THIS is the first of a special six-part investigation by Paula Jardine into the way in which, and why, winning ‘vaccine confidence’ became the primary goal of world health agencies, regardless of need, efficacy or risk.
Since the UK’s Covid-19 vaccine programme began in December 2020, 140million doses have been administered to 55million people, representing 73 per cent of the population.
The high level of acceptance of these vaccines, which were developed in one tenth of the normal time frame – and in the case of the mRNA vaccines using a novel technology never previously licensed for use in either humans or animals – is a remarkable testament to the level of public trust in vaccines.
It is arguably the end product of two decades of work, first by GAVI, the Global Alliance for Vaccines and Immunisations (now called The Vaccine Alliance) and recently by initiatives such as that of the London-based Vaccine Confidence Project, established to deliver the goal of universal childhood vaccination set 40 years ago by UNICEF, the United Nations children’s welfare organisation.
GAVI was set up in 1999 ‘to save children’s lives and protect people’s health through the widespread use of safe vaccines, with a particular focus on the needs of developing countries.’
It was founded at the instigation of Dr Seth Berkeley, its current CEO, who was then working for the Rockefeller Foundation. ‘We will have an outside body that can bring in industry (which the World Health Organisation can’t legally do), do advocacy and build a truly international alliance,’ he said.
The Vaccine Alliance, a public-private partnership financed by vaccine manufacturers, the Bill and Melinda Gates Foundation and national governments, aimed to give impetus to the universal vaccination campaign and to revitalise the fortunes of a stagnating market for new vaccines. The UK government is currently is largest single donor, having made a five-year pledge in 2020 of £1.65billion.
Its initial focus was on gaining the ‘long-term commitment of client governments and donors to full immunisation’, the latter implying vaccination on schedule and for every possible disease. This was different to its twin, the concept of universal vaccination.
When GAVI was launched, a UNICEF employee and anthropologist, Dr Heidi Larson – who would later found the Vaccine Confidence Project – was chosen to lead its vaccine communications and advocacy work.
She later explained how the nature of the advocacy was soon to evolve away from the initial focus on client governments.
‘There was a growing epidemic of individuals and communities and even some government officials questioning and refusing vaccines,’ she said. ‘I ended up getting the nickname “Director of UNICEF’s Fire Department,” because it turned out to be a crisis management position, because people weren’t taking vaccines.
‘I saw what seemed to be a trend: The northern Nigeria boycott of the polio program made it into the international press, but it wasn’t one place, it was everywhere.
‘I didn’t have time in my day job to investigate what was going on there, because there was not a quick fix. That’s when I put together a proposal and got some seed money and founded the Vaccine Confidence Project.’
There is no seminal document laying out a case for universal vaccination. As a public policy objective, it originated with the Rockefeller Foundation (RF). Its end goal is to eradicate diseases one-by-one via vaccination, the so-called vertical approach to public health introduced by the RF soon after its founding in 1913. It was part of a package of cheap, technological quick fixes for health care in developing countries originally called Selective Primary Health Care.
These interim measures were necessary because matching the industrialised world’s standards of sanitation, clean water, nutrition and health care to reduce the disease burden was ‘prohibitively expensive’.
An RF trustee, James P Grant, had been appointed executive director of UNICEF in 1980, operating it as a rival to the vaccine-agnostic World Health Organisation of his era.
In 1980, in an article on the eradication of smallpox, WHO director-general Dr Halfdan Mahler did not even mention vaccines. Rather, he stressed: ‘Smallpox eradication is a sign, a token, of what can be achieved in breaking out of the cycle of ill-health, disease and poverty.’
But Grant engaged in what the New York Times called ‘tireless, peripatetic proselytising’, using his UNICEF pulpit to zealously promote vaccination.
With rearguard reinforcement from the US Centres for Disease Control (CDC), by 1984 he had brought the WHO, the agency meant to provide the technical lead, on board with ‘universal’ vaccination.
Today, UNICEF is a quasi-arm of the pharmaceutical industry. Figures in its most recent Immunisation Roadmap document show it is now responsible for distributing 40 per cent of vaccines in developing countries, while its 659 staff spend more than half their time managing immunisation programmes and supply chain logistics.
In Part 2 tomorrow, I will explain how GAVI’s ten-year strategic plan, the Decade of the Vaccine, set out to eliminate vaccine scepticism.