‘Vaccinate as many as you can, and the most vulnerable’

Q&A

Seth Berkley is CEO, Global Alliance for Vaccines and Immunisation (GAVI), which gave a record $165 million to India to induct the pentavalent vaccine into the universal immunisation programme. Penta combines protection against DPT, Hepatitis B and, for the first time, Hib, the leading cause of bacterial meningitis and second leading cause of bacterial pneumonia deaths among under-fives. Having rolled out in Tamil Nadu, Kerala and Goa, it should ultimately cover18 million children. He spoke to Bachi Karkaria:

Vaccines made by Indian pharma companies fuel 43% of the world’s UIPs, yet every third unimmunised child on the planet is Indian.
It’s truly surprising especially when India also produces new, innovative vaccines. Bharat Biotech is making the rotavirus vaccine (against one form of diarrhoea), has offered it to GAVI at $3 for three doses compared to GSK’s $5 for a two-dose vaccine.
What do you feel about the two-year delay in the pentavalent vaccine?
Disappointed. A multi-shot vaccine reduces exposures and increases coverage. It makes cold chain logistics easier, plus reduces the problem of disposing of both plastic and sharps. Generally speaking, 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. Immunisation is the single most important health intervention, often the only one in backward areas. Of course you need many interventions – sanitation, clean water, nutrition, education, good housing. But if you can’t get to that point, immunisation against diarrhoea helps.
There was some concern over Bill Gates dictating when and how we rolled out penta. As founder-president of the International AIDS Vaccine Initiative (IAVI) since 1996, you are familiar with the problem of donor-driven agendas.
GAVI (which includes the Gates Foundation) doesn’t thrust any vaccine on any country. We educate the immunisation community. WHO only makes data-based recommendations. But countries have to make an application for co-financing, so ultimately it’s their decision. It’s our belief that immunisation can be cost-effective and sustainable only if it is home-driven. When countries create their own database and analyse it themselves, it results in better decisions and utilisation of resources.
What are the biggest issues – finance, science, access, political will – in ‘reaching the fifth child’ in the world who remains unimmunised?
All of those. Also the invisible nature of the groups at highest risk: isolated, stigmatised, extremely poor. You don’t have to reach each individual; at one point herd immunity kicks in. But you want a twofold strategy: vaccinate as many as you can, and vaccinate the most vulnerable. By the time WHO recommends vaccines, they already have wide global usage and wellestablished safety patterns.
Is GAVI merely the world’s vaccine banker?
GAVI helps distribute new and underutilised vaccines, and drive down prices. The tragedy is that the wealthiest in wealthy countries get first access; it takes 15-20 years before it gets to the poor in poor countries. Our role is to accelerate the process, and ultimately simultaneous roll-out.
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 unimmunised 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.