WHO Leadership launch of the 1st consultation towards the co-development of "A Vision and Strategy for Vaccines and Immunization for the Decade Ahead 2021-2030"

Address by Ms. Kate Gilmore, United Nations Deputy High Commissioner for Human Rights

Geneva, 18 March 2019

I am delighted to have this opportunity and, on behalf of the High Commissioner for Human Rights, thank you for the ground-breaking, lifesaving, life-enhancing work in which you are engaged. Thank you for your multi-stakeholder consideration of these aims, and for the global scale of the essential leadership that WHO provides.
It is an honour join you and to share this platform too with Ambassador Maria Farani Azevêdo, noting the major role that Brazil historically has played in championing the Right to the enjoyment of the highest attainable standard of physical and mental health.

Friends,

The SDG agenda, of course, has already committed us to the very delivery that your discussions here will set out within that very same timeframe.

The promise of Universal Health Coverage implicates us all and within its opportunities and challenges necessarily lies these questions of vaccines and immunization - approaches to which engage too the interests of us all - as individuals in our own rights, as family members - as parents, as community members, as scientists, as leaders and, as critically, as duty bearers.

But let’s start at the beginning – putting first principles first: for in each instance, and in every setting, no matter the context, regardless of the actor or stakeholder, irrespective of the challenge we are striving to meet, wherever people are involved there too you will find rights-holders – there you will find human rights and thus duties too – duties so that rights are respected, protected and fulfilled. People are always rights holders - no exceptions, for no purpose, under no circumstance. Even in humanitarian settings, even along precarious migratory routes, even when in flight, still human rights prevail.

As you set out a vision and strategy for Vaccines and Immunization for the Decade Ahead 2021-2030, human rights must be understood as prevailing – prevailing in all settings for all populations and thus they can and should be providing you with normative, legal and ethical confidence, clarity and certitude.

Rights? As enshrined in the UDHR, they are simply an operating manual for what it means to be human and to be treated as such.

Medical science codifies our anatomy, physiology, our musculature. Human rights - their concepts, values and norms – their collectively and internationally negotiated definitions – codify the ways in which each of us is precious, unique, equal and, critically in this context, human rights set out the terms and conditions under which we may exercise our rights without cost to any other person’s rights.

Let medical science place before you the aetiology, pathology and epidemiology pertinent to communicable and contagious disease and immunization, but allow rights to place before you – at the centre of your consideration – the person – not in their physical anatomy alone but in the fullness of their legal personhood – the person as the holder inalienably of rights throughout their life course – rights, universal and indivisible.

In this, please understand that rights are not questions merely of personal preference, belief or ideology. They are not programming options. They are matters defined by international legal standards and universal norms: forged weighty, substantive and directive not via power’s arbitrary imposition, fabrication or convenience – but by decisions of the international community of members states, accrued now over decades, tested now in courts the world over; rooted in all traditions; concepts that can be tracked back to the earliest histories of human society, and values that are understood now to be our best effort yet to fulfil that proposition for which there simply is no conscionable or credible opposition – that born we all are free and equal in dignity and rights.

There is no purpose to health care, and specifically to vaccines and the immunization that they assure, unless people are squarely at the centre! – unless people are central both as those whose rights to and through health are to be protected, and inclusive of those who carry the duty to ensure and provide such benefit equally and justly.

Human rights are an asset, enabler and guide star for universal health coverage in respect specifically too of vaccines and immunization. The human rights framework stabilises in law, the programme-critical concepts and terminology; helping frame public policy within international standards to which Member States can be held accountable and offering supporting context for design of implementation that is effective, inclusive, non-corrosive of human dignity.

The human rights-based vision and strategic framework for vaccinations is one in which there is explicitly no discrimination on any grounds but rather an active establishment of equality of access and outcomes; delivering strengthened coverage that addresses that health system failings and the deprivation that this imposes.

For universal coverage, we are further obliged to recognise how human rights violations impede access to vaccines and prevent adequate immunization coverage and we must deal with the ways in which our service provision may entrench those violations, noting that vaccine-preventable illness is directly responsible for large numbers of people being pushed deeper into poverty and inequality each year.

Indeed, health systems’ failures in reach, provision and access more often than not tracks the deeper hate-lines of our bigotries and outlines the borders too of our ignorance and fears. In many instances, such deprivation of access is not a mere oversight – but an intentional consequence – with severe implications, for example, for adolescents – particularly girls – when we reject the realities of their sexual and reproductive health and status; for men who have sex with men when we pretend that their conduct is somehow other than normal or natural; for people on the move – migrants, refugees, asylum seekers - when we act as if it is somehow our prerogative to turn our backs to them; for people in humanitarian crisis when we think somehow that essential services do not include sexual and reproductive health care; when in our ignorance and contempt, key populations, indigenous people, people in detention, children in detention are somehow “legitimately” placed beyond the reach of essential services.

The toxic brew as this cruel interplay between poverty, inequality, discrimination and displacement - undermines rights to and through health, eroding the efficacy of universal health coverage, especially with respect to essentials such as vaccines. And under international law, States have a formal obligation to provide immunization to all people without discrimination.

So, in your strategy be sure to track demographic data on access and use, with particular attention to disaggregation by all forms of discrimination prohibited under international law and with a focus too on people across diverse settings – urban, rural, humanitarian.

We must further build in a major role for human rights-based national laws and policy frameworks to protect person-centered, rights upholding, pathways to comprehensive vaccination coverage, situating the institutional systems of rights protection, including national human rights institutions and courts, so that they too are charged to play their part in upholding this universal access.

Given that vaccination is the most effective and cost-effective medical intervention through which individual and collective immunisation is achieved, please found your overall vision and approach on the right to health which also obliges from us proactive measure to ensure vaccines are:

• Available in sufficient quantities;
• Accessible - physically and economically to all - without discrimination,
• Adequate in quality
• Supported by accurate information to enable informed decision-making.
• And, provided in a manner both acceptable and adaptable to the local context, respectful of the dignity of those receiving care and of those providing care.

Friends,

Refusal of vaccines against contagious disease may appear to some to be linked to the exercise of a right. And, to be clear, coercive measures in the name of the right to health must always be a very last resort: such measures closely be closely regulated and subject to the most rigorous of legal review, accountability and remedy where injury from such measures has been shown to occur.

However, there is no such thing as a general “right to refuse vaccines” when the consequences of doing so is to be borne by others in such a way as to undermine their rights, including their right to health. The rights framework allows for the recognition – which is critical in reality – that when my exercise of rights overrides your exercise of rights, all our rights are undermined.

What is further made clear and central by international human rights standards, is that the where policies impact directly on the child, it is their best interests that must prevail. The best interests of the child – not of some children, not only of your children, or their children but of all children. In this sense international standards create obligations for parents and carers - a first order obligation to the rights of the child.

Appreciation of this interface - this relationship - between individual choice and the rights of others - has been resisted before: against bans of smoking in public places and against legal obligations to wear a seat belt in a moving vehicle; to restrict a vehicle’s speed on the road: at one time or another, such policies were denounced wrongly as if they somehow violated individual rights. However, the impacts on collective rights of individual choice is a matter of grave concern, it must be mitigated by public policy, adjudicated – on the basis of impartial evidence – against international legal standards and resolved as necessary before the appropriate tribunals.

That after all is the whole point of society, of a governed society.

Our question then is how best to develop public health policy and service provision that upholds the dignity of all, resorting only to proportionate, “coercive” measures as a very last resort in response to those who reject practices that are in the public interest. International norms and standards – as articulated by such as the UNHRC, UNESCO, WHO - are tried and true guides for this purpose. International human rights courts have developed tests that analyse under which circumstances individuals’ rights may be restricted and in ways that are legitimate and lawful - strictly necessary and proportional.

Friends, vital as vaccines and immunization are, there is arguably even more at stake here today.

This is an era when universal standards and our loyalty to them are, by virtue of this world’s global realities, needed more than ever and yet somehow it appears – that thanks to such as the rising tide of populism – these standards are more widely and more loudly being drawn into question.

When for example, legislation named ironically “Protecting Life in Global Health Assistance” imperils $8.8 billion of funding for HIV and AIDS; for health systems strengthening; for water, sanitation and hygiene programming; when proven means of preventing newborn, child and maternal mortality are so deliberately eroded; when such a bill is drafted in the face of all evidence that it will notdecrease rates of abortion but will only increase rates of unsafeabortions, then you know that universal values and science itself - reason, evidence, facts - are also under threat.

In more places than here alone, the “vaccine paradox” i.e. a proven benefit faced with public opposition aided by politically sponsored scepticism - must be resisted for itself and for the broader trends it is representatives.

I have a right to my own opinion but not to my own facts. In this era of rising populism, fake news and daily betrayals of scientific evidence, fact and universal values by those such as political leaders, it is time frankly for the scientific community to stand up more visibly: to stand up not merely for their own interests – for their stock and trade as it were – but to stand up – alongside others - for the vital importance of international norms and standards, to stand up for evidence – however inconvenient those facts might be to some powers – however confronting it might be to some sensibilities: stand up for our rights to evidence-based public policy and for our right – enshrined actually in the UDHR itself - to “share in scientific advancement and its benefits.”

We have not as yet discovered a vaccine for hatred, for lies, for bigotry. But we can stand up for the vaccines we have in a way that challenges exactly those toxic and contagious threats to our human family!

There is a wonderful T-shirt available declaring: Vaccines cause adults. I would just edit that message slightly because after all “Vaccines cause rights holders”.