As World Immunisation Week comes to an end, child health expert, Dr Shamrin Zahan from BRAC in Bangladesh writes about her experiences visiting London as part of a RESULTS UK child health advocacy tour.

I arrived in London on Saturday afternoon, after a short trip to Nairobi to undertake media training hosted by ACTION. London is the city I consider my second home after Dhaka, since it is where I started my medical career, working in both a clinical and community setting. I moved to England just after my medical training in Dhaka Medical College and Hospital in 2001 and worked as a clinical doctor in Obstertrics and Gynaecology under different NHS hospitals. My significant time in London was spent at Tower Hamlets of East London, in addition to the Royal London Hospital in Whitechapel.

Sharmin Pic parliament

In 2008, I went back to Dhaka and started working for BRAC, a development organization which works on microfinance, health, education, agriculture, community empowerment and many other areas crucial to development. At present BRAC works in Bangladesh along with eleven other countries across Asia and Africa. In additional to my health work at BRAC, I have also been involved with the GAVI Alliance since 2009 – formerly, the Global Alliance for Vaccines and Immunization, as a Special Advisor to the Civil Society Organisation (CSO) Board member of GAVI and previously the Director of BRAC Health Programmes. Since June 2012, I have been representing BRAC and Bangladesh in the GAVI CSO Steering Committee, while continuing my main job at BRAC as an Anchor for BRAC’s International Health Programmes.

Going back to my initial excitement of being back in London – its vibrancy and sense of culture is something I miss in Dhaka and on my frequent trips to other cities across Africa and Asia. The reason I am here is to do some advocacy for GAVI with RESULTS UK, to meet with a few British Parliamentarians and representatives from DFID. Our aim is to be part of raising a strong commitment from the UK Government to continue their support to the GAVI Alliance and to participate in discussions around the successes and challenges of GAVI in reaching all children with immunization. These meetings will allow me to discuss GAVI’s 2016-2020 strategy and to advocate for a strong UK pledge at the next replenishment.

Since its inception in 2000, GAVI, a model global public-private partnership, has supported countries to immunize an additional 440 million children and save approximately 6 million lives. While vaccines save between 2 to 3 million lives globally each year, almost  22.6 million children are not immunized every year – that means one in five children currently miss the opportunity to receive the benefits of vaccination, the most powerful and easiest way of saving lives and protecting people’s health during their lifetime.

GAVI’s inception was at a time when I was a fresh graduate from medical school and completed my house job, living with the horrible experience of seeing the deaths of the children in the peadiatric wards. Everyday children were dying unnecessarily from diseases that could be prevented through vaccines – diarrhoea, tetanus, measles, pneumonia and meningitis to quote a few.

In Bangladesh, the Expanded Programme on Immunization (EPI) was officially launched in 1979 however, the programme really gained momentum much later in 1984, when the country committed to the United Nation’s universal coverage for immunization. Initially, Bangladesh started with 6 routine vaccines (diptheria, tetanus, pertussis, BCG, measles and oral polio vaccine), however, with GAVI support, Bangladesh was able to add Hep-B in 2003 and Hib in 2009, as part of the pentavalent vaccine. In addition, Bangladesh also started measles second dose in 2013, and launched a measles-rubella campaign at the end of 2013, along with receiving funds to introduce the pneumococcal vaccine. GAVI funds have been supportive of immunization programmes in Bangladesh for various important activities including the recruitment and training of district immunization medical officers, procurement of logistics, extension of cold and dry storage space at different levels of the health system, community activities, and additional support for hard-to-reach and high risk areas. This year, in February 2014, Bangladesh received funds for implementing the GAVI CSO Health System Strengthening Platform.

It is interesting to compare coverage rates of DTP3 before and after Bangladesh received funding from GAVI. In 2002, the DTP3 coverage was 67.7%, while now, that coverage is almost 96% (2012). A crucial innovation in the implementation was the use of households visit by the community health workers, both from government and NGOs (only BRAC provides more than 100,000 community health volunteers in this pool). Over the course of a decade, gender differentials in immunization coverage also disappeared. This notable achievement in the coverage of immunization could be attributed to a concerted effort of EPI and commitment from the government, the complementary services from NGOs like BRAC and importantly, support from GAVI.

It is the important relationship between GAVI and the UK that is the purpose of my trip to London this World Immunisation Week – this is a really exciting time for GAVI as it is transitioning from its current strategic period (2011 to 2015) to the next one (2016 to 2020), which will be finalized at the June 2014 Board Meeting. Later this year, GAVI will be holding its second replenishment in order to mobilize resources to implement its 2016-2020 strategy. GAVI will announce their funding needs on May 20th at a pre-replenishment meeting in Brussels. The UK is a strong supporter of GAVI and is expected to continue to show strong support as it has done in the past through contributing to multiple funding streams including, direct funding, Advanced Market Commitment (AMC) for pneumococcal vaccines, Matching Fund and Innovative Finance and Funding for Immunisation (IFFIm).

Investing in vaccines represents good value for money, particularly, when it comes to thinking about tax payer’s hard-earned money, as the British people and the UK Government are committed so strongly to GAVI’s mission of savings lives and improving health in the world’s poorest countries through increasing access to immunization. I simply recollect my memory, from my combined experiences working in England, Bangladesh and now also for the health programmes in Africa and Asia – all children’s faces are the same when they are fully immunized – bright and shiny, they are happy, healthy and leave a hope for their parents – they will avoid disease and death from vaccine-preventable diseases for the rest of their lives. So my request to UK parliamentarians and DFID representatives is why not continuing your investment for immunization and particularly for GAVI?

As I reflect on my visit to London, I have enjoyed the opportunity to walk around my favorite places in the city and meet with my friends and extended family members; however, I would be really happy when my visit will add even a tiny drop as an added value to GAVI’s current effort in ensuring long-term and sustainable immunization programmes in countries. I look forward to the UK’s pledge for GAVI!