, we needed to embrace bold and transformative change. REDEFINING THE GLOBAL HEALTH ARCHITECTURE Gavi, like all global health institutions, faces formidable challenges. In addition to preparing for the next five years and delivering the replenishment required to fund the execution of that five-year strategy,
As the foundations of global health shift, the time has come to lead with purpose. Bold reform and country-first principles can help shape a more coherent global health future
These principles, I humbly believe, not only will guide Gavi to success over the next five years, but can also help to guide the orderly and urgent reform needed to create a more effective, more inclusive and more coherent global health architecture. First, and most fundamental, the Gavi Leap is founded on the principle of country-centricity. We have distilled the spirit of the Lusaka Agenda into concrete steps to reform every process, from grant windows and management cycles to technical support, monitoring and evaluation. We do this to ensure that we are aligned with the priorities of countries at the same time as reducing the bureaucratic burdens and opportunity costs that we place on them. Everything that Gavi does, and every one of the reforms we have
Gavi has also needed to put in place structural and cultural changes if it is to continue to operate impactfully in a rapidly changing world. And that is a world in which funding will be increasingly scarce – for countries, for Gavi and for our partners. We, as Gavi and as global health stakeholders, need to embrace new opportunities: from the promise of new technologies to deliver efficiency and strengthen vaccine delivery, and the strong and growing commitment to immunisation by national governments in the countries that Gavi supports, to the promise of new vaccines themselves. Thus the Gavi Leap was born: a comprehensive programme of change that over the past 12 months has transformed the Gavi secretariat according to four core principles.
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Health: A Political Choice – The Future of Health in a Fractured World
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