Disease Busters

Mozambique's Graça Machel has served on the front lines of African politics and activism for three decades. She fought for her country's independence from Portugal in the 1970s, became the country's first education minister, married the late president Samora Machel, embarked on a long campaign for African children's rights and is now the wife of former South African president Nelson Mandela.

In Barcelona this week Machel spoke at a conference on immunization programs in Africa representing the Global Alliance on Vaccines and Immunization (GAVI), a nonprofit group based in Geneva that aims to create long-term vaccination policies for the world's poorest countries. GAVI, which has committed $3.5 billion in multiyear grants to the world's poorest countries for 2000 to 2015, unites activists, doctors, the pharmaceutical industry, and both rich and poor governments to immunize children in developing countries with vaccines already available in the West. Diseases that no longer pose a serious threat to children in wealthy nations, such as pneumonia, diarrhea-viral illnesses, measles and hepatitis B still ravage millions of children in Africa and Asia.

The alliance, including UNICEF, the World Health Organization, the World Bank and the Bill and Melinda Gates Foundation, has vaccinated 176 million children and has prevented around 2.9 million premature deaths. Nevertheless, looking ahead toward the goal of cutting vaccine-preventable disease mortality by two-thirds by 2015 compared to 2000, the WHO said it will not reach the goal without more funding for vaccines. Machel spoke with NEWSWEEK's Mike Elkin ahead of World Malaria Day about vaccines, big pharma and AIDS in South Africa. Excerpts:

NEWSWEEK: The WHO says that at the current pace we won't reach its vaccination objectives and GAVI will need an additional $1 billion per year to change this. What do you intend to do?
Graça Machel: GAVI has developed innovative financial initiatives to bring in additional funding, but we need more countries to contribute as well as foundations. La Caixa [savings bank] in Spain has been the first. When big companies with big foundations make GAVI part of their social responsibility, it changes the mentality of staying in your own backyard to embrace a global challenge like immunization. We also need to be much more forthcoming with strengthening the national health systems [in Africa], which means improving the infrastructure and improving the so-called pipeline through which the vaccines go if we are going to reach GAVI's goal of "every child, everywhere." For us it's not only getting the vaccines to the capitals, but they have to reach the villages. And that's where we need to do a lot of work. We also have to acknowledge the reality that these countries need more qualified staff. This means training and retaining them within the system.

What do you do with the money you raise?
We concentrate on taking vaccines available in the developed world and making sure they reach every single child in developing countries. In the past it has taken 10 to 15 years [for vaccines] to reach developing countries. Our mission is to shorten this period.

Are underused vaccines from the West the only solution for the health problems in Africa?
No, now we are also encouraging research. We not only use patented vaccines but we need to find new vaccines for big killers in developing countries.

How do you lower prices when they are controlled by profit-driven pharmaceutical companies?
One of the creative arrangements GAVI brings is that the pharmaceutical industry is represented on the GAVI board. The industry has to know that someone is going to buy the drugs. This guarantee gives the industry incentive to produce and produce massively, thus making the vaccines cheaper and affordable to developing countries … In the past, developed countries were not very sensitive to the priorities of developing countries because those diseases didn't exist [in the West] anymore. But we've seen a shift away from this mentality.

Is it difficult to sustain health programs in countries that are prone to corruption or instability?
First we need to avoid generalization, because Africa is 53 countries. And there have been many countries doing extremely well at fighting corruption … It is true that there are countries in turmoil, and it's not only health that suffers but education, water supply, transportation … Everything becomes disrupted. The good news from Africa is that the number of conflict zones today is lower than before. Just look at countries like Sierra Leone, Liberia, the Democratic Republic of Congo … They're all in peace now, which makes the environment for development much more conducive. A good example is the DRC. Although it emerged from conflict only a short time ago, it has reached high rates of vaccine coverage precisely because peace is giving a chance to immunization.

What is the HIV/AIDS situation in South Africa? In October UNICEF said death and infection rates are outpacing treatment, and it estimates there will be 5 million orphans by 2015.
Research data has shown that, among young people, a behavior change has taken place. But only with young people—we have to be specific. South Africa has been increasing the number of people in treatment, but the challenge is that in certain social groups the infection rate is not dropping. More importantly, South Africa is receiving a lot of refugees. There are 3 million people from Zimbabwe now in South Africa, and it has put a lot of pressure on the system. And when it comes to infectious diseases, you have more chances of increasing infections because of the influx. But I know where you want to go, because it was said that President [Thabo] Mbeki denies [a link between HIV and AIDS], but the government has named the deputy president, Phumzile Mlambo-Ngcuka, to lead the AIDS council, which includes not only government departments but also research institutions and NGOs.

How would you rate Mbeki's handling of the HIV/AIDS crisis?
I don't want to discuss that.

What about the rise in food prices and the production problems for farmers? Are initiatives like the African Green Revolution the answer?
The Green Revolution is just beginning, so it's still too soon to see. What I do know is that there is a renewed commitment by African governments, supported by foundations like the Rockefellers and the Gateses, to improve policy, provide better seeds and fertilizer, which will increase not only food production but also yields. Malawi, for instance, suffered a food shortage one year, but with the change in policy and some good rains, the following year they were exporting food to Zimbabwe. Just with that simple change.