Saving Lives, Saving Economies: In Conversation with Dr. Ngozi Okonjo-Iweala

Against the backdrop of protracted economic downturn, mass urbanization, climate change, and refugee crisis, threats to global health security and economic stability have become ever more acute. Growing risk of viral outbreaks endanger plans for economic growth and development and require greater international coordination between world leaders. There is increasing recognition that, in a globalized world, vaccination and immunization have become global public goods.

On October 3, 2016, the Brookings Doha Center (BDC) and the Center for Conflict and Humanitarian Studies (CHS) at the Doha Institute for Graduate Studies hosted Dr. Ngozi Okonjo-Iweala to reflect on how issues of global health security may be addressed. The event was moderated by Sultan Barakat, the director of CHS.

In the face of seismic global forces transforming population demographics and heightening the risk of the spread of contagious diseases, Okonjo-Iweala argued that childhood vaccination programs must be prioritized not just out of humanitarian need, but also out of economic necessity. In her words, “global health lies at the heart of saving our economies.”

She presented the Gavi model as a framework for tackling health challenges. By providing health assistance to populations most in need, Gavi, a global alliance of public and private actors, attempts to address gross disparities in the quality of healthcare between populations around the globe by equalizing access to vaccines for children. In doing so, it extends the idea of global health, drawing links between it and global economic stability.

Through knock-on effects on infrastructure and demand shocks to trade and service industries, Okonjo-Iweala explained that the outbreaks of Ebola in West Africa, Zika in the Americas, and SARS in Asia were as destructive to regional economies as armed conflict. She first discussed the evidence from the Zika and Ebola viruses. The economic ramifications of the Zika virus costed Latin American countries $3.5 billion in 2016 alone. In Guinea, Liberia, and Sierra Leone, the three countries most affected by the Ebola outbreak, experts estimate the cost of the Ebola virus at $2.8 billion. As it is too early to calculate broader long-term costs of those two epidemics, these figures are understood to underestimate their full impact. For example, in retrospect, the World Bank estimates the broader global economic cost of the 2002 SARS outbreak to be $54 billion.

In addition, Okonjo-Iweala explained that fear of viral outbreaks is often as contagious as the disease itself and can severely cut into national income from tourism. Even states in the Gulf region, which have highly effective immunization programs that successfully vaccinate almost the entire child population, are vulnerable if disease spreads across its borders. Saudi Arabia, for example, is at risk during Hajj when the influx of pilgrims travelling to the country numbers in the millions. Okonjo-Iweala emphasized that if the international community wants to ensure global health security and economic stability, then everyone must be vaccinated regardless of where they live. The effects of disease outbreaks are not localized; they have broader regional and global ramifications. Border security and immigration control possess limited effectiveness in dealing with viral outbreaks, because the scale and speed of human migration today often surpasses the speed with which symptoms appear on a patient. Thus, Okonjo-Iweala views the prevention of disease outbreaks through vaccines and immunization as the only viable solution.

Furthermore, vaccination produces myriad social benefits in addition to the prevention of viral outbreak. A vaccinated infant is less likely to require healthcare, reducing national health expenses. A vaccinated child is also less likely to take sick days from school, improving her education level and potential earning capacity, as well as boosting national productivity and economic growth. Okonjo-Iweala cited the results of a study in the Journal of Health Affairs that showed that each dollar invested in immunizing a child yields a return of $16 in saved healthcare costs and lost wages and $44 in broader benefits.

Yet, one out of five children still do not have access to basic vaccines and 1.5 million children die each year from vaccine-preventable diseases. Okonjo-Iweala stressed that the international community must accelerate efforts to improve vaccination coverage and equity. The children with least access to vaccines mostly live in rural villages and informal settlements in marginalized urban communities. With higher rates of urbanization and mass internal displacement and refugee flows, the risk posed to urban centers is expected to rapidly increase, aggravating the already fraught capacity to deliver necessary services to these communities. The growing phenomenon of sprawling slums that largely operate outside of the state’s formal governance structures has created fertile breeding grounds for infectious disease and has hindered states from compiling accurate health records for these communities. However, the current global economic downturn and tightened aid budgets threaten to further constrain ability to effectively respond to viral outbreaks in high-risk zones.

It has become ever more critical to focus on ensuring global health security in order to respond to the difficulties accompanying new economic, demographic, and political challenges that are reshaping the global landscape. Okonjo-Iweala has elucidated the role vaccination can play as a response to twenty-first century challenges, regarding vaccination as an integral component in the larger structure of economic development. At the same time, she exhorts governments to realize that the international community cannot ensure security without equity. Failure to immunize the world’s poorest and most vulnerable populations creates security liabilities for wealthier, developed countries in a globalized and interconnected world. Okonjo-Iweala concluded that the international community must prioritize universal vaccination schemes “not just because it is the right thing to do, but because it is the smart thing to do.”