Infectious disease epidemiologist Dr. Seth Berkley talks about the challenges of delivering vaccines to some of the poorest places on earth.

“The single greatest health intervention ever produced – and by far the most cost-effective – is immunization,” says Dr. Seth Berkley. “Yet vaccines are not accessible to every child on earth, which is just crazy.”

Berkley is CEO of Gavi, an international organization founded in 2000 – initially with funds from the Bill & Melinda Gates Foundation – with the aim of improving access to vaccines for children in over 70 of the world’s poorest countries, including Chad, Somalia, South Sudan, Yemen and the Democratic Republic of the Congo. It’s been astonishingly successful and, since its launch, has reached almost 640 million children in the poorest regions on earth. In 2016 alone, 62 million children were immunized with Gavi-supported vaccines.

Gavi has done this, notes Berkley, by creating a partnership between the public and private sectors, and convincing pharma manufacturers that supplying vaccines to developing countries is a win-win situation. “We’re not looking for their charity,” says Berkley. “Instead we are creating shared value. We ask them to scale up production of vaccines, which drives down cost. Poor countries then pay a nominal amount initially supplemented by Gavi funds; but as they get wealthier they pay more and more until they’re able to take on the full amount. So, for the manufacturers, these countries become their markets of the future. We’ve also worked to create a healthy marketplace so that prices for vaccines in developing countries are around 95-99 percent less than they are in the West.” And while Gavi doesn’t have a ground presence in developing countries, it works with partners who do – such as the World Health Organization (WHO), UNICEF and individual countries’ health ministries – in order to deliver its programs.

Before joining Gavi in 2011, New York-born Berkley led the drive to develop a vaccine for the AIDS virus as founder of the International AIDS Vaccine Initiative, and has since been named one of the 100 most influential people in the world by TIME magazine. So what’s his proudest achievement? “I think the most important thing I’ve done is create trust and good working relationships between the public and private sectors, and between the United Nations, non-governmental organizations (NGOs) and others,” he says. “Why? Because a giant problem like infectious disease is only going to be solved if we all work together.”

What are the main challenges facing Gavi?

I’ll give you two. The first is equitable uptake and coverage of vaccines. We’re working in the poorest and most difficult countries in the world and we have to try to reach everybody – so an efficient supply chain is vital. The percentage of children receiving a single vaccine dose in these countries is now close to 100 percent. The problem is, they need to receive multiple doses in order to be fully immunized. For example, we estimate that 86 percent of children get their third dose of the DPT vaccine (for diphtheria, whooping cough and tetanus). Which means 14 percent aren’t receiving it. 

Secondly, there are now 66 million displaced people in the world – the highest number ever – because of war, environmental disasters and other factors. We have to find ways to supply vaccines to children in emergency situations and track them to ensure they become fully immunized and so able to realize their full potential.

How difficult is it to deliver vaccines to remote areas?

Getting vaccines from a national storage point out to the regions in a refrigerated truck is usually simple in most countries that have roads. The real challenge is then delivering them to remote areas or to those children who don’t live within a short distance of a clinic. Technology helps a lot here, so we’ve created a program called INFUSE – Innovation for Uptake, Scale and Equity – to find interesting tried-and-tested logistics technologies that have the potential to improve vaccine delivery. For example, we’re working with a drone-based system in Rwanda that’s primarily designed to carry blood – but we’re talking about the possibility of it carrying vaccines and antivenom for snake bites too. We’re using geographic information systems to find off-the-grid houses so that the children who live in them can be immunized. We’re working with companies that have supply chain monitoring capabilities, and want to get our vaccines barcoded. We’re protecting vaccines with cloud-based temperature monitors; and we’re working with DHL to increase efficiencies on the systems side.

What are the potential disease outbreaks that keep you awake at night?

As an infectious disease epidemiologist, I could have a lot of nightmares – although some outbreaks need to be kept in perspective. The world went hysterical about Ebola, for example, but the truth is that Ebola is not easily spread. On the other hand, flu can spread like wildfire and, as we know, the 1918-1920 Spanish flu killed around 50 million people. We will at some point get a strain of flu that is much more deadly – and the world isn’t prepared for it. The most important thing for avoiding global outbreaks is that we control infectious diseases in their home countries with immunization.

Are you optimistic that, at some point, vaccines will be available to all?

Yes, but I’m also a realist. The world’s population is estimated to grow from 7 to 11 billion by the end of the century. We’re overcrowded and we’re urbanizing, so more epidemics are inevitable. After Ebola, the world sat up and took notice – then attention dropped. The same happened with flu and the Zika virus. The challenge is to keep the world focused on the infectious disease problem. It’s not going away. —  Tony Greenway

Published: November 2017

Images: Seijkens/Gavi