 20 years ago children of the world weren't getting the vaccines they needed. The children at most risk in poor countries were the ones who were getting the least vaccines and so we needed to find the resources to get countries to adopt the vaccines so that every child would be protected against diarrhea, pneumonia and other killing diseases. GAVI is the the first global initiative of bringing all the different players to work together to get immunization for the children of the world. At the dramatic increase that happened over the years that followed illustrates how important the initiative was and still is and we still need the sufficient funding for GAVI for the future of today and tomorrow. GAVI was one of the first major platform initiatives of the World Economic Forum and in many ways it serves us as a role model for how the public and private sector should cooperate. GAVI does this better than anybody is bringing all of those groups around a common table and having a shared vision to move forward. I think that's the secret sauce of GAVI. I think GAVI has done exceptionally well since inception in 2000. It has immunized over 760 million children and saved 13 million lives. This is for me a very special moment. The World Economic Forum is celebrating 50 years of existence and GAVI which the panel will discuss is celebrating its 20th birthday. I look at GAVI like a child and in some way we were actually the midwife if I may say so for GAVI and I remember how 20 years ago we were sitting together Bill Gates, the director general of the World Health Organization and we just reflected on the fact that despite the promising progress which has been made in immunization efforts at such times there were still I think 30 million people, 30 million children which were living in poor countries and who were not fully immunized. So with the gracious gift of a pledge of Bill Gates of 750 million GAVI was created and GAVI in some way is probably the best example of public private partnership. What has been achieved in the last 20 years I think exceeds all the dreams which we may have had at such time and what I particularly appreciate in GAVI is not only like the World Economic Forum that it is a public private partnership but the way you are providing the assistance is not characterized by just doing good but by being efficient and really applying the best of managerial approach to make sure that as many children as possible can be integrated into the Waxhine efforts. So I'm not mentioning all what we have achieved I think this panel will do but please join me in congratulating GAVI for its 20th anniversary. Thank you Professor Schwab. Good afternoon everyone and welcome to this session on GAVI as it turns 20. As we just heard and you saw in the video the Global Alliance for Vaccine and Immunization is a public private partnership and it has was created 20 years ago and has done a tremendous job of having vaccinated 760 million people and saved 13 million lives. It has done this through welcome. It has done this through being very single-mindedly focused on its mission to save children's lives and to protect everyone's health by increasing immunization especially in poor countries. So what has been the key to success for GAVI and what is the future vision as GAVI enters its next phase. These are the questions we'll try to answer on this panel and I'm very pleased to introduce the panel to discuss this very important questions. To my left is His Excellency Felix Chishakadi the President of the Democratic Republic of the Congo. We have Seth Berkley Chief Executive Officer of GAVI. We have Christopher Elias President and the Global Development Program at the Gates Foundation Paul Hudson from Chief Executive Officer of Sonofi and then Ngozi Okwaja Ivalu from GAVI. So maybe I will start asking a question with the President here. You have recently faced some challenges and dealt with some emergencies in your own country as it relates to outbreaks of vaccine preventable diseases like measles and Ebola. How have you handled those and what role has vaccines been able to play there for you? I have worked with a lot of our fellow citizens and it has been very special to stay much longer than the previous epidemics. Here it has lasted more than a year and it has done a lot more than victims. There were 3,400 cases on which there have been 2,200 and a few victims. This has been very difficult in the first place because of the evolution of the disease. But thanks to the vaccination and the fastest charge taken by a Congolese expert at the international appointment, Dr. Jean-Jacques Mouillémbé, I immediately placed a few months on the head of the country. We organized an emergency cell in my country and from 21 cases that were active at that time, today we only have between 0 and 3 cases per day. So I think I can say that the illness, little by little, is disappearing. Thanks to vaccination and thanks to rapid treatment for the ill people. Maybe I can start with you first. As we saw, the Gates Foundation has been a founder of GAVI and 20 years ago this was launched. You have been involved in it yourself directly. What is the model that has made GAVI as successful as it is? Thank you, Serita. Let me join others in wishing Professor Schwab congratulations on the 50th anniversary of the World Economic Forum as well as celebrating GAVI's 20th anniversary. The other organization that turns 20 this year is the Bill and Melinda Gates Foundation. The story within the Gates Foundation about GAVI is that it was one of our first, one of our largest and one of our best investments. And it reflects, you know, it's hard almost to imagine where we were 20 years ago with under five child mortality almost double what it was today. And as Professor Schwab said, the GAVI model has been one of the best examples of an alliance of committed individuals, institutions, partners coming together for common purpose to reduce under five child mortality largely through the prevention of vaccine preventable diseases. And while Bill and Melinda made a phenomenal generous gift in 20 years ago, it was really just to spark the alliance and to bring in many other partners, governments, UN agencies, WHO, UNICEF, the World Bank were there at the launch 20 years ago to say we all need to come together to solve one of the world's biggest problems. And we've seen that happen. We've seen the GAVI model expand the number of vaccines available to children almost three-fold in the last 20 years. We've seen it work with the industry to bring down the per-vaccine prices dramatically in some cases. And in some ways, not by changing the profit motive of the industry, but providing clear signals about the demand, about the supply, what was needed from the industry so that they could shape their efforts in the development of vaccines and the production of vaccines to meet a market, a market that GAVI aggregates for the poorest countries of the world. And through that helps to make vaccines more affordable and available to children around the world. So we've seen tremendous expansion in the number of children reached with vaccine, 13 million lives saved as a consequence in the last 20 years, the last generation. We've also seen important models in terms of financial sustainability. The fact that GAVI requires even the poorest countries of the world to co-finance according to their means and to ultimately graduate as they achieve the economic growth that preventing vaccine-preventable diseases helps to fuel. You see a model of sustainability with significant proportions of the actual immunization costs now being born by countries themselves. And I think in the spirit of the theme of today's conference, one of the great things that GAVI has accomplished is to reduce the inequity. 20 years ago, vaccines would come out of a robust pipeline of science and technology and quickly be taken up by the world's richest countries. And the lag between those innovations being available to children in rich countries and children in poor countries was about 15 to 18 years and growing. And in a society where we see growing inequities in many dimensions, GAVI has fought that tide and has reduced the inequities. The rotavirus vaccine was launched in poor countries the same year it was launched in rich countries. So I think it's an incredible model. It's got some incredible challenges left for the next 20 years, but I think we have a lot to celebrate today. Well, thank you for that. Seth, moving to you, of course, you have been driving the engine behind the success. But as you look forward to the future, what else needs to happen and what is the vision for GAVI? So thank you and let me add my thanks to the forum. I've been coming for a long time and it's amazing how we bring together decision makers and have them focus on these important problems. But it isn't only vaccine people. It's obviously people working across all of the different areas that can help drive forward with this agenda. As Chris has just said, the model is really interesting and has been successful. We've launched 433 new vaccines. We've been able to lift up coverage over 20 percentage points for the basic vaccines. But where are we today? Well, vaccines are the most widely distributed health intervention. Today, 90% of children worldwide get at least one dose of vaccine as part of a routine vaccine system. That last 10%, though, those are the ones. Two-thirds of those zero-dose children are below the poverty line. If they're not getting vaccines, they're not getting any health intervention. So if they get sick, they're less likely to recover. If they have an epidemic that starts in those communities, there's not the system to pick it up. So what we'd like to do is not just pivot, but continue the work to really work with countries to try to focus in on those that are left behind. And once we bring a vaccine to them, of course, the secret is vaccines don't deliver themselves. So what we're bringing is a health worker, a supply chain, a data system, a cold chain. And with that, we really create the kind of setup for universal health coverage and primary health care. Of course, without prevention, we can't afford those types of health issues. Last thing I'd say on that is that not every country will be able to completely reform their health systems by 2030, the year the SDGs are done. But we could immunize every child, and that would make a dramatic difference. So this is one of our main goals. Of course, we still want to continue to work on epidemics. We still want to make sure that new vaccines that come out will be there. But that's the primary pivot that we're going to try to do. Great. And it's interesting because you talked about creating markets, financing, vaccines, innovation. So Paul, I guess you're representing the innovation part in the upfront, actually having vaccines. And what would you say from your standpoint and the overall industry standpoint, do you feel ready to be able to support that? I think that the success of GAVI is actually quite impressive because I believe GAVI went from having vaccines for six diseases to 18 diseases. So what else is industry able to do for the future vision? Well, thank you. And let me add my congratulations to GAVI at 20. Let me also add, actually, congratulations for the Alaska Bloomberg Public Service Award. I know how prestigious that is, and it says a lot about the work that's being done. You mentioned it in your opening, actually, that I think over 760 million patients have vaccinated or immunized, and 13 million child deaths avoided, and the tragedy that would unfold with those. You know, I've been in the industry close to 30 years. I've only recently taken over as the CEO of Sanofi, and I feel like vaccines is a very special place. We have an incredible team at Sanofi, David Lowe, who leads our team. The work they do is exceptional. Now, I've been in the industry a long time. You ask a little bit about preparedness and readiness, and if we get time for a second question, we'll talk ecosystem. At the front, as I've taught our manufacturing sites and MED-O people, I'm staggered by the call to action, the purpose-driven nature of the workers in this area. This is really, for me at least, having been around a long time. This is something above and beyond, whilst there's a huge amount of pride in what we do in the industry around medicines. There seems to be an extra calling, and it can be everything from polio right through to influenza. There's a speed, there's a discipline, and there's an excellence because people know what's at stake. And I think it's quite incredible, the work. It's the first time that I've worked with an organization such as GAVI, and it's bold. It must have been bold at the time, what it can bring together because it is one of those challenges that can't physically be solved by an individual contributor. It needs the collaboration and it needs the call to action. For us, we've put forward tremendous opportunities for patients with yellow fever, with cholera, with our pentavalent wholesale. We've really tried to bring something to that party and work with UNICEF, GAVI. It shows me actually and inspires me for other areas across the diseases. What is actually possible if you do it right now? I feel a bit of a fraud because I'm new and I'm enjoying the incredible work that's been done. There is tons to do for sure. We are the world's biggest producer of injectable polio vaccine. We have made over 16 billion doses in the last 30 years of oral polio. The job just simply isn't done yet. It just simply isn't done yet. In some ways we have to say there is still work to do in polio itself. There is something important about the ecosystem. If we get time, I'd like to talk about how maybe we can bring that together. We can back to that. Ingo Z, you're of course the chairwoman of GAVI and there's a lot there that you are playing a role. You bring a very interesting perspective from a development standpoint and also having been finance minister because as we heard the financing aspects were very well. From your standpoint, what do you see that countries need to do in terms of making themselves actually prepared for being self-sustainable at some point of the process? Well, thank you very much Rita. Let me also join others in saying that this is a happy moment in which both the forum and GAVI are celebrating. I think we really need to think about it because this is a success story and in a world where there's so much uncertainty and people are so dismal about many things. Here's one story of something working at scale that we can talk about and your question about how to institutionalize is really important. One of the reasons I was excited to join GAVI as chair of the board is because it's an organization that wants to work itself out of a job. So GAVI gets from the start as Walter, Chris and Seth said tries to make sure countries are involved in managing and financing their own program. For instance, in this next period we are going in 2021 to 2025 countries are going to pay 41% of the total cost of vaccines, 3.6 billion dollars and we try to work with them in a progressive fashion so they increasingly take charge until they graduate. So that's one of the things. The way we work with them makes it possible. So it's not like a sudden thing that you wake up over night and say okay now you're in charge of your own program. So that's one progressive taking over of the financing and of course supporting them to mobilize more domestic resources so that they can pay for the vaccines. The other aspect of the finance is the countries being helped to negotiate with pharmaceuticals. We have a mechanism so that the vaccines can be affordable. So that's on the finance side, one of the factors. The second factor is capacity. Even if you have the finance, if you don't have the capacity on the ground to deliver, you need to have a whole value chain with the coal chain, with the workers. So working with community-based organizations to deliver, working with the government itself to deliver civil society, this is one of the aspects that is critically important as countries take over that capacity on the ground. And the third aspect I think is data. For a government to know that it is succeeding in reaching the right levels of immunization for its children, whether if you're 81% as we have on average now, we'd like to move to 95% so that the child we haven't reached is covered, you have to have data and you have to monitor. So building that capacity to get good data is also very important. Great, thank you. Your Excellency, if I may come back to you. So you've heard the panel talk about what Gavi has done and how they have done it and also what countries can do. So as you think about what you want to achieve in your country, what would be your ask of Gavi and others on this panel and how can they help you? Where are the areas of need? Where are the gaps and what might you recommend as areas that we could develop in? Thank you. I think that the shortcomings are to be found in the level of vaccination, particularly compared with routine vaccination or response vaccination when there is an epidemic which has been triggered. Mrs. Conjua spoke about something which I think is very relevant here and I think that this is something that we really have to face up to and that is the price of vaccines. I think the price is relatively high and in my view, on the strength of international cooperation, thanks also to interventions such as the one provided by Gavi, I think what we need to do is to have prices brought down so that countries are in a position to be able to procure the vaccines necessary. I think it is through international cooperation and cooperation between different states that this will be achievable. Just to take the country that I represent, I was asked to be the champion in Central Africa of vaccination and I accepted to spearhead this project and we're going to have a follow-up meeting in February. In fact, it's on the 18th of February. I will be there and I'm really going to get firmly involved. For that, I've invited provincial governments and governments from the area to mobilize and I think that we need to go from a vaccination rate which in Congo is about 35 percent and I'd like her to double that figure and I'd like her to see the figure rise to 70 percent. We need to develop what we're trying out in Congo. That is to say we want to implement an opening of a universal health system. That is a crucial step. Why? Because it will mean that we will be able to reach out and to administer primary healthcare services and provide those services particularly to children and I hope that this will give us a much better response rate and we will be able to have vaccinations or vaccines rather which will be administered to all those who come along with various illnesses. Thank you for that and maybe some of the panelists as we speak now can address some of the points that the President has raised as well but maybe if I could ask you Chris what do you think in today's world of the fourth industrial revolution how can technology actually help us to get to the next levels of challenges that we have in both you and Seth mentioned some of them. Thank you Serita. I think that you know Gavi's journey like any race to do anything important the last mile's harder than the first mile and you know we've as Seth said we've reached at least 90 percent of children with some vaccines. We've reached about 80 percent of children with a full course we still have dropouts kids who get their first dose and don't get doses two and three and I think we need to take what has made Gavi a success in the last 20 years that is innovation and continue to apply it because those last 10 to 20 percent of children are not like the first 80 to 90 percent they may be in a slum they may be in a highly mobile family fleeing conflict conflict they may be in a very remote area they may be in places where seasonal interruptions of the road network prevent the vaccines from getting this is where technologies from the fourth industrial revolution came out when Gavi started 20 years ago we naturally work with the vaccine industry but if you look at Gavi's partnership list today it includes I met yesterday with the chairman of the NEC company in Japan and we have a fingerprint ID technology that is being used in a partnership with Gavi to help track children so that we can find children who may be moving from one place to another from their first dose to their final dose of a vaccine we work with a range of supply chain and logistics companies UPS others who are helping to bring their cutting edge expertise and tracking technologies to understand the best route to get around the flood that took out the bridge how do we get the vaccines to the places there are drone companies now involved in helping leapfrog geographic barriers to get vaccines into critical places a whole range of refrigeration and cold chain companies that are developing solar powered off grid long hold time refrigeration for the vaccines which are perishable they often need to be kept between 3 and 7 degrees centigrade from the factory to the child and if those last children are in very difficult to reach places we're going to need all of that technological so it's not just increasingly working with the vaccine industry to capture the cutting edge of science and technology for heat sensitivity etc but also working with a vast array of corporations who can bring their expertise to solving this last mile challenge reaching those zero dose children and making sure that every child that is reached gets the full dose and the full benefit of a Gavi model Thank you Seth I would like you to maybe address the point that the president raised especially related to pricing and in addition I would like to ask about this conversation around universal health coverage and how you think about that and the linkage of that and what you're trying to do in Gavi First of all I'd like to compliment the president because Chris and I visited him last year and he brought all of the provincial governors and said you're responsible in a decentralized systems you have to make sure that we move forward and the fact that he's just said publicly again I'm going to hold them accountable because he's really important of course he needs technology he has a very difficult geographic area and the issue he talks about in pricing is important if you look at the 11 vaccines that WHO recommends they cost around $1300 it's not exactly the same say in the US but similar vaccines right now they're about $27 in Gavi and that's because we buy vaccines for 60% and because we've been able to work with the pharmaceutical sector to help us we have to make sure they're still profitable and so the challenge has been to expand the number of manufacturers we've gone from a small number 5 when we started to now 17 different manufacturers creating healthy competition and so that process needs to continue to go on what I'm excited about is as new diseases appear the vaccine industry is on it and brings us new vaccines and that's one of the important issues we're this year moving into our replenishment we have to raise at least $7.4 billion and that's to bring these new vaccines forward but to do this type of work and that's important but just quickly answer your question our belief is if you build that system out that primary healthcare system which is responsible for 85% of health there's some stuff that you need the tertiary centers for but most of it can be done in the primary healthcare system if we can bring that out to every person in the DRC that is where we'll get the traumatic benefit and in a way as Ngozi said by doing it with vaccines we can actually measure whether that system is really delivering a just in change using the technology Chris talked about to make sure that we're able to do it and that's how we can get towards success Excellent Coming back to you Paul I know you had a few things in mind that you wanted to discuss but specifically maybe you can also talk about where is the industry going from the future standpoint what innovation and investment is the industry looking to make Thank you So I think what is quite clear as an industry we continue to push what we can in terms of breaking ground on new science we're challenged by Gavi, we're challenged by patients and rightly so for us at Sonofi of course we have a few things directly in front of us we have an improved process to help us with yellow fever which we think will bring benefits across the board we have a hexavalent six in one of which one is an injectable polio vaccine which we know how critical that's going to be of course we also have a preventative for respiratory synestheticial virus which again is a worldwide epidemic of sorts and we're proud to be behind those things I think the panel and others are right to say what are you doing next and where does it go there's excellence he also raises the question on pricing which I think is a very valid question you know coming you in like I said to vaccines I'm struck by this very delicate balance and it is a delicate balance in the ecosystem how do we make sure that we are there when you need us with the volumes and the inventory that is ready to go I think not everybody fully expects or understands that it can take up to six years to validate a new manufacturing facility and then start to build inventory and in this case you really six years is not responsive enough if you have an outbreak or a resurgence or a mutation or some form and that's a huge big investment there's a push of course for lower and lower prices and in some cases a push towards a dollar even to see where we get to and it's fine lines between building capacity for the long term and getting the appropriate price not what I think is special about the Gaby relationship is I think that that balance can be reached but it does require long term planning and long term thinking to maintain the ecosystem because if you're not planning ahead and if you're not building ahead you lose that ability to move and help support and that requires long term tendering for example and long term thinking we may see that as a big open question as we get to Topolio coming up so I think we're completely committed I think Seth mentioned the number of manufacturers we know because of the way tendering and price and volumes have gone there's only really one manufacturer for measles and rubella now remaining one and that has some inherent risk in it and that also means that's not a situation competitively or frankly for the patients that we serve that is acceptable over the long term so we have to get that ecosystem right so there are multiple players very long term thinking and a commitment to pull through the R&D from the industry and it's not easy I'm new to it but I'm excited about how we can balance those things together I think the industry is critical obviously and there are new outbreaks coming out so certainly you have your challenge there ahead of you as an industry to be able to provide that innovation that is so needed Inguzi maybe we can just take the learnings from Gavi and from your insights and how might we be able to take this and apply it to the broader development context there's a lot of conversation here at Davos as well as all year round that we are talking about we have the SDG goals, we have the 20-30 milestone are there learnings here that we can take and apply to other sectors and how might we go about it Thank you very much yes I think that the Gavi model was a bit ahead of its time it was something that was set up at that time and now it's become kind of the type of model that the whole world is seeking to go we should be seeking to emulate this multi-stakeholder approach to problems we've recognized that none of the sustainable development goals can be attained without a multi-stakeholder approach working in silos or one sector without partnerships we can do it so Gavi embodies this partnership with the private sector with civil society, with governments both developing and developed countries everybody is in there and I think this is a big lesson for development but what is good about Gavi is that it's shown that it can work just to give you an example of this multi-stakeholder approach His Excellency Mr. President spoke about the fact that they had the Ebola crisis and they were able to deal with it much faster that was because we had been able to stockpile this working with the private sector with the pharmaceuticals and so when that happened there was a stockpile ready to go if we were not doing this partnership approach this multi-stakeholder type of thinking we wouldn't be able to do it I think the second part is scale Gavi has shown that it can scale and one of the big problems we have in development is the lack of scale we have lots of good pilot projects and examples everywhere but how many times can we talk of reaching a billion people that's what Gavi is doing in the next five years we will reach a billion children and we will save you know more than 20 million lives so those two things are very applicable the last point I want to make is on the financing Gavi has a financial instrument called the international finance facility for immunization where we actually with government guarantees go to the market and we raise money on the markets to help finance this is also applicable everybody is looking for innovative approaches to financing and now education we are going to do the international finance facility for education based on this so I think on those three grounds we really got a model ahead of this time that we can use yeah I was also thinking of education when I was thinking if we took a model like this and applied it to education that would be a good foundation for the broader development so we have a few minutes left and maybe since it is the celebration of the 20 years that I would come back to you to talk about you know we've talked about what Gavi has done huge accomplishments and what you hope to do and what would be your ask of the stakeholders that are here in Davos to help you get to that mission and what might be some specific areas that you'd want to sort of leave behind as thoughts that we could all take back so one thing I want to say just before I answer that is you know we're celebrating us and the forum it was here in 2015 that the advanced purchase commitment and other innovative financing mechanism was set up to make sure they'd be in a bowl of vaccine just in case there was an outbreak and so when there was an outbreak and multiple in DRC we were able to bring that vaccine forward so I mean the important thing is people think about Gavi as a vertical initiative we're about vaccines, that's it but of course that's not true we're about health systems and supply chains and you know refrigeration and data systems and identity and so the real question is how does the rest of the world help us get to these goals these are noble goals we have to work with industries it's not about charity how do we open new markets for industry how do we get to the bottom of the pyramid and be able to bring them in and I think to me this is what I'm excited about because the more we can bring in the best technology from different sectors the more we can move forward in Rwanda today all blood is being delivered by drone if a woman goes and is hemorrhaging in a clinic in rainy season how many units of blood they're there for her there's no wastage and they're doing it for the price of a motorcycle delivery we're beginning to experiment with drones in the DRC in Ghana and other countries these are examples of how technology like the cell phone has leapfrogged and what I need is help from all of the corporate partners as well as the political leaders to move us forward in a movement great it is interesting to hear the panel here because this is truly a sample of a very good example of the multi-stakeholder approach and the public-private partnership and it's not just the business from the health sector but it's really businesses across the sector as you said from supply chain industries those who can reach the last mile and there are many industries and sectors who are actually providing all sorts of products in the last mile so there's opportunity there for them to engage I think the data piece that you talk about becomes very very critical to drive actually data that then helps us make the right decisions and know where the interventions need to come in so it's I want to thank the panel because the president has laid out very good explanations of where you have solved some of the situations that you have faced you have others you have some great targets to double the penetration of the vaccination and we have here for you the people who can make that happen I think on the industry side suddenly the industry has been critical and delivered on the vaccination unfortunately we do see new outbreaks coming out even this week we've had some news items so we do see challenges ahead of us and I think together we can really make all this happen so I do want to congratulate Gavi on its 20th anniversary certainly for the World Economic Forum it is a very special moment having launched it on our platform 20 years ago as you said Ngozi it was maybe ahead of its time but it is really showing us the way for what we can do not only in the vaccination arena but also in other development goals so thank you for your time and thank you very much