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The Aid Traders
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The Aid Traders
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Saving Lives

Kids in developing countries need vaccines, but will the world's wealthy financial markets really help to deliver them? A deal brokered by former British Prime Minister Gordon Brown has so far raised nearly $2 billion for just that purpose. It's called the International Finance Facility for Immunisation (IFFIm), and author Aminatta Forna wants to know how it works.

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Segment 1

TITLE
Kill or Cure
VOICEOVER
The heartland of Sierra Leone, the country in which Aminatta Forna grew up. She's watching local mothers bring their babies to be weighed and immunized
AMINATTA FORNA
Every woman with young children has turned up for this, there's almost a festive atmosphere.
VOICEOVER
It's very different from the world that Aminatta, as a London-based writer, now inhabits.
AMINATTA FORNA
You'd never see this in the West. I've never seen this in the West. But here it's really quite typical. I think everyone, apart from the kids, is enjoying themselves a lot.
VOICEOVER
Everyone's making the most of the vaccinations. But what they don't realize, is that most of the money used to buy these jabs comes from places thousands of miles away, like Canary Wharf in London, Aminatta's home town.
AMINATTA FORNA
Most of the money that funds vaccination programs in the developing world is raised in places like this. But we couldn't be further, perhaps 6,000 miles and a million light years away, from my family village.
TITLE
The Aid Traders
VOICEOVER
Aminatta Forna, a writer who grew up in Sierra Leone, has just arrived at the country's main airport. She's on her way to the capital, Freetown.
AMINATTA FORNA
From the airport to Freetown isn't easy. There's theoretically a road round but it's impassable. So you can go by ferry if the ferry's running, sometimes it isn't, or you can rely on the helicopter. Just a matter of scrambling to find out which one's working, if any of them are working at all.
VOICEOVER
Aminatta was born in Scotland to a Sierra Leonean father and British mother. But she grew up here. Today, she and her husband are on one of their regular trips back to the country.
AMINATTA FORNA
I enjoy coming back. I always feel, for me, I was born between two cultures, on the crossroads of cultures. I was born African and European. [Shouting in helicopter: "That's Freetown!"] We came here when I was six months old so I actually learnt to swim in the Atlantic Ocean, that's what I remember.
VOICEOVER
But Sierra Leone's beauty belies its troubled past. For the last two decades, it's been consistently ranked by the United Nations as one of the worst place in the world to live. From 1991 to 2002, civil war killed tens of thousands of people and displaced two million.
AMINATTA FORNA
Sometimes I've referred to Sierra Leone as a flawed paradise, because it seems to me that so much of the essence of life really is still, in Africa, in the developing world, where a place as beautiful like this is also a place where children die very young, where death is an everyday experience for most people.
VOICEOVER
Aminatta is preparing for a trip to her family's village, Rogbonko, a four-hour drive from Freetown. It was one of the worst-affected villages during the war, cut off behind rebel lines for over a decade.
AMINATTA FORNA
The rebels came on a particular day, the first invasion of the village. The women were raped, every woman in the village was raped. From then on, the rebels came back regularly for money, for food, there were various atrocities committed. When I first came back to the village in 2002 there was quite literally nothing.
VOICEOVER
Since the end of the war, Aminatta has returned twice a year. She's set up a school and helped with a farming project. But this time, she's looking into something a little different.
AMINATTA FORNA
I'm not absolutely certain the kids are being vaccinated. There's a hospital nearby, but I'm not certain what kind of level of coverage we have in the village.
VOICEOVER
She wants to see if vaccines are reaching the remote areas of the country like Rogbonko. Because she's heard about a new initiative which could be helping them. It's called the International Finance Facility for Immunisation, and it launched thousands of miles away.

Segment 2

VOICEOVER
It was in London, in 2005, that the International Finance Facility for Immunisation, or IFFIm, was launched. Six European governments pledged USD$5 billion to help fund immunization projects run by the GAVI Alliance in over 70 of the world's poorest countries. IFFIm's aim was to make those future aid pledges available now. But how?
AMINATTA FORNA
So how it works is a government pledges a certain amount of money for immunization projects in the future. IFFIm say, "OK, we'll raise that money now by issuing investments bonds," bonds that you or I could go out and buy, or our pension funds could go out and buy, and that makes the money available now for programs in the field. It's called front loading and it's something I'd like to know a lot more about.
VOICEOVER
The IFFIm chairman is Alan Gillespie.
AMINATTA FORNA
Can you tell me what the trigger was to getting IFFIm started?
ALAN GILLESPIE
When we look back at the last 50 years, there've been endless attempts to bring effective development assistance to the poorer countries. The [United Nations] Millennium Development Goals called for a very different approach. The [Bill & Melinda] Gates Foundation and a number of European governments said: What can we do to step in and make a dramatic difference to the way in which healthcare is delivered to the poorer countries?
VOICEOVER
In order to make the money pledged by governments in the future available today, IFFIm borrows the money from investors. They aren't donating money, they're investing: they get their money back, plus interest. It's proved popular and it's something about which Aminatta has questions.
AMINATTA FORNA
So the money that is paid to investors actually comes from future aid donations?
ALAN GILLESPIE
That's correct. The money that will be used to pay interest coupons on the bonds is pledged by eight wealthy governments over the next 20 years, and that is a little piece out of their forward aid commitments which will be used to pay the interest on these bonds. The average interest rate over all the bonds we've issued in the market is 2.3 percent.
AMINATTA FORNA
When I first heard that the money that was paid to investors came out of future aid donations, it made me feel uncomfortable. And I just wondered whether ... how you feel about that?
ALAN GILLESPIE
If we're creating healthier children today, going forward that will mean a far lower healthcare burden in those poor countries and on us in assistance. Secondly, our governments are all the time borrowing in the capital markets. So the principle of paying interest to do something is in-built in how our society works. And so one way or another we're going to pay interest on that in the future.
AMINATTA FORNA
So are you saying it's reality and actually it's a price worth paying?
ALAN GILLESPIE
It is undoubtedly a price worth paying. And when I think we have been able to mobilize over USD$2 billion on an interest cost of just over 2 percent that is a remarkable financial accomplishment in order to advance the cause of child health.
VOICEOVER
Over the next two decades, more than USD$5 billion will be made available to IFFIm by the governments of the UK, France, Spain, Norway, Sweden, Italy, and now South Africa and the Netherlands. So far, IFFIm have raised more than USD$2 billion of that on the capital markets to be used now. The press have hailed it as innovative and unique. Aminatta goes to meet Andrew Jack, from the London newspaper, The Financial Times.
AMINATTA FORNA
How innovative an idea do you think it was to raise the money in this way?
ANDREW JACK
I think it's been an exciting idea, it's innovative. No one else has really come up with alternative mechanisms for delivering large numbers of vaccines, to making good that lag between what's available and what's actually delivered to the world's poor countries. This is probably about the most efficient way you can do it financially.
AMINATTA FORNA
So everybody wins?
ANDREW JACK
I think there is perhaps a broader philosophical question, if you like, because what a government is doing today by taking part in IFFIm is pledging future generations to paying money up front today. It's restricting their ability to maneuver on future development aid.
VOICEOVER
The government pledges are legally binding and managed by IFFIm's treasurer, the World Bank. But should governments commit funds 20 years into the future? Aminatta asked the financial secretary to the British treasury, Stephen Timms.
STEPHEN TIMMS
Well I think the prize is in doing things now, rather than in 10 or 15 years time, because we'll have healthy children in the future thanks to immunization now rather than sick children. So I think actually the case for spending money now and using this mechanism is a very, very compelling one.
AMINATTA FORNA
What IFFIm are doing, in raising money for vaccines through the world of finance, is imaginative and interesting. But I think actually implementing it, on the ground, with all of the challenges that there are in Africa, is going to be quite different, and that's what I want to see.

Segment 3

VOICEOVER
Back in Sierra Leone, Aminatta is almost at the end of the four-hour drive to her father's village, Rogbonko.
AMINATTA FORNA
I normally come to the village about twice a year, but it's been a whole year since I've been back. I was here this time last year, I wasn't able to come at the end of the year. So I'm really excited. I'm actually just excited to be home.
VOICEOVER
The feeling appears to be mutual, with every member of the village turning out to greet her. But this isn't just a social visit. Aminatta wants to find out whether vaccines paid for out of the IFFIm initiative are reaching remote areas like this.
AMINATTA FORNA
I'd really like to know if all the kids in this village are being immunized, because that will absolutely change things around ultimately and forever.
TITLE
Kill or Cure.
VOICEOVER
Aminatta Forna is writer who lives in London, but grew up in Sierra Leone. She's staying in her father's village looking into the work of a vaccine initiative called the International Finance Facility for Immunisation.
AMINATTA FORNA
My father was a doctor, I myself was immunized by him, and I grew up in a clinic with people coming and going with different ailments, so I've always had an innate understanding really of not only how important healthcare is in a country like this one but also what the challenges of delivery are.
VOICEOVER
Poor roads and tiny budgets are just two of the reasons why Sierra Leone's health system struggles to cope. When Aminatta arrived in the village a few days ago, she learnt that her cousin Ibrahim had just lost a daughter to tetanus.
AMINATTA FORNA
Can you tell me, at any of the hospitals, did they tell you what was wrong with your baby?
IBRAHIM
Well I'm not a doctor, but I know when a baby is dying. You look out for signs like shivering. But we were told it was tetanus, so we took the baby to Makeni. After a while, I was told the baby had died.
FATMATA
I was devastated. I loved that child.
TRANSLATOR
He told me, indeed, he believed that she had not been given a tetanus vaccination and this is not the first child that has died in this way.
AMINATTA FORNA
Of theirs?
TRANSLATOR
Yes, of theirs.
AMINATTA FORNA
I'm so sorry this happened.
IBRAHIM
After everything I've been through, I never want to go through that pain again. Any life that is lost leaves a family devastated.
VOICEOVER
It's unlikely these children were immunized against tetanus, a vaccine-preventable disease. Ibrahim isn't sure if they had been or not.
AMINATTA FORNA
In so many parts of the world tetanus is virtually an eradicated disease. I mean, I can't remember the last time I heard of anybody in the Western world either contracting or dying of tetanus and yet it happens here all the time. Ibrahim and Fatmata had lost not one, but two children to tetanus.
VOICEOVER
The next morning, Aminatta is taken by another of her cousins to the nearest vaccination centre. There are a lot of villagers -- and Fornas -- in the vaccination register.
AMINATTA FORNA
So this is the list of vaccines that they've had and then you put the date according to which vaccine it is.
VOICEOVER
IFFIm money has helped to increase routine vaccination coverage here from just 40 percent to over 60 percent. In-country estimates indicate that figure is still climbing and could be as high as 85 percent by the end of the year.
AMINATTA FORNA
Yeah, I can see lots of people from Robonko here.
MARY [vaccination center nurse]
They are very attentive.
AMINATTA FORNA
I didn't know that anyone from my village came here. I thought that those kids that were vaccinated were actually going to the big hospital in Magburaka, which is much further away. So I was really impressed.
VOICEOVER
Normally, the villagers come here for vaccinations. But today, the nurse is taking the vaccines to the village to make sure every child is up to date.
AMINATTA FORNA
I guess for people in the West, taking your kids to be vaccinated is a routine and rather mundane activity: you go into a hospital, it gets done, you leave. But here, well you can see, it's such a festive atmosphere, it's like a party in here. Everybody has come together today, and they have actually decided to make a bit of a day of it. I don't think all the kids here actually need to be vaccinated but everyone's brought them anyway. One of the reasons the nurse is checking the records so carefully is to make sure that she doesn't accidentally double up and that's because people have got such a strong belief in medicine, free medicine, that they come anyway.

Segment 4

VOICEOVER
Until 2007, none of these babies would have been protected against the child killers Hib [Haemophilus influenzae type b] and Hepatitis B. IFFIm money helped to include vaccinations against them into the national program two years ago. By front-loading the money pledged over the next 20 years by donor governments, IFFIm has raised USD$6 million to be spent each year in Sierra Leone. The GAVI Alliance is the organization which distributes IFFIm funds. According to the World Health Organization, its support of vaccination programs has averted 3.4 million deaths worldwide. Aminatta meets visiting representative Arianne Leroy.
ARIANNE LEROY
We're funding a number of various vaccines and the most recently introduced vaccine is a vaccine called the pentavalent, which is a very new vaccine, and it's actually extraordinary to think that the pentavalent vaccine, which is a vaccine that is available in Western countries, is now available to all the kids in Sierra Leone for free. What we're trying to do is to give the same chance to all these children in Sierra Leone as Western children to start off their life healthy.
VOICEOVER
Rogbonko is just one of millions of villages around the world being helped by GAVI and IFFIm money, which supports immunization programs for half the world's population. In Sierra Leone, GAVI has committed funds until 2015. But what happens then, when the money is spent?
ARIANNE LEROY
We're trying to make sure that the countries are self-sustainable at some point. We are now requiring all countries to co-finance their vaccine, meaning that Sierra Leone is starting to pay part of the vaccine they are getting, and increasingly they'll have to pay for more and more as time goes through.
AMINATTA FORNA
Is it just the vaccine itself that GAVI funds in Sierra Leone?
ARIANNE LEROY
GAVI funds the vaccine itself but it couldn't just fund the vaccine otherwise nobody would be trained to use the vaccine, families would not know that the vaccine is there to get their children vaccinated, so GAVI is also strengthening the national health system so that people are trained, people know about the vaccine, the infrastructure is in place, and the vaccines can be administered.
VOICEOVER
Back in the village, it becomes apparent why this additional support is so vital. It transpires some of the women had, in the past, been charged for their free vaccinations.
AMINATTA FORNA
Can you tell me how much money you'd have to pay for this?
WOMAN [via translator]
Five hundred leones [SLL].
AMINATTA FORNA
Five hundred leones for what?
WOMAN [via translator]
Five thousand leones.
AMINATTA FORNA
Five thousand leones, for the card. We went round asking different women, we asked about 20 women, and they all told us exactly the same story that the previous nurse had been charging them all 5,000 leones for their immunization card, for something that should by rights have been given to them free. It transpires that some of the officials did know, they are onto it, they are stamping it out, so that was reassuring. It also demonstrates actually why GAVI money is needed for more than just the immunizations themselves, that actually monitoring the systems is as much part of it as delivering the vaccines.
VOICEOVER
The next morning, the village holds a meeting to discuss what has happened.
AMINATTA FORNA
This is a village meeting in the barrie and the representative health worker has come to talk to them about vaccinations and why they're so important. There's clearly more to an immunization program than simply sending over batches of vaccines, and I think that it's tremendously important that GAVI is and continues to spend money on the entire infrastructure, on the personnel, on the systems, on delivery, on giving the right messages.
HEALTH WORKER
The reason I am here today is to tell you about vaccinations. We want you to know that all vaccinations are free. You never have to pay for the vaccination card.
AMINATTA FORNA
I don't think the villagers have any real understanding that the money for their vaccines is coming from IFFIm and GAVI, I don't think those acronyms mean anything to them at all. But they do understand, now, that the vaccines are free, that's been made absolutely clear today.
VOICEOVER
The villagers have had their questions answered. And so has Aminatta.
AMINATTA FORNA
I didn't really know what to expect when I first began to look into this whole area. I knew about the challenges of delivering aid to a country like Sierra Leone but I knew absolutely nothing about financial institutions. I think there's a natural suspicion, which I've always shared, about capital markets, about the world of finance and business. It's been really interesting for me to see that there are times when that can be harnessed in a way which is productive, and in this particular case it's produced something enduring and really beautiful, and that is a child's life.
VOICEOVER
On the other side of the village, at the school Aminatta started, it's time for their annual photo.
AMINATTA FORNA
With the school that we run, what people love so much about giving to us is, if they give a pound, they see a set of pencils arrive; there's a very, very direct correlation. So I think with the IFFIm program, it's vaccinations. You're getting something that's very measurable back. If that's what you're investing, that's what a child at this end gets.
TITLE
[end credits]
TITLE
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