In an article in Nature in December 2022 Dr Seth Berkley, CEO of Gavi, explored the failings of global vaccine strategies as we continue to emerge from COVID-19. Dr Berkley has a wealth of experience in both epidemiology and health leadership, which he draws on in his argument that we have made little progress since his previous warning, addressing the issue of Ebola in 2015, and since COVID-19. So, what are the areas of weakness that he identifies, and how does he suggest we improve? 

We are “asleep at the wheel” 

The article begins with a reflection on the current situation in Uganda. Thankfully, at time of writing, no further cases have been declared, and we are eagerly counting down the days until the outbreak is officially over. With this news came concerns about the future of vaccine trials, as doses arrived in record time.  

For Dr Berkley, the whole situation “could have been avoided”. He argues that if we had learnt our lesson from previous outbreaks, vaccines would have been ready for testing at the start. Indeed, we might wonder what oversight occurred to cause doses of an investigational candidate to be forgotten in the freezer rather than ready to go.  

“The fact that they aren’t is a global failure.”  

Although Dr Berkley acknowledges the collective “rallying” during COVID-19, we are “asleep at the wheel” when it comes to “developing vaccines to prevent a disease in the first place”. Why is this? For Dr Berkley, there is “still no incentive for markets” even when the technology is there. He convincingly argues that our inability to prepare for “known severe threats” like Ebola does not stand us in good stead against “future unknown pandemic threats”.  

Short-sightedness strikes  

Beyond the quickly and effectively contained threat of Ebola, Dr Berkley recalls another recent “wake-up call”: COVID-19. However, after the years of incredible vaccine research and development, we were unable to conceal one of the “biggest chinks in our pandemic-preparedness armour”. Here the unfortunate truth is emphasised. Producing specific quantities of doses to prevent spread is “not profitable for drug companies” and donor governments are “reluctant to waste money” on vaccines that might not be used.  

“Short-sighted hardly describes the situation. Preparing preventative vaccines for a few million dollars per batch should be seen as a small insurance policy”. 

Warning against a “repeat of the US$12 trillion the world just spent on COVID-19″, Dr Berkley continues that this market failure should “worry everyone”. The risk of pandemics is growing, and as we continue to extract ourselves from COVID-19’s shackles, there is a “2% chance of a new pandemic outbreak”. We learnt about how climate change and population changes are influencing this, but clearly there are factors more within our control.  

Vaccines in the wings 

Dr Berkley indicates that “our best defence is having vaccines ready to use the moment disaster strikes”. He refers to the WHO list of priority potential pathogens, and activities to prepare for disease X. All these potential threats “deserve a full effort”. The whole vaccine shebang, as it were.  

“By doing much of the preclinical and clinical work in advance, we can have doses as close to ready as possible when we need them.”  

With wealth comes responsibility 

Everything that Dr Berkley has so far argued seems acceptable and in line with other opinions now, but what does he suggest we do? The sad fact that he is writing about this, 7 years after his first article, is a reminder that unless we act, we will find ourselves reading something more desperate in another 7 years. What is needed to “finally catalyse change”?  

Dr Berkley recognises that “we have come far”. He is “optimistic that a change in mindset is in view”, and with that will hopefully come action. The first step that he identifies is the “establishment of an adequate, publicly subsidised market”. This will promote coordinated efforts to drive “research, development, and flexible small-scale manufacturing” to produce appropriate vaccines.  

“Wealthy countries should take the lead.” 

However, this should be done through funding agencies like CEPI and IAVI, and collaborating with Gavi and WHO, rather than a blundering we-know-best approach that often drives us backwards. We are already aware of great initiatives to empower, rather than impress, local health mechanisms in areas where outbreaks are predicted, and look forward to hearing of more.  

What next? 

“COVID-19 has brought a renaissance in vaccine development.” 

However, if we let the exciting technology and “sense of urgency” slip, the pipeline will clog, and progress will slow.  

“We can’t continue closing the stable door after the horse has bolted. If we keep relying on a market-based model that churns out millions of doses only after an epidemic is under way, then we have already failed.”  

We will hear more on some of these key vaccine development and preparation themes from senior representatives of Gavi at the World Vaccine Congress in Washington next year. Do join us if you can!