Seth Berkley is the new CEO of the Global Alliance for Vaccines and Immunization (GAVI) which gave a record $165 million grant to induct the pentavalent vaccine into India’s universal immunization program. It combines protection against DPT, Hepatitis B and, for the first time, Hib, the leading cause of bacterial meningitis among infants and children, and second leading cause of bacterial pneumonia deaths among under-fives. Penta has just rolled out in Tamil Nadu, Kerala and Goa, and will ultimately cover 18 million children. I spoke to Dr. Berkeley at the recent Pacific Health Summit in Seattle.
Vaccines made by Indian pharma companies fuel 43% of the world’s UIPs, yet every third unimmunized child on the planet is Indian.
It’s truly surprising especially when India also produces new, innovative vaccines. If I were responsible for the country’s health, I would make my No. 1 priority a high level of vaccinations for the poorest people in the poorest states. If you get rotavirus infection in Delhi and you are poor, you could still get some care; outcomes are much worse in remote areas. It’s not just mortality but also morbidity. Your Bharat Biotech is producing the rotavirus vaccine, not just multinationals like Merck or GSK, and it has offered it to GAVI at $3 for three doses compared to GSK $5 for a two-dose vaccine.
What do you feel about the two-year delay in the pentavalent vaccine project?
Disappointed. You want to save lives. A multi-shot vaccine reduces exposures and increases the coverage. It makes cold chain logistics easier, plus reduces the problem of disposing of both plastic and sharps. The GAVI Alliance’s aim is to reach those in the poorest quadrant of the world, not 80% but 100%.
There is some concern over Bill Gates dictating when and how we rolled out the pentavalent. As founder-president of the International AIDS Vaccine Initiative (IAVI) since 1996, you are familiar with the problem of donor-driven agendas.
GAVI (which significantly includes the Gates Foundation) doesn’t thrust any vaccine on any country. We educate the whole immunization community.WHO, based on data, only makes recommendations. But it’s always a country decision. They have to make an application for co-financing. It’s our belief that immunization will be both cost effective and sustainable only if it is country-driven.We support countries doing their own database and analysis of this data. This results in better decisions and utilization of resources. GAVI also helps drive down vaccine prices. You can do this with production of large quantities, by encouraging competition, and by better technology.
Why are you so bullish on universal immunization?
Vaccines are the truly democratic intervention: they work for all in the same way, whether delivered in a state-of-the-art pediatric clinic or in some remote facility. The cost is relatively small. Immunization is the single most important health intervention, often the only one in backward areas. You can reach every person. India showed this with smallpox, now you’re showing this with polio (only one case was recorded last year in India). Of course you need many interventions– sanitation, clean water, nutrition, education, good housing. But if you can’t get to that point, immunization against diarrhea helps, though only against the one caused by the rotavirus.
What are the biggest hurdles – finance, science, access – to ‘reaching the fifth child’ in the world who remains unimmunized?
All of those. Also the invisible nature of groups which are isolated, stigmatized, extremely poor, biased against. So it takes an extra level of outreach, In many cases political will is lacking, but that’s the group you have to get to. Vaccination is complex– you don’t have to reach each individual; herd immunity kicks in. But you want a twofold strategy: vaccinate as many as you can, and vaccinate the most isolated because those are the children at highest risk.
At GAVI’s first pledging conference in London on June 13, world leaders committed $4.3 billion. Are you merely the world’s vaccine banker?
GAVI’s role is not just about financing but to help distribute new and underutilized vaccines. The tragedy is that the wealthiest in wealthy countries get first access to vaccines. There are delays of 15-20 years before it gets to the poor in poor countries. Our role is to accelerate the process. And the ultimate goal is simultaneous roll-out in rich and poor nations. Routine screening for HPV (the cervical cancer-causing human papillomavirus) wasn’t rolled out in developing countries. That’s a tragedy when you have the technology. By the time WHO recommends them, vaccines already have tremendous usage around the world and well-established safety patterns.
What will be your No. 1 priority as CEO of GAVI?
I have quite a few No. 1 priorities. Try and make sure we live up to the pledges we made to governments to get out the vaccines that aren’t getting out. Do a better job in shaping the vaccine market. Work with some large countries like India and Nigeria where a large number of unimmunized children still remain.
What lessons from IAVI will you bring to GAVI?
An abiding faith in the power of innovation in the way we work and in science and technology. IAVI is building a lab in India to take advantage of your edge in medicinal chemistry, computer modeling, structural biology to help solve the problems of developing an HIV vaccine. GAVI is about all vaccines.
Source: Bachi Karkaria, The Times of India Blog