[As Seth Berkley leaves Gavi, the Vaccine Alliance, the
epidemiologist reflects on its growth and challenges ahead]
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SUNDAY SCIENCE: CHILDHOOD VACCINE CRUSADER SHARES CONCERNS FOR FUTURE
 
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Jon Cohen
July 20, 2023
Science
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_ As Seth Berkley leaves Gavi, the Vaccine Alliance, the
epidemiologist reflects on its growth and challenges ahead _

Gavi, the Vaccine Alliance CEO Seth Berkley (left) visited the
Democratic Republic of the Congo in 2019 during an outbreak of Ebola,
which now is one of the vaccine-preventable diseases the nonprofit
works to combat., GAVI/2019/FREDERIQUE TISSANDIER

 

By the start of 2011, the year epidemiologist Seth Berkley became CEO
of Gavi, the Vaccine Alliance, the ambitious nonprofit had over its
11-year history supported the immunization of 288 million children in
poor countries. But it also had a $3.7 billion funding gap between its
plans and donor financial pledges. Making matters worse, an internal
battle raged about how much it should invest in strengthening health
systems versus more technological solutions, such as new or improved
vaccines, favored by its main funder, the Bill & Melinda Gates
Foundation. “It was a crisis,” Berkley says.

Berkley plans to step down from Gavi’s helm on 2 August, arguably
leaving it in a much better place. Between 2011 and 2022, it raised
$33.3 billion in financing from governments, philanthropies, and
industry—a jump of 683% from its first decade. To date, Gavi has
helped low- and middle-income countries vaccinate 1 billion children
against a widening range of diseases. Tensions have eased between the
organization and the Gates foundation, which has donated another $3.5
billion to Gavi under Berkley’s watch.

Berkley and Gavi also played a central role in the COVID-19 pandemic,
helping create and run the COVID-19 Vaccines Global Access (COVAX)
Facility. Although the new nonprofit fell short of its goal of getting
COVID-19 vaccines to lower and middle-income countries at the same
time as they were rolled out to wealthy countries, it still ended up
providing nearly 2 billion doses, accounting for 74% of the shots that
went to the world’s low-income countries.

Berkley came to Gavi from IAVI, a nonprofit he founded that aims to
speed HIV/AIDS vaccine development. Before IAVI, he represented the
Rockefeller Foundation in the Children’s Vaccine Initiative, which
had a Gavi-like vision but never left the runway.

Last week Science spoke with Berkley about Gavi’s past and future.
In the background of his home office in Geneva sits a large, model
sailboat. “Now what I’d like to do is go sailing,” Berkley says.
“I’m tired, and this has been a stressful last few years.”

This interview has been edited for clarity and brevity.

Q: Given your work with the Children’s Vaccine Initiative, did you
think Gavi would grow into what it has become? (The initiative
disbanded in 1999 after 8 difficult years
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A: The Children’s Vaccine Initiative did not turn into what we had
hoped it was going to do, and yet we knew that we needed something.
The idea was that Gavi was going to try to solve that problem, and
because it was coming on the heels of a failure, it really was an
experiment. And, to be honest, the chance of it succeeding, given how
problematic the previous experiment had been, was challenging. But it
took off.

Q: In Gavi-supported countries, 77% of children in 2021 had a complete
course of vaccinations with shots that protect against diphtheria,
tetanus, and pertussis—a jump of 19% since 2000 and only 4% shy of
the global rate. Is that Gavi’s greatest success?

A: No, no, I wouldn’t think that. With other vaccines, against
hepatitis B, haemophilus influenzae B, and pneumococcal disease, we
went from, in essence, zero to 40%, 50%, 60%. So it’s not just the
number of children being reached, but it’s the number of vaccines
that they have been provided. Now, when I think of successes, the most
important one is the 70% reduction in vaccine-preventable disease
deaths in Gavi countries, which then contributed to the more than 50%
reduction in the under [age] 5 mortality rate. Those are the kinds of
things I’m proudest of.

Q: Gavi has had 19 countries transition to self-financing, and other
countries are now cofinancing another $1.5 billion of the vaccination
costs. Do you see Gavi fading out over time?

A: Many countries started out at such low income that it is going to
be a long time. Rwanda, even though it’s made great strides, is a
very poor country. The other part, of course, is fragility. Mali,
South Sudan, Yemen, Somalia, Haiti—they will not be on their own for
a long time.

Q: A vaccine against respiratory syncytial virus (RSV) may soon be
approved for pregnant women because their antibodies will spill over
and protect their newborns. Would Gavi fund that?

A: Yes, absolutely. It depends on what the vaccine ultimately costs.

Q: But Gavi has never vaccinated pregnant women to protect their
children, has it?

A: Not systematically. One of the questions that Gavi will struggle
with in the future is a lot of the vaccines that are being considered
in its plans are for adults. What COVID showed us is that we could
move into an older age group—not perfectly, there are lots of
challenges—but we’ve proven we can do it. So the challenge then is
do we want to make that routine? Or will it just be in an emergency
effort? [Gavi’s portfolio in the future may include vaccines for
COVID-19, tuberculosis, Sudan ebolavirus, and the Marburg virus.]

Q: What do you think of COVAX’s performance and the criticisms that
it didn’t rapidly offer COVID-19 vaccines to the 92 low- and
middle-income countries that opted to be part of it?

A: There’s always going to be a day one problem: The richest, most
powerful countries are going to want the available doses of vaccine,
but what we can do is improve the speed, efficiency, ability to scale
vaccine production and delivery.

If you look at the 92 countries, they have 55% primary coverage with
COVID-19 vaccines, as compared to 65% globally. It’s not equitable,
it was delayed, but it’s better than it’s ever been. We’ve got
to start right there. My worry is if you start out and say, “COVAX
was a complete failure,” what that means is then, OK, we’re not
going to learn the lessons, we’re not going to build on the
positives. That’s what I think has to happen now. How can you have a
coalition at the ready? How can you best have vaccines ready,
including having zero-day financing available, so you can start
ordering quickly? And hopefully you’re going to have more
diversified manufacturing. [COVAX relied heavily on the Serum
Institute of India to make vaccine doses, and the country blocked
exports until it met its own needs.]

Q: Gavi recently introduced a vaccine that works against six diseases.
That obviously simplifies delivery of shots. In the future, do you
foresee, say, a 20-in-one shot?

A: I suspect what will happen is instead of going to 20, you’re
going to have a respiratory disease vaccine for COVID, flu, and RSV,
and a vaccine for infants that covers a range of diseases, and maybe a
combination vaccine for the pregnant women that covers group B strep,
RSV, and a diphtheria/tetanus booster. That’s probably the way
we’d go first before we went to one master vaccine. There’s also a
vaccine patch technology—that’ll be an advantage. And if we
ultimately get to really good inhalable products, then they can be
self-administered. So it’s easier.

Q: What are the biggest challenges for your successor?

A: It’s a tough fiscal time, so making sure that there is continued
support for the priority of vaccines and public health is really
important. Climate change is the biggest, most important problem going
forward. It’s going to lead to a polyepidemic. We’re going to have
massive movement of people, water challenges, desertification,
displaced people, and that’s going to all lead to disease, because
it’s going to affect ecosystems.

And then we hit the wall of populations in all countries getting
older. We should start thinking about providing vaccines for older
people in developing countries. How do we use prevention technology to
reduce disease burden and keep people healthy? That is scary to
donors, because it’s more money and more work, but at the end, what
other choice do we have?

_JON COHEN is a staff writer for Science._

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EXTINGUISHING THE IDEA THAT HOBBITS HAD FIRE
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Elizabeth Grace Veatch
Research has overturned earlier claims that a diminutive human
relative, Homo floresiensis, lit fires—but big stories die hard.
Sapiens.org
July 27, 2023

* Science
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* health
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* Medicine
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* vaccines
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* children
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* Inequality
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