‘No single sector can tackle these challenges’: Shoaib Rizvi interviews global finance leader Cyrus Ardalan on immunisation and innovation

Cyrus Ardalan guided Shoaib as a mentor for the Blavatnik School of Government, providing support that proved invaluable as Shoaib charted his path in public service—from early internships at the United Nations in New York, to impactful work on women’s empowerment in his hometown of Karachi, and ultimately, to meaningful contributions within Canada’s public service in Ottawa.

What inspired your involvement with Global Alliance for Vaccines and Immunisation to promote access to vaccination for children across the world? 

My involvement with Global Alliance for Vaccines and Immunisation (Gavi) began with my appointment as the Chair of the International Finance Facility for Immunization (IFFIm). To provide some context, Gavi was founded in the early 2000s as an international organisation with the mission of promoting the vaccination of children in the world’s poorest countries. It aimed to combat vaccine-preventable diseases that, without intervention, resulted in the tragic loss of millions of young lives. 

Gavi experienced rapid growth and success, largely driven by support from major industrialised nations, the Gates Foundation, and other philanthropic organisations. However, as is often the case, the amount of funding available from governments was constrained. This led to the creation of IFFIm, a unique initiative in social financial engineering. IFFIm enabled governments to commit substantially larger sums of money than they could in any one year by spreading their contributions over an extended period. For example, the UK committed to contributing $2 billion over 25 to 26 years. IFFIm’s innovation lay in converting these long-term commitments into immediate funding, allowing Gavi to access the funds it needed up front or as and when needed, rather than waiting for years. This approach enabled Gavi to acquire and distribute vaccines promptly, saving countless lives in the process. 

Gavi’s impact has been immense, having vaccinated over 1 billion children and saved more than 17 million lives to date. The mission was compelling, and the financial strategy through IFFIm was both innovative and effective. 

How about your work with the Coalition for Epidemic Preparedness Innovations to finance vaccine development for preventable diseases? What are the most pressing challenges demanding immediate attention to enhance worldwide preparedness against such crises? 

The Coalition for Epidemic Preparedness Innovations (CEPI) presents a very different proposition. I joined its board about two years ago. CEPI was established in 2017 to address a pressing issue: there were numerous infectious and very serious diseases in low income countries that could be prevented through vaccines, but no vaccines existed due to the lack of economic incentives for pharmaceutical companies to develop them. The market was too small, and the purchasing power of these countries too limited. As a result, diseases such as Lassa, MERS, Mpox and Nipah virus remained largely unaddressed. CEPI was established to fill this gap by financing vaccine development for such diseases and funded by a number of major governments, the Gates Foundation and the Wellcome Trust. 

CEPI has been highly successful and played a crucial role during the COVID-19 pandemic by financing multiple vaccine development projects. Its work continues to have a profound impact, particularly in the poorest regions, by ensuring that vaccines are developed and made accessible to save lives and avoiding what could result in potentially devastating global pandemics. 

As for the key challenges in this area, they differ between Gavi and CEPI. Gavi’s ongoing challenge lies in ensuring that vaccines continue to reach the most remote and underserved populations. In contrast, CEPI faces the challenge of developing new vaccines for emerging diseases, accelerating the timeline for vaccine development and ensuring equitable access to low-income countries. 

One of CEPI’s most ambitious goals is the 100-Day Initiative. This aims to reduce the time from pathogen identification to vaccine development to just 100 days. If successful, this initiative could be transformative. Historically, vaccine development has taken 6 to 10 years. With COVID-19, we witnessed a remarkable reduction in this timeline to about a year. Reducing this further to 100 days would be a game-changer. The significance of this lies in the way infectious diseases spread at an exponential rate creating epidemics and potentially pandemics. If a vaccine could be developed within 100 days of a new and potentially dangerous pathogen’s identification, it could effectively eliminate the risk of a future pandemic. This would allow us to contain diseases before they have the opportunity to spread widely, as was the case with COVID-19, where despite rapid vaccine development, containment was not fully achieved resulting in large loss of life and huge economic damage globally. 

In the realm of vaccine development and distribution, particularly within underserved regions, how do you perceive the pivotal role of private-public partnerships as envisioned from the perspective of a board member? 

Public-private partnerships are absolutely critical, as they bring together the strengths of both sectors to address global challenges. From a resource perspective, these partnerships are invaluable because they allow for a significant increase in the resources available to tackle complex issues. Resource constraints are always a challenge, and by combining the capabilities of both the public and private sectors, we can expand our reach and impact. 

In addition, these partnerships help leverage the unique strengths of each sector to ensure that interventions, such as vaccines, can reach all segments of society, particularly in low income countries. A key issue, for example, in vaccine distribution is ensuring that vaccines are not only available but also accepted and integrated into daily life. Building trust and confidence within local communities is essential. This requires sensitivity to cultural and social factors at the grassroots level. Achieving this level of acceptance calls for close collaboration between the public and private sectors, as well as engagement with social institutions. 

How might we strategically cultivate and bolster public trust and confidence in vaccination programs? 

Optimising vaccine acceptance is always going to be a challenge, and there will inevitably be individuals or groups who take a contrary view on these matters. The key is to understand, as thoroughly as possible, the factors driving a reluctance to use vaccines and to address them in a thoughtful and empathetic manner. 

For example, this may stem from cultural or religious beliefs, or simply from a lack of accurate information. Therefore, any effective strategy must be multifaceted. Education is critical—providing clear, factual, and unbiased information in a way that is accessible and relatable. Open communication is equally important, fostering dialogue rather than dictating or lecturing. 

It's important to engage with individuals and communities in a way that builds trust. This means working alongside local leaders or representatives who are part of the community, as they are often better positioned to convey messages effectively. People can understandably be wary of outsiders presenting information on topics they might not fully understand or trust. Therefore, a localised, community-driven approach is crucial. 

In your assessment, which insights from past epidemics should influence CEPI's strategies as they steer towards the future? 

One of the key challenges we face is our ability to respond quickly and develop vaccines rapidly, which is absolutely critical to preventing future pandemics. This capacity for swift action is essential. 

Another major issue is that many diseases, for which vaccines could provide a solution, have historically been neglected because the private sector lacks the financial incentives to address them. Pharmaceutical companies typically focus on areas that are revenue-generating and profitable, where there is a sufficient market. CEPI, by providing funding from public-sector resources and foundations, supplements the private sector and creates a foundation for developing vaccines that will ultimately save many lives. 

The COVID-19 pandemic highlighted another critical issue: even when vaccines are available, accessing them can be a major challenge during a global health crisis. Some countries were able to secure vaccines quickly, but others, even if willing to pay, struggled to obtain them. This underscored the need for more balanced global manufacturing capabilities, especially in lower income countries. It is essential that these countries have the infrastructure and capacity to produce vaccines locally, ensuring that the most vulnerable populations can access life-saving treatments in a timely manner. 

Moreover, CEPI’s role extends beyond vaccine development to fostering collaboration with global health organizations like Gavi, the World Health Organisation, and other key institutions. Ensuring that the entire ecosystem works together efficiently is crucial for future pandemic preparedness. During COVID, we saw the importance of close coordination between sectors, which was pivotal in ensuring that the response was swift, effective, and achieved its objectives. 

Reflecting on your journey, could you share a defining initiative you led at the World Bank and how it shaped the socioeconomic development of a particular region? 

The first was one of my earliest assignments at the World Bank in the mid-1970s, when I joined through the Young Professionals Program. I was assigned to Yugoslavia—a federation of eight distinct regions, many of which are now independent countries. As an economist, I was tasked with analyzing the country's complex economic model: worker self-management, a hybrid of market-based and centrally planned systems. 

At the time, the Bank was reconsidering its support for Yugoslavia, given its relatively high per capita income. However, through my research, I demonstrated that the uniqueness of Yugoslavia’s economic system made it poorly understood by international financial markets. This hindered its access to private capital despite its income level. I presented a case for continued World Bank support, which was accepted by the Board. The decision proved pivotal—World Bank lending helped stabilize the country’s economy, and Yugoslavia later hosted the Bank’s annual meetings, underscoring the strength of the partnership. 

The second initiative came later, in the World Bank’s Treasury, where I was involved with the institution’s first-ever currency swap—at a time when such markets were virtually nonexistent. By conducting the transaction transparently and publicly, the Bank set a precedent that catalyzed the growth of a market that now exceeds $600 trillion. I was then entrusted with leading the Bank’s swap operations, positioning it as one of the largest end users of both currency and interest rate swaps in the 1980s. 

This innovation significantly enhanced the Bank’s financial flexibility, reduced its borrowing costs, and enabled it to extend those savings to low- and middle-income countries—amplifying its development impact through smarter, more efficient financing. 

In crafting effective development initiatives, what critical insights should aspiring young policymakers take note of? Within the remit of the Sustainable Development Goals, what key considerations can foster sustainable and transformative change? 

First and foremost, there is no universal solution that fits all circumstances in addressing the challenges we face in this domain. It is an inherently complex and idiosyncratic area, requiring a nuanced approach that starts with understanding the people we aim to help. This means engaging deeply with the communities in question to grasp the specific constraints they face and the unique challenges they encounter, rather than imposing preconceived notions about what they need or how they should proceed. 

Sensitivity to local needs, cultural nuances, and contextual realities is paramount. In this process, it is essential to set realistic and achievable objectives, define clear deliverables, and establish robust systems of accountability. A well-defined vision of what success looks like—and a commitment to holding all stakeholders accountable for achieving it—is critical to meaningful progress. 

Equally important is leveraging the strengths of multiple sectors—public, private, and social. No single sector can tackle these challenges alone. Each brings unique strengths, objectives, and risk-return considerations. By blending these elements, we can create innovative and impactful solutions that would not be possible within a single sector's silo. 

To achieve sustainable success, we must also operate within an environment conducive to positive change. This requires the rule of law, secure property rights, and strong governance systems. Without these foundational elements, even the most well-intentioned efforts are unlikely to succeed over the medium to long term.