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August 26, 2021 36 mins

Health equity is undoubtedly a global challenge, with some of the most vulnerable communities in the poorest countries bearing the brunt of the injustice. Improving access to basic health care needs, including vaccination against deadly infectious diseases, is a critical step to improving lives and creating a safe world for us all. How does health inequity affect your community? Would you recognize it among your own family, your friends, or your neighborhood? How can local solutions to Covid-19 help us fight the pandemic at a global scale? Health equity isn’t just a distant problem; it is a very local problem.


On this episode of Force Multiplier Baratunde sits with two leaders working tirelessly to provide equitable health care for all. Aurélia Nguyen, Managing Director of the COVAX Facility at Gavi, shares how a global coalition of public and private organizations is transforming the lives of individuals, helping to boost the economies of lower-income countries, and making the world safer for everyone. Dr. Dominic Mack, the director of Morehouse School of Medicine National Center for Primary Care, describes how a cross-sector partnership uses critical resources and data on Covid-19, to connect families to culturally and linguistically appropriate information and services.

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Episode Transcript

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Speaker 1 (00:04):
Welcome to Force Multiplier, a new podcast about leveling up
the impact we can have in the world through our relationships.
I'm barretton Day Thurston and in collaboration with I Heart
Radio and Salesforce dot Org, I sit with leaders from
across the public, private, and nonprofit world who are forging
partnerships to tackle some of the toughest challenges facing us today.

Welcome back to Force Multiplier. What's up? How you doing.
I'm barretton Day, I'm your host. Now today's episode, we
are going to talk about health equity, which are two
words that you probably understanding isolation, but together there's a
lot of different interpretations of that. So I think health
equity means that everybody's got a fair opportunity, adjust opportunity

to live their healthiest lives. It's not just about access
to medicine or quality doctors. It's the opportunity to live
a full and healthy life. Now, this is something that
applies globally as well as locally and in one acute
area right now, it's very present as an issue. I'm

talking to immunization, vaccination. Yeah, we're gonna talk about the Rhona.
This is a COVID centric episode. Because when COVID showed
up here in the US and in many places around
the world, a lot of us got hit with this
message of unity, like this pandemic is going to bring
everybody together, is gonna flatten some of the distinctions of

economics and race and culture in the US and around
the world. And in some ways it did. We all,
for the most part, upgraded our Zoom accounts right. That
brought us together. We got brought together on a platform
like Zoom. But in other ways, COVID has been not
so much a leveler as a revealer. It's been a

kind of truth serum, showing us the truth of the
health and equities we have for too long lived with.
Because some people were overexposed to this virus and continue
to be so because of the occupations they hold or
the neighborhoods they live in, and some of that aligns
with their class and their race and their ethnicity. Other

people have been bearing a mental weight of this pandemic
in an extraordinary way. And then there are those who've
been hit by that financial impact of the pandemic, again
a burden unequally distributed. This matters because we're not gonna

be healthy until we're all healthy. That's kind of how
infectious diseases work. And the longer we have large numbers
of people without vaccination, the more their bodies can serve
as incubators to the next variant, which might undermine our

defenses and threaten us in new and more horrible ways
than COVID has already proven an ability to do. So
we've all got an interest in all of us being
healthy and COVID showing us what it means when we
succeed and when we fail. Now in this episode, we're

gonna hear from two amazing people who are creating good
news out of this Maelstrom, because I know a lot
of the COVID news. It's hard. It's hard. You've got
political disagreements about who should get vaccinated, is it even real.
You've got economic disparity. You've got the vast majority of
the world not even able to argue about whether they

want to take a vaccine or not because they don't
have access to it. So our first guest, she's working
on that one. Aurelia Guyen is the Managing Director at
the Office of the Kovac Facility at the seventy four
World Health Assembly, quite a title I acknowledge. I talked
to her about her role in leading the coordination for
curement and delivery of COVID nineteen vaccines to the vast

majority of the global population in a multilateral, global, cross
sector partnership kind of way. I don't envy the job
she has, but I am very impressed that she signed
up to do this. After that, we're going to hear
from Dr Dominic Mac. He's the director of more House
School of Medicines, National Center for Primary Care and leads

across sector partnership gathering critical resources and data on COVID nineteen,
using that to connect families to culturally and linguistically appropriate
information and services. I hope you enjoy it. Global health

equity is about how we bring forward a level of
access to healthcare that everyone can depend on. It's not
about just coping with COVID nineteen. So it's only through
really strong healthcare systems in all parts of the world
that we as a human society will be better protected.

Aurelia Guyan is the managing director of the Kovacs Facility.
She's dedicated her life's work to enabling equitable access to
medicines and vaccines for some of the world's poorest and
underserved communities. So can you share with listeners how did

this organization come to be and what specific problems is
it trying to solve. So GAVY is a vaccine alliance.
It helps to vaccinate about half of the children in
the world against infectious diseases that can be deadly or
very debilitating. It was founded in two thousand and its

mission is to save lives, to reduce poverty, and to
protect the world against the threat of epidemics and other diseases.
Since two thousand, GAVY has vaccinated more than eight hundred
and eighty million children in the world's forest countries. And
what you get by vaccinating that many children is that

you're saving fourteen million deaths from happening. Gavy's focus seems
to be so much on equity right, making sure everyone,
as much as is possible, has access to vaccines. Why
is that so important. It's part of what I would
think is a fundamental human right in terms of having

access to healthcare as needed. So it's a question of
equity that regardless of where you are born, you will
have access to vaccination. There's also the economic argument. Diseases
circulate very very rapidly, and so having a small portion
of population protected or even a country doesn't mean that

we can re engage in trade, in travel and the
viruses keep circulating. And then lastly, perhaps from an evolutionary perspective,
as we've seen with the emergence of variance, as long
as viruses circulate, they continue to evolve, and so again
making sure that everyone is protected regardless of where they

live is really important in terms of being able to
have ultimately a lasting response, whether you live in a
rich country or in a poor country. Is the lack
of equal access to vaccines due to the high cost
of vaccines, that due to production challenges that due to
intellectual property laws. What's the hold up? Yeah, it's been

a longstanding problem and it's definitely been amplified by COVID nineteen.
At the basis, there isn't an off vaccine manufacturers in
the world, or they're very concentrated in some of the
richer countries. So this is a problem that my organization, Gaby,
we've been working to remedy for some time. When the

organization started, I think it was buying vaccines from five manufacturers,
most of which were in rich countries. Two decades later,
we buy from seventeen suppliers, more than half of them
in Africa and Asia, in Latin America. And so the
work that I do and that I've been doing even
before the pandemic, we call it market shaping. Essentially, by

creating a sustainable and a predictable market, you encourage manufacturers
to come in and it helps create the right sort
of competition in terms of getting the best vaccines, in
terms of getting more affordable vaccines, and also getting the
volumes that we need to vaccinate very very broadly. And

so as the managing director of the COVAC Facility, I've
been pooling all of the demand from the country so
a d countries and then contracting for two billion doses
for this year and making sure that we have that
supplied coming online. On the surface, vaccine hoarding makes some sense.

I mean, we in the United States had this policy,
which is we're gonna distribute to ourselves first and then
whatever is left over we'll give to the rest of
the world. We're not the only nation to have approached
it this way. But how do you define vaccine hoarding
and how do you convince a nation's leaders to choose
a different path, one that might seem a bit more

selfless and not in their own self interest. Essentially, the
way that I read it is that it's an action
a government will take to use its wealth, or to
use its position of power, to procure more vaccines than
they really need. And I think there are lots of
reasons why this could happen. Governments need to be answerable
to a citizens. Also, when this crisis happened, we didn't

know which vaccines would work, in which vaccines would not,
and so um, there were many contracts for many different vaccines.
But that's not to say that there haven't been I
think deliberate cases of vaccine hoarding that I think we're
motivated more from a sort of political or sort of
financial type of agenda. A lot of the early supply

that we were counting on was from India for international use,
and of course, with the very devastating Second Wave in India,
those vaccines were used domestically and weren't available. And so
we have a diverse manufacturer based so that if there
are instances, their impact is as limited as possible. And
then as countries get took place like in the United States,

where vaccine coverage is reaching a high level enough then
being able to really be able to access the excess
supply for international rollouts through vaccine donations, I think is criticals.
So it's about really being able to move into a
different space from a domestically focused response to an international
focused response. These nationalistic leaders, do they understand that a

more vaccinated world is safer for everyone in that world.
I think it's been a slow realization as the pandemic
has evolved. I think it's been a bit of a
wake up call in terms of really understanding that this
very often used phrase of no one is safe until
everyone is safe. What it means in practice, which is

vaccination within one's borders is not going to be enough
to protect one's populations. We've dabbled around it, but we're
going to get right to it now. Kovacs a term
I hear on global radio broadcasts and my news feeds,
but many of us don't fully understand what is this

Kovacs collaboration, who's involved, and what is Gavvy's role in it.
So it was a partnership of four organizations, so my
own GAVY, the Vaccine Alliance, the Coalition for Epidemic Preparedness,
Innovations or SEPPI, the World Health Organization and Unit SEF.
And basically what these four organizations did is they brought

together the experience in development, procurement and rollout of vaccines,
really focused on COVID and so within KOVACS we brought
together a hundred and ninety three governments. So that's about
the global population into a multilateral global effort. And I

think it's the largest efforts since the Paris Climate Agreement.
In terms of the numbers of countries that came together,
this collaboration sounds a bit miraculous, from the number of
countries to the amount of dollars to the number of
doses that are on your road map. What is everyone's
role within KOVACS, Like what does w h O doing

That's different from what gavvy is doing, different from SEPPI
and UNSF. So if you think about sort of the
journey a vaccine needs take, each of the organization has
a little bit of a piece of that journey. So
SEPI has very much been focusing on the research and
development side, making sure they were getting the best science
in the fastest time. GAVY has really been looking at

the financing the procurement of the vaccine contracts with the manufacturers,
and then thinking about how to deploy in countries. The
World Health Organization has all of the normative functions if
you like, you know, is the vaccine safe and effective?
Are we going to need boosters? What do we think
about variant vaccines? And then newnes SEF is very much

doing the rollout the shipment, making sure that everything is
in place so that ultimately the vaccines can get to
the countries and then get through to the vaccination centers.
So it's that little journey the organizations coordinate together to
bring a vaccine from a lab to arm with so
many moving parts, with such high expectations and requirements around this,

what's the hardest part of maintaining this collaboration. I think
that the hardest part of maintaining collaboration is that things
are moving so fast. We're still understanding a lot about
the disease, about how efficacious the vaccines are. We're trying
to make sure that we can do things as quickly

as possible. Usually they would happen over ten years. Here
we're asking people to do things in ten days, and
that really involves a huge amount of communication, and I
think it really implies making a lot of decisions with
imperfect information at times, and so I think having a
real premium on communicating as much as possible the best

information that we have and being able to understand whose
best place to make the decision and whose best place
to act on it. That's the number one challenge. I've
known people who've worked in international development, and there's been
a criticism of a top down sort of imposition of
a solution on a local community. How does Kovacs with

Gavvy work to involve local communities in decisions about something
as intimate and urgent as this COVID nineteen vaccine rollout.
For me, vaccination is really only going to be successful
if it's about empowerment. That's the individual, it's the family,

it's the community. And then beyond that, of course you
know the health system, the government. But really at the
heart of it is making sure that there is very
very strong community involvement, from the healthcare workers, from the
volunteers who go into communities and do the outrage. It's
interesting to think that outside of the context of COVID,

in developing countries, usually there is a strong acceptance of
vaccination because people are familiar with very deadly diseases and
understand the role that vaccines have. And we see people
walk very very long distances, wait for hours to make
sure that their children are protected. And so making sure
that people understand the benefits the risks of vaccination in

a way that's really meaningful to them. That's driven from
within in terms of the decision making on the ground.
What role does a local partner play in the decision
about how some of this global collaboration lands in their community.
So in Gavy, we have a board that also brings
in all of the voices of the different actors, be

it the donors, the technical partners, the implementing countries, but
also the civil society organizations. And so for any of
the strategic discussions that take place or any of the
big financing investments, those are brought together where everyone has
a voice at the table. Every one is able to
deliberate and give an opinion, so that they very much

can see themselves reflected in the decision making, not just
being sort of a passive recipient of funding that's being
asked to do things. That's good. I'm glad to hear that.
In all of the levers and connections and links in
the collaboration of this size. What would you say is
the force multiplier in making it effective? I think the

force multiplier is around how each of the organizations are
able to bring what they do best aimed towards a
single objective, around getting vaccinations out and around ultimately saving lives.
And so it's about using the private sector for the
expertise they bring, the vaccine manufacturers for the R and

D they do, the technical partners for all of the
knowledge they have, the countries who want to save the
lives of their citizens, and really bringing them together in
a way that's quite the opposite of the lowest common denominator,
but actually being able to build more than each individual
partner would be able to do, and bringing it all

together in one vision. Yeah, thank you for sharing that.
I want to talk to you a bit about your
your personal experience in all of this. As far as
I've discovered, you studied as an accountant with a focus
on health policy, planning and financing. Did you always know
you wanted to work in the area of health and
health care? I mean, I've dedicated my whole career pretty

much to enabling equitable access to medicines and vaccines. It's
a little bit my north star, but I would say
I never expected to be in a position like this.
But even going back to my days at university, I
was really fascinated by how science through drug discovery can

really make a huge impact to people's lives, and particularly
in developed in countries. So what I did is, over time,
I brought together my technical skills and finance. I brought
my fascination for the impact of medicines and the vaccines,
and then my passion around the health inequities in developing countries,

all of those together. So it is an honor, I think,
to be able to do the work that I do
today and I think hopefully we'll make a difference to
this pandemic. You describe this as your north star, and
having such an interest in the health of developing nations,
where does that come from? And I think for me,

I SIT's a little bit with a foot in two worlds,
having sort of a French and a Vietnamese heritage in
terms of developed world and developing world, and maybe being
able to sort of see the contrasts in the levels
of healthcare that people have access to the impact that
it has on their lives, So I think maybe it

was very much through personal journey that I got more
and more interested and wanted to see how I could
reconcile a little bit the two worlds that I come from.
It seems like you have one of the most pressure
filled jobs I could imagine on the planet right now,
helping find ways to equitably distribute a much needed vaccine

to as many people as possible, as quickly as possible,
as safely as possible. Do you have doubts or fears
about your role in this at any time? I think
the way that I approached it is really focusing on
doing everything I could do to ensure that Kovac succeeded.

And for me, that's because Kovac is the only global
actor in this whole crisis that was going to look
at COVID nineteen vaccine access for everyone. And there is
a lot of pressure because it's drawn a lot of attention,
and that comes with the negative, the detractors, the naysayers,
And I don't think I would say that we've got

everything perfect by any stretch of imagination. I mean, we
are building a ship while sailing it, so to speak.
But we really have to I think stay focused on
the fact that at the moment, no one else is
looking at this global crisis in a global manner. Without Kovac,
the world would be in a worse off position. But
that's not to say I'm not feeling out of my

depth several times a day. Possibly I have a good
friend of mine who likes to remind me. Shehes and
says that, you know, with the pandemic, the world is
out of its depth, So perhaps I'm not so different
to the rest of the I like that, but ultimately
focusing on what do we need to do to end
the acute phase of this pandemic, and just doing it

one step at a time. It's one manufacturer deal, it's
one vaccine delivery, it's one vaccine injection at a time. Yeah,
one shot at a time. I want you to imagine
that there is a leader or future leader listening to
you right now who's going to end up in a
position of multilateral collaboration on an epic scale in their

own life, in their own future. Given what you've been through,
given what you're in the middle of right now, what
advice would you offer this person. I would say, find
your north star and don't worry too much about the labels,
whether you're working in the private sector, in the public sector,
in the government, whether you're working as a technical this

or a managerial that, find the building blocks that you
need to chart that road and keep pushing for it
and surround yourself. Will thank you, Aurelia for this wonderful conversation.
Keep pursuing your north star. Thanks. You're listening to a

podcast called Force Multiplier, Action meets Impact. Now you've probably
grown to expect ads inside your podcast, but we're gonna
do something a little bit different to walk the walk.
We're gonna take a quick break and hear from one
of the organizations featured in this episode. Be right back.
One year ago, Gavy launched the Kovacs Advanced Market Commitment,

an innovative solution for an unprecedented pandemic designed to ensure
no country misses out on vaccines that offer us all
a route back to normality. Twelve months later, KOVACS has
a long list of accomplishments. Vaccines have been approved for use,
countries are ready to receive them, a scheme to help

people access compensation is in place, and one point three
billion doses are contracted to KOVACS. But we now face
a fork in the road. Down one road lies a
two tier world in which the pandemic continues to rage,
economies continue to be hit, the vulnerable are thrown into

extreme poverty, and variants continue to evolve. The Kovacs a
MC can help put us on another path in which
we defeat this virus together united. But to do this,
the a m C needs urgent resources. It needs long
term financing to help the am C evolved as the

pandemic evolves. It needs argent doses donated from countries with
vaccines to spare. And it needs the connective will of governments, financiers,
civil society, and vaccine manufacturers to leave no one the time.
Kovacs is committed to deliver. Hey you, it's Baritone Day,

host of the podcast you're listening to right now. When
I was a kid, my mom told me to come
up with a system we could live under after democracy
had failed. Yeah, my mom was intense. I haven't finished
that assignment, but I did make a podcast. It's called
how does Citizen? With Baritone Day. It reimagines citizen as
a verb and reminds us how to wield our collective power.

Find seasons one and two and whatever podcasts app using
right Now and Season three All about Tech drops in October.
Learn more at how does citizen dot com? So, as
we've heard, health equity is undoubtedly a global issue, but

none of us is like a global person. We live somewhere,
You live, some fair So what does health equity mean
for you, for your neighborhood, for your community? Have you
noticed among your own family people who are struggling not
because of choices that they made, but maybe because of
choices they're unable to make. Have you noticed in your

daily life and the workers and colleagues and other people
you interact with, who's living a healthier life and who
is and who has access and who doesn't. We had
an opportunity to speak with Dr Dominic Mac, director of
the more House School of Medicines, National Center for Primary
Care and the National COVID nineteen Resiliency Network. Check it out.

The National Center for Primary Care is a research training
center that provides resources to strengthen the primary care system
so we not only identify inequities in health when it
comes to primary care and primary care related health concerns,
but also to produce solutions and community oriented primary care

is significant to the n C PC or the National
Center for Primary Care model, because you know, terminologies come
and go, but it's a concept that's very important. If
you go into a community and you're trying to improve
the health of that community, and the street lights are
not on and as dilapidated cars on the street, the

people don't have housing, and they don't have food, maybe
you need to give them a meal first, turn those
lights back on before you can talk to them about
improving the health. You know, someone has three jobs, they
may not have time to come visit the physician right
or get a vaccine. Those social determinants that are so important.

We know your lifestyle or where you live a number
of factors the environment really impact your health. Healthcare is
twenty percent unless of your health. So starting to look
at the communities, you have to look at those social
determinants that affect them. So how can we begin to
do that. Data is important and taking a scientific approach.

Data helps you to discover inequities within the communities. But
that same data, different data that you gather can also
help you to develop solutions. You know, you will find
some pockets of underserved communities where they're doing maybe better
than other communities. So you can get the data, whether

it's around hypertension, diabetes, are physician assets, bias, racism, etcetera.
And analyzing that data helps you develop solutions that may
work within the community. The problem is is the data accurate?
Is it comprehensive? Does it include all communities? Well, it

still comes down to garbage and garbage out. If it's
not inclusive, then you have communities who are left at
a disadvantage. So what happens with the funding? Do they
get the funding? Resources go to those areas that are
identified that have a need, and if they can't be identified,

you can't get the resources to those communities. In June,
more House School of Medicine received a forty million dollar
grant to help fight COVID nineteen by nurturing existing partnerships
and developing new ones. Dr MCIN team created a network
designed to work with community based organizations across the nation

to deliver education and information to help fight the pandemic
with the National COVID nineteen Resiliency Network. Once we received
the award, the first step was to develop, strengthen and
secure partners. We have about forty fives to teach it partners.

Another two plus community based partners. It's a team. So
what we had to do is build the program to
meet the objectives that we had proposed and to meet
mainly the barrier of overcoming obstacles within communities, to link
the disproportion impacted communities to care. Still, the issue comes,

just like with the data, that the best technology, the
latest technology, gets to certain communities first. So we started
to work with our technology partners to make sure that
we developed a communication system will first get the message
out to people how to be safe, social distance, masking, fascination,

et cetera, but get it out in their language. So
we have about thirty languages now that could reach those
partners mobilely within their homes on their mobile phones, etcetera.
KPMG is our major partner with that, and then developed
the messaging that can overcome those barriers. How do you

convince somebody remotely to take a vaccine um that takes messaging,
that takes testing other messaging, but also utilizing messaging out
there that's already successful and working hand in hand with
the Office of Minority Health who provided this award, And
then c d C and i H and others to

team up to affect communities. So how do you develop
a program where you're fair and equitable and that you're
addressing all the needs. The force multiplier is to include
the community at the beginning stage in the development of
these programs and give them the resource. The United States

has the resources, give them the resources to develop an
implemented program. So having someone of a light racial, ethnic group,
al disability, someone else who's who has been an immigrant
to the United States, a refugees to adminage program to
you as a refugee who understands your plite, you know,

that's powerful. They're more likely to listen to them than
they are to me. So it's understanding the importance of
that communication from a trusted source. That's been the cornerstone
of the program. To seek and rely on partners who
really know these communities to disseminate a message within their

own communities. Advice I would give to others who wanted
to make an impact is find something that you truly
like to do. You know a lot of people have
jobs they really don't like, So do something you really
enjoy and hopefully that's something where you can give back

to others. I think when you can give back, um,
you're more satisfied at the end of the day. And
if you're thinking too much about people thinking about you
every day and what you do, I think you're thinking wrong.
Just do the best you can for others. Don't worry
about your legacy. Right, It's gonna be what it's gonna be,

But the best way to build it is to work
for the people. You know, if you can help one person,
if you could save one life, I mean, that's tremendous.

You aren't those some extraordinary people. I'm glad they're on
our side against this pandemic. And they both spoke to
the value of communication, which is kind of what stands
out to me that they share. Aurelia spoke about it
as one of the greatest challenges in administering the kvac's facility,
and as one of the most important skills communicating among

the partners with imperfect information that's constantly changing, keeping everyone
updated with the latest, investing for possible and being mindful
of who's in the best position to act on a decision. Meanwhile,
Dr Max spoke of communication on the ground and the
value of trusted messengers in convincing people to take certain
actions for their health, like getting vaccinated. The awareness that

it's not just the message, but the messenger and the
language that the messenger uses is key to closing some
of our health equity gaps. It's clear technology plays of
critical role and facilitating and accelerating these efforts. For Aurelia,
it's enabling fast to access to vaccines with a single
secure portal that all participating countries can use, sharing information

and communicating with more efficiency and greater accountability. For dr MAC,
it's leveraging technology to collect and assess community data, isolating
the pockets of inequities that exist, and developing customized messaging
to address them. Both Aurelia and dr MAC have crossed
the lines that often separate us by profession, organization, industry,

and even nation. They've built teams and use their talents
to pursue the achievable goal that everyone can live a
full and healthy life. Do you want to dig in
more on today's guests and the work they're doing, or

maybe you want to understand what action you can take
in your community. Either way, go to salesforce dot org
slash force multiplier. That's one word, force multiplier. Force Multiplier
is a production of I Heart Radio and salesforce dot org.
Hosted by me barretton day Thurston. It's executive produced by
Elizabeth Stewart, produced by Ivan Chien, and engineered, edited and

mixed by James Foster. Join us next time for more
stories of how we can change the world, one relationship
at a time. Listen to Force Multiplier on the I
Heart Radio app, Apple Podcasts, or wherever you get your
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