A Matter of Sovereignty: Immunization Financing
Photo: Parliamentarians from Uganda, Nepal, Congo, DRC, Senegal, Cameroon, Madagascar, Vietnam, Nigeria and Sierra Leone draft a parliamentary declaration expressing their commitment to sustainable immunization financing.
Last month, the Sabin Vaccine Institute gathered 126 representatives from 17 countries for the Third Colloquium on Sustainable Immunization Financing. Members of Parliament, officials from Ministries of Health, Finance and other national and subnational ministries, and international partners joined to exchange ideas and experiences in developing innovative, long-term financing solutions for immunization.
Many low- and middle-income countries rely on external funding from donors like Gavi, the Vaccine Alliance, to finance their immunization programs. In fact, only 15 countries in Africa fund more than 50 percent of their immunization costs. As these countries’ economies grow, they graduate from Gavi financing and become responsible for 100 percent of their immunization costs.
In keeping with Sabin’s mission to support country-led solutions for a healthier future, the Sustainable Immunization Financing Program convenes officials from key public institutions, enabling them to induce institutional change by designing innovative, country-specific approaches to transition to full immunization program ownership.
During the three-day Colloquium in Kathmandu, Nepal, participants discussed financing arrangements, legislation, budget and resource tracking, and domestic advocacy techniques. Each country presented on their recent efforts and reviewed each other’s progress, rating each other on their innovativeness.
A few participating countries have achieved full government financing of immunization, and are now striving to make that funding sustainable in the long term in the face of rising costs from an expanding list of vaccines. However, most are still largely dependent on donor funding for their immunization programs. Parliamentarian Hon. Ranju Kumari Jha of Nepal emphasized the importance of government financing as the primary source for immunization. “We need to support by the government. Others’ funding sometimes grows, sometimes don’t, but government funding is always sustainable,” said Jha. “Especially as a parliamentarian, my feeling is always that this is the most responsible for the government.”
At the close of the Colloquium, each country formulated an action plan to carry out upon its return home. Since the second Colloquium in 2013, three countries have passed laws establishing and protecting funding for immunization; Nigeria in 2014 and both Uganda and Nepal within the past year. In 2013 and 2015, following Sabin-led advocacy workshops, Vietnam, Georgia, Cameroon, Mali and Senegal each increased their annual domestic immunization budget by an average of 48%.
“You can’t really underrate the value of this Colloquium,” said Hon. Huda Oleru, chair of the Ugandan Parliamentary Forum on Immunization. “Since I started at 2011, whenever you go back, you go back with new ideas. It progressively keeps you thinking…Every country has its own way of doing it: the method of advocates, how they want to put their law in place. You continue to get new ideas that you continue to incorporate in whatever you are doing.”
During the Colloquium, 14 parliamentarians representing 13 countries drafted and signed the Kathmandu Parliamentary Declaration of the Third Colloquium on Sustainable Immunization Financing, stating their commitment to support domestic immunization financing, increase advocacy efforts and share best practices in oversight, advocacy and lawmaking to assure sustainable public immunization financing. The signatories also reiterated their commitment to establish an International Parliamentary Caucus on Sustainable Immunization Financing to serve as a platform for information exchange.
Hon. A.B.D. Sesay, parliamentarian and health committee chairman of Sierra Leone, stated that every government needs to establish a national parliamentary caucus, because “we are the people advocating, we are the people pushing forward to make sure that immunization budgeting is properly supported by our government.”
The Declaration recognizes the emerging importance of parliament’s role in immunization financing. In the nine years since Sabin established the Sustainable Immunization Financing Program, parliamentarians have played a crucial role in major achievements across the 21 partner countries. In the Democratic Republic of Congo (DRC), an advocacy coalition formed by parliamentarians has successfully convinced leaders in the majority of the country’s districts to increase local immunization budgets. The recent passage of immunization laws in Uganda and Nepal would not have been possible without years of tireless advocacy work by parliamentarians.
As of 2015, the Republic of Congo’s government paid for 39 percent of its immunization expenditures, up from 26 percent in 2006. Despite this progress, the country is still reliant on partners such as Gavi for the majority of its immunization funding and unprepared for the eventual withdrawal of their support. Hon. Alain Pascal Leyinda, parliamentarian and health committee chair from Congo, said, “Autonomy over immunization financing is an objective for Congo, that immunization be financed one hundred percent by the Congolese state, the Congolese, because it is unacceptable to still count on external sources to fund vaccines or immunization in our home.” Leyinda stressed parliamentarians’ responsibility to join together to spread this message to the people, because “immunization is a matter of sovereignty.”
This drive for long-term autonomy and sovereignty permeated each presentation and discussion over the course of the three-day Colloquium. “It’s paramount that every country must own its immunization program,” said Hon. Huda, a key champion of Uganda’s immunization law. “These are your own citizens, so you cannot just expose your own citizens to be managed by other people.”
Signatories of the Kathmandu Parliamentary Declaration: Hon. Sukias Avetisyan, Armenia; Hon. Ranju Kumari Jha, Nepal; Mr. Uy Visal, Cambodia; Hon. Gaston Komba, Cameroon; Hon. Alain Pascal Leyinda, Congo; Hon. Louis Kaswende and Hon. Grégoire Lusenge, Democratic Republic of Congo; Sen. Joshua Lidani and Hon. Muhammad Usman, Nigeria; Hon. Elène Tine, Senegal; Hon. Abdulai Daniel Sesay, Sierra Leone; Hon. Huda Oleru, Uganda; Hon. Nguyen Van Tien, Vietnam; and Hon. Lova Herizo Rajaobelina, Madagascar.