Chapter 1“All of us who call ourselves human beings are brothers. But if we are brothers, it is also our duty to share with each other the lovely and good things that we have received.”

Jørgen Edvin Nilssen8

Northern Lights above Peach Blossom Hill“I’m aware that many of you have roots going far back to here in Yiyang. I do too.” This statement brings loud cheers from the large crowd gathered for the celebration. Here we have ordinary Chinese citizens side by side with party officials, military leaders and the local media.

“Many of you have roots here in Yiyang. I do too.” From the centenary celebration of Yiyang City Central Hospital, Hunan, China.

14 November 2006: I’ve just unveiled a bust of Dr Jørgen Edvin Nilssen next to the hospital’s main entrance. The hospital’s director Hu Youquan is on the right in the picture.

It is 2006, and we are in the heart of China, the world’s new superpower. I have been invited as a guest to celebrate a very special occasion. The hospital which they are all so proud of is celebrating its centenary. It has served the population here every single day since 14 November 1906. It has seen wars and crises, floods and poverty, revolutions and changes of regime. But it has carried on doing its job. Nowadays, this central hospital looks after 4.5 million Chinese. This anniversary is being celebrated locally with almost the same gusto that we celebrate Norway’s national holiday on 17 May at home. The whole place is buzzing with excitement. Speeches are made and wreaths are laid, not to mention the music, dancing and theatre. The hospital staff have put on a musical with a politically correct focus on health workers’ heroic deeds in the patriotic history of the People’s Republic. The whole spectacle is broadcast live on television and ends with a firework display in true Chinese style. This is a public holiday for the whole population.

I have just unveiled a bust of the hospital’s founder 100 years to the day after the hospital was established. A host of nurses in ceremonial dress and doctors in white coats have lined up to honour the man who was, in many respects, responsible for bringing Western medicine to this part of China. Today I can both represent and honour him at the same time. This bust is in a central

location, next to the main entrance of the new hospital building.

When I met China’s health minister Zhang Wenkang seven years previously in Beijing to sign the agreement which would bring Chinese medicine to Norway, Zhang welcomed me with the following words: “I visited once the hospital in Yiyang in Hunan Province and heard about two Norwegian doctors who built the hospital at a time when there wasn’t any like it in the whole region. I now know that one of these doctors was your great-grandfather.”

This explains my roots in China. My grandmother lived here in Taowhalun or “Peach Blossom Hill” from the age of 2 to 18. She brought with her many tales from here that I heard as I used to sit on her lap as a boy. She would tell me about her adventures along the Yangtze River and Lake Dongting and the trips she made with aching feet across paddy fields. Not to mention her journeys in a litter up into Hunan’s beautiful mountain regions. She also talked about the girls who had their feet bound and sewn together, crippling them for life, and about robbers, rebels and social unrest in this country in a state of abject poverty with its proud history. There was something special about my grandmother’s tales from China. I could never get enough of them. She loved China, the Chinese and the tales about them. She would often demonstrate her Chinese culinary skills with a wonderful meal. I learnt to eat with chopsticks and we were allowed to slurp our food like the Chinese did. I can still sense the tastes and atmosphere of that time today. The word “exotic” does not do justice in describing my experience. She shared that world over there with me.

Jørgen Edvin Nilssen was the name of the man who started it all. He was born in Sørreisa in Troms County, a land of northern lights and midnight sun, but was to be a pioneer of the modern health service in the Middle Kingdom. His father Søren was a parish clerk and teacher, able enough to receive both an academic and practical education. When they moved to the east of the country, he made the boy go to both lower and senior secondary school. During his time at the cathedral school in Kristiania before the turn of the 20th century, it was obvious to Jørgen that he had a wider purpose with his life. He believed that all human beings were brothers and sisters. He wanted to share with others the blessings that he himself had received. This is the programme he set out for himself while he was still a young student:

The old adage about every race being of the same blood applies across the globe and asserts that we are all brothers. All of us who call ourselves human beings, irrespective of our races with different colours, languages and completely different attributes, are all brothers. But if we are brothers, it is also our duty to share with each other the lovely and good things that we have received.9

Starting with this philosophy, true to his word, he set his sights on the missionary service. He deliberately started to learn a variety of practical trades which might come in handy during this type of service, such as bookbinding, shoe-making, photography, carpentry and wood carving. After this, he studied medicine and qualified as a doctor in the spring of 1900. In the meanwhile, he also found time to get married to my great-grandmother Marie Wisløff, or Maja, as he called her. My grandmother Elisabeth was born in 1901.

It was already obvious that she was going to grow up in China. Jørgen travelled ahead by steamship to Shanghai, and then he took the riverboat up the Yangtze River to Changsha, the capital of Hunan Province, and continued to the neighbouring city of Yiyang. The journey took two months. He relates in his diary about how he and two other envoys from the Norwegian Mission Society arrived at the port in Yiyang one day in May 1902 and were given a friendly welcome on the riverbank by Chinese soldiers, who accompanied the visitors through the city’s main thoroughfare. The crowd had already seen the odd white man before, but never so many at the same time. They pointed and laughed, saying: “one, two, three!”

The young doctor channelled a great deal of energy into starting up his practice in Changsha. He mentioned great social and medical needs in the first report he sent home. In a letter to the mission’s headquarters in Stavanger barely a year later, he describes his plans for a temporary hospital with 30 beds in rented premises in Changsha. “With this plan we will be the first to start up a hospital here in Changsha,” he said in his letter.10 At the same time, he introduced set days at the outpatients’ clinic in the city of Yiyang, 15 miles away. He had purchased there a fairly large piece of land on Peach Blossom Hill11 – Taowhalun – a ridge that was surrounded at that time by woods and fields with shady bamboo groves and peach trees. He found the great human deprivation challenging, but he was also captivated by the landscape. He described Yiyang in his diary as the most beautiful place he had ever seen in China. It was at its loveliest in the spring when the pink blossoms appeared on the peach trees. He then requested approval to build a new hospital on the hill, not far from the bank of the Zi River. On 21 April 1904 he received the telegram from Norway, giving him the green light to set his plans in motion on Taowhalun. He received a brief message, completely to the point: “Yiyang; Yes!”12

This marked the start of a little Norwegian adventure in China. My great-grandfather used all his practical and administrative skills to turn his great visions into a reality.

Jørgen was the only doctor, in the centre, and he had to provide the training himself for the Chinese nurses. This picture from 1907 shows the staff along with Jørgen and deaconess Dorthea Gulbrandsen.

He had the hospital designed and built with the help of Chinese who had never seen a Western house. As time went by, much-needed living quarters were also built to replace the mud hut which was his home during the construction. Schools were also built later on, including a junior secondary school, a school for the blind, a school for children with other disabilities and a children’s home.

This also kindled what was to be a whole family’s love affair with China. Jørgen and Maja had five children who all spent long periods of their time growing up in China. Three of them returned as adults and served for periods of varying length at Taowhalun.

But this is primarily the story about the strength of belief in a universal vision about all people being equal and the challenge of sharing the blessings bestowed fairly. Long before the UN’s Universal Declaration of Human Rights had come about, Jørgen expressed notions about people’s right to life, health and quality of life. This vision planted a seed which sprouted in the young medical student’s heart. It grew into a healthy tree capable of bearing fruit in generations after him, of forming an attitude towards life and setting missions in life for many of his descendants.

On 14 November 1906 the hospital opened its doors in Yiyang for treating patients, with an outpatients’ clinic and 60 beds spread across nine buildings. Conditions were spartan. There was no electric lighting and connection to the water mains.

Jørgen in the hospital’s laboratory.

Jørgen was the only doctor and he had to provide the training himself for the Chinese nurses. Already in the first year 6,000 patients were treated in the outpatients’ clinic and 200 in the ward. The funding was provided by donations collected in Norway. There were collections for foundation walls,

doors, windows and beds. Indeed, there was even action a campaign for nails to build the hospital. This is how the hospital came to be referred to by the local population as the “Nail Hospital”.

This was all going on at a time when Norway itself was a poor country. The newly qualified doctor was not a very demanding type either. In one of his first letters home to the management of the Norwegian Mission Society, he felt obliged to ask for money so that Maja, Grandmother Elisabeth and her oldest brother Ragnar, who travelled to China after him, could ensure that they had everything they needed for the journey: “When it comes now to the departure of my wife and the two little ones, they will need the right equipment in terms of clothing, boxes, suitcases etc. I therefore have to ask headquarters to provide a sum of money for this.”13

They were actually setting out on a major expedition. They did not know if they would ever get to see their homeland and loved ones again. The situation in China, in the wake of the Boxer Rebellion14 and the colonial powers’ invasion in the early 1900s, was unsettled and complex. There was widespread mistrust and opposition towards foreigners and everything they had to offer.

The climate and the types of illness were unusual. Not to mention the language and culture. But most important of all: they were among the first to do this. There weren’t many to ask advice from.

Changsha was, in many respects, a hotbed for revolutionary forces. Opposition was growing to the reigning emperor’s dynasty. In spring 1911 Jørgen was in charge of the hospital that he had established in Changsha, immediately after his arrival in China. That summer a young country lad, Mao Zedong, came to the city to go to school. He discovered a completely new world in the provincial capital. The young Mao read his first newspaper and watched the political and social movements rallying against the empire. He witnessed everything from intensive political propaganda to spontaneous strikes and outright military action. The 18-year-old became quickly involved in the dramatic events which contributed to the fall of the empire and establishing the first Chinese republic in autumn 1911. He later joined the rebel forces. His political activities in Changsha during the first revolution were to mark the start of a revolutionary and military career, enabling him,

forty years later, to declare the People’s Republic of China a reality.

At that time, Jørgen was busy at the city’s hospital tending to the human suffering which the unrest entailed. The need for medical and humanitarian intervention was much greater than what this hospital could provide. Against this background, he felt obliged to set up the Red Cross in the area. On 28 October 1911 the Hunan Red Cross Organisation came into being15. Jørgen took responsibility for financial matters on the board. Along with chairman Yan Fuqing, he arranged beds, mattresses, bed linen and other equipment in next to no time for setting up the Hunan Red Cross Organisation’s hospital. The short-term aim was to meet the great humanitarian need caused by the unrest. He was later honoured for this work by being granted honorary membership of China’s Red Cross. The hospital established at that time later became the Hunan Provincial People's Hospital and is still fully operational.

Almost a hundred years on, in September 2010, I am sitting with colleagues from the Christian Democratic Party’s parliamentary group in the Communist Party’s headquarters in Beijing, face to face with one of China’s strong men, Wang Jiarui, the party’s foreign minister. What was planned as a courtesy visit becomes a discussion lasting almost an hour about mankind’s material and spiritual needs, which was more interesting than any conversations I’ve had with Norwegian ministers on the same subject. I feel that I almost have to pinch myself to make sure that I’m actually hearing what is being said. After a few minutes discussing foreign policy, Minister Wang turns the conversation towards what we do in Norway to take care of people’s spiritual needs. He is obviously curious about what my views are on this, given my background. He is particularly concerned about ageing among the Chinese population, the loneliness experienced by many elderly people and how to provide for their psychological and spiritual needs. “Man is not a mere body, but also has a soul and spirit,” I point out, while thinking: China’s powerful Communist Party has abandoned the idea of religion as being the “opium of the people”.

This leads into an exchange of views which I can interpret in no other way than a result of genuine understanding. While in the midst of huge material progress which has brought millions of Chinese out of poverty, the country’s senior leadership realises that people also have other needs. If a human being is made up of a body, soul and spirit, our quest for meaning can never be

completely fulfilled by material things. The current Chinese state acknowledges that it needs to understand faith and religion. Perhaps they see some value in it for community and working life. I hope that, through greater understanding, the Chinese can develop greater respect for the universal freedom which every person must have so that they can experience their spiritual side. If this does not happen primarily from an obligation to human rights, it may happen out of self-interest, pure and simple. No modern society can manage without the tools which such an understanding represents. Societies which are “illiterate” in the area of faith will be vulnerable to conflicts, and not only fail to understand but also miss out on solutions which specifically take a holistic view of mankind. This applies to small Western countries as much as large countries in the East.

Jørgen Edvin Nilssen’s vision accommodated precisely such a holistic view of mankind and human life. He never seemed to doubt that his main task as a doctor was to provide relief, cure and comfort. Jørgen’s first job was to treat the sick and build the hospital. Later on there was a church in Taowhalun. The church was built cheek by jowl with the hospital. People’s spiritual needs also had to be taken care of as part of this kind of holistic view of mankind.

While the family was having a break in Norway from 1909, Jørgen, the jack-of-all-trades that he was, spent the time studying theology so that he could also be ordained as a minister before departing again in 1911. He was therefore a doctor first, then a minister. This paved the way for him to take charge of the Norwegian mission work in Hunan and become general secretary of the Norwegian Mission Society (NMS) when he returned home in 1919. This had given him enough time to make a lasting impression in China.

After the People’s Republic of China came into being in 1949, foreign missionaries had to leave the country. This also applied to the Norwegians who were serving at Peach Blossom Hill. China was becoming closed again. For generations Jørgen’s and Maja’s family knew little or nothing about the work done in the former mission territory in Hunan. The little information which emerged about the consequences of the Cultural Revolution was frightening, not least with regard to the situation of believers. There was every reason to fear that the traces of Western influence would be wiped out at any cost.

But, when Deng Xiaoping came to power in Beijing, this marked the start of a change. The reforms made to economic policy were also accompanied by greater openness towards the outside world and with regard to the chapter in China’s history which was more or less suppressed during the Cultural Revolution and Mao Zedong’s leadership. It also become clear that the small group of Christians numbering 700,000 in 1949 had grown, in spite of the uncompromising policy on religion, to at least 100 million in five decades.

One day in 1995, Norway’s ambassador in Beijing, Sverre Bergh Johannessen, received a letter out of the blue. The letter was from Yiyang City Central Hospital. They wanted to celebrate the hospital’s 90th anniversary, but knew little about its early history other than it was founded by a Norwegian Dr Nilssen. Could the Norwegian ambassador help?

The ambassador could not think of any other option but to call the Aftenposten newspaper in Oslo to find out whether they might consider writing about the hospital’s request so as to get those who could possibly come forward and shed some light on the story to get in touch. This happened, resulting in the doors opening up again. Back in Norway there were several members of Jørgen’s family who had grown up at Peach Blossom Hill and were rather surprised to hear that the hospital was still going strong. Contact was re-established with the “home areas” in Hunan. This is how the door was opened again, providing Jørgen’s descendants with access to their roots. At the same time, it opened a door for the Chinese to learn about the hospital’s early history. The political climate allowed them, for the first time, to mention the hospital’s origin in the Christian missions and to honour its founder – a missionary doctor sent from Norway.16

I was therefore received not just as Norway’s health minister, but as one of the city’s own when I came here for the first time in 1999. I encountered all the honourable respect and hospitality which only the Chinese can provide. There were banners hanging across the whole city to welcome me. With a definite sense of the historical aspects, the chairman of the city council invited me to lunch at a Taowhalun hotel where the chef was a descendant of one of those who prepared the meals for the Norwegians at Peach Blossom Hill. After a walk along Taowhalun Road I met Dr Yiran Cao. This was a moving encounter. It was almost like meeting an old relative that you didn’t know you had. This 82-year-old Chinese doctor worked at the hospital before the

Communist period alongside my great-uncle Ragnar, Jørgen’s and Maja’s son. Ragnar worked at the hospital in Yiyang as a doctor and administrator. He also established a hospital in Sinhua, Hunan Province, for treating lepers. When he was no longer able to work in China, he made a great contribution to the Red Cross during the Korean War and later took the initiative of setting up a Scandinavian hospital in Korea.

I couldn’t help but feel the tears welling up as I entered the hospital grounds and a host of nurses in freshly pressed uniforms were lined up along the entrance. Yiyang, 1999.

I couldn’t help but feel the tears welling up as I entered the hospital grounds and a host of nurses in freshly pressed uniforms were lined up along the entrance. “We hope that the Norwegian health minister will accept the chairman’s invitation to become the hospital’s honorary president,” said hospital director Hu Youquan, who was almost just as emotional and full of anticipation. I didn’t feel that I had done anything to deserve such an honour, but I accepted it on behalf of all the Norwegians who had served here.

Director Hu was now tending the seed that my great-grandfather had planted: a hospital with more than 650 beds and 1,100 staff, offering extensive research and training, in addition to clinical activities. Above all, he told me that 240,000 patients were treated in the outpatients’ clinics every year and as many as 20,000 were admitted to the wards as inpatients. What started off as a modest dispensary of Western medicine in this part of China had turned into a hospital which served a whole region with a population the size of Norway’s. This made me proud, but most of all grateful for the recognition which my great-grandfather’s pioneering efforts now received from the Chinese authorities, from the senior officials in Beijing to the local leaders in Hunan Province and Yiyang. As an extension to the visit, we set up together the Jørgen Edvin Nilssen memorial scholarship for doctors from the Yiyang Hospital.

As I wandered around the hospital buildings in Yiyang, I had much to reflect on. As human beings, we are often so obsessed about doing something that is relevant, that will get noticed and be meaningful. My great-grandfather had a vision. He would hardly believe that his footprint in China would be so big and clear several generations later. The impact of what he did is bigger today

than it was then at the very outset. This is not because he was interested in doing something that would be noticed, but because he had faith in his vision.

Why did a doctor and his young family go to China? This is the question that I have been asked by Chinese on countless occasions. And I have told them, just as many times, about Jørgen's vision: all people are brothers and sisters. They are all equally precious. It is our duty to share the blessings that have been bestowed on us. This is a universal concept which is just as challenging today as it was a hundred years ago.

This philosophy has meant more to me in my political work than I had realised during my life. Not least because it has given direction and meaning to the work I do on health and international issues. When, at the start of the new millennium, I was in the process of drafting the white paper which was to be a kind of mission statement for the Norwegian health service, this was actually my starting point: the infinite, inviolable value of every single human being. The right to health care must apply absolutely, whether a person is an illegal asylum-seeker, infected by HIV, a drug addict or a COPD patient. Everyone is vulnerable at the beginning and end of their lives. There are times during our lives when most of us experience this kind of vulnerability. This is why solidarity with the vulnerable is an important value which is a continuation of this view of human beings and their right to health care.

Likewise, the legacy from my great-grandfather forms the basis for my commitment to international justice and the right to health care for all. We know that promoting good health in poor countries is economically beneficial. It contributes to development and growth but, most of all, it is just. It is about granting basic human rights. This is the reason that the struggle to make vaccines available to every child in the world to prevent sickness and death is so important to me.

During my visit to the Yiyang Hospital in 1999, I was shown round the departments which nowadays provide treatment using state-of-the-art methods from knowledge-based Western medicine, as well as offering traditional Chinese treatment. It is a statutory requirement in China for these services to co-exist in hospitals. This gave me more inspiration.

My great-grandfather brought Western medicine to China. I am bringing Chinese medicine to Norway. Signing of agreement with Chinese health minister Zhang Wenkang, April 1999.

After all, while my great-grandfather brought Western medicine to China, I intended to bring more traditional Chinese medicine to Norway. Under the agreement signed with health minister Zhang Wenkang, exchanging experiences and developing expertise in this area were a key component. The intention was for Norwegian and Chinese research and health institutions to expand their cooperation.

In the department for Chinese medicine I was diagnosed using traditional methods. Some felt that this was a fairly provocative act. As I lay in 2002 with needles sticking into me in one of Beijing’s best acupuncture hospitals, with NRK (Norwegian public broadcasting company) in tow, it caused a real stir in some medical circles back in Norway. The pictures were broadcast on every channel with a great symbolic impact.

This action came about neither from a moment of spontaneity or an attempt to impose my own enthusiasm for acupuncture on the Norwegian population. I wanted to challenge the arrogant attitude which some Western doctors show to a traditional treatment dating back a thousand years. Some of the academic elite in the healthcare sector have refused down the generations to have anything to do with forms of treatment which are very widespread among the population. My intention was to do something about this.

So, there was a slightly provocative aspect to it. Once back home in Norway, I received a reprimand in a letter from a medical director at one of the major hospitals in the Oslo region. He thought that I was promoting quackery and I should make sure and get myself checked for hepatitis because the needles at the acupuncture hospital in Beijing might have been infected. The editor of the website forskning.no wrote scathingly that I had been in China and saved – using acupuncture. “This should perhaps not come as a surprise when the country has for a health minister someone who believes in faith healing,” he wrote.17

But when I spoke at a seminar organised by the Norwegian Medical Association a few days later, I announced a health policy reform. The Medical Quackery Act of 1936 was to be abolished and replaced by a new, more up-to-date law on alternative treatment. The bill removed the ban on anyone other than healthcare staff providing “treatment to sick people”. The right to provide treatment would continue to be restricted to healthcare staff

for procedures and interventions requiring specialist expertise. But we paved the way for offering alternative treatment as a supplement to orthodox medical treatment, even in the case of serious illnesses. A register was also suggested to ensure honest and reliable marketing. The key development was a focus on research and expanding a centre for alternative medicine at the University of Tromsø. The Norwegian Parliament unanimously adopted the reform, thereby consigning the Medical Quackery Act to history from 1 January 2004.

In the department for Chinese medicine I was diagnosed using traditional methods. Yiyang, 1999.

As I lay in 2002 with needles sticking into me in one of Beijing’s best acupuncture hospitals, it caused a real stir in some medical circles back in Norway.

I have found that it is precisely research and accumulation of knowledge which provide the foundation for improving the integration of alternative treatment methods into the entire provision of health care in Norway. There is no common ground between orthodox medicine and alternative treatments other than to come up with treatment methods which have a documented effect. It is also the best basis for protecting patients and users of alternative treatments against quacks and tricksters. There is no doubt that people trust most and use alternative treatments on a large scale. But public support is not enough. The answer that the Chinese gave me to questions about the documented effects of traditional medicine was: “We actually know that it has worked for 5,000 years.” If there is to be any interaction with orthodox medicine, this effect must be documented through research. There is still a very long way to go here.

This is why I am pleased that the health service is increasingly including the best from alternative medicine in its normal provision. A comparative study published in 2011 highlights that the integration of alternative forms of treatment has made good progress in Norwegian hospitals.18 Half of Norway’s hospitals offer some form of alternative treatment, compared with a third of hospitals in Denmark making similar provision. 40 hospitals in Norway offer acupuncture, while 19 provide other forms of therapy. The fact that Norwegian hospitals have a far more extensive offering than Danish hospitals is attributable to the change in attitude which has taken place following the introduction of the reform in Norway. However, the potential is significantly greater, not least when it comes to prevention.

Great cheers erupted among the local people in Yiyang when I declared that I also had my roots there. This meant far more to me than just a piece of rhetoric. Your roots shape who you are. The legacy from my mother’s family is part of my identity. The door was opened for me to the worldwide fellowship that we human beings are part of from when I was quite little. China was just one part of this. My mother, Åse Margrethe, was born in South Africa when my grandfather, Ernst Hallen, was a sea chaplain there. He was later an outstanding leader of the Norwegian Santal Mission, with India being the main area he worked. My grandmother was in charge of missionary work for and among women. She regularly wrote short stories in the children’s magazine Glimt fra India (Glimpse from India). As a child, I knew more than average about not just China and India, but also about Japan, Hong Kong Madagascar and South Africa because we had family and friends who lived or had lived in these countries. There is no doubt in my mind that my lifelong commitment to international solidarity had its humble beginning in precisely these strong, colourful impressions from my childhood years. My encounter with China confirmed this for me. It was like a homecoming in numerous respects. Norway’s long coastline and strong seafaring tradition has made a significant contribution to the country’s international outlook. Historically speaking, trading with the outside world has been a great necessity for us, and we have had sought-after raw materials to export. This gradually laid the basis for an open economy which is heavily dependent on trading with other countries. At one time, Norway was also the country which had sent out the most missionaries in the world in proportion to its population size. The way in which it rallied people in towns and rural areas, in families and associations is also one of the factors that has moulded Norway and the nation’s place in the international community. Along with the humanitarian tradition promoted by Fridtjof Nansen and the labour movement’s international outlook, the missionary movement has shaped our modern national identity as a humanitarian superpower and peace-loving nation.

I am pleased to be involved in this broad national tradition where we are not selfishly engrossed in looking after ourselves and our own personal or national interests. We have just one Earth. The people on Earth are basically brothers and sisters. This makes it our duty to share the “beautiful and lovely things” that have been bestowed on us.

Chapter 13“Supporting child vaccination is, without doubt, the best investment that we have ever made.”

Bill Gates139

The miracle of vaccinationHolding a newborn grandchild in your arms for the first time is one of the most wonderful feelings I have experienced. It is just as wonderful every time. I don’t take it at all for granted. While I used to smile slightly at grandparents’ boundless enthusiasm for their new role, I now cannot but endorse it. I have become just as fanatical myself. Old tricks as well as old games, songs and books reappear. It’s a wonderful life.

There are few things in life that give me greater joy than my children and grandchildren. At the same time, there is little that fills me more with worry and concern than when the little ones are affected by illness and pain. This is why we have good reason to be grateful that we live in a country with advanced healthcare provision and are protected against many of the diseases and epidemics that rob so many children of their lives in other parts of the world. I firmly believe that we also have a responsibility in this area, as brothers and sisters on the same Earth, to “share with each other the lovely and good things that we have received”. The fact that there are still more than 7 million children under the age of 5 who die every year tugs at my heart strings as a grandfather.140

There has definitely been a renewed focus on children in my life with the arrival of my grandchildren. At the same time, children have also become more important in my public work. In recent years, I have been increasingly spending my time fighting to save children’s lives and provide children with basic health services in poor countries.

My work to ensure that every child has access to vaccines which can protect them against disease and early death has provided a wonderful opportunity to draw the threads together in my own life: the legacy from my great-grandfather Jørgen’s medical work at Peach Blossom Hill in China.

There were plenty of such cups of coffee shared, meetings, telephone conversations and text messages between Jens Stoltenberg and me while I was party and parliamentary leader.

My own father’s radical social commitment. My political work for the world’s poor and experiences from the healthcare sector. The view of a human being’s worth. Responsibility for managing resources more fairly. Impatience to see results from my work. With my vaccination work, it seemed as if these various threads became woven together. It’s hardly surprising then that I find this job the most meaningful in my entire life in public service.

It all started with a phone call from the prime minister’s office a few months after the change of government in 2005. Prime Minister Jens Stoltenberg asked me to drop into his office for a cup of coffee. I had just left the government offices and had become parliamentary leader in the Norwegian Parliament. Stoltenberg had just begun his second term as prime minister.

There were plenty of such cups of coffee shared, meetings, telephone conversations and text messages between Jens Stoltenberg and me while I was party and parliamentary leader. We travelled once together to New York to promote Norway’s global health campaign. On another occasion Jorunn and I were invited to dinner and given a complete guided tour of the new prime minister’s residence in Parkveien.

We quickly reached an informal and confidential rapport in our new roles. It was often friendly and pleasant, but also offered a unique opportunity for some frank, direct talking when difficult matters arose between the Christian Democratic Party and the government. These conversations provided the basis for compromises on State and Church, policy on the elderly, the private schools law and pension reform. Controversial matters relating to biotechnology and family policy gave rise to respectful, but sharp exchanges. He has always listened, even when we were completely at odds.

We are both interested in the fact that there is a lot in common between the labour movement and the Christian community. The notion of solidarity and the message of loving thy neighbour are related. But it can be taken too far.

When I was President of the Nordic Council, I attended a reception at the Icelandic Embassy in Oslo. There was a cheerful atmosphere when the left-wing socialist leader and future finance minister Steingrímur Sigfússon stood up and declared: “Jesus was the first socialist.” Former prime minister Halldór Ásgrímsson then protested: “No, he wasn’t. A socialist says: ‘Everything of yours is mine!’ Jesus said: ‘Everything of mine is yours!’”

There were often clashes between Jens and me on matters that were being discussed in the parliament chamber. But, when it comes to fighting for the world’s poor, we were and remain close allies. From 2001 Jens Stoltenberg was Norway’s first member of the GAVI (Global Alliance for Vaccines and Immunization) Vaccination Fund Board. The fight to save children’s lives through the use of vaccines had become an important cause close to his heart. This is what was foremost in his thoughts when we met in his office in the tower block in the government district at New Year 2006. “Do you want to take over from me?” he asked after I had settled comfortably on the sofa in his office. “I mean in GAVI, of course,” he added quickly, when he saw the quizzical look forming on my face. “Yes, I could start with taking over from you in GAVI,” I retorted, with the hint of a smile on my lips.

This was a declaration of trust that I really appreciated. Jens could have simply gone ahead and appointed one of his own people to the job that he himself had invested a great deal in. Instead, it was one of the opposition leaders in the Norwegian Parliament who, with Norway’s active support, was elected as an independent member of the Vaccine Foundation in summer 2006. At that time, Graça Machel had taken over as Board Chair from her husband Nelson Mandela. I remember at my first Board meeting how she described in an animated fashion how African mothers fight for their children’s lives. “We must always remember that we are doing this job for the children’s sake,” said Graça Machel whenever the discussions become too abstract.

“We must always remember that we are doing this job for the children’s sake,” said Graça Machel, on the right, whenever the discussions become too abstract. The Hague, 2010.

There is still one child dying every 20 seconds from diseases which can be prevented with vaccines. That gives a total of almost 2 million children every year.141 This is an outrage, a tragedy and an injustice, which is completely unnecessary. This is because it is possible do something about it. A child’s

access to vaccines should not be determined by where he or she is born. Since 2006, I have been able to use my experience as health minister and my commitment to the world’s poor in a job aimed at providing vaccines to children in low-income countries. It is a great privilege for me to be involved at the heart of this work.

When I’m travelling around with my vaccines work, I have my oldest granddaughter, six-year-old Evelina, as my number one cheerleader. We study the globe together before I set off. She’s well aware of what her grandfather is doing for the poorest children, and she always puts aside some money to go specifically to them. While I was writing this book, Evelina asked me what I was doing. I answered her that I was writing a book about what I think is most important in life. When I asked her whether she knew what was most important to her grandfather, she answered with a big smile: “Making sure that children can live.”

A child’s access to vaccines should not be determined by where he or she is born. From a visit to an outpost served by the Haydom Lutheran Hospital, Mbulu, Tanzania, 2011.

I definitely agree. There is something about vaccines which appeals to me in a particular way. It is because we are talking about one of the most efficient and cost-effective healthcare tools in history. A vaccine is like a little miracle. Just a few doses protect a child against fatal diseases for life. This provides a rare opportunity for affirmed supporters of prevention to get involved in something that has a huge influence on the lives of individuals, families and nations. The vaccinations which we take it for granted that our children and grandchildren will receive must be made available to all children. New vaccines must be distributed just as quickly to poor countries as to the rest of the world. Last but not least, new vaccines must be developed and produced to combat diseases which mainly claim lives in poor countries.

I am fascinated by the history of vaccines. Vaccination has made an historic breakthrough worldwide in the fight against infectious diseases. The infectious disease smallpox claimed the lives of up to 500 million people in the 20th century. This disease has been eradicated thanks to an effective vaccine. There were polio outbreaks in 125 countries 20 years ago. Following an intensive effort involving vaccines, there are nowadays just 3 or 4

countries which still have outbreaks. Between 2000 and 2007 the number of people who died from measles was cut by 78%.

Vaccines save lives, but also ease the burden of illness and disability on families, health services and society. This means, in turn, saving expenditure and time which used to be spent on taking care of the sick. The expenditure on medical treatment for sick children can be for many families what tips their parlous finances over the edge. Healthy children are in a better position to perform well at school and later on in their working lives. They become part of society’s economic and social backbone. Vaccination also provides direct socio-economic benefits. When smallpox was eradicated 30 years ago, this resulted in a saving of NOK 7 billion every single year in expenditure on treatment and prevention, more than 10 times the cost of the programme to wipe out the disease.

However, there are many obstacles hindering the effort to provide better vaccination coverage. Military conflicts, instable governments and natural disasters prevent many places from combating diseases which can be prevented using vaccines. When such situations arise, we often notice a fall in the proportion of children routinely vaccinated. Poorly developed healthcare systems are also a problem in a number of developing countries. To ensure that the vaccines get right to children in remote areas, qualified staff, systematic organisation and cold distribution are required to ensure that the vaccine doses keep until they reach the place where the children are being vaccinated.

During visits to several countries in Africa, Asia and Latin America, I have been allowed to track the vaccines’ journey through this critically important “cold chain”. The vaccines must preferably be delivered in one trip from the central cold storage facility in the capital, via the local hospital, to the refrigerator at the health stations. Finally, they are, in some cases, transported on the last leg of the journey to remote villages in a cool bag contained in the pannier of a bicycle.

These hard-working, self-sacrificing health workers are the local heroes of the vaccine effort. Take, for instance, the young Afghan midwives who, in spite of the poor accessibility, war and prejudice, provide mothers and their children with vaccines, health advice or help in delivering babies every single

day.

On a home visit with two of the vaccine effort’s heroes: Emebet and Feven. The family proudly shows off its health certificate. Ethiopia, 2011.

In spring 2011 I met Emebet and Feven in a village south of the Ethiopian capital Addis Ababa. These two young girls were among the 34,000 health service staff recruited locally. They knew all 1,100 households in their area. They provided assistance during births, made home visits, gave vaccines and promoted basic preventive health measures. They explained to me how vaccination was a driving force in everything they did. It was precisely the offer of vaccines which made mothers come to the health station as they were aware of the dangers with infectious diseases after experiencing previous epidemics. I visited the mud hut of a family which proudly showed off a certificate confirming their vaccination and other health-promotion measures on their little farm.

Thanks to the efforts of these local health workers, vaccines have been made accessible and provided protection to millions of people around the world. Vaccines are one of the key reasons why the number of children dying before they reach the age of 5 has been significantly reduced in recent years: from a figure of 20 million in 1960 to around 12 million in 1990 and then to 6.9 million in 2011. Director-General of the WHO, Margaret Chan, gives vaccines credit for more than half of this reduction. Providing support for the development of good health services has been just as important. Without a healthcare system there will only be vaccines, but no vaccination.

Those of us working with vaccines nowadays are building on the work of some pioneers in this field. Thirty years ago, in the midst of a global economic recession and debt crisis, UNICEF’s legendary chief, Jim Grant, launched a high-profile campaign to reduce child mortality. At that time, more than 14 million children were dying every single year. Jim Grant’s target was to halve this figure by carrying out vaccination and other extremely cost-effective measures, such as teaching about the benefits of breastfeeding and simple ways to treat children suffering from severe diarrhoea. Millions of children’s lives were saved through this effort, with the proportion of children in developing countries being vaccinated doubling to 40% by the mid-1980s. This rose further to 70% in 1990.

Unfortunately, the global community lost some of its focus on vaccines in the years that followed. The progress made halted and the percentage of vaccinated children dropped in many places. By the end of the 1990s, 30 million children were born every single year who had little or no access to basic vaccinations. In Sub-Saharan Africa fewer than 50% of all children were vaccinated. Nearly 3 million died every year from diseases that could have been prevented with vaccines.

It became obvious to many people that something had to be done. During a meeting in Davos in 2000, all the key players in the field of vaccines rallied together around a new initiative: a global alliance for vaccinating the world’s children – GAVI. Freedom-fighter and statesman Nelson Mandela was the first Board Chair of the Vaccine Foundation which was to fund the alliance’s work.

The objective set for the new organisation was to save children’s lives and improve public health by increasing access to vaccines in poor countries. But its ambitions went even further. There has traditionally been a lag of 10-15 years between children in rich countries being able to benefit from a newly-developed vaccine at a price low enough so that the vaccine can be purchased for children in developing countries. Millions of children are dying needlessly during this unacceptably long wait. Vaccines against diseases which mainly cause child mortality in poor countries were also never produced. GAVI was set up to collate the demand from poor countries and purchase the vaccines on their behalf. This meant that the purchase of vaccines could be guaranteed, along with increased use of and quicker access to existing vaccines, while also ensuring that new vaccines capable primarily of saving lives in poor countries are actually produced.

The combination of a huge need for vaccines and an extremely small amount of purchasing power may be regarded as a “market defect”. To rectify this defect, donor countries fund the final phase in the development and production of vaccines, which is adapted to developing countries’ needs. For the time being, GAVI has used this model to ensure long-term access for developing countries to vaccines against pneumococcal disease. Thanks to this, GAVI reckons that it will be able to help prevent 7 million deaths which would have otherwise been caused by pneumococcal disease by 2030.

The GAVI Alliance’s work has already delivered brilliant results. More children than ever are being vaccinated. GAVI contributed in its first decade to almost 330 million children in the world’s 73 poorest countries receiving life-saving vaccines. More than 5.5 million needless deaths have been averted. The time required for the new vaccines to reach those most in need has also been significantly reduced. The newly-developed vaccines against pneumococcal disease and severe diarrhoea were available, thanks to GAVI, in low-income countries just one year after they were launched in the US and Europe, and at a fraction of the price they sell for in industrialised countries. The power of the market has been used to push vaccine prices downwards. For instance, GAVI purchases vaccines against pneumococcal disease at a 90% discount, compared to the market price in industrialised countries. Between 2000 and 2011 the price of vaccines against the infectious hepatitis B dropped by 69%.142

The man who seriously started the snowball rolling in 2000 was Microsoft’s founder Bill Gates who, through his foundation, provided USD 750 million in start-up capital for the new initiative. I met him for the first time in his modest office at the Gates Foundation premises in Seattle, USA, in January 2011. I had prepared myself well and some people had warned me that he could be demanding and added, with a smile, that you should be familiar with his “Billology” prior to such a meeting.

The meeting left me in no doubt that Gates has a powerful commitment to development. He is impatient and knowledgeable. When Bill Gates says that “supporting child vaccination is definitely the best investment we have ever made,” both the public and private sectors sit up and take notice. I was well prepared for our meeting, but Bill had also done his preparation. He had written up three points on his board which he wanted to discuss with me. After my introduction, I got a lecture that I wanted to forget afterwards.

Impatience for results is just a moderate description of his message. He is almost obsessed by the thought of what vaccines can do. Bill focuses greatly on the value of each individual child’s life and on the obligation that he believes we have to cut the time it takes for life-saving vaccines to reach every child. My aim was to get his help to raise USD 3.7 billion. Using this money, GAVI could save the lives of another 4 million children over five years. Bill came onboard, but also wanted to use his position to get others to

take greater responsibility for this unique investment in human life. We discussed how different donor countries, including Norway and the UK, could be challenged to give more than they were already doing. Bill mentioned that he could think about increasing his support for GAVI by the equivalent amount that the British might be willing to increase their support by. He was also willing to play the role that we might want him to play at the meeting we were planning for contributors later on in the year.

From the outset, Norway has been one of the key mainstays of the GAVI Vaccination Alliance. A number of Norwegians have also played a pivotal role in expanding the new organisation from its beginnings in 2000. Gro Harlem Brundtland was head of the World Health Organisation (WHO). Her chief of staff was Jonas Gahr Støre, and they both had a great say in shaping the new organisation. One of the key persons involved in establishing GAVI was the former head of the WHO’s tropical diseases research programme, Dr Tore Godal. This Norwegian was GAVI’s first CEO. The knowledgeable, hard-working Godal, with his long experience of moving within international health circles, acted, in many respects, as the “glue” which held the whole thing together in the early days. I am full of admiration for what this man achieved within the field of global health. Back in Norway, he is an eminence grise, playing a role behind the scenes in government. In global health circles, he is a giant whom everyone looks up to.

There were many things during my meeting with GAVI that delighted me. First of all, there is the genuine sense of partnership. Representatives of major, international players and independent individual representatives come together around the board table with a humble attitude to cooperating on achieving a common goal. The GAVI Alliance is made up of government representatives from both donor and developing countries, as well as representatives from UNICEF, the World Health Organisation, the World Bank, Bill and Melinda Gates Foundation, voluntary organisations, vaccine producers and research institutions. It goes without saying that internal conflicts of interest arise, with major cultural differences and disagreements being normal in this kind of cooperation. I have chaired both government conferences and parliamentary meetings, but chairing Board meetings in GAVI is unlike any other experience. Here there is a meeting of different languages and cultures, different government and administration traditions, private and public ways of thinking, health expertise, the development sector

and finance, North and South. You get the whole feeling of everyone genuinely mucking in together. Everyone makes their own contribution, whether members just representing themselves or those representing the giant UN agencies. No one tries to dominate proceedings. GAVI has managed to create a unique climate of cooperation which has been instrumental in the organisation’s results.

Secondly, the GAVI Alliance has introduced a refreshing new way of thinking within the established global health sector. An exciting dynamic has been created by trying to bring together the best in terms of creativity, expertise and experience from both the private and public sectors, with innovation also being one of GAVI’s hallmarks.

The bane of development programmes is their dependency on the annual aid budgets being approved in the relevant countries’ parliaments. This undermines the opportunities for using resources in an efficient, planned way, where and when they are needed. GAVI has come up with a funding solution which means that bonds are sold on the international finance markets that are secured by long-term obligations from donor countries. Thanks to these instruments, GAVI has been supplied with USD 3.6 billion, making it possible to increase quickly the proportion of children in the world who are vaccinated.

The well-known British financier Alan Gillespie was in charge of the job of setting up the new scheme along with financial experts who previously had careers in the field of investment and share trading in a completely one-sided, profit-orientated business environment. He tells how several of them were moved to tears when they realised that their involvement could help save children’s lives with vaccines.

GAVI has also developed schemes for attracting donations from the private sector. The UK Government has promised to double all the contributions made to GAVI by private UK donors. The Gates Foundation has followed the UK’s example by saying that it would do the same. This makes GAVI a unique “investment target” for the private sector. Not only does the money go to a good cause with guaranteed achievable results, but every private contribution to GAVI will also be doubled as soon as it is made. This simple model has helped GAVI bring onboard several new private players in its

vaccination work.

In February 2012 I hosted in Davos along with Bill Gates a breakfast for business leaders. This breakfast raised USD 9 million for the vaccination effort.

In January 2012 Bill Gates, the UK’s development minister Andrew Mitchell and I hosted a breakfast for business leaders during the World Economic Forum in Davos while the financial crisis was the predominant theme. MTV founder Bill Roedy asked rhetorically whether anyone in the room could point to any other investment where the result was guaranteed and the investment doubled the moment it was made. We raised USD 9 million in the “collection” made during the breakfast. We reckon that by the end of 2015 we will have obtained USD 260 million through the Matching Fund. Hopefully, Norwegian companies will also commit to this effort.

Innovative financing is about getting more money for health care and more health care for your money. If GAVI’s promotional activity for vaccines had merely contributed to moving money from other development aid causes, it would not have been so impressive. Fortunately, this isn’t the case. Studies highlight that GAVI has attracted new and increased funds for providing health care for the world’s poor.

A third feature is that the developing countries themselves are in the driver’s seat. They apply for aid, they include routine vaccination as part of their own healthcare plans and must contribute themselves to funding their vaccination programmes. GAVI’s role is to support the countries’ own efforts to provide the population with life-saving vaccines.

This is where GAVI is in the forefront and sets a new benchmark in international development cooperation.

The size of the countries’ contribution depends on their economic situation. The poorest countries pay a small share, but their responsibility increases gradually as the countries’ economy grows. Several countries are currently in the process of “graduating” from GAVI because they have a level of economic growth which gives them scope to pay completely for vaccines for their own population. Self-financing ensures the countries’ ownership and the aid’s sustainability.

It is obvious that I should mention China as an example. From 2002 to 2006

GAVI collaborated with the Chinese authorities in distributing the hepatitis B vaccine to the country’s poorest provinces. Vaccination coverage increased dramatically. 66.6 million children were vaccinated and 900,000 potential deaths due to liver disease were averted. Since then, China has “graduated” from GAVI, is providing its own vaccines and is now considering how they themselves can contribute to GAVI’s work.

In spite of the impressive results, there were still plenty of challenges for the young health organisation to face when I joined the Board in 2006. Cooperation between partners and between the partners and the secretariat was far from perfect. The management model was simplified, but it was to become clear quickly that the biggest challenge lay elsewhere. New vaccines for illnesses including diarrhoea and pneumococcal disease would soon be ready. Millions of lives could be saved when these vaccines were introduced. At the same time, GAVI was heading towards a situation where the lack of money could end up bringing this launch to a halt. A change of CEO and Board Chair was about to take place. During a Board retreat in Rotterdam in 2009, I presented the following challenge to the Board on what needed to be done: GAVI had to go to the world’s leaders and tell them what we can do with more resources.

Rwanda 2011. As newly-elected GAVI Board Chair talking to mothers waiting to have their children vaccinated.

This situation was still not resolved when I agreed in the early summer of 2010 to stand as Norway’s candidate for the post of GAVI Board Chair. When I was elected at a meeting in Kigali, Rwanda, in November of the same year, the organisation didn’t have a CEO and there was a financial gap of USD 3.7 billion for implementing the planned vaccination programmes up to 2015. My first task was to come up with good solutions to these challenges. I was aware that the following months would be crucial to the Alliance’s drive and opportunities for the coming years. Many of us had to pull together if this were to be a success.

The job of finding a new CEO was under way. My predecessor as Board Chair, the former Irish president Mary Robinson, had already asked me to get involved and take charge of this task before I took over. In January 2011 we

were at the final stages with a few suitable candidates. In early March we were able to announce that the acclaimed head and founder of the International AIDS Vaccine Initiative (IAVI), Seth Berkley, was appointed as GAVI’s new CEO.

The second main task was to obtain the funds which would ensure the countries got the vaccines which were now available. Given that we were in the midst of the financial crisis, we had to expect this to be a very challenging task. The medical journal The Lancet wrote in February 2011:

“.., former Norwegian Minister of Health Dagfinn Høybråten is facing one of the hardest fund raising challenges of his career. As the new Board Chair of the GAVI Alliance, which implements global vaccination programmes, Høybråten must now convince philanthropic organisations, aid agencies, and world leaders to raise the US$3.7 billion funding shortfall that the alliance is facing between now and 2015.”143

We set 13 June 2011 as D-Day. This is when contributors would gather to explain what they would commit to provide in the next few years. I spent a lot of my early days as Board Chair travelling around and visiting the capitals of main donor countries and important partners in the Alliance. I had never spent more time travelling in the course of a year. I met UK development minister Andrew Mitchell in London already in January. He had good news for me: the UK Government, headed by Prime Minister David Cameron, would host the donor conference. The Cameron government had already made an important value choice: although every budget area had to be cut, it would increase development aid. They had now made another important choice: they would ensure that GAVI’s success could continue.

The message I took with me as I travelled around was clear and powerful: 2 million children were still dying every year from diseases which vaccines were available for. GAVI can make a contribution to the battle to reduce this figure by immunising another quarter of a billion children by 2015, an action which would save 4 million lives. Most of all, we wanted to cooperate with the developing countries in introducing vaccines for two major childhood killers – severe diarrhoea and pneumococcal disease. These two diseases account alone for 40% of children dying before reaching the age of 5. The vaccines are available. There is the demand from poor countries. In London we can obtain the money needed to do this! How can we allow a situation like this to go on?

We also received valuable support from a comprehensive assessment carried out by the UK’s Department for International Development (DFID) of all the aid supplied by the UK in terms of cost-effectiveness and achieving objectives. When the results were published in March 2011, it showed that GAVI was right at the top as the best multinational aid organisation. This helped us mobilise resources and gave the whole GAVI team a real boost. GAVI subsequently achieved similar results from both an Australian and Swedish aid surveys.

The entire GAVI team worked hard to recruit more donor countries and ensure increased contributions from existing donors. At the same time, we had to respond to increasingly vocal criticism from individual organisations which believed that it was unfortunate that the vaccine industry was included in the Alliance. The loudest criticism on this score came from Médecins Sans Frontières. They felt that the interest issues for GAVI were blatant with the vaccine industry earning money on the back of GAVI’s funding for vaccines. They also believed that lower vaccine prices could be achieved if the industry was kept outside the Board.

I agreed that it was important to tackle these conflicts of interest in an orderly manner. But, in my view, throwing the industry off the Board would not be a good solution. GAVI would not have achieved the results it had without a proper interaction with the vaccine industry. Mistrust and a lack of understanding between the private sector and the international development sector had blocked good initiatives on several occasions, resulting in a setback for the vaccination cause. We had to avoid ending up in such a situation again.

Conflicts of interest are obviously inevitable in such an alliance. Now and then, everyone around the board table has strong interests based on individual agendas. It was therefore important for us to handle these interest issues correctly. I outlined a solution which the GAVI Alliance reviewed, and it tightened its rules on interests. I also suggested that any market-sensitive issues should be handled in the Executive Committee where the industry would no longer be represented. Such an organisational change would ensure a definite separation and indicate more clearly to the outside world that the industry did not participate in decisions relating directly to their business activities. The industry’s representatives gave their backing to this change.

They realised that it would protect both their own and GAVI’s integrity.

Throughout the spring of 2011, it was a tough job, in several respects, mobilising contributors prior to the gathering in London. A number of the Alliance’s supporters were mobilised. Global superstar Bono wrote a letter to a number of state leaders, including French president Nicolas Sarkozy, to get them to up their support for GAVI. Singer Bob Geldof came forward and appealed for a greater vaccination effort. Bill Gates went on a tour of several countries, including a visit to Oslo and Jens Stoltenberg. The objective was to plug the financial gap of USD 3.7 billion, an almost unrealistic amount at a time when the financial crisis was forcing more governments to make swingeing cuts. There was a great deal of uncertainty for a long time about how we stood. But in the final weeks in the run-up to the meeting, more positive messages came in about donors who would contribute more than before. The vaccine industry also made an announcement about lower vaccine prices for GAVI countries, including a two-thirds reduction in the prices of new anti-diarrhoea vaccines.

The tone was already set when the meeting in London opened. David Cameron declared that the UK was standing by its promises to increase its aid. He stated that the UK would not let the poorest pay for its own economic problems and promised to treble the aid provided to GAVI by the UK. Bill Gates similarly increased the amount he had promised, laying USD 1 billon the table with the brief remark: “It’s not every day that we give away so much money, but this is a good cause.” Jens Stoltenberg, for his part, committed to double Norway’s contribution.

The meeting held in London on 13 June 2011 raised USD 4.3 billion for vaccines over the next five years. From left: GAVI CEO Seth Berkley, Liberia’s President Ellen Johnson-Sirleaf, HRH Princess Cristina of Spain, UK Prime Minister David Cameron, Bill Gates, UK’s development minister Andrew Mitchell and myself.

I met 12-day-old Raswiri and her mother in a trackless village in Malawi. 2007.

Several other countries also increased their contributions. Liberia’s President Ellen Johnson-Sirleaf appealed on behalf of the partner countries.

When the total figures appeared on the screen, I had to pinch myself and dry a tear from my eyes. It was almost unreal. In the midst of a deep financial recession, the world showed a strong determination to stand up and save

children’s lives and health. When we totalled all the contributions made, we ended up with USD 4.3 billion, USD 600,000 more than our target. We could now implement our ambitious programme. We had the money and vaccines needed to save 4 million lives. Perhaps we could still do more and do it faster. This was a huge vote of confidence in GAVI, but also an expression of colossal expectations. 13 June 2011 will remain an historic day for GAVI and a milestone for global health, showing that it is possible.

During 2011 and 2012 we were able to roll out the new vaccines against diarrhoea and pneumococcal disease in one country after another. At the same time, we forged full steam ahead with continuing existing vaccination programmes. At a meeting in Dhaka, Bangladesh, in November 2011, the GAVI Board approved the provision of support for introducing a vaccine against cervical cancer (HPV).

Little Fathema from Bangladesh. A precious moment for a grandfather far away from his own family. 2011.

The prerequisite for this approval was that GAVI managed to obtain a significant reduction in the prices for this vaccine, which is something we seem to manage to do.

Cervical cancer kills 275,000 women every single year. More than 88% of these deaths occur in developing countries. The HPV vaccine can prevent 70% of these deaths, but currently, it is largely only available in the world’s rich countries. The world can no longer accept that cervical cancer kills a woman every two seconds when vaccines are available.

Some time in the future, we hope that there will be a new vaccine against malaria, dengue fever and, later on, against HIV/AIDS too. The potential is great, and by continuing the immunisation effort the vaccine miracle can continue to save increasing numbers of lives.

The meeting in London was almost a magical experience. Similarly, many meetings take place with mothers and children who are benefiting from the vaccine miracle which leave the strongest impression. Let me just give you a brief insight. I met Raswiri and her mother under the tree in a trackless village in Malawi.

In earthquake-hit Port-au-Prince I vaccinated little Madeline Isaac against polio. April 2012.

This little girl was 12-days-old when I got her vaccinated against polio. After being given approval by the village chief, I was allowed to talk to the colourful assembly of mothers and children. They performed a two-part chant in appreciation of the vaccination campaign.

In the village of Bara Goan in Bangladesh, I was involved in the vaccination day at the house of health worker Rabbi Aztor. Little Fathema, just 10-weeks-old, was weighed and measured and then received a couple of drops of the anti-diarrhoea vaccine orally and five vaccines through a single injection in her arm. The five minutes that the whole procedure took are so incredibly important to little Fathema’s life. I was then given permission by her mother, Maksuda Aketer, to lift the little girl in my arms and hold her next to me. A precious moment for a grandfather far away from his own family.

In the earthquake-hit capital of Haiti, Port-au-Prince, I was able to take part in a spectacular launch of a radical offensive to vaccinate several age-groups which were missed out in this poor country and prevent futile deaths among children. This is where I vaccinated little Madeleine Isaac against polio with two protective drops of vaccine in her mouth, ably assisted by health minister Florence D. Guillaume.

Our children and grandchildren in Norway have access to a team of top-class specialists when their life and health are in danger. I encountered a completely different reality in Haiti. In the district of Haiti’s capital I visited, they had no gynaecologist and just a single paediatrician in a hospital meant to serve 100,000 people. There is less likelihood of getting specialist help in a crisis than winning the lottery.

The disparities in terms of living conditions in these countries compared to Norway are almost impossible to comprehend. We live in one of the richest countries in the world. They live in some of the poorest. We are constantly chosen as the best country in the world to live in. In countries like Malawi, 2 out of 3 people in rural districts live in abject poverty. The average life expectancy in Norway is around 80. In many African countries it is almost half this. There are also so many in the same situation. We are brothers and sisters sharing the same Earth. Therefore, being able to lift and hold a newborn child or grandchild for the first time is one of the greatest feelings you can experience, no matter where you live in the world. Vaccination

means that many more will also get to enjoy seeing them grow up.