enacted through the Leap, stems from a ‘country-first’ mindset. This in turn gives rise to the further three Leap principles of supporting national self-reliance, focused mandates and finite lifespans. A COUNTRY-CENTRIC APPROACH The implications of these principles for a reformed global health architecture are clear. Institutions can only be truly country-centric if they are designed to empower and enable all countries to assume full responsibility for health programmes, including immunisation, within a strong and resilient national health system. Achieving this requires a fundamental shift in mindset and in practice. Our point of reference as global health institutions should be centred in the communities we serve. A young mother from a remote community in a low-income country who comes to the primary healthcare facility could have her needs and priorities met through the combined and coordinated efforts of the various international organisations with a presence in her country, with services
integrated at the point of delivery. This would be good for her, good for national resilience and good for international organisations, which would be freed up to concentrate on what they do best: generating global public good and maximising the beneficial impact of the substantial investments we make collectively each year. Success in this endeavour will depend on the political will of national governments, and also on building consensus among international organisations. We must come together as stakeholders and forge a pathway for more effective collaboration in countries, to minimise duplication and fragmentation and to make a ‘merger at the last mile’ for delivery. In practice, a merger at the last mile means ensuring that collaboration and partnership among organisations moves from the ad hoc model that has thus far been the norm to a more formal, predictable, mandated and scalable model of operational integration in countries. ▪
SANIA NISHTAR Sania Nishtar is the chief executive officer of Gavi, the Vaccine Alliance. A trained medical doctor and former senator in Paki- stan, she served between 2018 and 2022 as special assistant to the prime minister. During this time, she founded a social pro- tection programme and chaired the Coun- cil on Poverty Alleviation and the Benazir Income Support Program. In 2013, during Pakistan’s caretaker government, she served as a federal minister with responsibility for re-establishing the country’s Ministry of Health among other roles, winning acclaim for transparency and accountability during her time in office. X-TWITTER @SaniaNishtar @GAVI gavi.org
Health: A Political Choice – The Future of Health in a Fractured World 49
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