Check against delivery

President and Provost of University College London, Mr Malcolm Grant,

Editor of The Lancet, Mr Richard Horton,

Ladies and colleagues,

It is a great honour for me to speak before such a learned audience, comprising experts from a number of countries who are devoting their life and time to the issues of child mortality. We are in this together and I hope to be able to learn more from your work, and to develop further how we as a country, and in particular the Norwegian government, can improve how it pursues critical and global health issues.

University College London is a distinguished university and has been a pioneer in many fields. I have been told that this was the first university to welcome women on the same terms as men, and that this happened as early as 1878. As you know, Norway and the Scandinavian countries see themselves as in the forefront with regard to most gender issues. But here, the University of London was ahead of us. The first female student was matriculated at the University of Oslo in 1882, four years after you.

I am grateful also to the The Lancet for inviting me to speak here today. I have come to know the Lancet as the pre-eminent medical journal which has held that leading position for almost two centuries.

It is therefore a great pleasure and honour to be here today to give this year’s UCL/ Lancet Lecture.

This is the sixth Lancet Lecture dedicated to health and well-being. And I note with interest that I am the fourth economist to give the lecture. Which illustrates how different professions must work together to extend the benefits of medical research and breakthroughs to reach as many of the needy as possible.

I believe the importance we attach to health today is steadily increasing. In addition to its value in itself in terms of welfare and well-being, we recognise its vital role in economic development and prosperity. And new hundreds of millions are aware that many of the health problems they are facing can be alleviated, and often with modest means.

We live in a time of exceptional opportunity. We have never had greater possibilities to make a quantum leap forward. It will take our combined resources and efforts. We need to place health more in the centre of international relations, high on the development agenda and political leaders need to focus increasingly on it.

Six years ago, at the UN in New York, I participated in the adoption of the Millennium Development Goals as Prime Minister of Norway.

It was not the first time world leaders made fine and solemn declarations that gave poor and destitute peoples and nations hope for a better tomorrow. Unfortunately, so far many of them had remained unfulfilled.

I felt then, as I do now, that it would be wrong of us to set out the goals and leave it at that – and return to business as usual, hoping that somebody else would do the job.

I decided then to devote much of my time and efforts to making sure that the world achieved at least one of the Millennium Development Goals – No 4 – the one that compels us to reduce child mortality by two-thirds by 2015.

Our performance on MDG 4 can be seen as the litmus test for our ability to achieve the other Millennium Development Goals.

As a father, I have been sensitised to the injustice of the fact that while in Norway all infants are immunised, in parts of Asia and Africa very few children enjoy the same privilege.

As an economist, I understand that vaccine programmes and improved health early in life is the key to economic growth in poor countries.

As a politician, I have the privilege to be in a position do something about it.

More than 10 million children die every year from diseases that are largely preventable and treatable. These include old scourges like pneumonia, diarrhoea, malaria, measles, malnutrition, and in many countries HIV/AIDS.

Forty per cent of these deaths occur among small babies, in the first month of life. These deaths are associated with the health and survival of mothers, their nutritional status and the care both mothers and children are given at delivery and in the days immediately afterwards. Giving birth in a safe environment with skilled attendants should no longer be a privilege of the rich. It is a right all women should have. It would also affect the lives of newborn infants, children and entire families.

More than 99 per cent of child deaths affect the world’s poorest families. This is a tragedy of unacceptable scale. The tragedy is compounded by the fact that two thirds of these deaths could be prevented. We know what works, and we have the means at our disposal. We need the political will.

We are making progress though. Under-five child mortality has been reduced from 12 per cent in 1990 to 10 percent in 2005 in the 60 most affected countries. These countries account for 94 per cent of all child deaths.

But we need to accelerate the reduction. With the current trend we will reach 8 per cent by 2015. Remember, we need to reach 4 per cent to achieve a two-thirds reduction. Seven large countries are already on track to reach MDG 4. These are countries that vary in terms of economy, geography, history and experiences: Bangladesh, Brazil, Egypt, Indonesia, Mexico, Nepal, and the Philippines.

The lesson is clear: Policies do matter, and reaching MDG 4 is feasible. Mexico, for example, has managed to reduce its child mortality by two thirds between 1980 and 2005. This is a twenty-five year span, just like the time frame of the Millennium Declaration.

The economic argument for fulfilling MDG 4 is also very strong. Scientists at Harvard University claim that more than one third of the economic growth in Asia from 1965 to 1990 could be attributed to reduced child mortality.

That makes sense. A healthy child can attend school, and its cognitive development and performance will be enhanced.

A healthy child can give a helping hand at home and with younger siblings. And the more likely a child is to survive, the fewer children the parents need to ensure they are cared for in old age.

So, you may ask – what is the Norwegian Government doing to achieve MDG 4?

First of all, we firmly believe in international development assistance. We are moving steadily towards the goal of allocating 1 per cent of our income to this end. We are likely to reach this goal within 2–3 years.

We are a staunch supporter of the UN. But we also believe that the UN needs to reform in order to fulfil its crucial role. I have the privilege of co-chairing a panel on UN reform, including several other prime ministers and your Chancellor, Mr Gordon Brown.

Norway is among the largest contributors to UNICEF and WHO, who are at the forefront of the fight against child mortality.

Moreover, since 2001 we have been one of the largest contributors to the Global Alliance for Vaccines and Immunization, GAVI. Currently, Norway gives over 70 million dollars a year to GAVI.

GAVI’s results-based approach has produced remarkable results. According to UNICEF and WHO, during its first five years GAVI has ensured that more than 10 million children, who would otherwise not have been immunised, have received basic vaccines.

Moreover, about 100 million children have received additional vaccines against Hepatitis B, meningitis and yellow fever. No less than 1.7 million lives have been saved so far.

GAVI is also at the forefront of introducing new vaccines in the poorest countries. Soon we will be ready to introduce vaccines against two other major killers of children: Bacterial pneumonia and rotavirus.

GAVI is also showing the power to mobilise partners internationally.

Furthermore, Norway is supporting the development of new financing mechanisms to ensure more stable long-term funding for vaccination.

The first of these is the so called International Financing Mechanism pioneered by Chancellor Brown. And because GAVI has delivered concrete results, it has been chosen as a pilot in this effort.

The principle here is that donor governments raise money in the capital markets by issuing bonds. This will more than triple the funds available to GAVI and will secure predictable funding over the next 10 years.

Another mechanism being developed is the so called Advanced Market Commitments which will ensure the purchase of vaccines that are under development. The vaccine industry would therefore be guaranteed a return on its investments once a vaccine reaches the market.

But all of this is not enough. Unfortunately, many diseases can still not be prevented with current vaccines. Better access to other preventive methods, to adequate food and to medicines is also critical.

When I once again became Prime Minister last year, the Norwegian Government decided to strengthen Norway’s commitment to Millennium Goal 4.

We added another component to our Millennium Goal 4 strategy: the development of partnerships with a few large countries. Our first partner country is India. The Norwegian and Indian governments share many of the same ideals – both are committed to enhancing equity, solidarity and inclusiveness. However, India is still the country with the highest number of child deaths in the world.

Together, Norway and India have the ambitious goal of saving 500 000 children yearly in India by 2009. We will focus on the five Indian states that together account for 60 per cent of child mortality in India.

India is making large investments in its health sector, but this may not be enough. Innovation is required to achieve maximum effect. To this end, Prime Minister Singh and I have initiated a partnership. The Norway-India Partnership will use the creative resources of both countries to overcome obstacles to reaching marginalised groups. The partnership will play a catalytic role in facilitating the implementation of the recently launched, multibillion-dollar National Rural Health Mission of India.

The creation of a flexible, problem-solving, “help-desk” mechanism is the key to the success of the partnership.

These are all important steps, but it is not enough. The challenges ahead are greater than the responses the world has come up with so far.

This brings me to the final component of our strategy: global action.

Last month the Norwegian Government organised a Child Survival Symposium in New York together with UNICEF and The Lancet.

The symposium brought together world leaders and health experts, and the goal was to draw attention to child survival and to re-energise global commitment to MDG 4.

A key conclusion of the symposium was that we need to work together to develop a global strategy to reach MDG 4, a global plan of action for child survival. This plan should specify the following:

• First, what the financial needs will be, based on the extrapolation of national budgets and expenditure, and on the projections made by bilateral and multilateral aid agencies, GAVI and the Global Fund.
• Current estimates suggest that there will be a very substantial gap to be filled by 2015, perhaps as much as 7–11 billion dollars. But this should be possible, since development assistance is predicted to grow from around 80 billion dollars today to 130 billion dollars by 2010.
• Second, how support for country action can be coordinated based on each partner’s comparative advantage.
• Third, what research is needed to identify best practice and robust indicators for measuring progress.
• And finally, it should include a global advocacy plan to mobilise political commitment.

I am pleased to inform you that Chancellor Brown and Bill and Melinda Gates have agreed to join in this effort to develop a global plan of action for child survival. And that the Partnership for Maternal, Newborn and Child Health will work with us to bring all actors together in this global effort.

Achieving MDG 4 is perhaps the most important goal the world has set itself. We cannot pursue it half-way or part-time.

The stakes are high, but so are the potential rewards. In order to succeed, we must all muster courage, perseverance, and sustained commitment.

When I took over as Prime Minister, I asked Dr. Tore Godal to come and help me on a daily basis with the development of policy and coordination of national and international efforts.

Dr. Godal was in charge of the WHO Tropical Disease Research programme for very many years and he was one of the architects of GAVI and its first director.

He is with me here today. And we will take questions jointly.

I invite all of you to join us in this global campaign to save millions of little children from dying unnecessary. Together we can build a better world. We hold the key to a better future for the world’s children.