There is a powerful but strangely underdiscussed truth in global health: The malnourished children that health agencies and nonprofits are trying to provide with good nutrition are the same children desperately in need of life-saving vaccines, and vice versa. Not the “same” in the abstract, the same in the cruel specific.
Malnourished children are significantly more likely to get — and die from — diseases such as pneumonia, diarrhea, measles, meningitis, and tuberculosis, while infections increase the risk of malnutrition. Some scientists have even suggested that malnourished children may not get maximum protection from vaccines because of their compromised immune response. Despite this, these services are rarely provided together to a child.
That’s why I’m so excited by two announcements involving the integration of nutrition and vaccine programs made during the Raising Generation Immunity conference — the Midterm Review of Gavi, the Vaccine Alliance’s 2021-2025 program cycle.
“Those of us working in global health and development know that children and families do not experience their lives in silos and fragments, yet much of development assistance flows as though they do. Vaccines for the child here. Deworming there. Nutrition services some other time and place. It is time we put the holistic needs and wellbeing of the child at the heart of all we do, now and throughout their life.”
– Anna Hakobyan, chief impact officer, Children’s Investment Fund Foundation
Held against the backdrop of the worst pandemic in a century, global health experts convened in person for the first time in five years at the event in June to highlight progress in vaccination, and to pause for critical reflection on how to address the disruption to the routine immunization of children. The pandemic led to drops in childhood immunization coverage for the first time in 20 years.
At this event, the Children’s Investment Fund Foundation announced its joint $30 million partnership with Gavi with the goal of integrating its nutrition, social protection, and immunization programs in Ethiopia. This will be delivered through UNICEF and its Child Nutrition Fund, which offers innovative programs and financing solutions to high-burden countries.
Meanwhile, the Eleanor Crook Foundation announced its own joint investment with Gavi in a $2 million nutrition and immunization research agenda, including a randomized control trial in Nigeria to validate the use of nutritious supplementary food as an incentive for increased vaccine uptake.
I believe these partnerships can be truly transformational, though, of course, I am biased as I run Stronger Foundations for Nutrition — the global philanthropic community founded by leading philanthropies including these two new Gavi partners — and I am proud to have helped kick-start conversations between these important institutions. Still, I think my excitement about the potential of these partnerships is justified.
“Malnutrition services and immunization are already two of the very best buys in global development, especially when it comes to preventing children from dying. There is some evidence that malnutrition interventions can be bundled with vaccination services to save more lives and increase demand for vaccines.”
– William Moore, CEO, Eleanor Crook Foundation
Integration is essential. It is almost impossible to imagine what a siloed approach to delivery means for millions of young families who struggle to routinely access even one of these services — let alone all. But we do know what money flowing down vertical pipes does to the health systems: It looks like strained and short-staffed health care workers — a reality in 55 countries around the world, because as separate sectors we struggle to work together to strengthen these systems.
Right now, immunization and nutrition are financed — and most often delivered — almost entirely separately, even though there are tragic interdependencies. We can flip this on its head by putting children at the center — integrated diagnostics, prevention, and treatment can deliver stronger health outcomes than standalone programs, and save precious time and resources for caregivers and health workers.
How can we fill in the cracks between these separated systems? We must align incentives to work across sectors and find solutions that take very separate outcomes such as immunization and improved nutrition, and make them one because each investment makes the other stronger.
Gavi’s partnerships with CIFF and ECF attack these interconnected challenges, and propose creative new solutions for how to address them. By bringing together previously separate immunization and nutrition delivery platforms, new opportunities for leverage emerge; a cash transfer in a social protection program, or the provision of Small-Quantity Lipid-Based Nutrient Supplements, or SQ-LNS, may suddenly become an incentive for vaccination.
These types of creative incentives are possible because families love nutrition interventions like SQ-LNS — a food-based supplement designed to prevent malnutrition in children 6-24 months of age, which can reduce their risk of mortality by 27%. SQ-LNS tastes good, is easy to consume, and delivers real gains for children that families can quickly see.
This desirable experience — with a quick and visible return — differs from many immunization services, which may be intimidating for some families and have benefits that are not felt until far in the future.
By bundling and creatively leveraging services as incentives, we open up pathways to co-investment that were previously trapped in vertical silos and create opportunities for cost-sharing that can strengthen and deepen the reach of strained health systems — a critical impact and learning agenda for all partners, including the Government of Ethiopia in its Seqota Declaration.
The evidence is still forming, but there is a real promise that through the co-delivery of nutrition and immunization services, we can turn the vicious cycle of malnutrition and infection into a virtuous one.
“Integrated interventions that begin at birth, that include nutrition and vaccines, protect against devastating preventable illnesses that claim the lives of millions of children worldwide. These two partnerships — catalyzed by the Gavi Matching Fund — are great examples of how we can work together to help prevent millions of deaths and save the lives of the most vulnerable children.”
– Guillaume Grosso, director of sovereign and private sector engagement, donor relations and campaigns, Gavi
Together, we can reach more children — including some of the hardest to reach — with interventions and outcomes that are mutually reinforcing, and with the costs truly shared across multiple sectors.
Two years from now, it will be time for Gavi’s next replenishment. When the world gathers to make those crucial commitments, my hope is that these partnerships will be beacons for a stronger commitment to integration.
It is good for nutrition, good for immunization, and most importantly, it is good for the families who need all of these services urgently.
The author wishes to acknowledge the hard work of many individuals working across these institutions, including those quoted, as well as Corina Campian, Jack Clift, Yashodhara Rana, Saul Guerrero Oteyza, Shahira Malm, and Alia Poonawala.
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