Anuradha Gupta, Deputy CEO of Gavi, the Vaccine Alliance
The author with children, partners and health workers in Guyana. Photo: Shabana Shaw.
I found my recent visit to Guyana in South America to be instructive and uplifting. The country exudes optimism, aspiration and pride. Once a British colony, it attained independence only in 1966. A country rich in gold, diamonds and bauxite, Guyana is making rapid progress. Yet the mountainous hinterland, and a general lag in development, has left some behind.
Immunisation in Guyana is a major success. They have introduced the full range of children’s vaccines. Now they are preparing to roll out the human papillomavirus (HPV) vaccine for adolescent girls. Although Gavi has supported these vaccine introductions, Guyana has taken full ownership. Coverage levels are high, with most vaccines reaching almost 95% of children. Immunisation has wider reach than any other health programme. But I am glad to see that the government offers a package of guaranteed health services free of charge.
Yet for Guyana, good is not good enough. Everybody that we met, from political leaders to health managers, cared about equity. It bothers them that more than one in ten people in the hinterland lives in poverty. Deep rooted cultural practices remain a challenge. For example early sex, often without contraception, brings teen pregnancies. Rates of violence against children and girls are also very high. Poverty and malnutrition lead to anaemia and stunting. Too many children are still born at home with only the care of a traditional birth attendant, which can put mothers and babies at higher risk.
The hinterland is also where the five percent of children miss out on essential vaccines. These are the children the government is keen to reach. We travel across thick rainforest to reach a remote region. It accounts for one third of the country’s land mass, but only four percent of the total population.
A rural village clinic. Photo: Shabana Shaw.
We fly for more than two hours in a small plane to land at Aishalton. This is a small village of Amerindians, an indigenous tribe. The landscape is very challenging. I can see immediately why it is so hard to deliver immunisation and other health care services. Their traditional way of life is to move from place to place in search of arable land. Each village only has a small number of children to vaccinate, anywhere between one and ten.
Health workers have to cross torrential rivers, dense forests and steep mountains. They often take several hours to reach them. Yet against all the odds this region topped the charts on maternal and child health care last year. We watch as they receive the trophy for best performance.
A small delivery plane. Photo: Shabana Shaw.
Delivering vaccines by plane to these communities is very costly. Attracting, training and retaining health workers requires extra incentives. Social mobilisation of scattered populations takes time and money. It is very challenging to deliver healthcare without good roads and electricity.
From Aishalton, we drive on to Lethem, the regional Headquarters. It takes over six hours on an unpaved, bumpy track, rattling every single bone! How can pregnant women survive it? Without an obstetrician or blood storage facility Lethem cannot provide emergency obstetric care. Women must go to Georgetown which is another 18 hours away, or cross over the border into Brazil.
Even though Guyana relies on Cuba to train their doctors, specialists are very scarce. This is a common problem in most developing countries. Yet, the question is not whether Guyana can afford to reach and serve these hinterland communities – can it afford not to do so? This is a moral imperative. In the age of the sustainable development goals no one should be left behind.
The author talks to a mother and her baby at a Guyanese clinic. Photo: Shabana Shaw.
There is also a strong business case. Unvaccinated populations have a high risk of diseases that easily cross borders. At the moment yellow fever outbreaks in Brazil pose a grave risk across the region.
I leave Guyana reflecting on their request for continued Gavi engagement. They no longer need us to pay for vaccines. Guyana has always paid its share, and has increased its total immunisation budget. Gavi support is ‘a hand up rather than a hand out’. But they still want the ideas, expertise and innovation offered by Gavi and its partners.
This, they believe, holds the key to reaching the last five percent of children. After all, these children deserve the same chance to “survive, thrive and transform”.