A week ago, on 2nd August 2023, Dr Seth Berkley’s tenure as CEO of Gavi came to an end after 12 years. The following day the position of Interim CEO was assumed by David Marlow, a “transformational global life sciences and social responsibility executive” who has worked with Gavi for just over a year. He takes this post in Dr Muhammad Ali Pate’s stead, after the Nigerian health leader declined the role to “prioritise serving his country”. So, as Gavi enters a period of transition, what is on the cards for the Alliance? 

Dr Berkley’s departure 

Reflecting on his 12 years as CEO of Gavi on LinkedIn, Dr Seth Berkley commented that he leaves with “deep pride” and “gratitude” for the “incredible people” he has met. He also celebrated some of Gavi’s most notable achievements since its establishment at the turn of the century. Among these achievements, Dr Berkley recognised a “dramatic 70% reduction in vaccine-preventable child deaths”.  

Another remarkable success is the recent surpassing of 1 billion children immunised through Gavi’s “direct engagement”. This protection of “an entire generation” is particularly notable as a piece of good news amidst concerns about global immunisation rates. However, as Dr Berkley emphasises, Gavi’s successes “are not just statistics”. 

“They are lives saved, futures secured, and opportunities created for the next generation.” 

In a recent interview with STAT, Dr Berkley reflected that he has “watched the organisation from the beginning”, growing from a “small secretariat” to make an “extraordinary” difference. In the interview he offered a greater insight into his pride in what has been done; he refers to the work done around Ebola.  

Through Gavi’s involvement in an advance purchase commitment and ensuring that there would be sufficient doses in between proof of efficacy and licensure, they were able to trigger the incentive that was lacking: “it was a disease of poor countries, and the outbreaks were little”. Thanks to Gavi’s encouragement, we currently have a licensed stockpile of vaccines, which can limit the “scary, terrible disease”.  

Room for improvement 

Despite Gavi’s clear successes, Dr Berkley does acknowledge that “we got it wrong” in some cases. In the STAT interview he identifies Ebola Sudan and Marburg as examples of this, as “the candidate vaccines weren’t in vials ready to go” when the need arose. Dr Berkley suggests that the timeline of vaccine investigation to deployment will require a “lot of work”.  

Other areas for improvement include routine vaccination for HPV, for which Dr Berkley believes pilot programmes could have been terminated sooner to give way to vaccination.  

“This is our most impactful vaccine. There are more women who die of cervical cancer than who die in childbirth today, so we need to get that vaccine out.”  

Another example is the malaria vaccine, as Dr Berkley considers “moving it quicker would have saved lives”. Finally, in COVID-19, he bravely admits “I made a mistake – and I will live with that”. To the outsider, the “enormous” pressure Dr Berkley experienced would surely be enough to encourage errors. It appears that Dr Berkley’s mistake was optimism: 

“We felt, OK, we don’t need to worry at the beginning about delivery, because others will flood countries with money to deal with that. That turned out not to be true.”  

This oversight is something that Dr Berkley raised again in an interview with TIME. Among the lessons he thinks we should learn from COVID-19, he states that “we did not prioritise having delivery systems for the vaccines”, which “led to delays”.  

“Had we started with enough financing for delivering the vaccines alongside purchasing them, that would have been a really good thing.” 
A long road ahead 

Without speculating too much about what David Marlow’s inbox contains, we wonder what big challenges he faces in his new role. From Dr Berkley’s interview with STAT, there are a “few things” to consider. The first is the “tough economic time” that will make raising resources “difficult”. However, he insists that we must be prepared to address multiple challenges at once.  

“The world tends to think about things seriatim…That is important. I’m not balancing the importance of different things. But we need to think about this and this and this.”  

As evidence of this, Dr Berkley refers to an “era of poly-epidemics”, thanks to “land use and population growth and climate change”. These will encourage “more and more outbreaks” that will require “resilient systems”. Within this demand, the need to develop technology for “preventative mechanisms” must include the consideration of accessibility.  

Marlow takes the reins 

In a blog post for Gavi dated 8th August 2023, David Marlow expresses his excitement and humility as he begins the interim assignment as CEO. He mentions that he is “optimistic” about what the Alliance can achieve in “the coming months”, signalling his intention to get off to an ambitious start. Acknowledging the history of “tirelessly” working to reach vulnerable populations and a “historic pandemic response”, Marlow is conscious that there are “many more children and communities left behind”.  

“During my tenure, I will focus on supporting the organisation in maintaining a laser-sharp focus on executing its current mission, setting an ambitious strategy for the 2026-2030 period defined and approved by the Gavi Board, and ensuring Gavi is properly resourced to accomplish our work in the coming years.” 

So, what expertise is he bringing to this “laser-sharp focus”? For “more than 30 years” he has served multiple organisations is various capacities, from audit and legal and compliance, to risk management and international operations. Before joining Gavi he was Chief Operations Officer of the Mastercard Foundation, during which he led the redesign and implementation of a new operating model. He also held “various senior executive global roles” at Bristol-Myers Squibb.  

At Gavi, Marlow has “spearheaded” Gavi’s Operational Excellence (OE) work, which he describes as “efforts to simplify day-to-day Alliance processes to help carry out our mission more effectively and efficiently”. In the first few days of this new interim role, Marlow emphasises that the “leadership team remains deeply and firmly committed” to the Gavi mission. He also highlights that the “strength” of the Alliance depends on “core partners”: governments, private sector and philanthropic partners, civil society, vaccine manufacturers, academia, and other health actors.  

“My personal commitment is always to listen and be open to constructive feedback from our partners, contributors, and supporters, ultimately acting in the best interest of the Alliance and our vital collective work.

What do you expect to see from Marlow in the coming months, and what advice might you offer to Gavi’s leadership at this time? We look forwarding to hearing more from Gavi at the World Vaccine Congress in Barcelona this October; get your tickets here today! For more on international vaccine programmes and policies, don’t forget to subscribe here.