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7 Billion Doses: The Man Who Vaccinated the World | Gavi CEO Dr. Seth Berkley
45 Plays6 days ago
Developing a vaccine is one challenge. Delivering it to billions is another entirely. Dr. Seth Berkley, former CEO of Gavi, joins us to unpack his new book Fair Doses, which discusses the hidden systems, politics, and economics behind global immunization.
Gavi’s work has helped deliver over 7 billion vaccine doses and immunize more than 3 billion children, reshaping access across the world’s poorest regions. Dr. Berkley explains why vaccine mistrust has persisted for centuries, and why today’s misinformation environment is uniquely dangerous. He breaks down how Gavi’s alliance model coordinates WHO, UNICEF, and manufacturers to move vaccines across continents. We also go inside COVAX, from vaccine nationalism to the supply-chain barriers that defined COVID-19 distribution. Finally, Dr. Berkley looks ahead to how mRNA, synthetic biology, and AI could transform our response to the pandemics to come.
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Transcript
Introduction to Healthcare Theory Podcast
00:00:00
Speaker
Welcome to the Healthcare Theory Podcast. I'm your host, Nikhil Reddy, and every week we interview the entrepreneurs and thought leaders behind the future of healthcare care to see what's gone wrong with our system and how we can fix it.
Who is Dr. Seth Berkley?
00:00:14
Speaker
Today on the Healthcare Theory we're joined by Dr. Seth Berkley, one of the most influential figures in global health and global immunization and author of the new book Fair Doses which unpacks the science, politics, and economics behind vaccines.
00:00:28
Speaker
Dr. Berkley has been an expert and the CEO of Gavi. For over 12 years we vaccinated 1 billion children, introducing 700 vaccines to low income countries and mobilizing 20 billion in global funding.
Vaccine Trust and Misinformation
00:00:40
Speaker
In today's conversation, we dive into the themes from his book, why public trust has collapsed, how global vaccine systems have actually function, and what actually happened behind the scenes during the COVID vaccine race, and why we're entering a new era within global health.
00:00:55
Speaker
Hi, Dr. Berkeley. Welcome to the Healthcare care Theory, and thanks for coming on today. Thanks for having me. Of course. It's great to have you on. And I want to start off with the beginning of your book. it's really one really interesting point when you talk about the history of vaccines was how even back to the 1850s, people were very hesitant with even their very first smallpox inoculations.
00:01:16
Speaker
And I'd love to hear is public trust in vaccines been so consistently fragile across history? And what makes today's rabid skepticism fundamentally different? Yeah, so thanks for the question. And you're absolutely right. um If you go back to the first vaccine, which was smallpox, um you know, in the late 1700s, soon as that was used, people published, um ah you know, pictures of people with cow's horn growing out of their head because it's It came from cows. And so that type of misinformation you know has been there. um The challenge that's different now is is that is is really a few things. First of all, because we have social media, things can spread literally at the speed of light.
00:02:00
Speaker
But second, we have intentional disinformation. So we have bots from Russia, from China, North Korea. um The US has even gotten in this game. We can talk about that if you want. um but But they use this as a way to divide the population, to have people not trust governments. And so that information is there.
00:02:23
Speaker
But the third thing that's a really big deal is the fact that um this has become highly politicized. And so when you have politicians now talking about this, that creates a whole other complexity because people say, well, what do they know that I don't know?
Impact of Public Trust on Vaccine Distribution
00:02:40
Speaker
And in the old days, the proper way to deal with with ah these types of questions was to have expert answers, to have – and sometimes that was your local healthcare workers, your nurses. Sometimes it was the village chief. Sometimes it was, um you know, the the local political, you know, contingents.
00:02:59
Speaker
um But ah more and more, um it becomes very difficult to try to um change these issues. And then when when um the COVID pandemic occurred, of course, um you know there was a lot of anger. um This was something that affected every person in the world.
00:03:16
Speaker
and And people began to question, you know, did people get it right? Were people being honest? And it created a lot of conspiracy theories, et cetera. So it's been a it's been a very tough time in my career in vaccines. This is the worst we've ever seen.
00:03:30
Speaker
Yeah, and it's it's really ironic. I mean, in your book, you describe a fascinating example. So heat-stable polio vaccine that was 100% safe never moved forward because they used heavy water, which triggered public fears about the nuclear industry and toxicity. And you point out that skepticism isn't limited to like these fringe anti-vaxxers, conspiracy theorists, even well-meaning parents, wealthy communities can hesitate when they don't understand what's in vaccines.
00:03:59
Speaker
So, i mean, given these dynamics, how has public trust not only shaped the rollout of vaccines, but even the development and adoption of these pretty promising technologies?
Dr. Berkley's Challenges at Gavi
00:04:09
Speaker
Well, it's an enormous problem. And and the interesting thing is that we used to see of it more of a problem in high-income communities and wealthy countries than in poor countries. Now, you might expect it to be the other way, but here's the big difference.
00:04:25
Speaker
Vaccines are so successful that we don't see these diseases anymore. And so if you're living in a wealthy community and you're trying to live an organic life and you're trying to eat healthy and take care of your children, you can imagine that, you know, all of a sudden you have to give many, many shots to your children for diseases you've never heard of. You've never seen, you know, kids kids cry when they get vaccinations. Sometimes they get fevers. You know, there's some side effects.
00:04:51
Speaker
And so people begin to question them. In the developing world, people see these diseases. Auntie had a kid that died down the street. They see somebody who's walking with a limp from polio. They they are aware of these diseases. And so you know no parent wants their child to die or to end up you know with a severe disability. So there people wanted and understood vaccines. So that's one um you know paradox that's really there. But but now that um you know people have
00:05:23
Speaker
spread all of this misinformation, it's affecting vaccines all over the world. In the developing world, because we just spoke about the fact that, you know, they're they're saying, well, what do we know? What do politicians know that they don't know?
00:05:38
Speaker
And in the high-income countries, there's been this partisan divide. I mean, during COVID, many more Republicans died um from not being vaccinated than Democrats. That makes no sense because, you know, your protection should be nonpartisan. So, So this is really a problem going forward and one that we're going to have to
Gavi's Achievements in Vaccine Introduction
00:05:57
Speaker
solve. Yeah, and it's definitely obviously a very difficult situation. And I want to go into you' taking over Gavi. So Gavi, huge organization, and you took over at a moment of instability. um There's a funding crisis, internal tension. a board chair, as you write, who told you to simply deliver, deliver, deliver. What is striking about this is that none of this was a so scientific challenge.
00:06:19
Speaker
It was more organizational, it was political, it was economic. So can you take us back to that moment? What motivated you to join Gavi? And what did the organization look like when you arrived? And what were the biggest obstacles in your mission to set out as a new CEO?
00:06:33
Speaker
but Thanks for the question. and And prior to Gavi, I was running a a an effort to develop an AIDS vaccine called the International AIDS Vaccine Initiative. and And the reason we were doing that is because most of the research that was going on, it wasn't enough. And it was mostly focused on high-income countries because that's where and naturally the research agencies are and the companies are.
00:06:56
Speaker
And so for me, it was a little bit of a hard decision because I was doing interesting work with industry on R&D. What Gavi's role was is to try to get these vaccines available to everybody in the world who needs them. And that was really the the focus of why Gavi was set up. We knew there were all these new, exciting vaccines, and they weren't getting to particularly poor people in the developing world. Of course, there are patches in wealthy countries that also don't have them. But it really, if you go back to 1974, there actually was less than of people in the world received even one dose of a vaccine, not all doses of vaccine. So it really was a a big difference. So um Gavi was a great opportunity to move that forward. And in the 12 years I served there, we introduced about 700 new vaccines to the countries that in those days were Gavi eligible, which was started was around 74 and got reduced to 56. So we brought all kinds of new vaccines, vaccines for
00:08:01
Speaker
diarrhea, pneumonia, the two largest killers of children. Recently, vaccines against cancer, um HPV for cervical cancer, hepatitis B for liver cancer, and even today, a vaccine um for malaria.
Global Collaborations for Vaccine Access
00:08:16
Speaker
So the idea was to get this out, to build those systems.
00:08:20
Speaker
And today, um vaccines have gone from that dismal figure I just said to being the most widely distributed health intervention in the world. where about 90 to 91% of kids in the world get access to at least one vaccine through the routine system. So we've gone far, but we haven't gone far enough. We need to get this to everyone and build those systems out so they're there to deliver in an emergency in the future or to be the ah people who can then say there's something funny going on in this community and we have to you know go investigate it.
00:08:55
Speaker
And one theme you emphasize that the alliance and Gavi is just as important as the vaccine themselves. I mean, in healthcare, you can't simply build a better product and disrupt incumbents. You have to work with the existing ecosystems. Why was building an alliance across WHO, UNICEF, and the industry so essential for Gavi's mission? And what did that collaboration actually look like in practice when you're trying to scale vaccine access globally? Yeah.
00:09:20
Speaker
but Well, first of all, we've talked about the issue of hesitancy, and that's an important issue in trust. But, you know, vaccines don't deliver themselves. so and and And because vaccines are are mostly um from living things, they also have to be in what we call a cold chain. That means it's a fancy word for being refrigerated and held at the right temperature. So what you need is a system that can bring in adequate amounts of the vaccines, making sure they get used before they expire.
00:09:49
Speaker
And then you have to distribute them around a country, including maybe having regional stores if it's a big country and local stores. And then you have to provide um the cold chain keeping it cold the whole way. you have to provide syringes, you have to provide the knowledge for health workers on how to use the different types of vaccines. So um it's really important to pay attention to those system issues as well, um as as we do need to pay to attention to hesitancy and making sure there's adequate money to buy vaccines.
00:10:19
Speaker
And those are all part of the effort that were done. Now, the innovative idea and in Gavi was first of all, work with industry because the other the people who make vaccines but also work with other international agencies. Don't try to replace them.
00:10:32
Speaker
Don't try to create a new agency, but rather, you know, WHO does a lot of work on regulation and on, on um you know, providing technical standards.
Market Mechanisms and Vaccine Access
00:10:43
Speaker
UNICEF traditionally had worked on cold chain and it worked on on on some of the distribution aspects of this. And so rather than recreate those, we brought everybody together and each one serves an important role. And this became later important when we created COVAX because now we had ah people who knew how to do these things worldwide and and we could take advantage of it. So that was those were some of the ideas that um went into this ah um as ah as an overall effort.
00:11:14
Speaker
And I think that's really interesting. And one other point I'm thinking about is that, I mean, these pharmaceutical companies aren't looking for a global disease burden and how sick people are getting. They're looking for ah ROI. That's their expectation to their shareholders. And you write that unlike mobile many global health efforts, Gavi actively partnered with that industry. And he used novel tools like vaccine bonds and advanced market commitments to align incentives, expand supply. So what did those relationships with the pharma actually look like on the ground? How did you build them up? And these financial mechanisms, like how do they matriculate into providing vaccines for low-income countries?
00:11:50
Speaker
So, um you know, first first comment on on on this is, um if you think about um industry, you're absolutely right. Their goal is to try to increase profit. So then our goal is to try to make a win-win situation. So, I mean, you know, you can say, oh, you should give it away free of charge. You should give away your patents. i mean, there are people who advocate for that. That's not my role. My role is to go to a company and say,
00:12:14
Speaker
hey, if you are now producing a vaccine in relatively small volumes at high cost, if you can increase it and sell it at a much higher volume, you'll drive the cost of the vaccine down and then you'll make more money in your primary markets, but you'll also make some money in middle income markets and then you'll make a little bit in the poorest countries.
00:12:36
Speaker
And under that curve, this is so-called Ramsey pricing, you actually end up maximizing your return on investment, but you also maximize the access.
00:12:47
Speaker
And that's really what we want to do. But there was another part of it, which is um the the developing world is extremely price sensitive. You know, when you're in the U.S., every year they increase the prices and ah margins are massive. And, you know, there's, you know, i why we allow that, I don't know. But that is the way we work. In the developing world, when you have countries where some countries only have five or seven or ten dollars to spend annually on health care, the price points become really important.
00:13:21
Speaker
So for us, what we wanted to do is shift to um a different strategy. We started with five manufacturers, most of which were in the developed world.
00:13:32
Speaker
and And by the time I left Gavi, there were 19 manufacturers, the most of whom were in the developing world. And and in COVID, we added even more. and And so what we ended up doing is finding companies who were willing to take um much less, you know, of ah of ah of a profit margin of a return and
COVAX: Ensuring Global Vaccine Distribution
00:13:52
Speaker
were willing to produce the same high quality vaccine. So that's how we we kind of changed things up. And and and that rate ah made a real difference. But to your point on delivery companies, it's the same thing. you know, you have very fancy companies who can do delivery.
00:14:06
Speaker
but they do it at a high price. And they're not experienced at doing it at the absolute lowest cost. And that's what we had to innovate in and work on. In terms of of new tools, we we created all kinds of new market mechanisms. So you mentioned a few of them. One was something called the International Financing Facility for Immunization. That was a tool that was put together by Gordon Brown when he was chancellor of the Checker in the UK.
00:14:34
Speaker
and And what it was is it said, if we could create a way to provide financing that was guaranteed and we were able to do that over a period of time. So an example would be, let's say you have $20 million dollars and you um want to commit timeframe of that million. dollars That would be million. dollars um What would happen is you could take that money out any time in that 20 years. You could front load it by floating bonds against the guarantee of the money or you could backload it.
00:15:12
Speaker
That gave you flexibility in dealing with pandemics, epidemics, but also increasing. in in um you know making commitments from donors that would allow a big scale up by front-loading vaccines. So that was a really interesting component. We did about $10 billion dollars worth of that.
00:15:28
Speaker
And then these advanced market commitments, advanced purchase commitments would go to a company and say, if you're willing to put a vaccine out that makes sense for us, in terms of having the right strains in it.
00:15:41
Speaker
And if you will give it to us as a good price so that countries will know they eventually can afford it, we'll give you a top up for a period of time and and increase the incentive for you because you can use that money to scale up your production and get the effects I talked about before.
00:15:58
Speaker
And so that turned out to be a very interesting um way to get companies engaged in global supply and scaling up. And then we did something similar in COVID when we wanted to get companies to ah provide vaccines before we knew if they worked. And we set up an advanced purchase agreement for that as well. So so many did different innovations to try to make it a a real public-private partnership working with industry.
00:16:27
Speaker
quick interruption here. i do want to apologize. The audio from here on out is a little bit worse um through some editing issues through our platform. So want to apologize for that, but you should still be hearing the same content with the great voice that is Dr. Seth Berkley.
00:16:41
Speaker
Yeah, i think i think it's really interesting. The last one you just mentioned, because I think like they want ri risk adjusted returns almost. And like if you're, you can obviously get them more returns getting a larger market, but you guys adjusted for the risk terms of like take the risk burden off of them a little bit, which I thought was really cool.
00:16:55
Speaker
um And i want to jump ahead a little bit. I mean, COVID-19 emerges. um Basically, everyone in the world hears about this. And you said you were over drinks with Richard Hatchett. And you so thought this like this might be the one um over drinks. And I was wondering of you take us back to that night a little bit. Like, what were those initial conversations looking like? How did you guys realize this would be such a big deal? And once you recognize that this would be a global pandemic, a global issue, like, what were the first principles in key theories in the design of COVAX?
COVAX's Challenges and Vaccine Nationalism
00:17:26
Speaker
So um we were sitting in ah in ah in a bar together and um it was interesting because Donald Trump was down the street talking about how this was nothing and don't worry about it and it's not going to matter.
00:17:38
Speaker
um We didn't have official confirmation at that point that this was person to person spread. We had, um um you know, ah there was an outbreak at the Wuhan ah market.
00:17:51
Speaker
um And the issue there was um initially the cases were thought to come from the market. So it could have just been, you know, everybody exposed to something there.
00:18:02
Speaker
But we began to hear on on um other sources, because we have networks and and and people talking about things, that there seemed to be some spread. So it wasn't official.
00:18:15
Speaker
And we also saw more cases occurring in China. And so, you know, something that's moving fast that may be spreading person to person that has people in intensive care units is scary. And and that's that's the information we had at that point. So we began to prepare at that point as if it was a severe disease.
00:18:34
Speaker
outbreak. What we did is we said, is this the big one or is this just a dress rehearsal? Didn't really matter. let's Let's move forward. Now, we had no money, we had no people, and um you know we um had no mandate, but we decided to move forward anyway. Richard used a little of his money to give Moderna, for example, its first little grant to get a clinical vaccine produced.
00:18:58
Speaker
I went back and worked um and and got money to begin to prepare w h o UNICEF, our partners to begin to work with countries to get them ready. And then over time, we had to build up an enterprise. Ultimately, the enterprise had 193 countries engaged with it, which was extraordinary. The US didn't engage, ah Russia didn't engage, a couple of others, but basically, it was the whole world came together. And at the end,
00:19:25
Speaker
um We delivered about 2 billion doses to 146 countries. And, you know, we didn't have perfect equity in this outbreak for any stretch of the imagination, but we did better than had ever been done before. We ended up with ah about 57% of people in the poorest 92 countries, which is about half of the world's population, having a primary dose as compared to about 67% globally.
00:19:52
Speaker
So not perfectly equitable. but also there were less high-risk populations in those developing countries. So it was a pretty good effort, but it was it was complicated. It was hard. It was blocked with um export bans and vaccine nationalism and vaccine diplomacy problems. All of these things happened, and um you know we did the best we could.
00:20:15
Speaker
Yeah. And you have like that NASA analogy where it's like NASA, for example, i mean, the hard part is the science, but like the hardest part might just be about like the actual politics and project management of all this stuff on the ground.
00:20:26
Speaker
And it's it's so difficult. And I think like, I mean, I want to talk about this vaccine nationalism, vaccine diplomacy angle, because i mean, you think, every country would be ah completely charitable. And in some lens they are, but how did you and your partner, like what is vaccine nationalism to you?
00:20:41
Speaker
And how did you and your partners like grapple with this tide of it? And like, what were some of its main roadblocks and like challenging COVAX? Are you guys getting your goals across and trying to get these vaccines out to people? So if you didn't have any politics in that a world, what you would do is you would, as soon as you, first of all, you want to develop vaccines as quickly as possible. And it was remarkable how quick, I mean, you know, 327 days from the time the original genome was published until...
00:21:09
Speaker
The first vaccine outside of an experimental you know basis in the UK was given. um But what you want to do in in an ideal world would be to say, OK, where are the places that have the highest risk populations? Let's vaccinate them. And then, you know, let's go to the less higher risk, less highest risk so that you can use your vaccines most wisely, most effectively to dampen down the outbreak or prevent or prevent disease or death. Now, of course, that's not the way it works.
00:21:37
Speaker
And every political leader's job is to protect their own population. So, of course, every country wants to get vaccine for their country, and they don't want to give it to anybody else because they haven't vaccinated their country yet.
00:21:49
Speaker
And so vaccine nationalism is about saying we're going to just use the vaccines for ourselves and we're going to prioritize that. And, of course, when wealthy countries have big treasuries, they can open their treasuries early and say, we'll buy it, we'll buy it at whatever price. And, and um you know, there were all kinds of shenanigans that went on. I talk about some in the book of people trying to get access to doses, et cetera. It was a worldwide panic for this.
00:22:15
Speaker
and And the real question is not, should you have vaccinated your your country first? Of course you should. That's that's what your your countries are going to do. But the question is, once you covered your high-risk population,
00:22:27
Speaker
Should you help in other areas? Should you, for example, help health care workers in other countries get vaccinated so they can take care of the populations and try to block the spread of the disease, et cetera? And that that idea of trying to do this is what we pushed. We said what we'd like to do is vaccinate 20% of the world's population first.
00:22:47
Speaker
you know, before we get to 100%, if we're going to get to 100%, not to have 100% in the US, 100% in the UK, 100% in France, and zero in, let's say, India, you know, Africa, whatever. So that was that was the discussion we tried to do. But the other thing that happens in a pandemic is we have no idea whether any of these vaccines will work. And so you're taking a lot of risk in buying them. But if you're a wealthy country, again, you say, well, I'm not going to put all my you know eggs in one basket. I'm going to not buy one vaccine, but I'm going to buy three, four, five vaccines.
00:23:23
Speaker
So you ended up with the wealthy countries just putting out purchase orders for basically all the vaccines. and and and And then they had a problem because they got flooded with vaccines. They had too many vaccines. They didn't want to waste all the money And so all of a sudden they're coming to us and saying, oh, my God, we want to give you these vaccines, you know, but they tried to give them to us very late in their shelf life because they kept them until they seated needed to see if they could use them. And then, you know, the countries are scrambling trying to use them. And that's not good either. So we had to change that as well. So it was a it was a complicated process.
00:24:00
Speaker
Yeah. And it's like the world, I guess the world made enough doses. There's enough doses on the road. the allocation that kind of failed a little bit more. um But you guys obviously massively successful in getting that out. So once you got these vaccines from these like larger countries that had were cash rich countries, what was your process like in understanding how you'd want to distribute them and allocate them throughou throughout the rest of the rest of the world?
00:24:20
Speaker
Because I think you guys providing vaccines to I think it was almost like 150 countries is is massively impressive. 146 countries. but the But the issue here, there was a lot of debate because, for example, people said, well, you should vaccinate the countries that have the highest incidence of disease. you know So if you have an outbreak here, you should go.
00:24:39
Speaker
Challenge with that is by the time you get the vaccine there, it's already spread like wildfire. And so that's not really the you know the best strategy. The best strategy would be get to those countries before they had outbreaks. But how do you predict that? How do you do that? And so this is where we ended up having a strategy that said, let's try to get to this 20% equally across all the countries in the world.
00:25:02
Speaker
And so that's what we were trying to do to move that forward. um But it was it was quite controversial, and we did have a ah challenge on, um you know, how to make those decisions. And so we had some type of, you know, randomization system to figure out where to send them. We also had, later on, ability for countries to purchase vaccines, working with the World Bank and others, um you know, which we would then help facilitate doses as well if countries wanted more doses. But that was only occurring when doses were much more available than they were at the beginning when, um you know, it really was an issue. Everybody wanted them and and um it was hard to get them at to to everybody.
00:25:44
Speaker
Yeah,
Misinformation's Impact on Vaccine Efforts
00:25:45
Speaker
I think it's really it's it's something is really difficult. And I think that's something i want to touch on today is that I mean, this problem of distribution, but also developing vaccines is is still occurring today.
00:25:55
Speaker
i think something you've talked about, we've been hinting at throughout this episode that misinformation is like is basically higher than ever. Oftentimes the reason vaccines have this mistrust is not because people think they're like, well, not because people are like scientists and they're looking through reports and finding these if errors, there's just misinformation spreading. So I'd love if you could talk about, and today, like what is the biggest like parts of misinformation you see now? I think a lot of it um is eroding from the top a little bit. I would love to hear like, what do you think has got, especially in the US and the Europe, um what are the main critical points you see that are hurting are <unk> immune preparedness basically as a world?
00:26:30
Speaker
Yeah, I mean, i mean ah let's use the example of m mRNA vaccines. I mean, Robert Kennedy said, you know, before he got into his current role that these were the most toxic vaccines ever made. I mean, you know, we know how these vaccines operated. We used billions of doses across the world. And so you got a pretty good sense of what the side effects are and what the problems are.
00:26:52
Speaker
But if you thought that they really were so toxic, you know First, you've got to have the data to show that. But then what do you try to do? Normally, you go and do more research to try to make them safer. or You try to understand what the what the challenges are.
00:27:07
Speaker
And instead, what's happened is they've cut um all of the research funds for um mRNA vaccines and and um and have have have cut contracts that were trying to make them for new things. Now, why is that important?
00:27:21
Speaker
um mRNA vaccines may not be the best vaccines. There are a lot of other different types of vaccines. But no vaccine we have, at least today, can be made faster. So just to give you an example, the Moderna vaccine was, I believe the number is from the time the the um the genome was published, they had a vaccine in a vial in 42 days.
00:27:42
Speaker
And in 63 days, they had the first injection. That is, you know, normally it takes years. and And the reason that's important, imagine there is an evolutionary certainty that we're going to have more outbreaks and more pandemics. So imagine the next one is worse. And so instead of having a mortality rate of a one and a half percent, you have a 10 or 20 or 30 percent mortality rate. Every minute counts.
00:28:08
Speaker
and how long it takes. So, and um mRNA is right now the best technology. We should be working on improving it, getting it better, you know, um so that we are prepared to do this again. And by the way, and mRNA is also gonna be important for personalized medicine,
00:28:24
Speaker
You know, now one of the things that's really exciting are cancer vaccines that actually target, you know, the actual cancer antigens, but those may have to be personalized. So again, for a personalized vaccine, it's really important how quick you can make it. You don't want the person to die of cancer before the vaccine, you know, is able to be made. So so these are some of the interesting things that are out there and that are creating a problem.
00:28:50
Speaker
um in, you know, for for moving forward. But the general distrust in science, in institutions, in experts, you know, is a
Future Pandemics and Global Preparedness
00:29:02
Speaker
broader problem. We're seeing it, you know, around climate. We're seeing it around um education. We're seeing it around universities. We're seeing it around research.
00:29:11
Speaker
and And that, of course, is a problem that, you know, creates an environment where nobody trusts anything. And that's not a good place to be in. Yeah, of course. And like there's cycles to this, I guess, maybe be over years, like this fluctuates up and down this level of institutional mistrust.
00:29:27
Speaker
um But it has been like this. Never been like this. Okay. And I think like, yeah, I guess I obviously don't have that perspective exactly. But I mean, if it's never been like this, I mean, it's really interesting to me because the fact that like global health has kind of like fallen off the political agenda, like a lot of these larger organizations aren't focusing on global health as much as they used to. Do you have a, is that, do you think that's because of the mistrust? Like what do you think is kind of um perpetuating or poking into that? The reason why global health is not like a core critical issue. Maybe it's COVID fatigue up about that, but what do you think that could be? Well, a couple of things happened. I mean, in the U.S., you know, ah Mr. Musk took, quote unquote, USAID to the wood chipper.
00:30:08
Speaker
And, you know, they slashed and shut down USAID. That was the largest development funding agency in the world. So that obviously had an effect. They also withdrew from WHO, which, you know, WHO is not a perfect institution, but of course it is the one institution that works in every country in the world and therefore is important for these types of activities.
00:30:30
Speaker
You saw the attack on on um on academic institutions. I mean, again, these are institutions that have been around for hundreds and hundreds of years and people everywhere in the world want to come to these great institutions and, you know, they're being attacked and, And um you know we're seeing the n NIH, the FDA, the CDC under enormous attack. So this is an intentional effort to discredit, you know ah break apart and destroy institutions.
00:30:59
Speaker
Now, what's happened in the rest of the world is is different. First of all, people still believe in science. They still um want to have innovation and new things. But of course, they're also being pushed now to spend more and more money for defense, for example, And having to deal with things like tariffs and other things. So what's happening is they're also pulling back from of development aid and financing. And so this has been just ah an incredible crisis.
00:31:28
Speaker
And i think I think that's very interesting, especially because, as you mentioned, like there's some. It's not like if another pandemic happens, but like when there's like some epidemiologic like certainty to it.
00:31:39
Speaker
um But let me get that into that. Why is it so certain that there might be another pandemic? Can you provide some like of the interesting, like I say, the evidence towards it Like, why do you think there might be another pandemic? And then also, if there is one, like, what do you think are some things that we should be doing in theory to prepare for that? I know you've hinted at a few so far, but I'd love to get some color on what does the whole picture of this look like?
00:31:59
Speaker
So first of all, um there is – the reason I say that it is it is evolutionarily certain that there will be um a um ah you know more pandemics is, first of all, um we are seeing an increase in population numbers still, although that's slowing down, but the number of people is going to go up.
00:32:19
Speaker
And then you have, because of climate change, large shifts in people. um And we also see that the the vectors, those are the mosquitoes and and other things that can transmit infections, are going to new places because of climate change.
00:32:36
Speaker
We also have a world that's unstable and you have people that are moving and then living in you know tight environments, whether it be urban slums or or refugee camps, et cetera. So all of this together increases the risk of spread of infections. And of course, if we're now pulling back from vaccination and public health interventions, that even further increase the risks that's there.
00:32:59
Speaker
So all of that together tells us that we are going to see um further outbreaks. The Lancet Commission on Global Health 2050 suggested that there is a 50% probability of having a um a pandemic at of the size of COVID or larger um in the in the next 25 years. So, you know, we don't know when they're going to happen, but it's going to happen. and And we are constantly seeing new outbreaks of infectious disease that are
Advancements in Vaccine Technology
00:33:29
Speaker
occurring. And so the real challenge is since we know that, we should be prepared.
00:33:34
Speaker
And so one point to make is if you look at, you know, military preparedness, you know, we're about to move to spending $1 trillion dollars in the U.S. on military preparedness.
00:33:45
Speaker
And, um you know, if you look at how many people have died in all the wars since the Civil War, it's less than Americans have died in COVID. And so, you know, when we think about relative risks for a population, infectious diseases are the highest risk. And so we have to make sure that we um work to um uh uh you know deal with those going forward and i think one interesting thing you bring up is like personalized vaccines for this i mean that's a way to keep it's a bit different from like building an emerald i guess it's it's not like something you can rapidly build that for everybody but in the future this could be something that's really interesting of course it's difficult now but i would love to kind of bridge into the question of like what are you most excited about in the future in terms of like vaccinations and
00:34:29
Speaker
And not only the technology for distributing, but actually discovering them. is there anything you've thought about that could be exciting? Cause I know so far we've seen that it's a little bit, we're a bit of a dismal state right now. It's a lot of mistrust and institutions and people.
00:34:42
Speaker
um But what are you excited about in the future in the terms of that? I think quite the opposite. That's the general population, the scientific community. It's amazing what's happening. We're in a renaissance because we have a combination of AI um working with synthetic biology, working with, you know, um new delivery mechanisms and technology. As a result of that, I think we're going to see even more amazing science going forward. And so the challenge for us then is, given that that's happening, how do we make sure it it it um it it goes to fruition, that it keeps moving forward? and It's very hard time now for biotech companies to raise capital, given the attacks that have been going on and given what's happening with basic funding. But as I said, i think, for example, the idea that you can use the immune system to fight cancers is extraordinary.
00:35:37
Speaker
and And that will ultimately be the way to fight cancers. I mean, people have cancer-like cells in their body all the time, and the immune system just shuts it down. occasionally something breaks out. But instead of giving somebody a you know a chemical that poisons, hopefully, the tumor faster than it poisons the person, you'll now have very specific things that will attack the tumor. And you know we've just seen crazy, amazing things like just you know, treating hunt Huntington's disease, you know, by going in and in now they have to do it with opening, you know, that the brain up and putting it locally, but people are doing that or or treating, you know, congenital deafness by injecting, um you know, the actual um viruses with the actual proteins that are missing and and seeing, or you know, a restoration of hearing. So science is just exquisite in terms of what's happening. And,
Advice for Global Health Newcomers
00:36:33
Speaker
And um we just need to make sure we continue to prioritize it.
00:36:37
Speaker
Yeah. And I think there's like it's like, it's very exciting in that lens for sure. Cause I think like even neurological diseases, you're seeing like the gene therapies, like really do work really well to get these like vectors into like passive brain well barrier and actually like cure these, least like cure the symptoms of these diseases. And I think that's really exciting to see how like with AI, we're able to like much be much better, like biomarker detection and getting these drugs out.
00:36:59
Speaker
And last question really quick is, um I mean, there's, you mentioned that there's so many in your book that there's so many different pathways to a career in like global health, but It requires more of an active search. It's not something you just stumble upon in class. or Maybe you might, but like you have to search for the mentors and people that will help you build you up.
00:37:16
Speaker
We'd love to hear if you have any advice for a new like incoming generation of people going to public health, going into medicine and other different careers in health care. What advice do you have from your experience working across these different bureaucratic organizations and quickly moving biotechs? What is that? What advice do you have for the next generation?
00:37:35
Speaker
So, um the you know, the way I framed it in the book is, you know, if you want to be a cardiologist or a cardiac surgeon, you know exactly the pathway. You go to a great institution, you train under a great leader, you know, and and then you go publish research in these certain journals and, you know, et cetera, et cetera.
00:37:52
Speaker
for For global public health, it's been harder to do that. And for a while, it was a real renaissance in that, and there was a lot of money and a lot of effort, and there were a lot of institutions. But what people had to do if they wanted to figure out how to work their way through that was to find a set of mentors, not necessarily one, because you're not going to be exactly like one person, but rather learn from this person and from that person and then put yourself into a place where you have an opportunity to not only learn and make a difference, but also to have access to other experienced people. And and that's really the way that that um people have moved forward in in in public health going forward. I worry now, though, that with all these cuts in funding and all the demonization of this stuff, that people may not go into it.
00:38:40
Speaker
And that's a tragedy because in the past, people were willing because it's so rewarding to make a difference, to take less pay, to have an interesting life and to have, you know, really make a difference. And, you know, if you make it unpleasant enough and you don't pay people a lot, of people say, well, I'll just become an investment banker, you know, and forget about these other things and, or a plastic surgeon, you know, and, and, um, And that would be a great tragedy because this is a way you can, you know, um really make a difference and and save lots of lives and and have a very rewarding career.
00:39:14
Speaker
Yeah. and And life is just a game of trade-offs, really, in the decisions you make. I think some careers might be more communicative to make you feel better. Other careers might pay more. But I think you've really ah illustrat illustrated here that you can have a lot of impact while providing a lot of good to the world. So I really appreciate you coming on, Dr. Berkley, just discussing all your different experiences and how vaccines are more than just a drug discovery. There's so much more to it. So thank you so much for coming on the Healthcare care Theory.
00:39:38
Speaker
Thank you for having me.